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Obesity emergence in the Pacific islands: Why understanding colonial history and social change is important



Objective Between 1980 and 2008, two Pacific island nations – Nauru and the Cook Islands – experienced the fastest rates of increasing BMI in the world. Rates were over four times higher than the mean global BMI increase. The aim of the present paper is to examine why these populations have been so prone to obesity increases in recent times. Design Three explanatory frames that apply to both countries are presented: (i) geographic isolation and genetic predisposition; (ii) small population and low food production capacity; and (iii) social change under colonial influence. These are compared with social changes documented by anthropologists during the colonial and post-colonial periods. Setting Nauru and the Cook Islands. Results While islands are isolated, islanders are interconnected. Similarly, islands are small, but land use is socially determined. While obesity affects individuals, islanders are interdependent. New social values, which were rapidly propagated through institutions such as the colonial system of education and the cash economy, are today reflected in all aspects of islander life, including diet. Such historical social changes may predispose societies to obesity. Conclusions Colonial processes may have put in place the conditions for subsequent rapidly escalating obesity. Of the three frameworks discussed, social change under colonial influence is not immutable to further change in the future and could take place rapidly. In theorising obesity emergence in the Pacific islands, there is a need to incorporate the idea of obesity being a product of interdependence and interconnectedness, rather than independence and individual choice.
Obesity emergence in the Pacic islands: why understanding
colonial history and social change is important
Amy K McLennan* and Stanley J Ulijaszek
School of Anthropology and Museum Ethnography, University of Oxford, 51/53 Banbury Road,
Oxford OX2 6PE, UK
Submitted 1 April 2014: Final revision received 7 July 2014: Accepted 10 July 2014: First published online 29 August 2014
Objective: Between 1980 and 2008, two Pacic island nations Nauru and the
Cook Islands experienced the fastest rates of increasing BMI in the world. Rates
were over four times higher than the mean global BMI increase. The aim of the
present paper is to examine why these populations have been so prone to obesity
increases in recent times.
Design: Three explanatory frames that apply to both countries are presented:
(i) geographic isolation and genetic predisposition; (ii) small population and low
food production capacity; and (iii) social change under colonial inuence. These
are compared with social changes documented by anthropologists during the
colonial and post-colonial periods.
Setting: Nauru and the Cook Islands.
Results: While islands are isolated, islanders are interconnected. Similarly, islands
are small, but land use is socially determined. While obesity affects individuals,
islanders are interdependent. New social values, which were rapidly propagated
through institutions such as the colonial system of education and the cash
economy, are today reected in all aspects of islander life, including diet. Such
historical social changes may predispose societies to obesity.
Conclusions: Colonial processes may have put in place the conditions for subsequent
rapidly escalating obesity. Of the three frameworks discussed, social change under
colonial inuence is not immutable to further change in the future and could take
place rapidly. In theorising obesity emergence in the Pacic islands, there is a
need to incorporate the idea of obesity being a product of interdependence and
interconnectedness, rather than independence and individual choice.
Pacic islands
Colonial history
Social change
Dietary change
Obesity is disproportionately prevalent in island nations,
including those in the Caribbean and Pacic. Among the
Pacic islands, mean BMI increased by more than 2·0kg/m
per decade between 1980 and 2008 for men and women
in both the Cook Islands and Nauru
. This is over four
times higher than the mean global BMI increase of 0·4 and
0·5 kg/m
per decade for men and women, respectively.
There is little evidence of signicant society-wide obesity
in the Pacic islands prior to World War II
and detailed
colonial reports make no mention of fatness prior to this
. Comprehensive longitudinal evidence reviewed
in numerous papers by epidemiologist Zimmet and col-
leagues strongly indicates that obesity emerged rapidly on
Nauru in the second half of the 20th century
. Ulijaszek
documented a similar secular trend towards increasing
body weight in the Cook Islands between 1966 and
Previous attempts to explain the disproportionately high
rates of obesity in these, and other, island nations have
predominantly focused on two physical characteristics of
islands: (i) their geographical isolation and susceptibility to
food shortage, which is hypothesised to have enhanced
islandersgenetic predisposition to gain weight
; and
(ii) their small size and productive capacity, which means
they are both relatively dependent on imported foods and
relatively powerless in international trade policy negotia-
. Both of these characteristics make island inhabi-
tants disproportionately open to the global food system
and abundance of modern food products. However, the
timescales with which genetic structure, productive capa-
city and political power change do not align with the short
timescales in which obesity has emerged.Nor do they
currently present opportunities for intervention.
Islanders and their communities, on the other hand, are
dynamic and highly susceptible to agents of change such
We do not address epigenetics, because while epigenetic changes are
more rapid than evolutionary genetic change, they do not appear to be
particular to island nations.
