The Double Burden of Malnutrition in Bangladesh: Policy Architecture, Implementation Realities, and Future Directions.

BACKGROUND: Bangladesh faces a growing double burden of malnutrition (DBM), where persistent undernutrition coexists with rapidly rising overweight and obesity. Although the country has a comprehensive National Nutrition Policy architecture, it remains unclear whether current policies address DBM as an integrated challenge. OBJECTIVES: This study aimed to explore stakeholders' perspectives on the DBM in Bangladesh by examining how DBM is understood and framed, assessing the responsiveness of the current national nutrition policy architecture, identifying implementation challenges, and exploring policy and governance priorities for strengthening future nutrition outcomes. METHODS: This study employed a qualitative design conducted in Bangladesh between June and August 2025. A total of 12 purposively selected senior-level nutrition stakeholders participated in semistructured key informant interviews (KII), including representatives from government, international and national nongovernmental organizations, and research institutions. Participants were selected on the basis of their expertise and direct involvement in nutrition policy development and implementation. Interview data were analyzed using reflexive thematic analysis following Braun and Clarke, with themes generated inductively from participants' accounts. The integrated Health Policy Triangle-Centers for Disease Control and Prevention Policy Process Framework was used as an interpretive lens to contextualize and organize the emergent themes within established health policy frameworks. RESULTS: KII generated 4 themes that extend beyond policy description to illuminate implementation realities, causal explanations, and reform priorities: 1) growing recognition of DBM among senior stakeholders that has not yet translated to frontline or community levels; 2) stakeholder-confirmed undernutrition-focused policy architecture, with explanatory accounts of the cognitive and institutional barriers preventing DBM integration; 3) implementation challenges characterized by symbolic multisectoral coordination, weak accountability systems without DBM-specific indicators, and limited subnational workforce capacity; and 4) stakeholder-identified priorities including stronger multisectoral governance, food system regulatory reform, DBM-focused capacity building, and adaptation of existing programs as double-duty actions. CONCLUSIONS: Recognition of DBM in policy is necessary but insufficient without broader reforms in governance, program design, and resource allocation. The ongoing revision of Bangladesh's Third National Plan of Action for Nutrition provides a timely opportunity to incorporate operational DBM indicators, adapt existing programs as double-duty actions, and strengthen accountability systems to track progress across multiple forms of malnutrition. These findings may also inform policy responses in other low- and middle-income countries undergoing similar nutrition transitions.