Obesity in the Pacific

Overview of the causes for and prevalence of obesity in the Pacific

Nauruan residents walking around Nauru International Airport Young Nauruans in 1914 Share of adults that are obese in different countries in Oceania, 1975 to 2016

Pacific island nations and associated states make up the top seven on a 2007 list of heaviest countries, and eight of the top ten. In all these cases, more than 70% of citizens aged 15 and over are obese.[1] A mitigating argument is that the BMI measures used to appraise obesity in Caucasian bodies may need to be adjusted for appraising obesity in Polynesian bodies, which typically have larger bone and muscle mass than Caucasian bodies[citation needed]; however, this would not account for the drastically higher rates of cardiovascular disease and type 2 diabetes among these same islanders.[2][3][4]

## Overweight populations

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World ranking[1] | Pacific country  | % of overweight persons (age 15 and over)

|
|

1. | Nauru | 94.5
2. | Micronesia, Federated States of | 91.1
3. | Cook Islands | 90.9
4. | Tonga | 90.8
5. | Niue | 81.7
6. | Fiji | 80.4
7. | Palau | 78.4

## Obese populations

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Rank[5] | Country | % of obese persons

|
|

1 | Nauru | 61.00
2 | Cook Islands | 55.90
3 | Palau | 55.30
4 | Marshall Islands | 52.90
5 | Tuvalu | 51.60
6 | Niue | 50.00
7 | Tonga | 48.20
8 | Federated States of Micronesia | 47.30
9 | Kiribati | 46.00
10 | Samoa | 47.30

## Nations

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### Nauru

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Main article: Obesity in Nauru

Obesity is seen as a sign of wealth in Nauru.[6] 31% of Nauruans are diabetic.[7] This rate is as high as 45% among the 55–64-year-old age group .[6]

### Tonga

[edit]

Life expectancy in Tonga is 71 and has been steadily rising since the 1960s.[8] Up to 40% of the population is said to have type 2 diabetes.[9] Tongan Royal Tāufaʻāhau Tupou IV, who died in 2006, holds the Guinness World Record for being the heaviest-ever monarch— with a weight of 200 kilograms (440 lb).[9]

### Fiji

[edit]

In Fiji, strokes used to be rare in people under 70. Now, doctors report that they have become common amongst patients in their 20s and 30s.[10] Research done on globalization's impact on health indicates that the rise in average BMI in Fiji correlates with the increase in imports of processed food.[11] Dr Temo K Waqanivalu, a Fijian representative for WHO, attributes health problems in his country to the replacement of traditional foods by more glamorous imported foods.[12]

### Marshall Islands

[edit]

In the Marshall Islands in 2008, there were 2000 cases of diabetes out of a population of 53,000.[10] Diabetes prevalence in adults in the Marshall Islands in 2011 was 21.8%.[13] A survey done in the Marshall Islands revealed that the percentage of the total population considered overweight or obese was 62.5%.[14]

### Cook Islands

[edit]

The Cook Islands comprises fifteen small islands and has a local population of about 10,000 people. In the Cook Islands, meals and feasts exemplify a level of community. Food habits play a role in maintaining social status and hierarchy.[15]

### Samoa

[edit]

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The arrival of fast food restaurants and other contemporary food items on the islands are one of the issues responsible for the obesity in Samoa. The earliest photographs of Samoans provide visual proof of the native population's natural physique before the introduction of processed foods by Western society. The natural lifestyle of physically labouring to provide for natural foods and building shelters and communities gave way to modern conveniences like drive through restaurants, motorised vehicles, air travel, wireless communications, and pharmaceutical and recreational drugs. The development of modern society, although advanced with technologies, has also made it easy for many to live an unhealthy lifestyle, therefore leading to obesity.

## Causes

[edit]

### Colonial history and social change

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In the early twentieth century, external people visiting the islands such as missionaries and colonial visitors to the Pacific Islands influenced local food habits. In the 1910s, European colonial powers introduced a number of foods to the Nauruans to mitigate impacts of drought and famine and add variety to the Nauruan diet. In the 1920s, the wife of one missionary taught Nauruans to fry fish in a pan rather than eat it raw. Over time, such changes led to skill loss (in fishing and food preservation) and dependence on foreign foods.[15]

A relatively sedentary lifestyle, including among children, is also contributing to rising obesity rates.[16]

### Cultural standards and practices

[edit]

Obesity in the Pacific Islands is also thought to be influenced by social and cultural factors (tambu foods), including past poor public education on diet, exercise and health.[17] Micronutrient deficiencies are also common.[18] Feasting and festivals are major parts of life,[19] imported foods have been given higher social status than local, healthier foods,[17] and historically a large body size was associated with wealth, power and beauty.[6][17] The Nauru term for satisfaction and feeling healthy, pweda, is the same as fullness or distention.[20]

High rates of obesity appear within 15 months of birth.[21]

### Nutrient transmission

[edit]