Public Health Nutrition: 18(8), 14991505 doi:10.1017/S136898001400175X
*Corresponding author: Email © The Authors 2014
as colonial education systems
, capitalist economic
and global media
. Social change may be
accelerated in small, closely networked populations. Rapid
social change, especially in response to a changing poli-
tical ecological environment, has been well documented
in the Pacic region
. The relevance of rapid social
change to obesity production is discussed.
The present paper draws on anthropological research
examining processes of social change on Nauru, the Cook
Islands and other Pacic island nations. While islanders,
island societies and their histories are diverse and it is not
theoretically useful to essentialise them, the authors have
previously carried out long-term obesity-related research
in Nauru (A.K.M.) and the Cook Islands (S.J.U.), and have
identied similarities between the two islands that precede
and coincide with rapidly increasing BMI in both places.
Anthropological data suggest that social change is as
fundamental to setting the conditions for rising obesity as
existing structuring factors.
The Republic of Nauru is a single coral atoll that has a total
land area of approximately 21 square kilometres and a
population of about 10 000 people
. In 1905, while
under German colonial rule, high-grade phosphate a
natural mineral resource formed from sedimented marine
organisms and used to produce chemical fertiliser was
discovered in a large proportion of Nauruan soil and
exploited from this time
. In 1920, the mandate for
Nauru was granted to the British Empire; administration
was led by Australia. This was more than simple coin-
cidence: Australian authorities in particular had identied
the importance of Nauruan phosphate supplies for their
countrys agricultural expansion
. Phosphate was sold
at cost price to the administering authorities until Nauru
gained political independence in 1968. Throughout the
colonial period (and until recently), there were roughly as
many foreigners living on Nauru at any one time as there
were Nauruans. In the second half of the 20th century, and
particularly after Nauru purchased control of its mines in
1970, Naurus new economic situation attracted attention
from investors and salespeople from all over the world.
Traders, bankers and importers arrived rapidly on Nauru,
and the people of Nauru travelled worldwide. In 1975,
nancial products and lending competition increased
dramatically as foreign banks were licensed on Nauru
Banks in Australia were not deregulated until almost a
decade later in 1983, at which time there was a change in
social attitudes towards consumer debt. It is no longer
considered a disgrace to buy on time. Nor is it only the
lower-income groups who make use of credit facilities
Similar patterns can be seen on Nauru, where unequal
income distribution resulting from changing family
dynamics, land ownership and practices of sharing was
associated with high levels of employment and increasing
bank loans at the time
The Cook Islands comprises fteen small islands and
has a local population of about 10 000 people. The islands
were named British Protectorates at the end of the 19th
century. Administrative control was transferred to New
Zealand until political independence in 1965. Today, the
Cook Islandsprimary industry is tourism. However, tourism
was historically strongly controlled by government and
limited to small numbers of high-income visitors
. Even
so, Cook Islanders were not isolated: there were high
levels of emigration throughout the latter part of the 20th
century, and there continue to be an estimated two emi-
grants living in places like Australia or New Zealand for
every resident
. The distribution of remittances is com-
plex and varies over time depending on both a persons
generation and whether or not he/she was brought up in
the Cook Islands or in New Zealand
Ethnographic data collection
Primary ethnographic data about Nauru are drawn from
eldwork (A.K.M.) carried out over eleven months in
Nauru in 20102011 (February to May 2010, then August
2010 until February 2011). Data collection involved a
mixed-methods approach and consisted largely of parti-
cipant observation, life history interviews and extensive
archive searches in libraries in Australia, Nauru and the UK.
The paper is also informed by the research of Wedge-
, an anthropologist who carried out four months
of ethnographic research in Nauru in 1935; and material
recorded by Stephen
, who was shipwrecked and grew
up on the island in the late 1800s and eventually married
into Nauruan society.
Primary ethnographic data about the Cook Islands are
drawn from eldwork in Rarotonga over a period of nine
months in 1996 (S.J.U.). Data collection was pre-
dominantly focused on nutritional health and physical
activity, and included anthropometric testing, eld surveys
and participant observation. The paper is also informed by
ethnographic research by Graves and Graves
, anthro-
pologists who carried out twelve months of mixed-
methods ethnographic research in Aitutaki in the Cook
Islands in 1974 and 1975. They documented the changing
ways of life in the Cook Islands through long-term eld-
work and complemented this with experimental socio-
logical interventions and surveys.
