Rapid economic development and increasing urbanisation have led to a dramatic rise in overweight among adults in many low-income countries. Paradoxically, overweight often coexists with persisting under-nutrition among members of the same household. The aim of this study was to assess whether child under-nutrition combined with maternal over-nutrition is a health concern among a sample of pro-poor households, and whether urban residence is associated with the phenomenon. The occurrence of stunted and/or underweight children and overweight mothers within the same household was studied in cohorts of 2,000 children aged between 4.5 and 5.5 years in each of Ethiopia, India (Andhra Pradesh), Vietnam and Peru. Multivariate logistic regression was used to estimate the effect of urban residence controlling for potential confounding factors. The prevalence of child stunting combined with maternal overweight was very low in Ethiopia, India and Vietnam, but as high as 14 per cent in Peru. Underweight child / overweight mother pairs were uncommon in all four countries. Urban residence significantly increased the likelihood of dual burden households only in India. In Peru and Vietnam, living in urban neighbourhoods decreased the coexistence of child stunting and maternal overweight non-significantly. In conclusion, the dual burden of over- and under-nutrition seems to be a health concern only among poor households in Peru. Interventions specifically designed for resource-poor settings that address the nutritional status of each household member individually and promote a healthy lifestyle are needed.