Obesity and Diabetes in Pacific Islanders: the Current Burden and the Need for Urgent Action

Obesity (J McCaffery, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity


Non-communicable diseases (NCDs) now account for more than 36 million deaths each year; many of which are premature. Pacific Islanders are some of the worst afflicted by obesity and diabetes with prevalence of both diseases rising disproportionately faster in the Pacific region over the past three decades than in the rest of the world. A high burden of disease is also found among enclaves of Pacifican migrants in the USA, Australia, and New Zealand. Urgent action is needed to alleviate the high economic and personal costs now associated with NCDs in Pacific Islanders. In this article, we describe contributors to the temporal trends in obesity and diabetes, discuss the current burden of disease in the Pacific Islands and among migrant communities, and suggest priorities for future research in this area. Finally, we discuss challenges unique to intervention among Pacific Islanders and highlight promising opportunities to reduce the NCD burden.


Diabetes Obesity Pacific Islands Non-communicable disease 


Compliance with Ethics Guidelines

Conflict of Interest

Nicola L. Hawley and Stephen T. McGarvey declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. 2014. http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf. Accessed 10 Dec 2014
  2. 2.
    The World Bank Human Development Network. The growing danger of non-communicable diseases. Acting now to reverse course. 2011. http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-Reviewed-Publications/WBDeepeningCrisis.pdf. Accessed 10 Dec 2014
  3. 3.•
    Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67. Finucane et al. describe global trends in non-communicable disease and provide a comparison of trends in the Pacific versus other world regions. CrossRefPubMedGoogle Scholar
  4. 4.
    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378:31–40.CrossRefPubMedGoogle Scholar
  6. 6.
    The World Bank. The economic costs of non-communicable diseases in the Pacific Islands. A rapid stocktake of the situation in Samoa, Tonga, and Vanuatu. 2012. http://www.worldbank.org/content/dam/Worldbank/document/the-economic-costs-of-noncommunicable-diseases-in-the-pacific-islands.pdf. Accessed 10 Dec 2014.
  7. 7.
    The World Bank. Country and Lending Groups. http://data.worldbank.org/about/country-and-lending-groups. Accessed Dec 11 2014.
  8. 8.
    United States Census Bureau. The Native Hawaiian and Other Pacific Islander Population: 2010. 2010 Census Briefs. 2012. http://www.census.gov/prod/cen2010/briefs/c2010br-12.pdf. Accessed Nov 29 2014.
  9. 9.
    Australia Bureau of Statistics. QuickStats Country of Birth. http://www.abs.gov.au/websitedbs/censushome.nsf/home/quickstatscob?opendocument&navpos=220. Accessed Nov 29 2014.
  10. 10.
    Statistics New Zealand and Ministry of Pacific Affairs. Demographics of New Zealand’s Pacific population. Wellington: Statistics New Zealand; 2010.Google Scholar
  11. 11.
    McGarvey ST, Seiden A. Health, well-being, and social context of Samoan migrant populations. NAPA Bull. 2010;34:213–28.CrossRefGoogle Scholar
  12. 12.
    Browne C, Mineshima A. Remittances in the Pacific Region. IMF Working Paper, WP/07/35. Washington, DC: IMF. 2007.Google Scholar
  13. 13.
    Connell J, Brown RPC. Asian Development Bank. Remittances in the pacific: an overview. Manilla: Asian Development Bank; 2005.Google Scholar
  14. 14.
    Popkin BM, Adair LS. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3–21.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Rolfe J, editor. The Asia-Pacific: a region in transition. Honolulu: Asia-Pacific Center for Security Studies; 2004.Google Scholar
  16. 16.
    Pirie P. Pacific transitions: population and change in island societies. East–West Center. 1995. http://www.eastwestcenter.org/fileadmin/stored/pdfs/api020.pdf. Accessed Dec 1 2014.
  17. 17.
