Gade Waqa

• Masters in Public Health
• Senior Researcher at College of Medicine Nursing and Health Sciences, Fiji National University

The Package of Essential Noncommunicable (PEN) disease interventions in response to the high prevalence of cardiovascular diseases and diabetes was implemented in Fiji commencing in 2012. This study aimed to understand implementation outcomes, and its contextual influences. Semi-structured interviews with health workers and patients across Fiji was...

Background Processed packaged foods are readily available in Fiji; however, the extent to which ultra-processed foods (UPFs) currently contribute to energy and nutrient intake is unknown. This study aimed to assess the contribution of UPFs to total energy intake and nutrients of concern (sodium, sugar, fat) in a representative sample of adults in t...

Background: Sugar-sweetened beverage (SSB) taxation has been recommended as an effective policy instrument to address rising numbers of diet-related non-communicable diseases. This study informs policy makers of health and economic impacts of various SSB tax scenarios in Fiji.Methods: A proportional multistate life table model utilizing body mass i...

Objectives: This study aimed to assess salt and sugar-related knowledge, attitudes and behaviours (KAB) of adults in the Central Division of Fiji. Methods: A randomised stratified sample of 700 adults were selected. Questions on salt and sugar-related KABs were developed. The survey took place from March to June 2022. For analyses, population and s...

Background Excessive salt and sugar intake influence the global burden of non-communicable diseases (NCDs). This study aimed to describe the knowledge, attitudes and behaviours (KAB) of Fijian adults relating to salt and sugar consumption to inform policy interventions in Fiji. Methods A randomised stratified sample of 700 adults in the Central Div...

In Fiji, packaged foods are becoming increasingly available. However, it is unknown if nutrition composition of these foods has changed. This study aims to assess changes in energy, nutrient content and healthiness of packaged foods by comparing data from five major supermarkets in Fiji in 2018 and 2020. Foods were categorised into 14 groups; nutri...

Background Excess salt and sugar consumption contribute to diseases, such as diabetes and hypertension. This study aimed to estimate salt and sugar intakes and main sources, in a population of adults in the Central Division of Fiji. Methods One adult per household was randomly selected to participate (n = 700). Sociodemographic characteristics; bl...

Introduction : Limited data on 24-hour movement behaviors of children aged 5–8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region. Methods : Cross-s...

Health System strengthening is high on the agenda of the global health community. We review some of the specific challenges faced by Small Island Developing States in the development of their health systems. We propose a list of action points for aid actors willing to adapt their health programs and interventions.

Introduction Food insecurity is associated with inadequate nutrition and increased rates of chronic disease. The primary aim of this study was to assess self-reported food insecurity and the perceived impact of COVID-19 on food security, in two regional districts of Central Fiji, as part of a broader program of work on strengthening and monitoring...

Obesity and diet‐related noncommunicable diseases (NCDs) have a profound impact on individuals, households, health care systems, and economies in low‐ and middle‐ income countries (LMICs), with the Western Pacific Region experiencing some of the highest impacts. Governments have committed to improving population diets; however, implementation chall...

Background Excess salt and sugar consumption contribute to diet-related diseases, such as obesity, diabetes, and hypertension. Given the increasing burden of these conditions in Fiji, this study aimed to estimate salt and sugar intakes and their main sources, in a population of adults in the Central Division of Fiji. Methods One adult (≥ 18 years)...

Background Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are s...

Background Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia–Pacific region, NCDs are s...

Background One of the challenges for countries implementing food policy measures has been the difficulty in demonstrating impact and retaining stakeholder support. Consequently, research funded to help countries overcome these challenges should assess impact and translation into practice, particularly in low-resource settings. However, there are st...

Background Gender equality, zero hunger and healthy lives and well-being for all, are three of the Sustainable Development Goals (SDGs) that underpin Fiji’s National Development Plan. Work towards each of these goals contributes to the reduction of non-communicable diseases (NCDs). There are gender differences in NCD burden in Fiji. It is, however,...

Background One of the challenges for countries implementing food policy measures has been the difficulty in demonstrating impact and retaining stakeholder support. Consequently, research funded to help countries overcome these challenges should assess impact and translation into practice, particularly in low-resource settings. However, there are st...

Objective To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island Countries (PICTs). Methods Secondary analysis of data from 21,433 adults aged 25–69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 200...

Objective To investigate perceptions of iTaukei Fijian women and men around diet and the ability to consume a healthy diet. Design Six focus groups conducted with women and men, separately. Six to 10 women and men participated in each group. Discussions were recorded, transcribed, translated, and thematically analysed. Themes were mapped to an int...

Objective: To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island countries. Methods: Secondary analysis of data from 21,433 adults aged 25-69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 2002 and 2...

