# Ethiopia's Nutritional Challenge: Recognizing Obesity as a Form of Malnutrition

Dagnechew Degefu Zeleke, Dawit Damte Shiferaw, Surender Reddy Pulluri

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Dagnechew Degefu Zeleke, Dawit Damte Shiferaw, Surender Reddy Pulluri. Ethiopia's Nutritional Challenge: Recognizing Obesity as a Form of Malnutrition. Journal of Complementary and Alternative Medical Research, 2025, 26 (2), pp.112 - 118. 10.9734/jocamr/2025/v26i2630. hal-04972543

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# Ethiopia's Nutritional Challenge: Recognizing Obesity as a Form of Malnutrition

Dagnechew Degefu zeleke a*, Dawit Damte Shiferaw b
and Surender Reddy Pulluri b++

## Authors' contributions

This work was carried out in collaboration among all authors. All authors read and approved the final manuscript.

## Article Information

DOI: https://doi.org/10.9734/jocamr/2025/v26i2630

### Open Peer Review History:

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers, peer review comments, different versions of the manuscript, comments of the editors, etc are available here: https://pr.sdiarticle5.com/review-history/131802

Received: 20/12/2024

Accepted: 22/02/2025

Published: 28/02/2025

## Minireview Article

## ABSTRACT

Objective Ethiopia is facing a growing challenge of malnutrition in two forms: The country has been dealing with undernutrition problems for many years while facing increasing challenges from over-nutrition which includes obesity and related diseases. The research investigates obesity as a developing public health problem by studying its origins and the necessary policy responses and advocacy roles required to tackle it. Methodology: This research is a comprehensive literature review analyzing existing studies, publicly available health data, and policy reports. Results: Recent trends indicate a growing prevalence of obesity, particularly in urban areas, driven by dietary shifts, reduced physical activity, and socio-economic changes. Ethiopia's National Nutrition Strategy has

<footnote>a Texila American University, School of Public Health and Social Work, Guyana.</footnote>

<footnote>b Department of Public Health, Gambella University, Gambella, Ethiopia.</footnote>

<footnote>** Professor;</footnote>

<footnote>* Corresponding author: E-mail: degndz@gmail.com;</footnote>
historically focused on undernutrition, necessitating policy updates to address obesity. Limited funding for obesity-related interventions remains a significant challenge. Research institutions, such as the Ethiopian Public Health Institute, are working to understand the epidemiology of obesity, but more targeted studies are needed. Advocacy efforts by international organizations and community-based programs play a crucial role in raising awareness and promoting dietary diversity and physical activity. Conclusion Ethiopia must implement a multi-sectoral approach to combat both undernutrition and obesity. Increased research funding, policy adaptations, and advocacy initiatives are essential to addressing over-nutrition. By integrating evidence-based strategies and promoting public awareness, Ethiopia can work towards a healthier population.

Keywords: Ethiopia; obesity; dual burden; malnutrition; dietary transition; policy; advocacy.

# 1. INTRODUCTION

Ethiopia, like many other low- and middle-income countries [LMICs], is grappling with a dual malnutrition challenge characterized by both undernutrition and over-nutrition. Traditionally, the emphasis has been on combating undernutrition due to its longstanding prevalence in the country (UNICEF, n.d.). Nonetheless, recent trends underscore an escalating issue of over-nutrition, manifesting as obesity and overweight, along with associated non-communicable diseases [NCDs] (PLOS One, 2022). This dual malnutrition challenge, known as the "double burden," suggests that the issue extends beyond mere food insufficiency and includes poor dietary diversity (Global Nutrition Report, n.d.). The nutritional transition observed in Ethiopia mirrors similar patterns seen in other developing nations such as China and India, where dietary and lifestyle shifts accompany economic and epidemiological transformations (Nature, 2020; USAID, n.d.). Addressing over-nutrition in Ethiopia necessitates targeted research, policy adaptations, increased funding, and robust advocacy efforts to mitigate its impacts (Nutrition International, 2023).

