A registered randomized controlled trial in Indigenous Maya communities in Guatemala is enrolling 766 pregnant women to test whether combined food supplementation and behavioral counseling can simultaneously address maternal overweight and child stunting — the so-called double burden of malnutrition. Participants under 28 weeks gestation are allocated 1:1 to the integrated intervention or enhanced usual care, with mother-infant dyads followed to 12 months postpartum. Co-primary outcomes are maternal weight and child length-for-age z-score at 12 months.
The double burden phenomenon — overweight mothers and undernourished children coexisting in the same household — affects more than 20% of households in some low- and middle-income countries and reflects the collision of food insecurity with caloric excess from ultra-processed foods. Most prior interventions have addressed either maternal obesity or child stunting in isolation; integrated approaches remain rare and under-evaluated, particularly in Indigenous communities where structural inequities compound nutritional risk. This trial's Hybrid Type 1 design, which evaluates both effectiveness and implementation factors simultaneously, is methodologically sophisticated and increases real-world translation potential. An embedded economic evaluation adds further policy relevance. Critical limitations: this is a protocol paper — no outcome data exist yet. The trial is also site-specific to highland Guatemala, limiting generalizability. As a preprint not yet peer-reviewed, even the methodology described here may evolve. If the intervention proves effective, it could offer a genuinely integrated, equity-centered model for a global nutritional paradox.
