The Bhutanese Leading the way.
Bhutan is facing a triple burden of malnutrition: undernutrition, micronutrient deficiencies, and rising overweight and obesity, that threatens the country’s human capital.
According to a report published by the Ministry of Health (MoH) and UNICEF Bhutan, while child stunting has declined from 33.5 percent in 2010 to 17.9 percent in 2023, child wasting and low birth weight remain at 5 percent and 6.9 percent respectively.
Four in ten children and women are anaemic, and overweight and obesity among children aged 5-19 years and adult women are increasing.
The report highlights, “Highly processed, unhealthy foods and beverages that contain excessive amounts of added sugar, salt, fat and refined starches, harmful additives and other ingredients are displacing traditional, minimally processed diets and reshaping what children, adolescents and adults buy and eat.”
Moreover, the expansion of transnational food corporations in India and Bhutan has accelerated this shift, influencing food availability, affordability, and marketing in homes, schools, retail outlets, and digital platforms.
Physical inactivity is also rising, particularly among adolescent girls, driven by higher screen time and limited outdoor play.
In the last two years, UNICEF Bhutan and MoH collaborated with international researchers to study child malnutrition and obesogenic food environments. Conducted between 2023 and 2025, the studies examined prevalence, risk factors, policy barriers, and adolescents’ perspectives using surveys, policy reviews, stakeholder interviews, and input from 325 school-going adolescents through the UNICEF U-Report tool.
The report states, “In the last 20 years, stunting among children under 5 years of age has halved, and overweight in children aged 5-19 years has tripled, with more girls than boys affected.”
Among women and adolescent girls, malnutrition remains a major concern: nine in ten are vitamin D deficient, 36 percent of girls aged 10-19 years are anaemic, and other micronutrient deficiencies are high, including iron (42 percent), folate (29 percent), and vitamin B12 (25 percent).
Overweight is common among adult women, with 53 percent having a high BMI and only 5 percent a low BMI. Maternal overweight can contribute to low birth weight, which affected 7 percent of babies in 2023, raising the risk of malnutrition and obesity later in life.
According to the report, early childhood feeding practices are mixed. Breastfeeding rates are high, with 82 percent of infants breastfed within an hour of birth and 69 percent exclusively for six months. Mixed feeding was low at 7 percent, while 87 percent continued breastfeeding up to 23 months.
Although 93 percent of infants received complementary foods after six months, only 63 percent met recommended feeding frequency, 16 percent had sufficient dietary diversity, 25 percent ate eggs or fresh foods, and 61 percent did not get any fruits or vegetables.
Furthermore, children are widely exposed to unhealthy foods both at home and in schools. The U-Report survey revealed that one in two adolescents chose fast foods, packaged snacks, chocolates, candies, or sugary drinks at school, mainly because these were the only options or cheaper.
One in three reported such foods were freely sold in school food-service facilities. About half noticed food brands and logos, with nearly three in five saying these influenced their choices. Almost half felt that unhealthy food brands and logos should not be advertised on school premises.
The report also finds that inadequate policies, programs, and legal measures limit children’s access to outdoor activities, healthy food choices, and care when nutritional risks are identified. “The National Nutrition Strategy and Action Plan (2021–2025) includes a target of no increase in the prevalence of childhood overweight and obesity by 2025. However, legislative provisions and policies to achieve this target have been either weak or missing,” the report notes.
The report notes that while food-based dietary guidelines exist, they do not fully support obesity prevention beyond the health system. There is no national food classification system or front-of-pack labelling.
The report adds that unhealthy foods are taxed under the Tax Act of Bhutan 2022, but the taxed items do not align with dietary guidelines, and there has been no public campaign explaining the benefits.
Additionally, advertising is regulated only on national television, leaving international channels and other media unregulated. Despite school nutrition initiatives, affirmative policies to ban junk food marketing in and around schools are lacking, as are legal measures for commercial milk formula and baby foods.
Physical activity guidelines exist but are not school-specific, and while children’s weight is measured, classification cut-offs do not use Asian standards. Additionally, targeted interventions for at-risk individuals are largely absent. Resource allocation focuses mainly on undernutrition rather than overweight and obesity, with challenges including reliance on food imports, limited local production, and complex legislation.
The report outlines priority actions across food, health, education, and social protection systems. In the food system, Bhutan should update dietary guidelines using the WHO-SEARO nutrient profile model, expand marketing regulations, ratify the International Code of Marketing of Breast-milk Substitutes, and reduce unhealthy food supply through import regulations.
In the health system, nutritional monitoring should continue, capturing overweight risk factors and providing care for at-risk individuals. In schools, legal measures should prohibit unhealthy food sales, support local food suppliers, mandate nutrition and physical education, and launch the ‘Eat Right Bhutan’ campaign. This campaign would grade schools on nutrition assessments, install sugar display boards, mandate physical activity, and establish Eat Right canteens.
The report also recommends expanding rice fortification to monastic institutions and a wider range of foods, adding protein sources, reducing salt, sugar, and fat content, and increasing student stipends for nutritious meals.
This report aims to address Bhutan’s triple burden of malnutrition and a coordinated action across all systems to safeguard children’s and women’s health and reverse rising trends in undernutrition, micronutrient deficiencies, and obesity.
