Monday, May 04, 2015

Islands of Obesity

Vital Signs is a monthly program bringing viewers health stories from around the world
(CNN)They're remote and beautiful. A place many long to escape to for sun, sea and serenity. But the Pacific islands have another reality for the residents living there -- a life based on imported food, little exercise and remote access to healthcare.
The result? The most obese nations in the world.

'A deadly epidemic'

"One third of the world is either overweight or obese right now," says Emmanuela Gakidou, professor of Global Health at the Institute for Health Metrics and Evaluation. Gakidou's recent paper used data from countries across the world to identify the global burden of obesity and trends seen in different populations. "The Pacific islands have a lot of countries with very high levels of obesity," she adds.
Among the top 10 most obese countries or territories globally, nine are Pacific islands, according to the World Health Organization (WHO), making this paradise the fattest region of the world.
"Up to 95% of the adult population are overweight or obese in some countries," says Temo Waqanivalu, program officer with the WHO's Prevention of Non-communicable Diseases department. 

As a Fijian Native, Waqanivalu has worked on the issue for over a decade and seen the epidemic evolve first-hand, aided by the cultural acceptance of bigger bodies as beautiful. "In Polynesia the perception of 'big is beautiful' does exist," he says. "[But] big is beautiful, fat is not. That needs to get through."

Percentages for obesity range from 35% to 50% throughout the islands, according to the WHO. The Cook Islands top the ranks with just over 50% of its population classified as obese.
"It's a deadly epidemic," says Waqanivalu.

Measuring up

Obesity is measured through an individual's body mass index (BMI) and a measurement above 30kg/m² is defined as clinically obese. 

Pacific islanders tend to have a naturally big build, says Jonathan Shaw, associate director of Baker IDI Heart and Diabetes Institute, Australia. "With Pacific islanders, their frame is typically bigger," he explains, "but that still doesn't account for the obesity we see."

Poor diets and reduced exercise have become a major public health concern for the region as they are not only a cause of obesity -- associated diseases are also rife, such as heart disease, stroke and diabetes, the latter of which has a known genetic basis among locals.

"This is a population with a genetic predisposition and when exposed to Western lifestyles results in high rates of diabetes," says Shaw. "[This is] undoubtedly caused by high rates of obesity."
The epidemic began through the tropical region turning its back on traditional diets of fresh fish and vegetables and replacing them with highly processed and energy-dense food such as white rice, flour, canned foods, processed meats and soft drinks imported from other countries. One of the root causes of the change is the price tag.
"All over the world, poor quality and highly energy-dense food is the cheapest," says Shaw. As demand for healthier alternatives remain low, their market is small.
This is exemplified by fishermen often selling the fish they catch to in turn purchase canned tuna. "[You] can buy a few meals with what you get selling fish," says Waqanivalu. 

The new food environment locals find themselves living in has accelerated the trend towards consuming processed food. "It's significantly cheaper," adds Waqanivalu. "It's cheaper to buy a bottle of coke than a bottle of water."
As with other regions of the world, increased urbanization and sedentary office cultures have further aided the rise in obesity among Pacific islanders.
"A lot of physical activity was in the domain of work," says Waqanivalu, referring to fisherman heading out to sea and others working their land on plantations. "The concept of leisure-time activity is new," he says.
The tropical climate desired by sun seekers is less attractive to those needing to keep fit. "In tropical countries there is a desire to avoid physical work and even walk," says Shaw. "We're all driven to conserve energy."

All in the genes?

Some scientists believe that Pacific island populations have evolved to maintain their larger build -- a concept known as the "Thrifty Gene" hypothesis. For this region of the world, the concept is based on the fact Pacific islanders once endured long journeys at sea and those who fared best stored enough energy in the form of fat to survive their journey.
"We have the remnants of those people ... and their metabolism as well," says Waqanivalu. The increased risk of obesity among native Pacific islanders is shown on the islands of Fiji, where the population has a more mixed ethnicity. The country stands at the lower end of the region's spectrum with 36.4% of the adult population classed as obese. Just more than half of the Fijian population are native iTaukei, with the remainder mostly of Indian origin, according to the CIA World Factbook. "That explains the lower rates," says Waqanivalu.

The naturally higher BMI of the people in the region has, however, prompted calls to increase the cut-off for the level of BMI denoting obesity in the Pacific region from 30 to 32 kg/m². A lower cut-off has been suggested for Asian populations based on the same premise, as Asian countries -- including Korea, Myanmar and Cambodia -- make up the majority of the lowest 10 countries globally in terms of obesity..

