Ayesha Zahid Khan is a Public Health Nutritionist, currently working as a lecturer and researcher at Aga Khan University. She has over 35 years of experience in nutrition, starting as a hospital dietitian at the Aga Khan University and later completing a fellowship at Massachusetts General Hospital, Boston. For the past 20 years she is working in the area of Public Health Nutrition with AKU’s Human Development Programme, working on several projects such as the Commmunity Mobilization Project funded by USAID focusing on nutrition and hygiene improvement of school children of Sindh. Presently she is leading the UNICEF-supported Reducing Inequalities by Enhancing Early Childhood Development for Vulnerable Population in Pakistan, a dietary intervention study for children with neurodevelopmental disorders, and studying the effect of environmental temperature on dietary intake of women Sindh. Her expertise spans clinical dietetics, public health, and child nutrition.

These threats are extremely serious. Stunting is not just about a child being short; it means the child’s brain development is compromised. Once that potential is lost, it cannot be regained. Every child is born with a certain physical and cognitive potential, but malnutrition robs them of it. A stunted child may look small, but inside, their brain has not developed the way it should. That child will struggle in school, may not be able to achieve academically or economically, and might even become a burden on society rather than a contributor.
Right now, almost 40% of children in Pakistan are stunted, which means nearly every second child is not reaching their potential. Wasting is also a major problem, made worse by repeated infections and poor immunity due to micronutrient deficiencies like iron and zinc. So, the threat is not just medical, it is social and economic. A nation where half the children are stunted cannot progress the way it should, which is a great concern for everyone in Pakistan.

Lack of affordability is an important deterrent, but other factors are equally damaging. Certain illogical cultural practices, lack of awareness, and even cooking methods make a huge difference. For example, believes that certain foods should not be given during menstruation, pregnancy or early childhood. In many households, vegetables are cooked for such a long time that most nutrients are lost. The food may look plentiful, but the nutritional value is reduced.

Then there is the influence of advertising. Families use a major portion of their food budget on buying sugary drinks, instant noodles, or packaged cereals/foods because the advertisements on TV make them believe that these are nutritionally superior to the locally available fruits, vegetables and meat. A packet of chips or cookies for 10 rupees feels more “modern” than a boiled egg, lentils, chickpeas or nuts/seeds even though the latter are far healthier. So, the problem is not only poverty, it is also mindset and awareness. Until we address that, children’s diets will remain poor.

The impact goes far beyond height and weight. Malnourished children suffer from weaker immunity, which means they fall sick more often. Every time a child gets sick and recovers, they need extra nutrition to replenish the lost nutritional stores. However, in poor households, it is hard to provide this support, so they fall into a cycle of illness and weakness. This leads to increased risk of micronutrient deficiencies like anemia resulting in reduction of energy, attention span, and the ability to concentrate in school.

This translates into lost human capital for the country. A child who is stunted or anemic is less likely to succeed in school, less likely to secure good employment, and more likely to remain trapped in poverty. So, malnutrition is not just a health issue, it is an economic and developmental crisis. It affects productivity, family well-being, and the future of the entire nation.

For the government, aside from the usual issues of poverty, infrastructure and nutritional interventions, one of the most urgent steps is to foster awareness and nutrition education, especially starting from childhood. Nutrition should be integrated into school activities in simple ways, not as a heavy subject, but through fun, small modules and stories that children remember. Fortification programs like iodized salt have already shown how effective policy can be when combined with education. Government must also support a multi-sectoral approach, linking health, education, agriculture, and social protection.

For parents, the responsibility is to use whichever resources they have access to wisely and with an understanding of which foods are best for growing children. Even in resource-limited settings, simple changes like including lentils, seasonal vegetables, or adding affordable protein source into daily meals can improve a child’s diet. For NGOs, the key is localization. Generic guidelines will not work. They must sit with communities, understand their diets, and show them practical substitutions within their local context. Only then will behavior change happen.

We need to separate two things. Packaged foods marketed as “fortified”: sugary drinks, flavored cereals, instant products, are not truly nutritious or ‘fortified’. They are expensive, lack necessary nutrients, and cannot replace a healthy, balanced diet. Families often waste money on these because they trust advertising, but in reality, these products may even harm long-term health, especially if given often to children.

On the other hand, genuine l fortification, is a safe, cost-effective, and proven public health strategy to prevent and control micronutrient deficiencies. Adding iodine to salt or vitamins to oil and flour has had proven benefits in Pakistan. The best example is iodized salt: initially resisted by people, but with education and persistence it became accepted, and iodine deficiency rates dropped drastically. Given the importance of iodine in cognitive development, that program changed the future cognitive potential of millions of children. This had benefits for all of Pakistan. So, fortification in staple foods is a powerful tool against malnutrition. If the population, and especially parents are informed and aware of the proper nutrients required in the typical diet, it can have a long-term positive effect on health outcomes, cognitive development and even the society and economy of Pakistan.