In recent years, Ethiopia has witnessed a notable rise in obesity, a trend that has garnered increasing attention from researchers and policymakers alike. The prevalence of obesity among adults in Ethiopia is estimated at 5.4%, with certain regions reporting even higher rates (PLOS One, 2022). This emerging pattern is part of a broader nutritional transition characterized by shifts in dietary habits and decreases in physical activity, trends observed in other countries undergoing similar transformations (Nature, 2020). This transition is marked by increased consumption of processed foods high in fats and sugars, coupled with a decline in traditional diets rich in grains and vegetables (ScienceDirect, 2022).

The Ethiopian Public Health Institute [EPHI] has been at the forefront of research on nutrition and food science, aiming to address both undernutrition and the burgeoning challenge of over-nutrition (EPHI, n.d.). Their efforts are focused on understanding the epidemiology of obesity and overweight in Ethiopia, including the socio-economic and cultural factors that contribute to these conditions. This research is critical for developing targeted interventions that are culturally sensitive and region-specific, ensuring that solutions are tailored to the unique dietary and lifestyle patterns of different Ethiopian communities (Frontiers in Public Health, 2024).

One significant finding from recent studies is the role of urbanization in the rise of obesity in Ethiopia. Urban areas tend to have higher rates of obesity compared to rural regions, largely due to lifestyle changes associated with urban living, such as decreased physical activity and increased access to high-calorie foods (Academic OUP, 2023). This urban-rural divide highlights the need for targeted public health interventions that address the specific challenges faced by urban populations, while also considering the unique needs of rural communities (Global Nutrition Report, n.d.).

Moreover, the cultural context in Ethiopia plays a crucial role in shaping dietary habits and perceptions of body weight. In some Ethiopian communities, being overweight is traditionally associated with wealth and status, which can hinder efforts to promote healthy weight management (USAID, n.d.). This cultural perspective underscores the need for public health campaigns that not only educate people about the health risks associated with obesity but also work to shift cultural norms and attitudes towards body weight (Nutrition International, 2023).
Research has also identified a lack of dietary diversity as a significant contributor to over-nutrition in Ethiopia. Many Ethiopian diets are heavily reliant on staple grains, with limited intake of fruits, vegetables, and protein-rich foods (PMC, 2022). This lack of diversity can lead to micronutrient deficiencies and can contribute to the development of obesity when combined with high-calorie, low-nutrient processed foods (FANTA Project, 2013). Efforts to promote dietary diversity are therefore essential in combating both undernutrition and over-nutrition, ensuring that Ethiopians have access to a variety of nutrient-rich foods (UNICEF, n.d.).

Furthermore, the role of international organizations in supporting nutrition research in Ethiopia is noteworthy. Organizations like USAID and the World Health Organization have provided funding and technical support for research initiatives aimed at understanding and addressing the nutritional challenges facing Ethiopia (USAID, n.d.). These collaborations have been instrumental in advancing the knowledge base on nutrition in Ethiopia and in developing evidence-based strategies to combat malnutrition in all its forms (ILRI, n.d.).

While significant progress has been made in understanding the dynamics of over-nutrition in Ethiopia, more research is needed to fully grasp the complexities of this issue. Future studies should focus on longitudinal analyses to track changes in dietary habits and obesity rates over time, as well as intervention studies to evaluate the effectiveness of different public health strategies (Frontiers in Nutrition, 2021). Additionally, research should explore the impact of socio-economic factors, such as income and education, on dietary choices and obesity risk, to inform policies that address these broader determinants of health (OUP, 2020).

In conclusion, research on obesity and over-nutrition in Ethiopia is crucial for developing effective interventions and policies to address this growing public health challenge. By understanding the unique cultural, socio-economic, and regional factors that contribute to obesity, researchers and policymakers can design targeted strategies that promote healthy lifestyles and improve the overall nutritional status of the Ethiopian population (USAID, n.d.).