    Prasad B, Roy KC, editors. Development problems and prospects in Pacific Island states. Hauppauge: Nova; 2007.Google Scholar
  18. 18.
    Ulijaszek S. Modernisation, migration and nutritional health of Pacific Island populations. Environ Sci. 2005;12:167–76.PubMedGoogle Scholar
  19. 19.
    Coyne T. The effect of urbanization and western diet on the health of Pacific Island populations. Noumea: South Pacific Commision; 1984.Google Scholar
  20. 20.
    Pollock NJ. These roots remain: food habits in the islands of the central and eastern Pacific since Western contact. Laie: The Institute for Polynesian Studies; 1992.Google Scholar
  21. 21.
    Thaman RR. Food for urbanizing Polynesian peoples. Proceedings of the Nutritional Society of New Zealand. 1983;8:25–37.Google Scholar
  22. 22.
    Thaman RR. Health and nutrition in the Pacific Islands: development or underdevelopment. GeoJournal. 1988;16:211–27.CrossRefGoogle Scholar
  23. 23.
    Campbell LV. Evolution of the diabetic diet: facts and fallacies. Asia Pacific J Clin Nutr. 2000;9:S83–5.CrossRefGoogle Scholar
  24. 24.
    Haden R. Food culture in the Pacific Islands. Denver: Greenwood Press; 2009.Google Scholar
  25. 25.
    Gewertz D, Errington F. Cheap meat: food flap nations in the Pacific islands. Berkeley: University of California Press; 2010.Google Scholar
  26. 26.
    Evans M, Sinclair RC, Fusimalohi C, et al. Globalization, diet, and health: an example from Tonga. Bull World Health Organ. 2001;79:856–62.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Sheperd AW. Agricultural marketing in the south Pacific. Apia: Food and Agriculture Organization, Subregional Office for the Pacific; 1999.Google Scholar
  28. 28.
    Galanis DJ, McGarvey ST, Quested C, et al. Dietary intake of modernizing Samoans: implications for risk of cardiovascular disease. J Am Diet Assoc. 1999;99:184–90.CrossRefPubMedGoogle Scholar
  29. 29.
    Ulijaszek SJ. Trends in body size, diet, and food availability in the Cook Islands in the second half of the 20th century. Econ Hum Biol. 2003;1:123–37.CrossRefPubMedGoogle Scholar
  30. 30.
    DiBello JR, McGarvey ST, Kraft P, et al. Dietary patterns are associated with the metabolic syndrome in adult Samoans. J Nutr. 2009;139:1933–43.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Seiden A, Hawley NL, Schultz D, et al. Long-term trends in food availability, food prices, and obesity in Samoa. Am J Hum Biol. 2012;24:286–95.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Taylor R, Badcock J, King H, et al. Dietary intake, exercise, obesity and noncommunicable disease in rural and urban populations of three Pacific Island countries. J Am Coll Nutr. 1992;11:283–93.CrossRefPubMedGoogle Scholar
  33. 33.
    Mavoa HM, McCabe M. Sociocultural factors relating to Tongans’ and indigenous Fijians’ patterns of eating, physical activity and body size. Asia Pac Clin Nutr. 2008;17:375–84.Google Scholar
  34. 34.
    Asian Development Bank. The state of Pacific towns and cities. Urbanization in ADB’s Pacific developing member countries. http://www10.iadb.org/intal/intalcdi/PE/2012/07773.pdf. Accessed Dec 10 2014.
  35. 35.
    World Health Organization. FSM (Chuuk) STEPS survey 2006. Fact Sheet. http://www.who.int/chp/steps/2006_Micronesia_FactSheet.pdf?ua=1. Accessed Nov 17 2014.
  36. 36.
    World Health Organization. Kiribati STEPS survey 2004–2006. Fact Sheet. http://www.who.int/chp/steps/2004_Kiribati_FactSheet.pdf. Accessed Nov 17 2014.
  37. 37.
