The policy challenge of coexisting undernutrition and nutrition-related chronic diseases.

The original focus on energy and protein needs for combating malnutrition gave way to UNICEF promoted concerns for maternal care and complementary feeding in association with longer-term breast feeding. Nevertheless the World Food Summit's drive to halve malnutrition rates by 2015 was not accelerating the fall in malnutrition prevalences. The UN's Standing Committee on Nutrition's commission highlighted the crucial role of maternal nutrition and low birthweights, the need for a life cycle approach to prevention and the current global effects of maternal/fetal and childhood malnutrition in amplifying the impact of the new epidemic of obesity and chronic diseases. The emphasis on poverty reduction and free market solutions is too crude and national interventions geared to protecting the vulnerable, promoting equity with major community involvement in integrated multifaceted programmes are needed. The same principles apply to overnutrition and specifically to the avoidance of the current pandemic of the metabolic syndrome. An intergenerational amplification of diabesity is now emerging as overweight but poorly fed micronutrient deficient girls enter pregnancy and produce ever more susceptible children. So new strategies are now needed as recognized by economists but not by doctors and nutritionists! Economy, agriculture, food processing and marketing policy changes are crucial in determining patterns of food consumption because the costs of foods and their availability, rather than policies centred on individual responsibility for consumer choice, are the keys to making coherent public health advances.