The nature of nutritionally-related disease (NRD) in transitional economies is such that deficiency can frequently co-exist with excess. This is most usually represented by the combination of diets of low nutritional quality (low and little food component density and diversity, FCDD) and decreased levels of physical activity, predicated, in part, on limited affordability of alternatives. Moreover, these changes are not simply inter-generational, as the pace of socio-environmental change is great enough for them to be intra-generational as well. The most troublesome situation is that of maternal undernutrition, with intra-uterine growth retardation, compromised lactation and infant feeding, leading to stunting in early life and to abdominal obesity and its consequences later in life. Weight management in these situations requires pre-conceptional interventions, effective maternal-child health programmes and life-long approaches to avoid inappropriate gene programming and body compositional disorders. It is unlikely that narrow strategies, located solely around energy balance, will do more than attenuate this growing burden of disease for most of the world's populations. The pluralistic approaches to health required are likely to build on more effective lifestyle, behavioural and pharmacotherapeutic strategies to weight management, and do so at all ages, from conception to later life.