Islands are isolated (but islanders are
Islands are generally depicted through images and maps
as small land masses surrounded by vast protective moats
of water, ocean or lake. This image of isolated islands is
1500 AK McLennan and SJ Ulijaszek
formalised in genetic theory, where it is proposed that the
remoteness of islands is central to understanding obesity
emergence on them
. During the peopling of the
Pacic, founder populations are said to have faced harsh
conditions as they migrated across the region
. Those
whose metabolism facilitated the most efcient energy
accumulation would have best survived. Island inhabitants
are then described as having been historically subjected to
whichever conditions food abundance or famine, for
example occurred on an island
. Underpinning the
thrifty genotype hypothesis of diabetes mellitus
obesity in a later formulation
is the assumption that
environmental pressures affected people living on isolated
islands disproportionately more than people living in other
parts of the world.
Islands may be geographically isolated; however,
islanders are not socially isolated. In pre-colonial times,
inter-island exchanges were an important part of islanders
lives; they remain important today. Prior to colonial
intervention, Pacic island inhabitants had sophisticated
sea-travel and navigation technologies and knowledge
that underpinned many maritime systems of trade and
. Even Nauru, one of the most remote of islands,
formed a part of these island networks. One of twelve
matrilineal Nauruan tribes, named Iruwa (or foreigner),
was reserved for people whose mothers were not Nauruan
and who were therefore tribeless; in this way, there was a
social structure in place for regularly bringing children of
foreign-born people into Nauruan society. National and
sub-national borders and boundaries are relatively recent
constructions which emphasise isolation. The division of
Oceania into individual Pacic islands in the 19th century
is the historical basis of the depiction of islands as small
and isolated
. In addition, on islands such as Nauru,
colonial authorities also enforced inter-district division with
strict curfews. Yet the economic framing of islands as
individual microstates dependent on larger geographical
and economic powers is rarely challenged
Also contra the assumption underpinning the thrifty
genotype hypothesis, complex social and technological
processes of food preservation may have buffered sea-
sonality and other climatic impacts on diet. Preservation
is contingent on being connected to others who have
specic knowledge, skills or ownership of food sources. It
often involves collective harvesting and processing, while
social norms and trust govern storage and distribution.
Drying, cooking and fermenting were once widespread
throughout the region. On Nauru, for example, complex
processes of cooking and drying meant that pandanus fruit
products could be stored in houses for up to six years at a
. Fermentation techniques, applied to many starchy
staples across the region, are widely considered an
important cultural adaptation to the constant threat of
drought, cyclonic storms, and warfare everpresent in
. Such data suggest that energy accumulation
would have been contingent not on individual metabolic
capacity to store fat, but instead on transport technologies,
collective knowledge about food storage, and local and
regional social embeddedness and trust, as these underlie
maintenance of local food stores and regional trade rela-
tionships. In this case, social change may be as important
in obesogenesis as genetic predisposition.
Islands are small (but land use is socially
The small size of islands is formalised in political ecolo-
gical theory about obesity. Two pathways in particular
have increased consumption of imported, energy-dense,
nutrient-poor food products to which obesity emergence
is at least partially attributed including in the Cook
and Nauru
. First, disproportionately more
food must be imported in order to feed growing island
populations. Second, island economies are today dis-
proportionately open and subject to regional-level trade
policies that are dominated by much bigger political and
economic actors, including large nation states and trans-
national corporations. Pacic island governments are
small, often reliant on colonial and post-colonial aid
funding, and have limited resources for the negotiation of
trade policies and consideration of their impacts. The
relevance for this to obesity is reviewed by Snowdon and
, who observe the close links between changing
diets and changes in food supply in the region.
While islands have comparatively small amounts of
available land, land use and food productivity capacities
are socially and historically determined. Land historically
used for food gathering was rendered inaccessible or
infertile with colonial initiatives such as mining or cash
crops. Such initiatives paid little attention to islanders
foodways; instead, they were accompanied by colonial
insistence on dietary change for social and health reasons
that were, in turn, based on colonial conceptions of
socially proper behaviours and healthy diets. Teaching
what were considered to be properfood habits at the
time was central to teaching islanders to be more civilised;
Delaporte, for example, proudly recounts her success in
teaching the people of Nauru to fry sh rather than eat it
. Based on his research in the 1910s, Hambruch
praised European colonial powers for introducing a
number of foodstuffs to Nauruans
, as he perceived it to
have mitigated the impacts of drought or famine and to
have added much-needed variety into the Nauruan diet.
Over time, such changes led to skill loss (in shing or food
preservation, for example) and dependence on imported
foods; it also permitted colonial powers to justify
expanding land exploitation insofar as the land was no
longer seen as essential for food cultivation. On Nauru,
the colonial legacy of strip mining without land rehabili-
tation has left much of the island uninhabitable and
uncultivable. Pollution from shipping lines and industry
has led to signicant degradation of the reef surrounding
the island, which was also once a rich food source.
