Child wasting and stunting - are we where we need to be?

By Tanya Khara and Carmel Dolan on 12 September 2019

We've been on a high this week with the publication of the Viewpoint from the ENN coordinated Wasting-Stunting Technical Interest Group (WaSt TIG). 'Beyond wasted and stunted - a paradigm shift is needed to fight child undernutrition' in the Lancet journal of Child and Adolescent Health. The Viewpoint reflects the combination of work we have been coordinating over the last 5 years with a dedicated and inspiring group of experts. For further information about this work, see the WaSt TIG project page

For those of you who are not familiar with the WaSt TIG, ENN formed the group in 2014 to fill a serious knowledge gap in the relationship between wasting and stunting. The group, which has grown in number over the years brings together experts in nutrition research, policy and programming. From the very beginning of the WaSt project, we were aware of the profound divide between wasting and stunting in research, programming and policy. Indeed, it had characterised our own work and careers. But we suspected that these two conditions were physiologically more closely related than was appreciated and we were very concerned that the nutrition architecture was overly siloed and forcing an artificial separation. Our mission over the last 5 years has been to review all the available evidence and collectively generate additional evidence to better understand the relationship between wasting and stunting and to encourage others within the international nutrition community to do the same. We've been pleased to see that others are doing exactly that.

It’s not all been plain sailing though. Over the years, we have questioned whether we are on the right track, whether we are stating the obvious, and if the connections we have uncovered are fundamentally important in terms of how we programme in nutrition. Ultimately, a big question for us has been ‘do we have enough evidence to push for change?’ 

Now, with 6 peer review publications based on the work of the WaSt TIG, an USAID/OFDA funded programmatic research study underway and some very positive feedback from our peers in the sector, we are confident that the paradigm shift we are calling for in this Viewpoint is essential to our efforts to successfully prevent and treat child undernutrition. 

In a nutshell, we can now confidently say that approaching wasting and stunting as separate problems fails to recognise the fact that individual children are at risk of both conditions, may be born with both, pass from one state to the other over time, and accumulate risks through their combined effects. Moreover, the current emphasis on identifying children once they are defined as being wasted or stunted, detracts crucial attention from the much larger number of children who are in the process of becoming under-nourished, and in whom harmful effects of the causes of wasting and stunting are already present. 

The WaSt TIG are calling for action in 5 areas:

1. Focus more research and practice on the concurrent and dynamic biological processes and pathways that underlie the entire spectrum of child weight and linear (height) growth faltering.
2. Develop innovative and early markers to predict, identify and monitor children at risk of weight and linear growth faltering.
3. Research maternal factors from adolescence through pregnancy that effect in utero and post-natal child weight and linear growth faltering.
4. Evaluate preventive interventions, universal and seasonal, for children at risk of weight or linear growth faltering, including in countries affected by protracted crisis.
5. Review and adjust therapeutic interventions to ensure that the children at highest mortality risk - including as a result of dual weight and height deficits - are included.

We are really pleased to be able to share this with you and would love to hear your thoughts and reactions. You can do this by contacting us directly (carmel@ennonline.net or tanya@ennonline.net), or by starting a new discussion (head to the top of this blog, beneath our share buttons on the right).