Addressing the double burden of malnutrition in Bangladesh: Evidence from National Policy Documents and gaps in policy integration

Abstract

Background Bangladesh faces a growing double burden of malnutrition (DBM), where persistent undernutrition coexists alongside rapidly rising overweight and obesity. Despite numerous national policies addressing malnutrition, the extent to which these policies explicitly recognize and integrate DBM remains unclear. Objective: This study critically analyzes major national nutrition, food security, health, and agriculture policies in Bangladesh to assess DBM integration and identify gaps requiring urgent policy attention. Methods: We conducted a narrative policy analysis of five purposively selected national policy documents on nutrition implemented between 2015 and 2030. Policies were evaluated using a structured analytical framework informed by Hawkes et al.'s double-duty actions framework, the Essential Nutrition Actions framework of the World Health Organization, and the policy principles of the Global Nutrition Report. The analysis examined three dimensions: (i) recognition and framing of DBM, (ii) intervention design and content, and (iii) implementation systems. Data were extracted using a pre-specified template, verified by a second reviewer, and compared against framework components to identify gaps. Recommendations were then classified into immediate, medium-term, and long-term priorities based on feasibility and urgency. Results: All five policies demonstrated comprehensive undernutrition programming, with measurable targets. However, overnutrition has received minimal attention in all the policies. Only the National Nutrition Policy (2015) explicitly acknowledged DBM, but this fell short of an integrated operational framework. The remaining four policies continued to treat malnutrition as synonymous with undernutrition, leaving overnutrition largely invisible as a policy concern. No policy has provided integrated service delivery models, household-level DBM strategies, life-course surveillance systems, or food environment regulations. Seven critical gap categories were identified: service delivery, monitoring and evaluation, human resources, dietary guidelines, food environment regulation, equity and targeting, and multi-sectoral coordination. Conclusions: Bangladesh's nutrition policies remain structurally misaligned with its evolving DBM burden. Urgent policy actions are needed to explicitly recognize DBM as a distinct policy problem, establish integrated operational frameworks, develop household-level strategies, strengthen food environment regulations, and build multisectoral governance capacity. Phased recommendations spanning immediate, medium-term, and long-term timeframes are proposed to guide systematic DBM policy integration and support progress toward Sustainable Development Goal targets.