Undernutrition is undernourished.

‘The persistence of malnutrition, especially among children and mothers, in this world of plenty, is immoral.’ This was an opening statement of a report published in 2000. The report was produced by the Commission on the Nutrition Challenges of the 21st Century and was presented to the UN System Standing Committee on Nutrition (UN SCN). Its title was Ending Malnutrition by 2020. We know now that undernutrition – the new name for an old outrage – is liable to persist indefinitely. Why? Some reasons are given in the Lancet series on maternal and child undernutrition, published earlier this year. The fifth and final paper in this series asks why all the efforts to alleviate undernutrition are so ineffective and proposes some ways forward. The paper, in common with the others in the series, is the product of the work of a large study group from all continents including senior people from relevant UN agencies, whose judgements have been informed by testimony from many other sources. The work was supported by the World Bank and the Gates Foundation, and was focused in a Bellagio workshop. So what follows is a concerted view. This commentary summarises some of the main points made in the paper. Its purpose is to involve the readers of this journal in the problems and – it is hoped – the solutions.