Severe Household Food Insecurity and Malnutrition Among School‐Going Adolescents in South Punjab, Pakistan: Implications for Sustainable Development Goal 2 (A Cross‐Sectional Study)

ABSTRACT Introduction Food insecurity and malnutrition remain major public health concerns among adolescents in low‐ and middle‐income countries. Adolescence is a critical period for growth and development, yet school‐going adolescents remain underrepresented in nutrition research and policy in Pakistan. This study aimed to assess household food insecurity, nutritional status, and their association among school‐going adolescents in peri‐urban South Punjab. Methods This cross‐sectional study included 384 school‐going adolescents aged 15–18 years from public and private schools in peri‐urban Lodhran district, South Punjab, Pakistan. Household food access was assessed using the Household Food Insecurity Access Scale (HFIAS), and nutritional status was classified using WHO BMI‐for‐age (BAZ) and height‐for‐age (HAZ) z ‐scores. Data were collected using a pretested, interviewer‐administered questionnaire. Associations were examined using chi‐square and Fisher's exact tests, multivariable logistic regression (adjusted for age, sex, school type, family size, socioeconomic score, and school grade) for the continuous HFIAS score, and Benjamini–Hochberg correction for multiple comparisons. Results The mean age was 16.6 ± 1.1 years, and 207 (53.9%) were female. Overall, 365 households (95.1%, 95% CI 92.4%–96.8%) were severely food insecure. Thinness was observed in 131 adolescents (34.1%, 95% CI 29.6%–39.0%), stunting in 107 (27.9%, 95% CI 23.6%–32.6%), and overweight/obesity in 35 (9.1%, 95% CI 6.6%–12.4%). Overall HFIAS categories were not significantly associated with stunting, thinness, or overweight/obesity. After correction for multiple comparisons, four individual HFIAS experience domains remained robustly associated with thinness specifically, and in multivariable analysis, a higher continuous HFIAS score was independently associated with greater odds of thinness (aOR 1.056, 95% CI 1.009–1.104, p = 0.019). Conclusion School‐going adolescents in peri‐urban South Punjab experienced a very high burden of severe household food insecurity alongside substantial thinness, stunting, and overweight/obesity. These findings support adolescent‐focused food security screening, school‐based nutrition interventions, and locally targeted policies aligned with Sustainable Development Goal 2.