Diet-related fiscal policy is an effective NCD prevention strategy. However, current sugar-sweetened beverage (SSB) taxes in Fiji and Tonga have not had the desired effect; SSB consumption in Fiji, for example, contributes to mortality more than double the global rates and is highest in the WHO Western Pacific Region. We therefore aimed to better u...

Background There is a crisis of non-communicable diseases (NCDs) in the Pacific Islands, and poor diets are a major contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food systems. Pacific Island leaders have adopted a range of food policies and regulations to improve diets. This includes t...

Purpose Social marketing has been widely used to effectively and voluntarily change behaviours worldwide. The social marketing benchmark criteria offer a framework to apply this approach. This paper aims to examine the extent of use and predictors of success of social marketing benchmark criteria in changing the health behaviours of Pacific Islands...

Background In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to descr...

Background In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to descr...

Objective To estimate the proportion of products meeting Fiji government labelling regulations, assess compliance with national sodium reformulation targets, and examine the sodium and total sugar levels in packaged foods sold in selected major supermarkets. Design We selected five major supermarkets in 2018 and collected the product information a...

Purpose of review: Childhood obesity is increasing substantially in many Pacific island countries and poses an urgent and serious challenge. The Sustainable Development Goals set by the United Nations and the NCD Roadmap created at the request of the Pacific Finance and Economic Ministers identify prevention and control of noncommunicable diseases...

Objective To draw lessons from Fiji regarding the challenges and opportunities for policy initiatives to restrict (i) food marketing to children and (ii) marketing of breast milk substitutes, to inform policy for the double burden of malnutrition. Design Qualitative political economy analysis of two policy case studies. Setting Fiji. Participant...

Background Non-communicable diseases (NCDs) have been declared a crisis in the Pacific Islands, and poor diets are a major contributor to this. The COVID-19 pandemic and resulting economic crisis will likely increase the burden on food systems, exacerbating this situation. Pacific Island leaders have been proactive in adopting a range of food polic...

Purpose of review: Whilst evidence indicates that weight gain occurs over holidays, the contribution of specific festive periods and celebrations to eating behaviour and weight gain is unclear. We aimed to synthesise literature on how festive periods and celebrations contribute to population weight gain and weight-related outcomes. Recent finding...

Many low- and middle-income countries experience a double burden of malnutrition and nutrition-related noncommunicable diseases (NCDs). Existing scholarship highlights adverse impacts of neoliberalism on nutrition, including the influence of laissez-faire economics on reshaping food systems and neoliberalism’s ideological emphasis on personal respo...

Objective To describe the development of Fiji’s fruit and vegetable fiscal policies between 2010 and 2014 and explore the impact they have had on import volumes. Design Qualitative case study and in-depth analysis of policy process. Policy impact was assessed using publicly available import volume data and prices of food products. Setting Fiji....

Introduction:: Policy interventions can encourage healthier dietary choices and help prevent noncommunicable diseases (NCDs). Consequently, governments are seeking to develop and implement food-related policies, but little research on food-related policies is available to guide policy development. Objective:: This study aims to provide an in-dep...

Background: Non communicable diseases (NCD) place a significant health burden on Pacific Island countries including Fiji. Policy interventions to curb NCDs have been implemented in Fiji including a 32% increase in the import duty on palm oil. This study aims to analyse the development and implementation of the increase in palm oil import duty in F...

Background Obesity and non-communicable diseases are significant public health issues globally and particularly in the Pacific. Poor diet is a major contributor to this issue and policy change is a powerful lever to improve food security and diet quality. This study aims to apply systems thinking to identify the causes and consequences of poor evid...

Background: The Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aimed to design, implement and evaluate a knowledge-broking approach to evidence-informed policy making to address obesity in Fiji. This paper reports on the quantitative evaluation of the knowledge-broking intervention through assessment of parti...

Background There is limited research on the use of evidence to inform policy-making in the Pacific. This study aims to identify and describe factors that facilitate or limit the use of evidence in food-related policy-making in the Health and Agriculture Ministries in Fiji. Methods Semi-structured face-to-face interviews were conducted with selecte...

Objective: To examine the relationship between diet quality and depressive symptomology amongst a community-based sample of Fijian adolescents. Methods: Participants included 7,237 adolescents (52.6% girls; mean age 15.6 years) at baseline (2005) and 2,948 (56% girls; mean age 17.4 years) at follow-up (2007/2008), from the Pacific Obesity Preven...

TREND Statement Checklist. (DOCX)

OPIC study protocol (objectives and designs). (PDF)

Request for use of data from the OPIC Project. (DOCX)

. Many studies examining smoking uptake among young people in the Pacific have not included their exposure to tobacco control promotions in the media in their assessment. This study examines how Fijian students view tobacco and tobacco-related media depictions to gain insight into both drivers of smoking uptake and potential directions for preventi...

