The Triple Burden of Malnutrition among Children and Adolescents in Indonesia during the COVID-19 Pandemic: A Narrative Review

Abstract

Children and adolescents in Indonesia are experiencing the triple burden of malnutrition (TBM), resulting from an increasing prevalence of overweight and obesity paired with persistent undernutrition and anemia. The extent to which the coronavirus disease 2019 (COVID-19) further exacerbated TBM within this group, because of lifestyle changes and increased food insecurity, has not been well documented. This narrative review aimed to fill that gap by exploring components of TBM (i.e., undernutrition, anemia, and overweight and obesity), its determinants (e.g., diet), and related nutrition policies and programs among school-aged children and adolescents in Indonesia during the pandemic. We reviewed a total of 10 peer-reviewed articles published between 2021 and 2025 on children and adolescents’ nutrition status and TBM-related determinants. Results suggested that during COVID-19, children and adolescents in Indonesia experienced a high prevalence of undernutrition, overweight and obesity, and anemia. Most children and adolescents also faced higher levels of food insecurity and lower physical activity. The implementation of online learning halted several school-based nutrition programs, including iron‒folic acid supplementation. Nutrition-sensitive programs, such as conditional cash transfers and food assistance, were poorly distributed and contained processed foods, respectively. Nevertheless, some positive changes were also observed, including innovations in the delivery of nutrition education. Dietary changes were mixed. Although some reported a higher consumption of deep-fried foods and snacks, more frequent vegetable consumption and less frequent consumption of sugary drinks were also reported. Future research is needed to understand the mixed findings related to dietary changes and how this contributes to TBM in Indonesia at the national level. Additionally, it is crucial to strengthen children and adolescent nutrition policies and programs that target TBM simultaneously.

Children and adolescents in Indonesia are experiencing the triple burden of malnutrition (TBM), resulting from an increasing prevalence of overweight and obesity paired with persistent undernutrition and anemia. The extent to which the coronavirus disease 2019 (COVID-19) further exacerbated TBM within this group, because of lifestyle changes and increased food insecurity, has not been well documented. This narrative review aimed to fill that gap by exploring components of TBM (i.e., undernutrition, anemia, and overweight and obesity), its determinants (e.g., diet), and related nutrition policies and programs among school-aged children and adolescents in Indonesia during the pandemic. We reviewed a total of 10 peer-reviewed articles published between 2021 and 2025 on children and adolescents’ nutrition status and TBM-related determinants. Results suggested that during COVID-19, children and adolescents in Indonesia experienced a high prevalence of undernutrition, overweight and obesity, and anemia. Most children and adolescents also faced higher levels of food insecurity and lower physical activity. The implementation of online learning halted several school-based nutrition programs, including iron‒folic acid supplementation. Nutrition-sensitive programs, such as conditional cash transfers and food assistance, were poorly distributed and contained processed foods, respectively. Nevertheless, some positive changes were also observed, including innovations in the delivery of nutrition education. Dietary changes were mixed. Although some reported a higher consumption of deep-fried foods and snacks, more frequent vegetable consumption and less frequent consumption of sugary drinks were also reported. Future research is needed to understand the mixed findings related to dietary changes and how this contributes to TBM in Indonesia at the national level. Additionally, it is crucial to strengthen children and adolescent nutrition policies and programs that target TBM simultaneously.