Social change and obesity on Pacic islands 1501
Lack of land is exacerbated by growing population size.
Following population decline linked to infectious disease
outbreaks in the late 1800s and early 1900s, colonial
governments, missionaries and scholars encouraged a
culture of population growth and the breaking of child-
spacing taboos in order to achieve it
. On Nauru, a
populate or perishpolicy was formally introduced for this
purpose in the 1920s
. Fears of depopulation following
World War II reignited an emphasis on population growth
on Nauru, and all women were encouraged to have seven
. Population growth on Nauru, and in the region
more broadly, was further accelerated by the decline of
child mortality in the Asia-Pacic region since the 1950s
Obesity affects individuals (but islanders are
Linnekin has previously observed that the apparent
insularityof Pacic peoples appears less signicant than
the connections between peoplewhere politics, eco-
nomics and social transformation are concerned
. The
same may be argued for obesity emergence. Pacic island
diets, for example, vary widely in their nutrient proles
and the iterative links between food and society are
diverse across the region. Where Pacic island foods and
foodways are similar, however, is in the broad social factors
that surround them. Themes in food-related research from
the region include cooperation
, reciprocity, obligation and
, hierarchy and land ownership
, competition
and status relations
, social memory and links to the
and the importance of food for forming and main-
taining social connections
. All of these are underpinned
by interdependence. In the Cook Islands, meals and feasts
exemplif[ied] a level of community participation and sharing
of resources that Western groups can rarely expect from their
. Similarly on Nauru, values governing food
distribution were based on underlying principles of giving
and sharing
. In Pohnpei, on the other hand, specicforms
of food distribution and consumption are both guided by,
and play a role in maintaining, social status and hierarchy
Food habits shape, and are shaped by, local social factors.
In the case of Nauru, Wedgewood observed that the
values that determined food sharing were taught to chil-
dren from an early age. She detailed how young Nauruans
were taught to give and share all manner of things; it
would be a matter of great shame if they did not do so.
To be reproved in public for meanness, she wrote,
was taken very seriously to heart and from an early age
children were taught to give
. Values were not taught
formally, but rather through everyday contact with family
and community members, who would reprove children
for something considered to be socially incorrect and
commend them for behaving as was expected of them.
Social values are not necessarily formalised or cognised;
instead, negotiation of them may elicit emotion and feel-
ings such as shame or pleasure (where pleasure is related
to social belonging
). The processes of socialisation that
promote continuity and change across generations in the
sociocultural life of foodhave been documented in Samoa
by researchers such as Ochs and Shohet, who show that
collective mealtimes are important sites for socialisation
and such socialisation can equally impact food habits
Social values underlying food practices were also
changed by people external to society, such as mis-
sionaries and colonial visitors. In Nauru, as the wife of one
missionary wrote upon trying to understand why she was
never supplied with good sh:
the Nauru maidens, with blushes,explained to
me that my method of cooking sh, i.e. frying them
in a pan, was very bad: and that if the really good
sh were cooked that way the ghosts of the air
would tell the other sh in the sea. It took me
some time to convince the natives of their error but I
nally succeeded
For the wife of Reverend Delaporte, eating sh raw was
one practice among many that she set out to change; not
through formal education, but through persistent encour-
agement and informal everyday interpersonal interactions.
This was not unique to Nauru: food and agriculture were
central to colonial processes of civilisinglocal populations
across the region.
Social values in the colonial period were also formally
taught through schools and churches. For example,
Graves and Graves document the successful propagation
of Western morals through the colonial system of educa-
tion in the Cook Islands
. They nd that:
[b]y contrast with these relatively weak associations
between rivalry and family background, the school
appears to have a strong and consistent inuence on
the formation of rivalry among both boys and girls.
This is reasonable, given the basic rivalrous philosophy
underlying Western education
They describe a form of rivalry related to the Western cash
economy, through a game where students can both
cooperate and compete to win money. Through this game,
they demonstrate competitiveness, particularly among
younger Cook Islanders, and show that the interpersonal
processes involved in this particular form of rivalry or
cooperation are transmitted through school rather than
in the everyday family setting. Similar emergence of an
emphasis on economic prot, or on takingrather than
giving, can be identied at a similar time period in the
distribution of remittances in the Cook Islands
and of
money, goods and food on Nauru
Food habits may be guided by such emergent social
values, which ostensibly have very little to do with food.
