During a recent visit to the Humla district, Dr Aruna Uprety, a public health expert, observed schoolchildren being fed noodles as part of the mid-day meal. She asked the principal and teachers why junk food was given to children instead of locally available nutritious food.

“They told me that the school management committee had unanimously decided to provide noodles and biscuits as a part of mid-day meal,” said Uprety. “I also talked to some parents about the practice, which I found awkward. However, they questioned me instead: ‘How many times should their children eat locally made food at home and also in school?’”

This was a common refrain in hundreds of remote villages, where malnutrition is so severe as to be beyond what the national figure portrays.

Real-time data from the ongoing national nutrition assessment campaign shows that nearly one-fifth of children aged between six months and five years are suffering from moderate acute malnutrition.

The two-week campaign, launched in all 733 local units on Wednesday, aims to assess the nutritional status of all children between six months and five years across the country and guide targeted interventions as concerns grow over poor diets, including rising use of processed and junk foods in both remote and urban areas.

Lila Bikram Thapa, chief of Nutrition Section at the Family Welfare Division under the Department of Health Services said the preliminary data indicate widespread nutrition problems among children.

Malnutrition has remained a silent crisis in Nepal for decades. Moderate acute malnutrition, also known as wasting, indicates recent significant weight loss or lack of weight gain, often caused by insufficient food intake or illness, according to the World Health Organisation.

The UN health body said that supplementary feeding is necessary to prevent children with moderate acute malnutrition from progressing to severe acute malnutrition.

Likewise, the same study shows over one percent are suffering from severe acute malnutrition, which is the most extreme and visible form of malnutrition, requiring urgent hospital care.

Experts say children suffering from severe acute malnutrition are 10 times more at risk of dying compared to healthy children.

Uprety, who has worked for decades to promote locally available nutritious foods through writing and advocacy, said malnutrition is not only an issue in remote villages of Karnali province, including Humla, but also in many places across the country.

“If you go to Madhesh and look at children and women from Dalit and other marginalised groups, you can see the true scale of nutrition and the growing use of junk and processed foods,” said Upreti. “The problem is severe in marginalised communities.”

Experts say the ongoing survey’s results may extend beyond children under five, since poor access to nutritious food affects older age groups as well. They add that a growing trend of consuming junk food—processed and packaged foods and sugary beverages—has worsened overall nutrition among children.

“Immediate interventions are required to address the growing problem of moderate acute malnutrition and prevent it from progressing to severe acute malnutrition,” said Atul Upadhyay, a nutritionist. “One may think a child died of pneumonia, but the underlying cause is malnutrition. Children must be provided with protein-rich, nutritious foods.”

Nepal has made visible progress in reducing stunting among children under five, which was 57 percent in 2001 and has now reduced to 25 percent, according to the Nepal Demographic and Health Survey-2022.

Wasting, a debilitating disease that causes muscle and fat tissues to waste away among children under five, was 11 percent in 2001 and has reduced to eight percent.

Experts warn that problems of malnutrition, if not addressed on time, not only affect children’s physical health and growth, but also their cognitive development. Impaired cognitive development limits productivity in adulthood, increases the risk of infections and multiple diseases, and affects the country’s overall progress.

“The real picture could be much worse than what is being depicted in the government study,” said Upadhyay. “Many children in the country are not getting adequate, nutritious food. Even those who are getting adequate food are not getting proper protein-rich, nutritious foods.”

Experts say that supplementary feeding is essential to prevent children with moderate acute malnutrition from progressing to severe acute malnutrition (SAM).

Nepal also has an international obligation to improve the nutritional status of children. To meet Sustainable Development Goals targets by 2030, Nepal must reduce stunting to 15 percent from the existing 25 percent, wasting to four percent from the current eight percent, underweight prevalence to 10 percent from the existing 19, and anaemia to 10 percent from over 43 percent at present.