## 2. POLICY AND FUNDING

Ethiopia's approach to addressing malnutrition has evolved significantly over the years, with an

increasing recognition of the need to address the dual burden of undernutrition and over-nutrition. The National Nutrition Strategy, first formulated in 2008, marked a pivotal moment in the country's efforts to combat malnutrition (World Bank, n.d.). This strategy emphasized a multi-sectoral approach, integrating efforts across health, agriculture, and education sectors to tackle the root causes of malnutrition (UNICEF, n.d.). However, as the issue of over-nutrition has gained prominence, there is a growing need to adapt these policies to address obesity and related non-communicable diseases [NCDs] more explicitly (USAID, n.d.).

One of the critical challenges in this regard is the allocation of funding. Historically, funding for nutrition in Ethiopia has primarily focused on undernutrition, with substantial investments directed towards alleviating hunger and improving food security (USAID, n.d.). While these initiatives have been successful in reducing rates of stunting and wasting among children (ILRI, n.d.) they do not adequately address the rising tide of over-nutrition. To this end, increased funding is required to support research, public health campaigns, and interventions specifically targeting obesity and overweight (Global Nutrition Report, n.d.).

International organizations play a pivotal role in supporting Ethiopia's nutrition agenda. Agencies such as the United States Agency for International Development [USAID] have been instrumental in providing financial and technical assistance to nutrition programs in Ethiopia (FANTA Project, 2013). These collaborations have facilitated the implementation of comprehensive nutrition interventions that address both undernutrition and over-nutrition, promoting a more balanced approach to tackling malnutrition (USAID, n.d.).

The Ethiopian government has also committed to increasing domestic funding for nutrition initiatives. Recognizing the economic burden of malnutrition, the government has allocated resources to support nutrition-sensitive programs that integrate health, agriculture, and education sectors (UNICEF, n.d.). These programs aim to promote dietary diversity, improve access to nutritious foods, and encourage healthy lifestyle choices among Ethiopians (Nutrition International, 2023).

To effectively manage the dual burden of malnutrition, Ethiopia's policies must also
address the underlying socio-economic
determinants of health. Poverty, limited access to
healthcare, and educational disparities are
significant barriers to achieving nutritional well-
being (PMC, 2022). Addressing these issues
requires a holistic approach that goes beyond
nutrition-specific interventions to include broader
social and economic reforms (ScienceDirect,
2022). By improving education and economic
opportunities, particularly for women and
marginalized groups, Ethiopia can create a more
equitable environment that supports better
nutrition outcomes (OUP, 2020).

Another crucial aspect of policy development is the integration of evidence-based strategies. Research has highlighted the importance of tailoring interventions to the specific needs of different communities, taking into account cultural, regional, and socio-economic factors (Frontiers in Nutrition, 2021). This approach ensures that policies are relevant and effective, addressing the unique challenges faced by diverse populations within Ethiopia (EPHI, n.d.).

In addition to policy adjustments, there is a pressing need for robust monitoring and evaluation mechanisms. These systems are essential for tracking progress, identifying gaps, and ensuring accountability in the implementation of nutrition programs (UNICEF, n.d.). By establishing clear metrics and regularly assessing the impact of interventions, policymakers can make informed decisions and allocate resources more effectively (WHO, n.d.).

Collaboration with international partners also
offers opportunities for policy innovation and
learning. By engaging with global networks and
sharing best practices, Ethiopia can benefit from
the experiences of other countries facing similar
challenges (ILRI, n.d.). This exchange of
knowledge can inform the development of
innovative solutions that are tailored to the
Ethiopian context (USAID, n.d.).

Ultimately, addressing the dual burden of malnutrition in Ethiopia requires a comprehensive and coordinated response. By prioritizing both policy adaptation and increased funding, the country can create a supportive environment for sustainable nutrition improvements (Global Nutrition Report, n.d.). Through continued investment in nutrition-sensitive programs, collaboration with international partners, and integration of evidence-based strategies, Ethiopia can make

significant strides towards achieving better health
outcomes for its population (WHO, n.d.).

3. ADVOCACY

Advocacy is an essential component in
addressing the dual burden of malnutrition in
Ethiopia, serving as a catalyst for policy change
and public awareness. Effective advocacy
involves a concerted effort by various
stakeholders, including government agencies,
international organizations, non-governmental
organizations [NGOs], and community leaders, to
promote nutrition and influence policy decisions
(FANTA Project, n.d.).