    World Health Organization. Marshall Islands STEPS survey. Fact Sheet. http://www.who.int/chp/steps/2002_MarshallIslands_FactSheet.pdf. Accessed Nov 17 2014.
  38. 38.
    World Health Organization. Nauru STEPS survey. Fact Sheet. http://www.who.int/chp/steps/2004_Nauru_FactSheet.pdf. Accessed Nov 17 2014.
  39. 39.
    World Health Organization. Papua New Guinea STEPS survey 2007–2008. Fact Sheet. http://www.who.int/chp/steps/PapuaNewGuinea_2007-08_STEPS_FactSheet.pdf. Accessed Nov 17 2014.
  40. 40.
    World Health Organization. Solomon Islands STEPS survey 2006. Fact Sheet. http://www.who.int/chp/steps/2006_SolomonIslands_FactSheet.pdf. Accessed Nov 17 2014.
  41. 41.
    World Health Organization. Vanuatu NCD Risk Factors STEPS report. http://www.who.int/chp/steps/Vanuatu_STEPS_Report_2013.pdf. Accessed Nov 17 2014.
  42. 42.
    World Health Organization. American Samoa STEPS survey. Fact Sheet. http://www.who.int/chp/steps/2004_AmericanSamoa_FactSheet.pdf. Accessed Nov 17 2014.
  43. 43.
    World Health Organization. Cook Islands NCD STEPS survey. Fact Sheet. http://www.who.int/fctc/reporting/party_reports/cookislands_annex4_steps_fact_sheet_2004.pdf. Accessed Nov 17 2014.
  44. 44.
    World Health Organization. Polynésie française enquête STEPS 2010. http://www.who.int/chp/steps/2010_FrenchPolynesia_FacthSheet.pdf?ua=1. Accessed Nov 17 2014.
  45. 45.
    World Health Organization. Niue NCD Risk Factors STEPS report. http://www.who.int/chp/steps/Niue_STEPS_Report_2011.pdf. Accessed Nov 17 2014.
  46. 46.
    World Health Organization. Samoa STEPS survey. Fact Sheet. http://www.who.int/chp/steps/2002_Samoa_FactSheet.pdf. Accessed Nov 17 2014.
  47. 47.
    World Health Organization. Tokelau STEPS survey 2005. Fact Sheet. http://www.who.int/chp/steps/2005_Tokelau_FactSheet.pdf. Accessed Nov 17 2014.
  48. 48.
    World Health Organization. Tonga STEPS survey 2004. Fact Sheet. http://www.who.int/chp/steps/2004_TongaFactSheet.pdf. Accessed Nov 17 2014.
  49. 49.
    International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels: International Diabetes Federation; 2013.Google Scholar
  50. 50.
    Swinburn BA, Ley SJ, Carmichael HE, et al. Body size and composition in Polynesians. Int J Obes Relat Metab Disord. 1999;23:1178–83.CrossRefPubMedGoogle Scholar
  51. 51.
    World Health Organization. Fiji Non-Communicable Diseases (NCD) STEPS survey 2002. http://www.who.int/chp/steps/FijiSTEPSReport.pdf. Accessed Nov 17 2014.
  52. 52.
    Ministry of Health. New Zealand Health Survey: annual update of key findings 2013/2013. Wellington; Ministry of Health; 2013. http://www.health.govt.nz/system/files/documents/publications/new-zealand-health-survey-annual-update-2012-13-dec13-v2.pdf. Accessed Dec 1 2014.
  53. 53.
    Australian Government Preventative Health Taskforce, Obesity Working Group. Australia: the healthiest country by 2020. Technical Report 1: Obesity in Australia: a need for urgent action. http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/E233F8695823F16CCA2574DD00818E64/$File/obesity-jul09.pdf. Accessed Dec 1 2014.
  54. 54.
    Queensland Government. Queensland health response to Pacific Islander and Māori health needs assessment. Brisbane: Division of the Chief Health Officer; 2011.Google Scholar
  55. 55.