Childhood consequences

After the global trends in obesity seen in her study, Gakidou's real concern is the rates her team saw in children in the Pacific. "The rate for children is high ... about one in five children [are obese]," she says. "This has repercussions in the long term."
Repercussions include diabetes, which is already a burden on health services in the region. "The concern in children would be early onset of diabetes," says Gakidou.
The WHO has made a series of recommendations to improve the situation and is implementing them through policy changes in the countries. "Type II diabetes is emerging in young children 10-11 years old," says Waqanivalu, who has also heard reports of a child as young as seven years old being affected. "[It's the] tip of the iceberg in children."

But Waqanilu is confident his department is making some progress through recommendations such as increased taxation on soft drinks, improving trade in the region, controlled marketing of products targeting children through schools, and policies to promote healthier diets and exercise. 

"The whole food environment needs to be changed," he says. This has been the ambition of the Healthy Islands Vision -- initiated by the ministers of health for the Pacific island countries in 1995 -- which aims to combat obesity and diabetes among its health priorities.

Health systems also need strengthening to better handle the consequences of obesity. "We have definitely made steps but need to make strides for this to be sorted in our time," says Waqanivalu.

Fiestas on Guam and obesity 
Pacific Edge
As I sat watching the sunset, I began to recall wonderful experiences prior to leaving Guam for the first time.

Fiestas in the village of Mongmong, where my family settled after the war, were so linked to the religious activities at Nuestra Señora de Las Aguas Church. The village’s patron saint is “Our Lady of the Waters.”

Families at different homes not only prepare for church activities but also prepare food to share with other family members and friends. Then there is the fiesta program presented by the school children under the guidance of older students and teachers.

Today, my experiences with fiestas in my adopted village of Malojloj, Inarajan, are quite elaborate in celebrating the feast of San Isidro, patron saint of farmers. San Isidro is honored during the month of May each year.
The families begin to prepare months ahead for the big feast at their homes. Our techa, or prayer leader, Ms. Dee San Nicolas, begins the nine-day San Isidro novena and leads the Christian mothers in preparing for the “Taotao Tumano” fiesta dinner.

The parish council members and fiesta committee members begin preparation for the entertainment, concessions and parade. The parade is coordinated with the village mayor, Father Ken Carriveau, as well as altar servers and Christian mothers. Our confirmation students prepare the church.

The major part of the celebration centers around the festal celebration of the Eucharist (Mass) on Saturday followed by the congregation procession for three miles within the village and back to the Church in honor of San Isidro. This is where the spiritual culture of the Chamorros is lovingly displayed through prayers and songs.

The “Taotao Tumano” follows in front of San Isidro Church, where parishioners and guests from throughout the island are welcomed to share. The table is laden with an assortment of Chamorro traditional and other ethnic delicacies.

Although the fiesta tradition, as I have learned from my elders, comes from the Spanish, Chamorros, around the year 1600, were observed as fun-loving, celebrating certain days with music, dance and chants, and centering their values on respect, care, acceptance and helping one another.

The Spanish missionaries called the celebrations fiesta. Chamorros also call fiestas “inafa’maolek,” meaning caring for one another with respect. The San Isidro fiesta each year allows the parishioners to honor San Isidro but to also share with the island communities a sense of “inafa’maolek.”

The question of obesity in relations to fiestas is thought-provoking. The other night, I sat with some young friends and brought up the question. We talked a little about what we have learned from what was handed down from our elders.

Chamorros, when Ferdinand Magellan arrived on Guam, were described as much taller, more robust and healthier than the Spanish. The Spanish extinguished the majority of the male population and the Chamorro culture from the 1500s intermixed. I remember my grandmother sharing the stories about how the Chamorro women keep the culture alive.

During World War II, those who survived concentration camps were introduced to processed food and whatever was available and affordable during that time. The people experienced hunger.

My young friends and I discussed that families gathering and eating especially during fiestas are celebrations of thanksgiving. No one must go hungry. The belief of not going hungry extends to weddings, christenings and backyard barbecues.

In most recent years, obesity has become a contributor to major health problems on Guam. The Chamorros of the present are conscious of this problem.

Is fiesta the problem?

My young friends and I agreed fiestas are not part of the problem, but overeating is the key factor in obesity.

Each person must be responsible in not overeating whether at fiestas or eating in restaurants. Some food on the fiesta table may have food high in fat contents, but wherever you eat, this is also true. Everywhere you go on the island there are fast foods and many people cannot resist hamburgers, hot dogs, french fries and many more.

I can say this much - many Chamorros are aware of eating the right stuff and, of course, exercising. Like in the mainland, many people here are doing these things. Kudos to those folks on this island, young and old, who are in some kind of fitness program.

