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Wasting and Stunting: Overcoming the divide

Since the 1970s, those working in nutrition have categorised undernutrition in two major ways, children are either wasted or stunted.

There has very rarely been consideration for the relationship between these two types of undernutrition in children with limited evidence to describe the associations between wasting and stunting or the overlaps in how a child experiences them. Little has previously been known on:  

• Whether one precedes, or predisposes, the other and what that might mean for policies and practice.
• The overlapping biochemical and physiological processes that lead to a child becoming wasted and/or stunted, and recovering from the same, and how they might be mediated and /or magnified.
• The scale of the problem of concurrent wasting and stunting in children and its implications for mortality risk and for programmes aiming at providing treatment for the most at risk.

Wasting and Stunting Technical Interest Group (TIG)

The WaSt Technical Interest Group (TIG) was formed to examine this relationship. The group, coordinated by ENN is made up of 42 experts in child growth, nutrition, epidemiology. 

ENN’s main role since the group's formation has been to harness the skills and enthusiasm of the TIG around the question ‘what is the relationship between wasting and stunting’ and facilitate a number of influential project workstreams to fill gaps in our understanding. The backbone of the expert group is the maintenance of a creative, transparent forum to scrutinise and explore evidence and practice, allowing it to serve the nutrition and wider humanitarian and development sectors as a hub for evidence and expert opinion which is free from organisational agendas.

WaSt TIG Membership and Governance

What we now know as a result of the WaSt Project and the WaSt TIG

• Research has shown that individual children are at risk of both conditions, might be born with both, pass from one state to the other over time, and accumulate risks to their health and life through their combined effects. This underlines the need for cohesive policies and the implementation of services and activities to prevent both wasting and stunting.
• Country level data suggests that up to 8% of children under 5 may be both wasted and stunted at the same time, global estimates translate to around 16 million children which highlights a significant public health burden that requires attention.
• Concurrently wasted and stunted children have an elevated risk of death and should be considered as a high-risk group in the targeting of treatment. Our reanalysis of data on survival shows that mortality risk for children concurrently wasted and stunted is equal to that of the most severe form of being wasted
• A combination of weight-for-age Z score and mid-upper-arm circumference may be the most effective way to identify children at highest risk of mortality, including those concurrently wasted and stunted. Further evidence is needed to understand the operational implications.
• Our research to date highlights that children with wasting and low weight-for-age respond to treatment but may need more intense treatment than those who are only wasted. 

Read our 2023-2025 workplan workplan.

For more information please contact Tanya Khara or Natalie Sessions.

WaSt TIG the work so far

Main areas of work

Resources on Wasting and Stunting

Reference this page

LD (). Wasting and Stunting: Overcoming the divide. www.ennonline.net/ourwork/reviews/wastingstunting

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