Double-Duty Actions Addressing the Double Burden of Malnutrition among Adolescents Aged 10-19: A Scoping Review

This scoping review synthesized the evidence on double-duty actions targeted at adolescents to address the double burden of malnutrition (DBM). Adolescents face unique challenges related to the DBM, including both undernutrition and overweight, obesity, or diet-related noncommunicable diseases (NCDs). Understanding effective strategies for addressing these issues is critical. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. We examined studies from MEDLINE, Embase, CENTRAL, CINAHL, and Google Scholar on double-duty actions, defined as an array of interventions, programs, and policies that aim to simultaneously reduce the risk or burden of both undernutrition (including wasting, stunting and micronutrient deficiency) and overweight, obesity or diet-related NCDs. The evidence was analyzed through narrative synthesis. Our comprehensive search of the published and gray literature identified 17 publications representing 16 studies. These included 5 cluster randomized controlled trials, 2 evaluation studies, and 10 quasi-experimental studies conducted across 10 countries, mainly in sub-Saharan Africa and Asia. The interventions varied in duration from 1 month to 5 years and incorporated multi-component approaches, such as physical activity promotion, school feeding programs, nutrition education, and water, sanitation, and hygiene (WASH) activities. While 2 studies effectively reduced both undernutrition and overweight, 9 were DBM-neutral, 4 were potentially beneficial, and 2 had potential DBM-harmful outcomes. Thirteen multi-component interventions showed improved nutritional indicators, particularly in anemia and dietary diversity, with strong engagement from the school community contributing to successful outcomes. This review emphasizes the need for multifaceted interventions to address the DBM among adolescents. The included studies showed that school-based, multi-component strategies, including physical activity promotion and nutrition education, can improve nutritional outcomes. However, variations in effectiveness highlighted the complexity of the DBM, requiring re-design of strategies to address common drivers of multiple forms of malnutrition through context-specific approaches that engage multiple sectors and local communities. Ongoing evaluation and adaptation of strategies to attain optimal nutritional status are key to success.