For example, the consumption of obesogenic diets may
contribute to a sense of social belonging in cash-based
economies for the following reasons: (i) foods that align with
a capitalist economic rationale are low cost and high volume;
and (ii) restaurant foods save time (and therefore money),
1502 AK McLennan and SJ Ulijaszek
and are fair insofar as no one person has to invest more
effort than others in preparation. Foods that require
minimal investment of time, money or effort for maximal
gain appear implicitly favourable
. Such values are
today reiterated through television, the Internet and in
food marketing campaigns, which arguably accelerate
social change. Adhering to social values is important for
social inclusion, while isolation from cultural norms
through food is one form of deprivation
. However, in
following such values, people also risk marginalisation
since obesity is framed in global health discourses, and
increasingly in local settings around the world, as moral
failure linked to laziness, gluttony and sickness
. This
view varies across the region, possibly according to the
extent to which a population is exposed to more dominant
global discourses as well as health education programmes.
Changing social values may have implications beyond
diet but which nevertheless may be associated with obe-
sity. Ethnographic evidence from Nauru suggests that
cash-based capitalistic values can change long-term trust
in, or obligation to, a social network. Such erosion of
interdependence is evident in the repeated failure of
kitchen gardens documented during eldwork in Nauru.
One such garden was cultivated by a woman near her
house, on land communally owned by her and other
family members. When the produce was ready, other
family members claimed a share of it as rightfully theirs
(as it had been planted on their land for free); some even
sold some of the produce for prots to purchase other
goods. She was angry with this because she had done all
of the work on the garden (and so had contributed dis-
proportionately more to it). She decided not to continue
gardening, as she feared her produce would be stolen
again. She and her family instead returned to purchasing
all of their food from local shops stocked with imported
goods. It is not clear whether conict in this case arose
because food production and exchange relations had
been monetised, or because there were multiple and
conicting social values in place, or for another reason
entirely. Nevertheless, such an example illustrates how
changing social values may also be related to non-food
factors that have been epidemiologically associated with
obesity emergence such as stress
, future uncertainty
and time-inconsistent decision making
. Further, capi-
talist competition fosters economic inequality, which has
also been linked to obesity
. While no single factor on
its own causes obesity, social change may contribute to it
through these and other as-yet unexplored pathways.
The anthropological evidence presented here suggests
that colonial and post-colonial forces, through demo-
graphic and social change, put in place the conditions for
rapidly escalating obesity on Nauru and the Cook Islands.
Food habits are modied by social inuences and learning
attitudes and beliefs
. People on both Nauru and the
Cook Islands understand social values and develop habits
through an ongoing process of interaction with the people
and goods (including food) around them. As these goods
and people have changed, so too have the ways in which
they are incorporated into peoples lives, experiences and
. Ethnographic evidence highlights the importance
of interconnectedness for determining health-related beha-
viours; this may provide some explanation for Christakis and
Fowlers observation that obesity seems to spread through
social ties
, however contested it may be.
There is good evidence in literature from the Pacic
region that social values and norms can change extremely
rapidly, in timescales similar to those of recent obesity
emergence. Becker and colleagues, for example, highlight
changing body ideals in Fiji in the 1980s and 1990s
They suggest that these changes may be related to the
proliferation of television and everyday exposure to global
media. This has implications for not only understanding
obesity emergence in the past, but also for addressing
obesity in the future.
Existing public health education programmes have
attempted to change attitudes to food and physical activity
with arguably little success; obesity levels on Nauru and
the Cook Islands remain high, and are increasing, despite
histories of over 30 years of public health nutrition inter-
ventions and education. Although social values and norms
can change quickly, public health nutrition interventions
are usually situated within individualist frameworks and
focus only on the domain of health (rather than social life
more broadly). This may be part of the problem. Under-
standing and ultimately addressing obesity in the Cook
Islands and Nauru, and likewise other island nations in the
Pacic, requires the recruitment of deeper histories of
social values and social change.
To achieve this, obesity must rst be understood as a
phenomenon with strong historical and sociocultural
dimensions. In this case, genetic and epigenetic theorisa-
tion might be considered to be incomplete without the
incorporation of social histories. Epigenetics is embedded
in local social processes through the management of
pregnancy and lactation, while the genetics of obesity is
related to processes by which genes are transmitted,
such as migration, settlement, kinship structures, marriage
and procreation. The relevance of colonial political and
geographic divisions might be questioned before they
are used as analytical categories in demographic and
epidemiological research. A focus on interdependence
and interconnectivity points to new possibilities for inter-
vention. As Holt-Lunstad and colleagues have previously
argued with regard to the strong links between social
integration and mortality, strengthening naturally-occurring
social relations and community-based interventions may
be more successful than providing social support through
hired personnel
. Such interventions need not be
Social change and obesity on Pacic islands 1503
targeted specically at those at highest risk, but instead
must distribute responsibility for health and well-being.
Understanding obesity in this way may help to shed new
light on what is now an old problem in the Pacic region.
