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It’s generally accepted that being overweight is a costly health care problem, but new data suggests that being undernourished is even more expensive.

Around the world, malnutrition has become a problem that costs a staggering $3.5 trillion per year, according figures cited by the latest Global Nutrition Report, which gives a comprehensive analysis of food and nutrition issues each year. That sum dwarfs the costs of being overweight and obese, which the report’s authors tallied at $500 billion annually.

Although most countries have fallen short in their efforts to address poor nutrition and food insecurity, the United States appears to be badly off track on all its nutrition targets, the report found. The world’s largest economy continues to suffer from high rates of obesity, diabetes and anemia, according to the data, and has more than a million overweight children.

“Malnutrition is responsible for more ill-health than any other cause.The health consequences of overweight and obesity contribute to an estimated four million deaths globally,” Corinna Hawkes, co-chair of the Global Nutrition Report and director of the Center for Food Policy, wrote in the report.

The dire figures “call for immediate action,” Hawkes said. “The uncomfortable question is not so much ‘why are things so bad?,’ but ‘why are things not better when we know so much more than before?'”

According to the study, most countries have at least two issues related to malnutrition: It stunts children’s growth, and affects their ability to learn. Overall, malnutrition contributes to about half of all childhood deaths, the research showed.

India has the highest number of malnourished children in the world. Many of them are “stunted,” meaning they are too short for their age. Their height is a visible sign that not only their bones are not getting enough nutrients, but also their brains.

Lucy Sullivan, executive director of 1000 Days and co-chair the Global Nutrition Report Stakeholder Group, said that stunted children do not do well in school. Down the road, those affected may not be able to get as good of a job as they could have, had they been well-fed.

It also prevents them from being able to contribute to society, and the economy, as well as they would have in a healthier environment, Sullivan added. According to Sullivan, fixing malnutrition comes with a $70 billion price tag, but compared with what it takes to maintain costs associated with the condition, that figure is relatively small.

A big part of the problem are eating and lifestyle choices, according to experts. North America alone purchases some of the highest volumes of packaged foods, the Global Nutrition Report found, and 66 percent of them are of low nutritional quality.