If you go to a fiesta, do not be afraid to taste a little of some of the best traditional delicacies. Just don’t overeat.

si Joyce I. Martratt


Guam's diabetes statistic hits alarming rate

Posted: Dec 09, 2014 5:16 PM Updated: Dec 09, 2014 5:20 PM

Guam - Diabetes on island is a very serious problem. According to Public Health program coordinator Pat Luces in the last ten years we were averaging 10%, meaning one in every ten people has the disease. And in 2013 that number jumped to 14%.

"The most alarming thing is that we are seeing it hit our youth at a very young age we are them the youngest that we have with type two diabetes is five years old," he explained. Luces says that diabetes patients are getting younger and the contributing factors is obesity, adding, "The 8-year-old that we had which is about eight years ago when this person was diagnosed this person was about 150 pounds and so we got some big kids obese kids and that is the alarming issue," he said.

He says they are seeing a lot of young adults in their twenties already needing dialysis treatment, and the youngest individual with diabetes who has lost their sight is sixteen years old.  "We at the department the data is so alarming that you cannot address diabetes and NCDs such heart disease stroke and cancer and obesity at a later stage of their lives when they actually have the disease," he said.

Seeing such alarming numbers and the age of those afflicted younger the Public Health is focusing on education working with the Department of Education, UOG, GCC and the private schools to address these diseases. "We are going to address NCDs where we learn where we live and that's in our homes changing healthy behaviors in our home where we work we have the worksite wellness program where we play what is it that we do after our day at work or what is it that our kids do after school," he said.

Luces says physical activity is key to protecting against diabetes and other non-communicable diseases.



By Brett Kelman
HAGATNA, Guam (Pacific Daily News, Oct. 21) – You might think Arizona's desert-dwelling Pima Indians and the ocean-loving Chamorros would have little in common, but experts at yesterday's Micronesian Medical Symposium argued that if Guam's childhood obesity epidemic continues, they will share one fate -- crippling diabetes.
Leslie Baier, of the Phoenix Epidemiology and Clinical Research Branch, explained that because of a genetic disposition for obesity and diabetes in indigenous populations called the "thrifty gene theory," 85 percent of the Pimas suffer from type-2 diabetes, the highest frequency in the world.
Guam is catching up, she said.
"The problem is, when an entire population gains weight at once, it becomes normal. People accept it. They say 'I'm a Pima. This is how we are,'" Baier said.
Symposium coordinator Dr. Saied Safa estimated that 25 percent of Guam's population already has diabetes, which can cause heart disease, kidney failure, stroke, blindness and amputation. Even scarier, he said, is that youth obesity is causing the disease in children under the age of 10.
The average diabetic population for Pacific Islanders is around 15 percent, and the disease is traditionally not diagnosed until middle age. Type-2 diabetes is completely preventable through a balanced diet and exercise.
Another presenter, Dr. Robert Nelson, explained that as pregnancy and diabetes overlap on Guam, children will be born predisposed toward the disease and it will spread exponentially. He said Chamorros currently reflect the Pimas around the 1940s, just before their diabetes skyrocketed when they entered into this cycle of diabetic birth.
"We need major changes in the lifestyle and diet of families and the community ... to at the very least delay the onset of this disease into adulthood to slow the spread," he said.
Hard on your health, worse on your wallet
Dr. Larry Agodoa, Director of the Office of Minority Health Research Coordination explained yesterday that diabetes can easily shorten a person's lifespan by 20 years. If the disease is left unchecked on Guam, "parents will start to bury their children," he said.
But that's not all -- it's expensive, too.
According to Agodoa, less than 1 percent of the United States' Medicare-dependent population suffers from diabetes-induced kidney failure, but they consume around 8 percent of the total funds. Last year, $32 billion was spent to treat this symptom alone.
Nelson agreed that widespread diabetes could cripple Guam not just physically, but economically as well.
"When (the people of Guam) should be saving for retirement, or spending money on their children's education -- all the things middle-aged people do to contribute to society -- instead they'll be paying for dialysis," he said.
Today's afternoon session of the Micronesian Medical Symposium is open to the public and concerned parents, teachers and professional caretakers are encouraged to attend. Presentations will include practical information on how to help curb Guam's obesity epidemic.

Pacific Daily News:

Copyright © 2006 Pacific Daily News. All Rights Reserved


 World's fattest man, Ricky Naputi, ate himself to death at almost 900 pounds  

TV cameras documented what ended up being Naputi's last days for a TLC special entitled '900 Pound Man: Race Against Time.'

Friday, May 24, 2013, 1:13 PM
The tragic final days of one of the world's fattest men were spent desperately hoping to lose the weight that kept him bedridden for five years.

Ricky Naputi, who weighed nearly 900 pounds, died in November 2012, but before he passed, the 39-year-old opened up his home to reality TV cameras from TLC. The cable network aired his story Wednesday night in a special called "900 Pound Man: Race Against Time."