Acknowledgements: The authors are grateful for the gen-
erous assistance, advice and support they received during
eldwork from communities in the Cook Islands and
Nauru. They thank the anonymous reviewers and editors
who gave feedback and suggestions that signicantly
strengthened the paper. Financial support: A.K.M.s
eldwork and data analysis in Nauru were supported by a
Monash Award (General Sir John Monash Foundation
(Australia)) and a grant from St Edmund Hall (Oxford).
No funders had a role in the design, analysis or writing of
this article. Conict of interest: None. Authorship: Nauru
data are contributed by A.K.M.; Cook Islands data are
contributed by S.J.U. Both authors contributed equally to
the framing, writing and revision of this paper. Ethics of
human subject participation: Ethics approval for this
research was granted by the University of Oxfords Central
University Research Ethics Committee (CUREC).
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Social change and obesity on Pacic islands 1505
... The United Nations (UN) recognises the administrative status of 58 Small Island Developing States (SIDS) in the Caribbean, the Pacific, Atlantic, Indian Ocean and South China Sea. In addition to their colonial pasts still having prevailing impacts on their modern socio-economic structures (McLennan and Ulijaszek 2015), SIDS today are also positioned to be part of solving major challenges that humanity faces, particularly in maritime affairs. Their critical and leading roles in protecting biodiversity and marine resources (Chan 2018) are further emphasised in their active participation and contribution in international collaborations for the Blue Economy and maritime security issues (Voyer et al. 2018). ...
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Resilience as a complex concept has been recognised and employed to strategise mitigation policies and processes during disruptive events. Island resilience in particular is used to frame islanders and their societies as vulnerable entities combating uncertainties with limited resources and capacities. On the one hand, public discourse on island nations tends to centre around victimhood amid disasters; on the other hand, islands are portrayed as peaceful and idyllic paradise during regular times. This opening chapter uses the term ‘imaginary’ to signify such discourses that construct one’s understanding of island societies. We first outline the conceptual framing around the evolution of resilience. Then we elaborate on four prominent ‘imaginaries’ of Small Island Developing States and island societies in general. By unpacking the term ‘imaginary’, we aim to expose the dominant discursive framing of island societies to elucidate constructive avenues for locally owned progress and development in an increasingly variable and glocalised world.KeywordsResilienceIsland imaginaryNeoliberalismIsland paradiseSmall Island Developing States
... This research was conducted without informed consent and without language translation. Researchers demonstrated health problems affecting those exposed (Kroon et al., 2004;Pollock, 2002;Takahashi et al., 2003) and changes in Marshallese health behaviors McLennan & Ulijaszek, 2015). ...
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OBJECTIVES/GOALS: Pacific Islanders have some of the lowest rates of initiation and duration of exclusive breastfeeding compared to other racial women once they migrate to the United States. The purpose of this study is to identify infant feeding initiation, beliefs, and experiences of Marshallese women living in the United States soon after delivery. METHODS/STUDY POPULATION: This study used an exploratory, descriptive qualitative design with 36 Marshallese women residing in the United States from July 2019 to July 2020. A Community Based Participatory Research Approach was used to design and implement the study. This approach enables the respect and integration of Marshallese cultural values and practices into every aspect of the research All study plans and documents – including recruitment plans and forms, consent plans and forms, retention plans, quantitative surveys, and qualitative interview guides – were developed in partnership with Marshallese research team members. RESULTS/ANTICIPATED RESULTS: Two themes emerged: 1) Infant Feeding Initiation and Practices; and 2) Concerns of Breastfeeding in Public. Within the first theme, two subthemes emerged: 1) Breast and Formula-Feeding; and 2) Return to Work. Within the second theme, two subthemes emerged: 1) Personal Beliefs about Breastfeeding in Public; and 2) Acculturation and Breastfeeding in Public. DISCUSSION/SIGNIFICANCE: This is the first study to document beliefs about exclusive breastfeeding initiation among Marshallese women living in the United States. Findings from this study can be used to develop health education programs to improve exclusive breastfeeding and can be used to stimulate future research in the area of breastfeeding among Pacific Islander women.
... This research was conducted without informed consent and without language translation. Researchers demonstrated health problems affecting those exposed (Kroon et al., 2004;Pollock, 2002;Takahashi et al., 2003) and changes in Marshallese health behaviors McLennan & Ulijaszek, 2015). ...
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Background Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups. Research Aim To describe infant feeding beliefs and experiences of Marshallese living in the United States. Methods We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants ( N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6–8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques. Results Participants’ mean age was 27.1 years ( SD = 6.1), and 88.9% ( n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership ( n = 28, 77.8%). Most participants had a high school education or lower ( n = 30, 83.3%). Mean household size was 7.2 ( SD = 2.8). Fewer than half of participants had no health insurance ( n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants’ infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public. Conclusions Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6–8 weeks postpartum. Findings will inform future health education programs.
