Document Type

Discussion Paper

Date of Paper



This research provides a single explanation for: (i) the persistence of malnutrition and (ii) the increased prevalence of metabolic disease (diabetes, hypertension, cardiovascular disease) among normal weight individuals with economic development. Our model is based on a set point for BMI or bodyweight that is adapted to conditions of scarcity in the pre-modern economy, but which subsequently fails to adjust to rapid economic change. During the process of development, some individuals thus remain at their low-BMI set point, despite the increase in their consumption, while others who have escaped the nutrition trap (but are not necessarily overweight) are at increased risk of metabolic disease. The model and the underlying biological mechanism, which are validated with micro-data from India, Indonesia and Ghana can jointly explain inter-regional (Asia-Africa) differences in nutritional status and the prevalence of diabetes.


We are grateful to Jere Behrman, Anne Ferguson-Smith, Nita Forouhi, Seema Jayachandran, K.M. Venkat Narayan, Nigel Unwin, and numerous seminar participants for their constructive comments. Johannes Maywald, Krithika Raghupathi, and Astha Vohra provided outstanding research assistance. Research support from the National Institutes of Health through grant R01-HD046940, Cambridge-INET, the Keynes Fund and the Newton Trust at the University of Cambridge, and the Agence Nationale de la Recherche (ANR) under the EUR Project ANR-17-EURE-0010 is gratefully acknowledged.