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TYRE is a small province on Lebanon’s border with Israel, a place of poor tobacco farmers and tin-roofed shacks. Only about half the population has enough to eat. Many say that, in the past six months, somebody in the household has spent a day without food or gone hungry to bed. But there is something odd about the burden of malnutrition. While in hungry households just over a quarter of children under five are too short for their age—a classic symptom of malnutrition—a third are overweight, malnourished in the opposite sense. Tyre is suffering malnutrition and obesity simultaneously. This “dual burden” is growing everywhere, but nowhere as quickly as in the Arab world. Between 15% and 25% of Arab children under five are too short for their age and between 5% and 15% are underweight. Almost half of pregnant Egyptian women are anaemic, reflecting an iron deficiency often caused by poor diets. Yet a survey in 2006 reckoned that 30% of Egyptian adults were obese. Obesity estimates for Jordan, Kuwait, Saudi Arabia and the United Arab Emirates were even higher: between 35% and 45%. The most obvious explanation for this paradox is that the two problems exist in separate realms: obesity among the well-to-do, under-nutrition among the poor. Yet this is not the whole story. Obesity and malnutrition exist not only in the same country but within the same community, the same household and even, strange as it may seem, in the same person. A study by Hala Ghattas of the American University of Beirut looks at three marginal populations in Lebanon: the villages of Tyre, a group of Bedouins and Palestinian refugees. All are relatively poor, but a third of the worst-off Bedouin were still obese and another quarter were overweight. In Tyre, some villages are largely unaffected; one, called Tayr Harfa, is many times worse off than its neighbours. Problems of under- and over-nutrition appear in the same communities. But how can they appear in the same household? It is largely because of the way the body reacts to changing diets. If a woman is severely malnourished in the womb or during her first two years of life, her metabolism will change permanently. She will store spare calories as fat—an insurance against future hard times. If 20 years later the family gets a more plentiful yet still poor diet (with a lot of calories but not many micronutrients, such as iron or vitamins) she will become overweight or obese, while her children will suffer nutritional deficiency, such as anaemia or blindness. They will be undernourished and she will be obese. As countries move from extreme poverty to middle-income status, this move from starvation rations to calorie-rich, nutrition-poor diets has become more common. In Egypt, 12% of children are stunted and have obese mothers. The mothers will not escape problems from nutritional deficiency. They still have an unhealthy diet. In Egypt, Peru and Mexico, about half the women with anaemia are overweight or obese. They are simultaneously over- and underfed: too many calories, not enough micronutrients.