Islands of Obesity
Below are a number of articles on the issue.
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..
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
11/21/2008
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.
Senseramente,
si Joyce I. Martratt
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.
Senseramente,
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
by Jolene Toves
KUAM News
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.
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.
*************
OBESITY GROWING THREAT TO GUAM HEALTH
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.
**************
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.'
BY Tracy Miller
NEW YORK DAILY NEWS
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.
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
PHYS.org
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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