One of the primary goals of advocacy in Ethiopia is to raise awareness about the growing issue of over-nutrition and its associated health risks. Public health campaigns aim to educate the population about the importance of a balanced diet and the dangers of excessive consumption of processed foods high in sugars and fats (USAID, n.d.). These campaigns are designed to shift cultural perceptions around body weight and promote healthier lifestyle choices, particularly in urban areas where obesity rates are higher (Global Nutrition Report, n.d.).

International organizations, such as Nutrition International and USAID, have played a significant role in supporting advocacy efforts in Ethiopia. These organizations have developed strategies to coordinate and finance advocacy activities, ensuring a unified approach to addressing malnutrition (Nutrition International, 2023). For instance, Nutrition International has implemented a food fortification advocacy strategy, which aims to enhance the nutritional quality of commonly consumed foods and reduce micronutrient deficiencies (Nutrition International, 2023).

Community engagement is another critical
aspect of successful advocacy. Local leaders
and influencers are often instrumental in
disseminating information and encouraging
behavior change within their communities (Alive
& Thrive, n.d.). By involving community members
in the planning and implementation of nutrition
programs, advocacy efforts can be more
culturally sensitive and relevant to the specific
needs of different populations (USAID, n.d.).

Policy dialogues are a vital tool for advocacy,
providing a platform for stakeholders to discuss
nutrition-related challenges and solutions. These
dialogues facilitate collaboration between government officials, health professionals, researchers, and community representatives, fostering an environment of shared responsibility and collective action (Right2Grow, 2024). Through these discussions, advocates can highlight the importance of nutrition in national development agendas and push for increased investment in nutrition programs (UNICEF, n.d.).

Advocacy also focuses on the need for comprehensive and integrated nutrition policies that address both undernutrition and over-nutrition. This includes advocating for policies that promote dietary diversity, improve access to healthy foods, and encourage physical activity (WHO, n.d.). By emphasizing the economic and health benefits of addressing malnutrition, advocates can make a compelling case for prioritizing nutrition in public policy (Global Nutrition Report, n.d.).

The use of data and evidence is crucial in strengthening advocacy efforts. By presenting compelling data on the prevalence and impact of malnutrition, advocates can persuade policymakers to allocate resources and support interventions that address the root causes of nutritional issues (WHO, n.d.). Monitoring and evaluation of advocacy initiatives are also vital to assess their effectiveness and make necessary adjustments (UNICEF, n.d.).

Lastly, advocacy efforts must be adaptive and responsive to the changing nutritional landscape in Ethiopia. As the country continues to experience economic and demographic shifts, advocacy strategies should evolve to address emerging challenges and leverage new opportunities for promoting nutrition (USAID, n.d.). By remaining flexible and innovative, advocates can sustain momentum and drive meaningful progress towards improving the nutritional status of the Ethiopian population (Nutrition International, 2023).

## 4. CONCLUSION

The dual burden of malnutrition in Ethiopia, characterized by both undernutrition and over-nutrition, presents a complex challenge that requires a multifaceted response. Research is essential to understand the underlying causes and develop effective interventions. Policy adjustments and increased funding are necessary to implement these interventions and ensure they are sustainable. Advocacy efforts

must continue to raise awareness and drive changes in societal norms and government priorities. By addressing over-nutrition alongside undernutrition, Ethiopia can work towards a healthier future for its population.

## CONSENT AND ETHICAL APPROVAL

It is not applicable.

## DISCLAIMER (ARTIFICIAL INTELLIGENCE)

The author(s) hereby declare that NO generative AI technologies, such as Large Language Models (e.g., ChatGPT, Copilot) or text-to-image generators, have been used during the writing or editing of this manuscript.

The content is entirely the work of the author(s), ensuring originality, accuracy, and adherence to ethical writing standards.

## COMPETING INTERESTS

Authors have declared that no competing interests exist.

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