Prevalence of the Double Burden of Malnutrition in Nepalese Students Aged 6–18 Years: An Urgent Call for Intervention

The double burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition within the same population or individual, is a growing concern in low- and middle-income countries (LMICs) such as Nepal. Identifying malnutrition in schools supports targeted interventions. This study estimates the prevalence of stunting, underweight, overweight and obesity among Nepalese schoolchildren and examines the coexistence of stunting and overweight. We conducted a cross-sectional study of 11 782 students aged 6-18 years from 111 randomly selected schools in Kaski, Nepal. Sociodemographic data were collected via questionnaire, and trained researchers measured height and weight. Malnutrition was classified using the World Health Organization (WHO) growth standards, and chi-square tests were used for statistical comparisons. The prevalence of stunting, underweight, overweight and obesity was 15.8%, 6.1%, 10.7% and 3.3%, respectively, while 1.0% of students were both stunted and overweight/obese. Stunting was more common in rural schools (20.5% vs. 15.1%, p < 0.001), whereas overweight (11.2% vs. 7.1%, p < 0.001) and obesity (3.6% vs. 1.5%, p < 0.001) were more common in urban schools. Public school students were more often stunted (18.2% vs. 13.2%, p < 0.004) and underweight (6.7% vs. 5.4%, p < 0.001), whereas private school students were more often overweight (13.3% vs. 8.2%, p < 0.001) and obese (5.0% vs. 1.7%, p < 0.001). The DBM occurs at both school and individual levels, including within the same school, with undernutrition more common in rural and public schools and overnutrition in urban and private schools. Tailored school-based nutrition programmes are urgently needed.