In this paper, we present a model of the spread of the COVID-19 pandemic simulated by a multi-agent system (MAS) based on demographic data and medical knowledge. Demographic data are linked to the distribution of the population according to age and to an index of socioeconomic fragility with regard to the elderly. Medical knowledge are related to two risk factors: age and obesity. The contributions of this approach are as follows. Firstly, the two aggravating risk factors are introduced into the MAS using fuzzy sets. Secondly, the worsening of disease caused by these risk factors is modeled by fuzzy aggregation operators. The appearance of virus variants is also introduced into the simulation through a simplified modeling of their contagiousness. Using real data from inhabitants of an island in the Antilles (Guadeloupe, FWI), we model the rate of the population at risk which could be critical cases, if neither social distancing nor barrier gestures are respected by the entire population. The results show that hospital capacities are exceeded. The results show that hospital capacities are exceeded. The socioeconomic fragility index is used to assess mortality and also shows that the number of deaths can be significant.
The Pacific region is experiencing a non-communicable disease epidemic largely driven by an ongoing nutrition transition from nutrient rich whole foods to imported staples and highly processed foods. Food trade is a major driver of this transition. We characterize regional and sub-regional trade from 1995 to 2018 for 18 Pacific Island Countries and Territories using the Pacific Food Trade Database. The analysis shows the growing dependence on imports of rice from South-East Asia and wheat from Australia, and recent growth in imports of meat from Australia, New Zealand and USA, and highly processed foods from South-East Asia. Findings are discussed in terms of policy and trade agreements, and global shocks including COVID-19 and the war in Ukraine.
Beslenme ve fiziksel hareket alışkanlıklarında meydana gelen değişimler, birçok ülkede artan obezite vakalarının nedeni olarak gösterilmektedir. Günümüzde günlük beslenme alışkanlıkları içerisinde sıklıkla yer bulan şekerli içecekler, içerdikleri yüksek şeker miktarı dolayısıyla tüketicilerde fazla kalori alımına neden olmaktadır. Kilo alımı ve dolayısıyla obezite ile ilişkilendirilen şekerli içeceklerin tüketimini azaltmak adına hükümetler, mali ve mali olmayan araçları çeşitli şekillerde kullanmaktadır. Obezite önleme politikaları içerisinde hükümetlerin tercih ettiği mali araçlardan bir tanesi şekerli içecek vergileridir. Şekerli içeceklerin vergilendirilmesi yolunu seçen hükümetler, vergi geliri sağlarken aynı zamanda ülkelerdeki obezite sıklığını ve obezitenin neden olduğu ekonomik yükü azaltmayı hedeflemektedir. Günümüzde şekerli içecek vergileri dünya genelinde 45 ülkede aktif şekilde kullanılmaktadır. Bu çalışmada şekerli içecek vergileri uygulayan 17 ülke örneği obezite sıklığında meydana gelen değişimler ile analiz edilmektedir. Analiz sonuçları, şekerli içecek vergilerinin şekerli içecek tüketimini azaltsa dahi obezite eğilimini azaltmada yetersiz kaldığını göstermektedir.
Introduction: Women from racial and ethnic minority groups in the United States are disproportionately likely to experience adverse perinatal outcomes such as preterm birth, low birthweight infants, and infant mortality. Previous research has demonstrated that exposure to stressful life events and social support may influence perinatal outcomes. Although studies have documented stressful life events and social support for the general United States population and minority groups, less is known about the experiences of Pacific Islander women in the United States, and no prior studies have documented these experiences in Marshallese Pacific Islander women. Methods: The present study examined data collected from pregnant Marshallese women (n = 67) in northwest Arkansas participating in a women's health program using descriptive analyses (means, standard deviations, proportions). Results: Results indicated a high prevalence of three stressful life events: experiencing a family member going into the hospital (35.8%), someone close to them dying (29.9%), and being unable to pay bills (53.7%). Food insecurity was higher than previously reported for pregnant women or Pacific Islanders (83.7%). Social support was high among the sample. A majority of women reported receiving help with daily chores (86.6%), help when sick (88.1%), and support on how to deal with personal problems (85.1%). Discussion: This study is the first to document the prevalence of stressful life events and social support in a sample of pregnant Marshallese women living in the United States. The findings provide important information to guide efforts to reduce adverse perinatal outcomes in a Pacific Islander population.