Nutrient transmission (change in diet) is the primary cause of the obesity epidemic in the Pacific Islands, with a high amount of imported foods high in salt and fat content.[22] Much of the local diet as of at least 2008 consists of processed, salty and calorie-dense imported food such as spam or corned beef, rather than traditional fresh fish, fruit and vegetables.[23][24][25][circular reference] Some foods high in saturated fat such as mutton flaps and turkey tails are sold in the Pacific islands due to relatively low wealth.[26]

## Results

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Obesity is leading to increased levels of illness, including type 2 diabetes[27] and heart diseases and other associated noncommunicable diseases.[22] Maternal obesity has been associated with preterm birth in Palau.[28]

A trend of childhood overweight and obesity rates is on the rise. In 2016, the highest rates of obesity for girls (over 30%) were in Nauru and for boys in the Cook Islands.[22]

## Efforts to treat obesity

[edit]

The World Health Organization implemented various fiscal policies to fight the rise of childhood obesity. Policies include (1) taxation of sugar sweetened beverages (20% SSB Tax) (2) New Marketing on Unhealthy Foods and Beverages to Children (3) International Code of Marketing on Breast Milk Substitutes.[22] Different nations implemented these WHO recommendations to a different extent.[22]

However, such existing public health programs based on nutrition and exercise, solely focusing on the domain of health, have achieved little success.[15] Histories of social values surrounding food and health is often overlooked, and may explain why food habits are hard to change through public health programs.

## See also

[edit]

* List of countries by Body Mass Index (BMI)
* Genetics of obesity
* New World syndrome
* Epidemiology of obesity

## References

[edit]

