“Joint action to prevent stunting and obesity” is the theme for 62nd National Nutrition Day in Indonesia on January 25th 2022. National Nutrition Day or Hari Gizi Nasional (HGN) was started from the establishment of “People’s Food Institute” or Lembaga Makanan Rakyat (LMR) lead by Prof. Poorwo Soedarmo that was also known as “Indonesian Nutrition Father”. This institute was established by J. Leimena, Indonesian’s Ministry of Health at that time in 1950, as a part of Eijkman Institute. HGN was held to commemorate the start of cadre of Indonesian nutritionists with the establishment of the Food Information Interpreter School (Sekolah Juru Penerang Makanan) by LMR on January 25th 1951.
Currently, both stunting and obesity are still double burdens malnutrition problems faced in Indonesia. Based on Basic Health Research (Riset Kesehatan Dasar/Riskesdas) 2018, the prevalence of stunting and severely stunting is still very high (total 30.8%) while the prevalence of obesity is 3.8 % for children under 5 years old and 21.8% for adults more than 18 years old. Stunting is a condition of failure to thrive of children under 5 years old resulting from chronic malnutrition so that the child is too short for his age (stunted) and intellectual development is hindered. In the long term, it can have an impact on metabolic disorders that increase an individual’s risk of obesity, diabetes, stroke, and heart disease. While obesity is a medical condition when the excessive body fat may lead to negative impact on health and increase the risk of various diseases such as diabetes, certain cancers, and heart diseases. Both stunting and obesity can be assessed using anthropometric standards.
In Indonesia, anthropometric standards for children were based on World Health Organization (WHO) Child Growth Standards for 0-5 years old children and WHO Reference 2007 for 5-18 years old children that was adopted in Indonesian’s Children Anthropometric Standard 2010 and then updated in 2020. Anthropometric standards are used to establish a reference in the assessment of nutritional status & growth trends of Indonesian children. This reference will provide guidelines for all central and regional stakeholders, users at various levels of healthcare facilities and to improve community nutrition in general. According to this standard, stunting is defined when body height/age is lower than -2 standard deviation (SD) for children under 5 years old while obesity is defined when body weight/body height or Body Mass Index (BMI)/age is higher than +3 SD for children under 5 years old and higher than +2 SD for children 5-18 years old. The details for all categories of nutrition status are as follows:
| Index | Category of Nutrition Status | Threshold (Z-score) |
| Body weight/Age for children 0-60 months old | Severely underweight | < -3 SD |
| Underweight | -3 SD to < -2 SD | |
| Normal | -2 SD to < +1 SD | |
| Risk of overweight | > +1 SD | |
| Body height/Age for children 0-60 months old | Severely stunted | < -3 SD |
| Stunted | -3 SD to < -2 SD | |
| Normal | -2 SD to < +3 SD | |
| Tall | > +3 SD | |
| Body weight/Body height for children 0-60 months old | Severely wasted | < -3 SD |
| Wasted | -3 SD to < -2 SD | |
| Normal | -2 SD to < +1 SD | |
| Possible risk of overweight | > +1 SD to +2 SD | |
| Overweight | > +2 SD to +3SD | |
| Obese | > +3 SD | |
| BMI/age for children 0-60 months old | Severely wasted | < -3 SD |
| Wasted | -3 SD to < -2 SD | |
| Normal | -2 SD to < +1 SD | |
| Possible risk of overweight | > +1 SD to +2 SD | |
| Overweight | > +2 SD to +3SD | |
| Obese | > +3 SD | |
| BMI/Age for children 5-18 years old | Severely thinness | < -3 SD |
| Thinness | -3 SD to < -2 SD | |
| Normal | -2 SD to < +1 SD | |
| Overweight | +1 SD to +2 SD | |
| Obese | > +2 SD |
Nutritional improvements need to be done to prevent stunting and obesity. Balanced nutrition should be applied in all age groups by consuming a variety of foods, getting used to clean and healthy living behaviors, maintaining a normal weight, and doing physical activity across all age groups. The focus of nutrition improvement during adolescence and also in the 1st 1000 days of life (from early pregnancy until the children reach 2 years old) including promoting exclusive breastfeeding, nutritious complementary food, children’s growth and development observation, iron supplementation during pregnancy and vitamin A supplementation for children also can prevent all types of malnutrition including stunting and obesity.
References:
Ini Sejarah Hari Gizi Nasional – Sehat Negeriku (kemkes.go.id)
Kemenkes RI. 2018. Hasil Utama Riskesdas 2018.
Peraturan Menteri Kesehatan RI nomor 2 tahun 2020 tentang Standar Antropometri Anak.
Tema Hari Gizi Nasional 2022: Cegah Stunting dan Obesitas (tirto.id)