Magnitude, drivers and adolescents’ perspectives on the double burden of malnutrition in urban slums

The double burden of malnutrition (DBM) which is characterised by the co-existence of both undernutrition and overweight/obesity in adolescence, has significant short- and long-term, health consequences. Sub-Saharan Africa (SSA) is among the regions with the highest burden of malnutrition and faces a growing challenge with increasing rates of overweight/obesity alongside persistent undernutrition among adolescents. This is largely linked to the increased consumption of highly processed, energy-dense and nutrient-poor foods. This PhD research uses quantitative and qualitative participatory approaches to assess the magnitude and trends of the DBM, dietary patterns, consumption of ultra-processed foods (UPFs) among adolescents in urban slums, and the extent and nature of UPFs advertisement in mainstream media. It also explores adolescents’ perspectives on the drivers and solutions to DBM and unhealthy (UPFs) diets. The study key findings indicate a higher and increasing prevalence in overweight/obesity compared to undernutrition among adolescent girls. Additionally, there is existence of both a traditional and a transitioning dietary pattern and substantial consumption of ultra-processed foods, contributing about a quarter of adolescents’ daily energy intake. Adolescents generally have a positive view of UPFs, driven by their perceived convenience, affordability, accessibility and body shape perceptions. Furthermore, UPFs are extensively advertised accounting for over 90% of all food advertisements on TV and 58% on radio in Kenya. These findings highlight the urgent need for interventions that: enhance adolescents’ knowledge and skills in preparing and consuming nutritious meals, implement food environment interventions that promote the availability and access to healthy foods, and develop policy and regulatory frameworks to limit adolescents’ exposure to unhealthy foods advertisements.