As obesity and diabetes have reached pandemic levels, the Pacific Islands are an area of particular concern: there, rates of obesity and type 2 diabetes are among the highest in the world. In some areas, adult body mass index has risen at five times the worldwide rate in the past 30 years alone.
In a paper soon to be published in Current Diabetes Reports, Yale School of Public Health researcher Dr. Nicola Hawley, assistant professor in the department of chronic diseases, and her colleague, Dr. Stephen McGarvey of Brown University, reveal the extent of this severe health problem, its contributing factors and the urgent necessity of large-scale intervention.
Some of the causes for the problem are common globally. “American Samoa is an example of a traditional subsistence society who were heavily reliant on local produce and manual labor before a very rapid modernization introduced a more caloric, high fat diet and more sedentary occupations,” said Dr. Hawley.
On the island of American Samoa, according to Hawley, nearly 94 percent of adults are overweight or obese. Approximately 47 percent percent of the people have diabetes.
But in this geographically isolated area of the South Pacific, there are also many region-specific causes. Indigenous foods such as fish, taro and yams have become expensive, and have been replaced, in some places almost completely, by imported and highly processed food. These foods are often poor-quality, and include high-calorie snack food and fatty cuts of meat, such as turkey tails and lamb flaps, that are waste products, considered unfit for human consumption in other regions.
Local tradition also presents a roadblock. In many areas, food is of great cultural importance, and larger body size is associated with beauty and wealth. Additionally, geographic isolation and the pressing need to treat communicable diseases means that local health care systems are overburdened.
Dr. Hawley said that there is still much research to be done to fully comprehend the root causes of the problem, including the genetic underpinnings of these diseases in Pacific Islanders, but it is not necessary to wait for full understanding before taking action.
“I think progress is being made slowly in some areas, but there need to be larger scale, comprehensive interventions targeted in this region” Hawley said. Samoa previously banned the importation of turkey tails (although that ban has now been lifted), and Fiji the sale of lamb flaps. In both areas, Hawley said, the elimination of these foods has helped increase consumer awareness about the adverse health effects of such foods. There are also many regional, small-scale programs in place to reduce obesity and control diabetes, although evaluation of these programs is still needed.
Despite its unique challenges, the plight of the Pacific Islands may hold lessons for other parts of the world. “There are many other societies who are experiencing a similar transition,” she said, “who may use American Samoa as an example of the rising burden of non-communicable diseases they might face without intervention.”