A shared responsibility: Why nutrition and NCDs must be addressed hand in hand

Global malnutrition is changing in complex ways. It is no longer only about whether people have enough to eat, but about the coexistence of undernutrition, micronutrient deficiencies, overweight, and obesity. These forms of malnutrition can occur within the same community, the same household, and even across a single person’s life.

Although their effects differ, these forms of malnutrition are often driven by the same underlying forces: poverty, limited access to nutrition knowledge as well as to healthcare and prevention services, water and sanitation, and food supply chains that favour the production and marketing of cheap, low-quality foods.

At the World Diabetes Foundation, our work shows why these challenges cannot be addressed separately. Undernutrition is often treated as a maternal and child health issue, while overweight and obesity sit more squarely within the NCD agenda. Yet people do not experience malnutrition in silos, and both under and over nutrition early in life can increase the risk of obesity, insulin resistance, and diabetes in later years.

The relationship also runs in the other direction: living with an NCD can deepen malnutrition by placing additional pressure on household food security; and substandard diet can cause micronutrient deficiencies in those experiencing obesity. Time away from work for treatment can reduce income, while untreated complications may undermine long-term earning potential. Healthcare and caregiving costs add further strain, making it harder for families to secure a reliable supply of healthy food.

Despite these connections, nutrition and NCDs are still too often addressed through separate systems. Unfortunately, when responsibility is divided across sectors, it can quickly become the responsibility of no one.

That is why our health promotion approach works across the life course, connecting nutrition and NCD prevention rather than treating them as competing priorities. Our approach focuses on early action, identifying early windows of opportunity, such as pregnancy and childhood, to prevent diabetes through healthy diets and lifestyle.

Our projects in Nepal put this approach into practice by linking nutrition and diabetes prevention across different stages of life. Addressing hyperglycaemia in pregnancy and NCD prevention is integrated into established maternal and child health policies, programmes, and community platforms. This makes the first 1,000 days of a child’s life, from conception through two years of age, a window not only for meeting immediate nutritional needs but also for reducing lifelong risks of obesity, insulin resistance, and diabetes.

The same life-course thinking is brought to the wider community. In schools, children grow vegetables, prepare meals, and learn where food comes from. The conversations are carried outside of schoolgrounds through outreach campaigns, community workshops, and financial wellbeing courses aimed at supporting families to generate income.

Community-level action, however, can only go so far without supportive policy and health systems.

In Nepal, the work strengthens primary care, reporting, and frontline capacity, while integrating NCD prevention into the country’s Multisector Nutrition Plan. Government departments work through existing structures rather than creating a parallel programme, establishing clearer lines of responsibility and a stronger basis for tracking whether commitments translate into services and healthier communities.

Closing the gap means rejecting the idea that countries must choose between transforming food systems and addressing NCDs, or between tackling undernutrition and preventing overweight and obesity. These goals depend on the same foundations: healthier food systems, stronger primary care, and policies that protect health throughout life.

As countries and global health institutions face growing financial pressure, bringing nutrition and NCD prevention closer together is sound policy. What is needed now is the leadership to turn that convergence into action.