Naputi, who lived in the U.S. island territory Guam, was bedridden and confined to his home, unable to walk or to bathe himself.
"The last time I got out and enjoyed myself must have been years. I miss feeling the sun on my face. Miss showering, feeling water run down my body," he said at one point.

But Naputi had also vowed to turn his life around. He was working on losing enough weight to be able to fly to the continental U.S. for weight loss surgery.

"I'm willing to try my best," he said. "My one goal and my one goal only is to get my life back."
The show also revealed Naputi's loving relationship with his wife, Cheryl, his primary caretaker.

Cheryl acted as Ricky's nurse, cooking for him, giving him sponge baths and helping him go to the bathroom, which she likened to "taking care of an overgrown baby."
The two met 10 years ago, and at first communicated only over the phone. Naputi was already obese, but still far from his heaviest.
"He asked me for my number so he could call me up, so we could talk," a smiling Cheryl told the cameras.

"When I went to Ricky's apartment ... he only cracked [the door] about an inch."
Three and a half weeks later, she moved in. The pair remained together until his death.


Pacific nations battle obesity epidemic
Apr 10, 2011 by Neil Sands
On Tonga's supermarket shelves, huge cans of corned beef the size of paint tins replaced traditional fare such as fish and coconuts long ago -- contributing to an obesity epidemic that sees the Pacific region ranked as the fattest in the world.

Meat in Tonga almost invariably comes in a tin, whether it be turkey breast, meat loaf, luncheon meat or Spam, which can be bought in a variety of forms including smoked, with chilli or laced with cheese for an extra calorie hit.

The common denominator, Tonga's Chief Medical Officer Malakai Ake says, is that the "junk meat" is loaded with salt and saturated fats, meaning islanders' waistlines continue to expand.
"This is the biggest issue facing Tonga," he told AFP, citing soaring levels of weight-related coronary disease, diabetes and strokes among islanders.

"Every other day there's a funeral, a next-door neighbour, a relative, a friend. It's always heart disease, diabetes, it's ridiculous."

The Tongan Health Department says more than 90 percent of the total population is classed as overweight and more than 60 percent is obese.

According to World Health Organisation (WHO) data released last year, Pacific island nations account for eight of the top 10 countries where the male population is overweight or obese.
Weight-related diseases are responsible for three-quarters of deaths in the region, Fiji-based WHO nutritionist Temo Waqanivalu said, with diabetes rates in some Pacific nations close to 50 percent.

"It's a problem that health systems are struggling to deal with," he said.

"If you walk into a hospital in any of the Pacific countries, about 75-80 percent of the surgeries are the result of non-communicable diseases linked to obesity."

Experts say economic, cultural and lifestyle factors have combined to make the obesity epidemic, which is an increasing problem across the globe, more acute in the Pacific.

Ake said the traditional lifestyles, where people kept fit through farming and fishing, gave way to a more sedentary existence in recent years and motor vehicles became more readily available. 

"In my young days we would walk everywhere and go swimming," he said. "Now people use the car to go just a little way down the street."

Traditional diets based around fish and root crops have also fallen out of favour, replaced with fatty foods imported from Western nations that islanders see as more convenient and prestigious.

"They are unable to compete with the glamour and flashiness of imported foods," Waqanivalu said, adding that cash-strapped consumers in the Pacific often had little choice about making poor dietary choices.

"In some countries it's cheaper to buy a fizzy drink than a bottle of water.

"When they go down the aisle of the supermarket, probably the last thing people are looking at is the nutritional information, they're looking at the price."

Pacific islanders sometimes argue that they naturally have big frames and are more prone to put on weight than other people, although it's a theory Waqanivalu rejects.

He said a generous girth had long been seen as a sign of status in the Pacific but the message was slowly getting out that bigger is not necessarily better.

"We're telling people that being large is OK but being fat is different and that's what we're beginning to see," he said.

Tonga's late King Tupou IV, who died in 2006, helped raise awareness about obesity in the 1990s, when he organised a national diet and exercise routine after receiving warnings from his doctors about his weight.

Listed by the Guinness Book of Records as the heaviest monarch in the world at almost 210 kilograms (463 pounds), he reportedly lost 70 kilograms.

But Tonga's current Prime Minister Lord Tu'ivakano said more needed to be done to combat the obesity problem and his government would look at restricting imports such as mutton flaps -- cheap, fatty sheep offcuts popular in the country.

"We have to go back to the old ways, just eating good food -- taros, kumaras (sweet potatoes), yams," he said

"It's a matter of saying 'sorry, you have to find an alternative', probably eat fish rather than mutton flaps."

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