Public Health Nutrition Editorial Highlight: ‘Thinness in young schoolchildren in Serbia: another case of the double burden of malnutrition?’ Authors: Visnja Djordjic, Jagoda Jorga, Snezana Radisavljevic, Ivana Milanovic, Predrag Bozic, Sergej M Ostojic.

Alarming trends in child obesity in many developed and transitional countries usually focus public attention to this health problem. On the other hand, thinness (or underweight) in children has received much less scientific interest although it may affect child health, growth and well-being in various ways, and perhaps impact a notable number of kids! According to national studies, thinness prevalence in young school-aged children in European countries ranges from 1% to 9% yet limited data are available for thinness rates among children in East European countries. But dynamic transitional changes in this region may affect different aspects of children health.

In this study, our group for the first time described the rates of mild, moderate and severe thinness in a nationally representative sample of Serbian school children. We used a cross-sectional design to evaluate weight, height and body mass index of 4861 children aged 6–9 years, as a part of the WHO European Childhood Obesity Surveillance Initiative. We found that thinness affects approximately one in ten Serbian school children, with young girls particularly susceptible to this condition. Also, living in an economically disadvantaged region seems to expose Serbian children to higher risk of being thin.

Although our study was not aimed to explore the causes of thinness among children, high rates are likely driven by possible exposure of all children (girls in particular) to specific socio-cultural pressures to achieve and maintain a thin figure even at youngest age. Cultural ideals of beauty and physical attractiveness stereotypes may be reaching very young girls through popular videos and books, and thus affect their body image, development of body dissatisfaction and drive for thinness. Another reason that drives high underweight rates among Serbian school children might be related to poor nutritional habits shaped by low economic power or poor dietary education of affected families.

Another interesting thing – we also found that the percentage of thin children (9.6%) exceeded the percentage of obese children (6.9%) reported previously in the same cohort of boys and girls, suggesting possible ‘double burden of malnutrition’ in Serbian kids, a phenomenon that implies coexistence of both undernutrition and overnutrition in the same population. Actually, thinness and obesity may share very similar causal mechanisms related to diet, physical activity and socio-demographic environment. As a middle-income country with its economy in transition, Serbia might fit the profile of the country susceptible to the double burden of malnutrition, so integrated action tackling all forms of malnutrition should be provided by health and public authorities.

The full article ‘Thinness in young schoolchildren in Serbia: another case of the double burden of malnutrition?’  in Public Health Nutrition is available to download for free until 6th February 2018.

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