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Carl Bergmann was an astute naturalist and physiologist. His ideas about animal size and shape were important advances in the pre-Darwinian nineteenth century. Bergmann’s rule claims that that in cold climates, large body mass increases the ratio of volume-to-surface area and provides for maximum metabolic heat retention in mammals and birds. Conversely, in warmer temperatures, smaller body mass increases surface area relative to volume and allows for greater heat loss. For humans, we now know that body size and shape are regulated more by social-economic-political-emotional (SEPE) factors as well as nutrition-infection interactions. Temperature has virtually no effect. Bergmann’s rule is a “just-so” story and should be relegated to teaching and scholarship about the history of science. That “rule” is no longer acceptable science and has nothing to tell us about physiological anthropology.
National-level survey data show that Galapagos has the highest rate of overweight and obesity of all Ecuadorian provinces. This phenomenon reflects trends observable nationally and globally, but also are the product of unique characteristics of the Galapagos population. Most importantly, nearly all food must be brought from the Ecuadorian mainland, as local production is limited. This factor necessarily means that food availability, variety, and quality are generally lower than elsewhere in the country, while prices are considerably higher. Much of the food that is brought from the continent—usually by ship but sometimes by air—consists of staples (especially rice), meat, and poultry. Additionally, industrialized food products are extensively imported. The NOVA system classifies foods according to the level of processing and identifies processed and ultra-processed products as those that incorporate artificial ingredients and added salt, fat, and sugar. These products have been associated with overweightOverweight and obesityObesity both globally and nationally. This chapter will analyze food availabilityFood availability and quality (according to the NOVA system) in order to shed light on the high rates of overweightOverweight and obesityObesity in Galapagos, not as a unique problem, but rather as a case in which national and global trends are clearly observed.
Technical Report
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This report focuses on the social determinants of health (the conditions in places where people live, learn, work and play), well-being and health outcomes of APIs living in NYC. To determine the best measures to represent the health of the API population, the NYC Health Department collaborated with a group of 21 partners who bring the expertise of health and service providers, academics and community-based organizers who know what information is needed to empower the API communities they serve. Using data from more than 20 sources, APIs were identified by race, ethnicity and ancestry fields. Definitions of API race and ancestry groups may vary for each data source. Where possible, mixed- race and mixed-ethnicity APIs were included. Because each health measure is shown among as many API ancestries as possible, the API ancestry group breakdowns will vary depending on the data source. When ancestry-level data were not available, data are shown only among APIs overall. Online supplemental tables provide additional statistical comparisons by major race and ethnicity groups, household poverty levels among APIs, nativity [United States-born (U.S.-born) and non- U.S.-born] among APIs, and years lived in the U.S. [less than (<) 10 and greater than or equal to (≥) 10 years] among APIs born outside of the U.S. These tables contain technical notes for further details. Additional health topics that did not have adequate population-based data were identified and included to provide a fuller picture of the health of the API community. These special sections may reference data from non-population-based studies or data from outside the NYC Health Department.
This book was first published in 2007. The Asia-Pacific region has seen great social, environmental and economic change across the past century, leading to dramatic changes in the health profiles of all populations represented in South East and East Asia, Pacific Islands and the islands of Melanesia. This volume considers evidence concerning prehistoric migration, and colonial, regional and global processes in the production of health change in the Asia-Pacific region. Notably, it examines ways in which a health pattern dominated by under-nutrition and infection has been displaced in many ways, and is being displaced elsewhere by over-nutrition and the degenerative diseases associated with it. This book presents a cohesive view of the ways in which exchange relationships, economic modernization, migration and transnational linkages interact with changing rural subsistence ecologies to influence health patterns in this region.
In 1994, the Pacific island village of Matupit was partially destroyed by a volcanic eruption. This study focuses on the subsequent reconstruction and contests over the morality of exchanges that are generative of new forms of social stratification. Such new dynamics of stratification are central to contemporary processes of globalization in the Pacific, and more widely. Through detailed ethnography of the transactions that a displaced people entered into in seeking to rebuild their lives, this book analyses how people re-make sociality in an era of post-colonial neoliberalism without taking either the transformative power of globalization or the resilience of indigenous culture as its starting point. It also contributes to the understanding of the problems of post-disaster reconstruction and development projects.
The prevalence of obesity has increased substantially over the past 30 years. We performed a quantitative analysis of the nature and extent of the person-to-person spread of obesity as a possible factor contributing to the obesity epidemic. We evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors. Discernible clusters of obese persons (body-mass index [the weight in kilograms divided by the square of the height in meters], > or =30) were present in the network at all time points, and the clusters extended to three degrees of separation. These clusters did not appear to be solely attributable to the selective formation of social ties among obese persons. A person's chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60). If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73). These effects were not seen among neighbors in the immediate geographic location. Persons of the same sex had relatively greater influence on each other than those of the opposite sex. The spread of smoking cessation did not account for the spread of obesity in the network. Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions.