From hunger to obesity: Developing countries face a growing threat to child health

JAKARTA: By the age of 4, Intan Permatasari had already outgrown her kindergarten uniforms.

Her mother struggled to refuse her repeated requests for food, and Intan eventually had to wear clothes sewn at home to school. As her weight increased, so did the bullying. Classmates pinched her arms, stole her money and threw books at her.

By the age of 12, she had left school.

“I whole class was bullying me,” said Intan, who spent years rarely leaving her home south of Indonesia’s capital, Jakarta.

Now 15, she is part of a much bigger global health shift.

Across Africa, Asia and South America, tens of millions of children are growing up in countries facing a rapidly expanding double burden of malnutrition: childhood obesity is rising while undernutrition remains stubbornly high.

And researchers say the centre of the global childhood obesity epidemic is increasingly shifting towards countries that can least afford the long-term health and economic consequences.

Childhood obesity rising fastest in developing countries

The warning comes from a major research project involving more than 1,000 scientists tracking nutritional trends among children and adolescents aged 5 to 19 across 200 countries.

The project, backed by the World Health Organization, published its latest findings in the journal Nature in May.

The results showed that childhood obesity is increasing rapidly in many low- and middle-income countries, even as the rate of increase has slowed or plateaued in several wealthier nations.

Between 2023 and 2024, obesity among boys increased fastest in Peru, reaching 19%, compared with less than 8% in 2010, according to the project.

Among girls, the fastest increases were recorded in Tonga and Samoa.

Indonesia recorded its largest absolute annual increase yet in 2024, with obesity prevalence among both boys and girls rising by more than half a percentage point.

The increases are occurring both in countries where childhood obesity remains relatively low, including Tanzania and Bangladesh, and in countries where rates are already high, such as Chile and the Bahamas.

The double burden: hunger and obesity

For decades, countries such as Indonesia have focused heavily on fighting undernutrition, poverty and stunting.

That battle is far from over.

But a new problem is now growing alongside it: children can consume enough — or too many — calories while still receiving diets that lack important nutrients.

Researchers describe this as a rapid nutrition transition, in which countries move from widespread food scarcity towards greater availability of cheap, highly processed and energy-dense foods.

The transition took decades in many Western countries. In some middle-income nations, experts say, it is happening in less than 20 years.

Chittaranjan Yajnik, director of the diabetes unit at the KEM Hospital Research Centre in India, warned that a long history of malnutrition followed by such a rapid dietary shift could be particularly damaging.

“A history of malnutrition for many hundreds of years, then a rapid transition, is the worst combination,” he said.

The consequences could extend well into adulthood.

Children with obesity face a higher risk of developing chronic health problems, including diabetes, cardiovascular disease, asthma and other non-communicable diseases.

Dr. Zulfiqar Bhutta, Chair in Global Child Health at The Hospital for Sick Children in Toronto and a participant in the WHO-backed project, warned that the long-term impact could threaten some of the health gains achieved through better vaccination and treatment of infectious diseases.

“All the gains that we have had in health are going to be washed away by this absolute tsunami of non-communicable disease,” Bhutta said.

Indonesia reaches a major turning point

Indonesia illustrates the speed of the change.

The country has spent decades fighting undernutrition linked to poverty, poor sanitation and major economic disparities across its thousands of inhabited islands.

Its prevalence of undernutrition has fallen significantly over the past two decades as economic conditions improved and successive governments prioritised the issue.

But obesity among children and adolescents has surged.

According to an analysis of global data compiled for Reuters by researchers involved in the WHO-backed project, obesity is now more prevalent among Indonesia's school-aged children than undernutrition.

Indonesia is the most populous country to cross that threshold after China and the United States.

Together, obesity and undernutrition now affect around 20% of Indonesia's 60 million school-aged children, according to the analysis.

The same global shift occurred last year, when obesity overtook being underweight among school-age children worldwide for the first time, according to a UNICEF analysis.

Yet many experts say awareness of childhood obesity remains limited.

“Indonesians have no awareness that obesity could make us sick,” said Aman Pulungan, a senior paediatric endocrinologist at the University of Indonesia in Jakarta.

Cheap processed food and changing lifestyles

Health experts point to a combination of factors behind the rise.

These include easier access to processed foods high in fat, sugar and salt, increasingly sedentary lifestyles and, in some populations, genetic susceptibility.

