Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 1;2(1):15.
doi: 10.1186/s44263-024-00045-6.

Mapping food system drivers of the double burden of malnutrition using community-based system dynamics: a case study in Peru

Carmen Quinteros-Reyes  1 , Paraskevi Seferidi  2 , Laura Guzman-Abello  3 , Christopher Millett  4   5 , Antonio Bernabé-Ortiz  1 , Ellis Ballard  6
Affiliations

Mapping food system drivers of the double burden of malnutrition using community-based system dynamics: a case study in Peru

Carmen Quinteros-Reyes et al. BMC Glob Public Health. .

Abstract

Background: Peru is facing a double burden of malnutrition (DBM), characterized by the co-existence of undernutrition and overnutrition. Double-duty actions that concurrently target common drivers of undernutrition and overnutrition, while ensuring no unintended side effects, are recommended to effectively address the DBM. To understand these complex common mechanisms and design context-specific double-duty actions, there is a need for participatory systems approaches. This paper provides a case study of applying a community-based system dynamics approach to capture stakeholder perspectives of food system drivers of the DBM in two regions in Peru.

Methods: We implemented a multi-stage community-based system dynamics approach, which included processes for research capacity building for systems approaches, and the designing, piloting, and implementation of stakeholder workshops. A total of 36 stakeholders, representing diverse perspectives, participated in five group model building workshops. Stakeholder views are presented in a causal loop diagram that showcases the feedback mechanisms between key food system drivers of overweight and stunting in Peru.

Results: The causal loop diagram highlights that prioritization of undernutrition over overnutrition in the policymaking process, due to Peru's historically high levels of undernutrition, may undermine action against the DBM. It also describes potential mechanisms of unintended impacts of undernutrition policies on the DBM in Peru, including impacts related to within-family distribution and quality of food provided through food assistance programs, and unintended impacts due to regional dynamics.

Conclusions: This paper highlights the importance of a participatory approach to understand local needs and priorities when recommending double-duty actions in Peru and shares practical methodological guidance on applying participatory systems approaches in public health.

Keywords: Community-based system dynamics; Double burden of malnutrition; Double-duty actions; Food system; Group model building; Peru.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study has received ethical approval by the Institutional Research Ethics Committee of Universidad Peruana Cayetano Heredia (approval number: 104098). Workshop participants provided written informed consent before their participation in the workshops. All data were anonymized and authors had no access to identifiable information following the workshops. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Project stages and activities. SD, system dynamics; GMB, group model building; DBM, double burden of malnutrition. *Methods Briefs are freely available in Spanish and English at the following link: https://socialsystemdesignlab.wustl.edu/publications/methods-briefs/
Fig. 2
Fig. 2
Synthesized causal loop diagram of the food system and the double burden of malnutrition in Lima and Iquitos. The colors represent dynamics that were particularly emphasized by different groups of stakeholders, as noted in the legend. The gray color represents dynamics that were added during the review session. Black arrows were added by the research team during the causal loop diagram synthesis. A Spanish language version of the causal loop diagram and further orientation to reading it is available online [37]. UPEP, ultra-processed edible products; MPF, minimally processed foods
See this image and copyright information in PMC

References

    1. Popkin BM, Reardon T. Obesity and the food system transformation in Latin America. Obes Rev. 2018;19(8):1028–64. - PMC - PubMed
    1. Loret de Mola C, Quispe R, Valle GA, Poterico JA. Nutritional transition in children under five years and women of reproductive age: a 15-years trend analysis in Peru. PLoS One. 2014;9(3):e92550. - PMC - PubMed
    1. High Level Panel of Experts. Nutrition and food systems. A report by the high level panel of experts on food security and nutrition of the committee on World Food Security. Roma: HLPE; 2017.
    1. Santos MP, Turner B, Chaparro MP. The double burden of malnutrition in Peru: an update with a focus on social inequities. Am J Clin Nutr. 2021;113(4):865–73. - PubMed
    1. Instituto Nacional de Estadística e Informática. Encuesta Demográfica y de Salud Familiar - ENDES 2005. Lima: INEI; 2005.

LinkOut - more resources