Two Burdens, One Nation: Indonesia's Nutrition Crisis and the Urgency for Bold Policy Leadership

Indonesia is not merely facing a single nutritional issue. The nation is carrying three simultaneous burdens: malnourished children, an increasing number of obese adults, and a poor population still haunted by parasitic infections due to inadequate sanitation. These three problems run in parallel, overlapping, and are gradually becoming a public health crisis that can no longer be managed through conventional means.

For years, conversations regarding nutrition in Indonesia have almost exclusively centred on stunting. This is not incorrect, as stunting remains a serious wound in Indonesia’s health development. Data from the 202cap Indonesian Nutritional Status Survey shows that the national stunting prevalence stood at 21.6% in 2022, decreased to 21.5% in 2023, and then further declined to 19.8% in 2024. While this decline is noteworthy, it is not a reason for excessive celebration. It means that approximately one in five Indonesian toddlers is still growing under sub-optimal conditions.

In certain regions, the problem is even more severe. East Nusa Tenggara (NTT) and several areas in Papua still record stunting rates exceeding 35%. This is not merely a statistic; behind these figures are children losing the opportunity to reach their full potential, families living with food insecurity, and a nation risking the quality of its future generations.

However, stunting is only one side of the issue. Simultaneously, Indonesia is witnessing another face of the nutritional crisis: overweightness from an early age. In the 2024 SSGI, the prevalence of wasting in toddlers was recorded at 6.2%, severe wasting at 1.2%, and overweight/obesity reached 3.4%. In other words, some Indonesian children suffer from acute malnutrition, while others are beginning to experience overweightness. These two seemingly opposing problems exist within the same health ecosystem.

The crisis becomes more complex when examining the adult population. Data from the 2023 Indonesian Health Survey (SKI) shows that the prevalence of obesity in adults over 18 increased from 21.8% in 2018 to 23.4% in 2023. Nearly one in four Indonesian adults now lives with obesity. Jakarta recorded the highest prevalence at 31.8%, followed by Papua at 31.3% and North Sulawesi at 30.6%.

Obesity is not merely a matter of body shape; it is a gateway to various non-communicable diseases, such as hypertension, diabetes, heart disease, and other metabolic disorders. The problem is that many of these diseases go undetected. The 2023 SKI noted that the prevalence of hypertension based on doctor diagnoses was only 8.6%, but based on blood pressure measurements, it reached 30.8%. This means many people live with high blood pressure without knowing the true state of their health.

A similar situation occurs with diabetes. The prevalence based on doctor diagnoses for those aged 15 and above was 2.2%, but based on blood sugar tests, it reached 11.7%. This is the irony of Indonesia’s public health: on one hand, some children are not receiving enough nutrients to grow; on the other, high consumption of sugar, salt, fat, and ultra-processed foods is driving the rise in obesity and non-communicable diseases. The Indonesian population is being pulled by two poles—deficiency and excess—both of which pose significant health risks.

Yet, there is a third burden that often escapes national discourse: intestinal parasitic infections. This issue works silently, particularly in areas with poor sanitation. Worm and protozoa infections do not only cause diarrhoea; they can interfere with nutrient absorption, reduce appetite, trigger iron loss, and exacerbate malnutrition. A study in Bandung Regency involving children aged 24-59 months found that 11.5% were infected with soil-transmitted helminths. Another study on Sumba Island found a prevalence of intestinal protozoa infection at 20% among 291 child samples. These figures demonstrate that parasitic infections are not a problem of the past; they remain present in society, especially where access to clean water and proper sanitation is not yet equitable.