Barry Popkin, a professor of nutrition at the University of North Carolina’s Gillings School of Global Public Health, said obesity can also coexist with other forms of malnutrition.

Children may gain excessive weight without reaching their full growth potential if their diets are high in calories but lack essential nutrients.

“Overweight and obesity in low and middle-income countries is a time bomb ready to explode,” Popkin said.

Data from the Netherlands-based Access to Nutrition Initiative, shared with Reuters, also raised concerns about the quality of food available to Indonesian consumers.

Only 21% of food products sold in the country's modern grocery stores met a recognised “healthy” threshold, according to its analysis.

That compared with an average of 41% in other countries it assessed, including the United States and the Philippines.

Just 10% of packaged food and beverages in Indonesia met World Health Organization guidelines for marketing to children, the analysis found.

“The food and drinks being sold here are unhealthier than those sold in developed countries,” said Siti Nadia Tarmizi, head of non-communicable diseases at Indonesia's Ministry of Health.

The health costs could be enormous

The consequences of rising obesity are not limited to individual health.

The World Health Organization estimates that the global economic costs associated with overweight and obesity could reach $3 trillion by 2030 without effective action.

These costs include healthcare spending, lost productivity and premature deaths.

In Indonesia alone, the World Obesity Federation estimates the economic costs associated with obesity could rise from $17.5 billion in 2019 to almost $47 billion by 2030.

Diabetes, which is closely associated with obesity, is already a growing concern in the country.

The prevalence of diabetes among Indonesians aged over 15 has more than doubled since 2011, reaching 11.7%, although experts believe the true figure could be higher because many cases remain undiagnosed.

There is also limited data on diabetes among younger children.

Can medicines solve the problem?

Weight-loss drugs have transformed obesity treatment in some wealthier countries.

But access remains a major challenge.

The World Health Organization estimates that, because of high prices and production limitations, only around 10% of people who could potentially benefit from such medicines will have access to them by 2030.

There is currently no WHO guidance specifically covering their use by children, while most countries approve obesity medicines only from the age of 12.

Intan's case shows both the potential and limitations of medical treatment.

By the age of 4, she weighed 35 kilograms. Her weight later reached 148 kilograms in January last year.

After local treatment, nutritional counselling and psychiatric support failed to control her weight, she was referred to a clinic at Dr. Cipto Mangunkusumo National Hospital in Jakarta, where she received care under paediatrician Dr. Yoga Devaera.

Intan's mother said Devaera later arranged for her to receive Novo Nordisk's weight-loss drug Ozempic, treatment the family would otherwise have found prohibitively expensive. Devaera declined to comment on Intan's individual treatment because of patient confidentiality.

Intan has since lost around 40 kilograms.

She now takes three short walks each day, monitors her steps and calories, focuses more on whole grains and lean protein and avoids sugar.

Prevention becomes the bigger challenge

Experts say medicines alone cannot stop the obesity epidemic.

Governments are increasingly looking at prevention, food labelling, clearer nutrition information and changes to the food environment.

Indonesia introduced a new food-labelling system in April based on a traffic-light model, using red warnings for foods high in salt, fat or sugar and green labels for healthier products.

Manufacturers, however, have been given two years to comply, while it remains unclear what penalties could apply for non-compliance.

A proposed tax on sugar-sweetened beverages has also been postponed repeatedly.

Health Minister Budi Gunadi Sadikin told Reuters that obesity was increasing but said it was not among Indonesia's top health concerns.

The Health Ministry said it considers obesity a priority and is focusing on prevention, early detection and intervention before children develop serious illness.

It has also launched a free health screening programme and plans to expand access.

The challenge, officials and experts agree, is that healthier outcomes cannot depend entirely on individual choices when unhealthy food is cheap, widely available and aggressively marketed.

Health Minister Budi said the government also needed to work with industry to provide healthier food choices and clearer information while encouraging regular physical activity.

Intan returns to school

For Intan, the change has been deeply personal.

The girl who once avoided leaving home because she feared being seen in public has regained confidence.

She goes to the gym, eats out with her parents and returned to school last month.

She now dreams of becoming a police officer.

“They like to help people,” Intan said. “I want to prove to people who bully me, who make fun of me, that I can be a hero.”

Her journey captures the human cost behind a much larger global health challenge.

For developing countries, the battle against child malnutrition is no longer only about ensuring children have enough to eat.

It is increasingly about what they eat, what is available, what families can afford and whether health systems can prevent obesity before its consequences follow children into adult life.

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