The Double Burden of Childhood Malnutrition in the Caribbean: Policy, Practice, and Public Health Imperatives

Abstract

Background
The Caribbean faces a growing nutrition crisis marked by the double burden of malnutrition — the simultaneous presence of childhood undernutrition and rising obesity. Despite policy progress, malnutrition persists across socioeconomic lines, threatening long-term public health and development outcomes.
Objective
This narrative review explores the epidemiological trends, biochemical consequences, social determinants, and policy responses to childhood malnutrition in the Caribbean. It highlights barriers and opportunities for public health action, with a focus on equity and sustainability.
Methods
This narrative review was informed by a structured bibliographic search conducted between January and June 2025. Sources were identified through PubMed, Scopus, Web of Science, and Google Scholar using combinations of terms such as 'childhood malnutrition', 'double burden’, ‘nutrition policy', 'obesity', 'stunting', 'food security', and 'micronutrient deficiencies', each linked to 'Caribbean'. Grey literature was obtained from Food and Agriculture Organization of the United Nations (FAO), the Pan American Health Organization (PAHO), the Caribbean Public Health Agency (CARPHA), the Healthy Caribbean Coalition (HCC), and the Caribbean Food and Nutrition Institute (CFNI).
Results
Undernutrition remains significant in low-income populations, with stunting and micronutrient deficiencies such as anaemia persisting across several countries. Simultaneously, childhood overweight and obesity are increasing rapidly, especially in urban settings. Biochemical evidence reveals an early onset of metabolic dysfunction and hidden hunger (micronutrient deficiencies), both of which contribute to a higher burden of non-communicable diseases (NCDs). Structural drivers include poverty, food insecurity, and ultra-processed diets. Weak health systems exacerbate disparities. While national policies such as sugar-sweetened beverage (SSB) taxes, food fortification, and school-based nutrition programmes show promise, their implementation is often fragmented and under-resourced.
Conclusions
Addressing the double burden of childhood malnutrition in the Caribbean will require multisectoral convergence, stronger data systems, targeted fiscal policies, and equity-driven interventions. Regional collaboration and investment in locally led research will be critical to designing sustainable solutions. The urgency of this crisis demands bold, coordinated action to protect the nutritional well-being of the Caribbean’s next generation.