From Hunger to Obesity: Developing Countries Face a Growing Threat to Children's Health

Intan Permatasari was just 4 years old when she outgrew every uniform at her kindergarten in Bogor, Indonesia. Her mother couldn't say no when Intan begged for food, and Intan's weight kept climbing. By age 12, she had been bullied so badly by classmates that she stopped going to school. Her story reflects a crisis hitting children across Asia, Africa, and South America.

Intan's classmates would pinch her arms, steal her money, and throw books at her. Too afraid to go outside, she spent her days watching TV and scrolling on her phone. She rarely left the house, and when she did, she would check first to make sure no one was around. 'My whole class was bullying me,' she said.

Intan is one of millions of children in Indonesia dealing with obesity. Tens of millions more in lower-income countries now face what experts call the 'double burden' — rising obesity rates alongside high levels of undernutrition. Undernutrition means not getting enough of the right nutrients to grow healthy and strong.

A team of more than 1,000 scientists studied the health of children aged 5 to 19 in about 200 countries. Their research, published in the scientific journal Nature in May, found that childhood obesity is growing fastest in countries that can least afford to deal with it. These are nations still working hard just to make sure children get enough food to eat.

Between 2023 and 2024, obesity rates among boys rose fastest in Peru, climbing to 19% from less than 8% in 2010. For girls, the fastest increases were in the Pacific island nations of Tonga and Samoa. In Indonesia, obesity among both boys and girls had its biggest single-year increase ever in 2024.

Experts warn that children with obesity face serious long-term health risks, including heart disease, diabetes, and asthma. Dr. Zulfiqar Bhutta, a children's health expert in Toronto, Canada, fears this obesity epidemic could undo decades of progress in saving lives. 'All the gains that we have had in health are going to be washed away by this absolute tsunami of non-communicable disease,' he said.

Health experts point to cheap, processed foods high in fat and sugar as a key driver of rising obesity. Many families in lower-income countries lack access to fresh, healthy food, and many don't understand the health risks. Children are also sitting more and moving less, which makes the problem worse.

For decades, Indonesia battled undernutrition caused by poverty and poor sanitation. The country made real progress, cutting undernutrition in half over 20 years. But now, obesity in Indonesian children has overtaken undernutrition for the first time, making Indonesia the most populous nation to cross that line after China and the United States.

Together, obesity and undernutrition now affect about 20% of Indonesia's 60 million school-age children. A non-profit group found that only 21% of foods in Indonesian grocery stores met a 'healthy' standard — far below the 41% average in other countries they studied. 'The food and drinks being sold here are unhealthier than those sold in developed countries,' said a top Indonesian health official.

Despite the numbers, many Indonesians don't see obesity as a serious problem. 'Indonesians have no awareness that obesity could make us sick,' said Dr. Aman Pulungan, a children's health expert at the University of Indonesia. Indonesia's health minister acknowledged obesity was rising but did not list it among the country's top health concerns.

Rates of diabetes — a disease closely linked to obesity — have more than doubled among Indonesians over 15 since 2011, reaching 11.7%. That rate is similar to the United States. Experts believe the real number is even higher, since many cases go undiagnosed.

Experts say Indonesia shows what happens when a country shifts quickly from widespread hunger to cheap, unhealthy food. In the U.S. and Europe, this change took many decades. But in middle-income countries, it's happening in less than 20 years. Barry Popkin, a nutrition professor in the U.S., called it 'a time bomb ready to explode.'

Intan tried many treatments over the years, but nothing worked until she visited a clinic at a major hospital in Jakarta two years ago. Her doctor arranged for her to use Ozempic, a weight-loss drug, at no cost to the family since it would have been too expensive. Her weight had peaked at 148 kilograms — about 326 pounds — before she started treatment.

Since starting Ozempic, Intan has lost 40 kilograms. She now takes walks every day, counts her steps and calories, and focuses on healthy foods like whole grains and lean protein. At 15, she goes to the gym, eats out with her parents, and returned to school last month. She still dreams of becoming a police officer.

Other families are making changes too. One mother in West Java was surprised when her 4-year-old active daughter was diagnosed as obese. The family cut back on sugar and added more fruit to their diet. University student Anisa Nurul Janah, 22, started speaking out about nutrition after her father died from diabetes-related causes in 2021. 'It is our right to know what we consume,' she said.

Indonesia introduced a new food labeling system in April using traffic light colors — red for unhealthy and green for healthier choices. But food companies have two years to follow the rules, and penalties for not complying are unclear. For Intan, the fight is deeply personal: 'I want to prove to people who bully me, who make fun of me, that I can be a hero.'