Prevalence and Determinants of the Double Burden of Malnutrition Among Adolescents in Nine Low- and Middle-Income Countries

Purpose: The double burden of malnutrition (DBM)—the coexistence of undernutrition and overweight/obesity—poses a significant public health challenge among adolescents in low- and middle-income countries (LMICs). This study examines the prevalence of underweight, stunting, overweight/obesity, and DBM among adolescents in nine LMICs, and identifies key sociodemographic, behavioral, and digital access factors that shape its distribution. Methods: We conducted a cross-sectional survey across 10 sites in nine LMICs, sampling 11,982 adolescents aged 10–19 years. Nutritional outcomes, including underweight, stunting, overweight/obesity, and DBM (defined as concurrent stunting and overweight/obesity), were assessed using height-for-age and BMI-for-age Z-scores based on the 2007 World Health Organization Growth Reference. Sex-stratified linear and logistic regression models were applied to examine associations between nutritional outcomes and individual- and household-level characteristics at both pooled and country-specific levels, adjusting for site-fixed effects. Results: Overall, 9.5% of adolescents were underweight, 10.7% were stunted, 13.2% were overweight or obese, and 1.4% experienced DBM. Underweight (11.6%) and stunting (12.4%) were more prevalent among male adolescents, while overweight or obesity (16.3%) was more common among female adolescents. Female adolescents were less likely to be underweight (odds ratio [OR] = 0.5, 95% confidence interval [CI]: 0.4–0.6) or stunted (OR = 0.5, 95% CI: 0.4–0.7). Low social class was linked to higher odds of underweight (OR = 1.2, 95% CI: 1.0, 1.5) and stunting (OR = 1.4, 95% CI: 1.1, 1.7), while being out-of-school increased the risk of DBM (OR = 1.8, 95% CI: 1.0, 3.3). Among male adolescents, lack of digital exposure was associated with increased stunting risk but decreased overweight or obesity risk, and insufficient physical activity increased the risk of both outcomes. Discussion: Adolescent DBM in LMICs is shaped by intersecting economic, educational, behavioral, and digital determinants, with distinct gender patterns. These findings underscore the urgency of integrated interventions—combining poverty alleviation, school retention, promotion of physical activity, and targeted online nutrition education—that are tailored to national and gender-specific contexts. Addressing these factors could reduce both undernutrition and obesity, with long-term benefits for adolescent health trajectories.