From Lacking Calories to Lacking Nutrition: The Poor's Dietary Dilemma
Cheaper, not necessarily healthier.
Poverty has always been synonymous with malnutrition. The “Zero Hunger” aim of the Sustainable Development Goals (UN, n.d.) reflects this global consensus to provide calories for all. However, in more modern economies with increasingly developed industries, the nature of the problem is beginning to change in less visible ways. Hunger may not be the only danger the poor faces.
As food systems become more industrialized, cheap, calorie-dense, and low-nutrition foods have become widely available (Popkin & Ng, 2022). Processed snacks, sugary drinks, and foods high in fat and sodium are now easier and cheaper to produce than fresh, nutrient-rich alternatives like fruits, vegetables, and high-quality proteins. Calories are abundant. Nutrition isn’t.
This shift comes with serious consequences. Diet-related non-communicable diseases, such as cardiovascular disease, diabetes, and certain cancers, are now among the leading causes of death globally (GNR, 2021). These are not diseases of infection, but of lifestyle, shaped by a combination of behavior, environment, and long-term exposure to poor diets.
For low-income populations, these changes reshape everyday choices. Cheap, highly palatable foods rich in sugar, salt, and fat are now within easy reach. They are not only affordable, but also calorie-dense, which makes them especially attractive for individuals engaged in physically demanding work. When food needs to be both filling and inexpensive, these options become hard to resist.
This creates a difficult trade-off. The poor are no longer only at risk of not getting enough calories, but also of getting the wrong kind of calories. In many places, undernutrition and obesity now coexist within the same communities, even within the same households. This phenomenon is often referred to as the double burden of malnutrition. At one end, food insecurity and nutrient deficiencies remain serious concerns, reflected in persistent rates of stunting and wasting. On the other, rising obesity rates and diet-related diseases are becoming increasingly common among the same populations.
This pattern is not limited to developing countries. In many high-income economies, lower-income individuals are more likely to suffer from obesity and related health conditions than their wealthier counterparts (Salmasi & Celidoni, 2017). The question is why?
One way to understand this is through a simple constraint. When income is limited, people are often forced to choose between foods that are cheap and filling, and foods that are more nutritious but also more expensive (Martin, 2005). In many modern food environments, unhealthy foods tend to provide more calories per unit of cost than healthier options. At the same time, humans are naturally drawn to flavors associated with sugar, fat, and salt (Drewnowski & Specter, 2004). The result is a systematic bias in food choice. When budgets are tight, and preferences align with what is cheap and available, the outcome is not surprising. People consume more calories, but fewer nutrients.
There is also a longer-term dimension to this problem. Investing in healthy food is, in a sense, an investment in future health. But not everyone values the future in the same way. Individuals with higher expected income and more stable prospects have stronger incentives to maintain their health over time. For those facing economic uncertainty, the future may feel more distant or less certain, making immediate needs and gratification more pressing. In economic terms, differences in time preferences across the wealth gradient can shape dietary choices in unfortunate ways.
As Indonesia’s economy continues to grow, it is beginning to face this same dual challenge. Non-communicable diseases are already the leading cause of death in the country (Arifin et al., 2022), and obesity rates are rising across age groups (UNICEF, 2022). At the same time, evidence suggests that an obesogenic food environment, one that encourages excessive calorie consumption, is becoming more widespread.
Given these challenges, policies that focus on “feeding” the population risk missing the problem altogether. Indonesia’s Free Nutritious Meal Program (Makan Bergizi Gratis) offers one example of an intervention with this potential risk. A program that merely redistributes food without addressing the underlying food system risks further reinforcing the trajectory of rising obesity and non-communicable diseases.
The challenge, then, is not simply about feeding the poor, but about understanding the conditions under which they eat. As food becomes cheaper, more accessible, and more engineered for taste, the problem of nutrition becomes less about scarcity and more about incentives. Without addressing this shift, efforts to improve welfare risk solving the wrong problem, and as is often the case, the poorest will be the least equipped to deal with the consequences.