1. ^ a b Lauren Streib (8 February 2007). "World's Fattest Countries". Forbes. Archived from the original on 25 January 2017.
2. ^ "Fat of the land: Nauru tops obesity league". Independent.co.uk. 26 December 2010.
3. ^ Bialik, By Carl (12 April 2013). "Island Where Obesity May Not be All It Seems". Wall Street Journal.
4. ^ Snowdon, Wendy; Malakellis, Mary; Millar, Lynne; Swinburn, Boyd (2014). "Ability of body mass index and waist circumference to identify risk factors for non-communicable disease in the Pacific Islands". Obesity Research & Clinical Practice. 8 (1): e36–45. doi:10.1016/j.orcp.2012.06.005. PMID 24548575.
5. ^ "Obesity - adult prevalence rate - the World Factbook".
6. ^ a b c Marks, Kathy (26 December 2010). "Fat of the land: Nauru tops obesity league". The Independent. Retrieved 23 January 2013.
7. ^ Streib, Lauren (2 August 2007). "Nauru: 94.5% overweight". Forbes.com. Retrieved 23 January 2013.
8. ^ "World Bank Open Data".
9. ^ a b "How mutton flaps are killing Tonga". BBC News. 18 January 2016. Retrieved 19 January 2016.
10. ^ a b "Modern life means modern ills for obese Pacific islanders". AFP. 8 February 2008. Retrieved 21 August 2009.
11. ^ Lin, Tracy Kuo; Teymourian, Yasmin; Tursini, Maitri Shila (14 April 2018). "The effect of sugar and processed food imports on the prevalence of overweight and obesity in 172 countries". Globalization and Health. Vol. 14\. doi:10.1186/s12992-018-0344-y.
12. ^ "WHO | Pacific islanders pay heavy price for abandoning traditional diet". www.who.int. Archived from the original on 19 May 2012. Retrieved 4 November 2018.
13. ^ "Diabetes prevalence (% of population ages 20 to 79) - Marshall Islands | Data". data.worldbank.org. Retrieved 22 April 2022.
14. ^ Ichiho, Henry M.; Seremai, Johannes; Trinidad, Richard; Paul, Irene; Langidrik, Justina; Aitaoto, Nia (May 2013). "An assessment of non-communicable diseases, diabetes, and related risk factors in the Republic of the Marshall Islands, Kwajelein Atoll, Ebeye Island: a systems perspective". Hawai'i Journal of Medicine & Public Health. 72 (5 Suppl 1): 77–86\. ISSN 2165-8242. PMC 3689463. PMID 23901366.77-86&rft.date=2013-05&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689463#id-name=PMC&rft.issn=2165-8242&rft_id=info:pmid/23901366&rft.aulast=Ichiho&rft.aufirst=Henry+M.&rft.au=Seremai,+Johannes&rft.au=Trinidad,+Richard&rft.au=Paul,+Irene&rft.au=Langidrik,+Justina&rft.au=Aitaoto,+Nia&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689463&rfr_id=info:sid/en.wikipedia.org:Obesity+in+the+Pacific" class="Z3988">
15. ^ a b c McLennan, Amy K.; Ulijaszek, Stanley J. (June 2015). "Obesity emergence in the Pacific islands: why understanding colonial history and social change is important". Public Health Nutrition. 18 (8): 1499–1505\. doi:10.1017/S136898001400175X. ISSN 1368-9800. PMC 10271720. PMID 25166024. S2CID 6823966.1499-1505&rft.date=2015-06&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10271720#id-name=PMC&rft_id=https://api.semanticscholar.org/CorpusID:6823966#id-name=S2CID&rft_id=info:doi/10.1017/S136898001400175X&rft.issn=1368-9800&rft_id=info:pmid/25166024&rft.aulast=McLennan&rft.aufirst=Amy+K.&rft.au=Ulijaszek,+Stanley+J.&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10271720&rfr_id=info:sid/en.wikipedia.org:Obesity+in+the+Pacific" class="Z3988">
16. ^ "Pacific Islanders are world's fattest". BBC News. 28 November 2001. Retrieved 21 August 2009.
17. ^ a b c "WHO Western Pacific | World Health Organization" (PDF).
18. ^ "WHO | Pacific islanders pay heavy price for abandoning traditional diet". www.who.int. Archived from the original on 19 May 2012. Retrieved 15 January 2022.
19. ^ "Pacific islanders are world's fattest". 28 November 2001.
20. ^ McLennan, AK (2015). "Bringing everyday life into the study of 'lifestyle diseases': lessons from an ethnographic investigation of obesity in Nauru" (PDF). Journal of Anthropological Society of Oxford. 7: 286–301.286-301&rft.date=2015&rft.aulast=McLennan&rft.aufirst=AK&rft_id=https://www.anthro.ox.ac.uk/sites/default/files/anthro/documents/media/jaso7_3_2015_286_301.pdf&rfr_id=info:sid/en.wikipedia.org:Obesity+in+the+Pacific" class="Z3988">
21. ^ "Samoan obesity epidemic starts at birth".
22. ^ a b c d e Foster, Nicole; Thow, Anne Marie; Unwin, Nigel; Alvarado, Miriam; Samuels, T. Alafia (2018). "Regulatory measures to fight obesity in Small Island Developing States of the Caribbean and Pacific, 2015 – 2017". Revista Panamericana de Salud Pública. 42: e191. doi:10.26633/RPSP.2018.191. ISSN 1020-4989. PMC 6386011. PMID 31093218.
23. ^ Nick Squires (12 April 2008). "Spam at heart of South Pacific obesity crisis". The Daily Telegraph. London. Retrieved 21 August 2009.
24. ^ Phil Mercer (26 February 2007). "South Pacific Leads the World in Obesity". Archived from the original on 24 June 2016. Retrieved 15 July 2016.
25. ^ Obesity in Nauru#Causes
26. ^ "How mutton flaps are killing Tonga". BBC News. 18 January 2016.
27. ^ Colagiuri, S; Colagiuri, R; Na'Ati, S; Muimuiheata, S; Hussain, Z; Palu, T (2002). "The Prevalence of Diabetes in the Kingdom of Tonga". Diabetes Care. 25 (8): 1378–83\. doi:10.2337/diacare.25.8.1378. PMID 12145238.1378-83&rft.date=2002&rft_id=info:doi/10.2337/diacare.25.8.1378&rft_id=info:pmid/12145238&rft.aulast=Colagiuri&rft.aufirst=S&rft.au=Colagiuri,+R&rft.au=Na'Ati,+S&rft.au=Muimuiheata,+S&rft.au=Hussain,+Z&rft.au=Palu,+T&rft_id=https://doi.org/10.2337%2Fdiacare.25.8.1378&rfr_id=info:sid/en.wikipedia.org:Obesity+in+the+Pacific" class="Z3988">
28. ^ Kaforau, Lydia S. K.; Tessema, Gizachew A.; Jancey, Jonine; Dhamrait, Gursimran; Bugoro, Hugo; Pereira, Gavin (1 April 2022). "Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: A scoping review". The Lancet Regional Health – Western Pacific. 21: 100402. doi:10.1016/j.lanwpc.2022.100402. ISSN 2666-6065. PMC 8873950. PMID 35243458.

* v
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Countries and territories of Oceania

* List of Oceanian countries by area
* List of Oceanian countries by population

Sovereign states|

| Entire|

* Australia
* Fiji
* Kiribati
* Marshall Islands
* Micronesia
* Nauru
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* Palau
* Papua New Guinea
* Samoa
* Solomon Islands
* Tonga
* Tuvalu
* Vanuatu

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In part|

* Chile
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Associated states

* Cook Islands
* Niue

Dependencies and
other territories

| Australia|

* Ashmore and Cartier Islands
* Christmas Island
* Cocos (Keeling) Islands
* Coral Sea Islands
* Norfolk Island

|

France|

* Clipperton Island
* French Polynesia
* New Caledonia
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New Zealand|

* Tokelau

United Kingdom|

* Pitcairn Islands

United States|

* American Samoa
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Obesity in Oceania

Sovereign states|

* Australia
* Federated States of Micronesia
* Fiji
* Indonesia
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* Nauru
* New Zealand
* Palau
* Papua New Guinea
* Samoa
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* Tonga
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Associated states
of New Zealand|

* Cook Islands
* Niue

Dependencies
and other territories|

* American Samoa
* Christmas Island
* Cocos (Keeling) Islands
* Easter Island
* French Polynesia
* Guam
* Hawaii
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