Many studies examining population differences in soft drink consumption or the association it has with fatness have not included serving size in its assessment. It is not clear what effect this has on their findings and our study aimed to investigate this by comparing the relationships that days (serving size unaccounted for) and cans/day (serving...

Nearly one-half of the adult population in Fiji between the ages of 15-64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Communit...

Objective: To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity. Methods: The study comprised 8947 children from forms 3-6 (age 12-18 years) in 18 secondary schools on Viti Levu, the main island of F...

The magnitude of the relationship between lifestyle risk factors for obesity and adiposity is not clear. The aim of this study was to clarify this in order to determine the level of importance of lifestyle factors in obesity aetiology. A cross-sectional analysis was carried out on data on youth who were not trying to change weight (n = 5714), aged...

Evidence-informed policy-making (EIPM) is optimal when evidence-producers (researchers) and policy developers work collaboratively to ensure the production and use of the best available evidence. This paper examined participants' perceptions of knowledge-brokering strategies used in the TROPIC (Translational Research in Obesity Prevention in Commun...

The importance of using research evidence in decision making at the policy level has been increasingly recognized. However, knowledge brokering to engage researchers and policymakers in government and non-government organizations is challenging. This paper describes and evaluates the knowledge exchange processes employed by the Translational Resear...

The health and wellbeing of children in lower-income countries is the focus of much international effort, yet there has been very little direct measurement of this. Objective. The current objective was to study the health-related quality of life (HRQoL) in a general population of secondary school children in Fiji, a low middle-income country in the...

Objectives: This study investigated cultural values related to body image and eating practices in Western and non-Western societies. Design and methods: In total, 628 Fijian, 463 Indo-Fijian, 598 Tongan, and 534 Australian adolescents completed measures of cultural values and religious influences in relation to the ideal body and eating practice...

Policies targeting obesogenic environments and behaviours are critical to counter rising obesity rates and lifestyle-related non-communicable diseases (NCDs). Policies are likely to be most effective and enduring when they are based on the best available evidence. Evidence-informed policy making is especially challenging in countries with limited r...

Mavoa, H., Snowdon, W. and Waqa, G. 2012, Embedding evidence‐informed decision‐making into policies that benefit health, Fiji journal of public health, vol. 1, no. 1, pp. 27‐28.

The current study examined the factors related to body-image concerns among adolescent boys in Fiji and Tonga. This qualitative study determined the impact of messages from family, peers, and the media on body image among 24 adolescent boys from the following cultural groups: Indo-Fijian, Indigenous Fijian, Tongan, and Australian boys of European h...

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four-country project (Fiji, Tonga, New Zealand and Australia) designed to preve...

Obesity is a significant problem among adolescents in Pacific populations. This paper reports on the outcomes of a 3-year obesity prevention study, Healthy Youth Healthy Communities, which was part of the Pacific Obesity Prevention in Communities project, undertaken with Fijian adolescents. The intervention was developed with schools and comprised...

This paper reports on the findings of studies that were conducted as part of the Pacific Obesity Prevention in Communities project. The studies evaluated the types of messages that adolescents received in relation to body image, physical activity and eating. The participants were male and female adolescents from Fiji (two cultural groups), Tonga, N...

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four-country project (Fiji, Tonga, New Zealand and Australia) designed to preve...

The current study was designed to investigate the body image and body change strategies of adolescents from Fiji, Tonga and Australia. Participants were 628 Fijians, 463 Indo-Fijians, 598 Tongans and 535 European Australians. Adolescents completed measures of height, weight, body dissatisfaction, strategies to lose weight, increase weight and incre...

The desire for muscularity is tied to Western views of the male gender role, which prescribe that men be strong, physically fit and athletically successful. Although, these ideals have been primarily studied among Western adolescent boys, there is emerging evidence that the same ideals are valued and promoted among males from the Pacific Islands. T...

Australian and Fijian adolescent girls reported on the influence that sociocultural factors, including parents, peers, and the media, had on their body image attitudes. It was expected that messages that promote a thin body would be less prevalent among Fijians, as their cultural traditions place more importance on robust body sizes. An inductive t...

Few studies have addressed Sociocultural factors underlying healthy lifestyles. The Sociocultural component of the Obesity Prevention in Communities (OPIC) project explores social and cultural factors that may promote or protect against obesity via adolescents' values, attitudes, beliefs and explanations for their patterns of eating and physical ac...

Research on body image has primarily been conducted among Western women who highly value the thin ideal body size. There has been limited research that has examined body image attitudes among Fijian adolescent girls who are exposed to both traditional sociocultural pressures that promote a larger body size and Western pressures that promote slimnes...