    Schiller JS, Lucas JW, Peregoy JA, et al. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. Vital Health Stat. 2012;10(256).Google Scholar
  56. 56.
    U.S. Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and obesity statistics. http://win.niddk.nih.gov/publications/PDFs/stat904z.pdf. Accessed Dec 1 2014.
  57. 57.
    Centers for Disease Control. Early release of selected estimates based on data from the 2011 National Health Interview Survey. http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201206_14.pdf. Accessed Dec 1 2014.
  58. 58.
    Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion (Division of Diabetes Translation). National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed Dec 1 2014.
  59. 59.
    Conroy SM, Lee AK, Pendleton L, et al. Burden of diabetes in California. Sacramento: Chronic Disease Control Branch, California Department of Public Health; 2014.Google Scholar
  60. 60.
    Karter AJ, Schillinger D, Adams AS, et al. Elevated rates of diabetes in Pacific Islanders and Asian subgroups. The diabetes study of Northern California (DISTANCE). Diabetes Care. 2013;36:574–9.CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Zimmet P. Epidemiology of diabetes and its macrovascular manifestations in Pacific populations: the medical effects of social progress. Diabetes Care. 1979;2:144–53.CrossRefPubMedGoogle Scholar
  62. 62.
    McCarty DJ, Zimmet P. Pacific island populations. In: Ekoé JM, Zimmet P, Williams R, editors. The epidemiology of diabetes mellitus: an international perspective. Chichester: Wiley; 2001. p. 239–45.CrossRefGoogle Scholar
  63. 63.
    Foliaki S, Pearce N. Prevalence and causes of diabetes in Pacific people. Pacific Health Dialog. 2003;10:90–8.PubMedGoogle Scholar
  64. 64.
    Keighley ED, McGarvey ST, Quested C, et al. Nutrition and health in modernizing Samoans: temporal trends and adaptive perspectives. In: Ohtsuka R, Ulijaszek SJ, editors. Health change in the Asia-Pacific region: biocultural and epidemiological approaches. Cambridge: Cambridge University Press; 2007. p. 147–91.CrossRefGoogle Scholar
  65. 65.
    Baker PT. Migration, genetics and the degenerative diseases of South Pacific islanders. In: Boyce A, editor. Migration and mobility. London: Taylor & Francis; 1984. p. 209–39.Google Scholar
  66. 66.
    McGarvey ST. Obesity in Samoans and a perspective on its etiology in Polynesians. Am J Clin Nutr. 1991;53:S1586–94.Google Scholar
  67. 67.
    Han Z, Heath SC, Shmulewitz D, et al. Candidate genes involved in cardiovascular risk factors by a family-based association study on the island of Kosrae, Federated States of Micronesia. Am J Med Genet. 2002;110:234–42.CrossRefPubMedGoogle Scholar
  68. 68.
    Hawley NL, Minster RL, Weeks DE, et al. Prevalence of adiposity and associated cardiometabolic risk factors in the Samoan genome-wide association study. Am J Hum Biol. 2014;26:491–501.CrossRefPubMedCentralPubMedGoogle Scholar
  69. 69.
    Hollis-Moffatt JE, Xu X, Dalbeth N, et al. A role for the urate transporter SLC2A9 gene in susceptibility to gout in New Zealand Maori, Pacific Island and Caucasian case-control sample sets. Arthritis Rheum. 2009;60:3485–92.CrossRefPubMedGoogle Scholar
  70. 70.
    Chan KH, Huang YT, Meng Q, et al. Shared molecular pathways and gene networks for cardiovascular disease and type 2 diabetes in women across diverse ethnicities. Circ Cardiovasc Genet. 2014; epub ahead of print.Google Scholar
  71. 71.
    McGarvey ST. The thrifty gene concept and adiposity studies in biological anthropology. J Polynesian Soc. 1994;103:29–42.Google Scholar
  72. 72.
    McMillen IC, MacLaughlin SM, Muhlhausler BS, et al. Developmental origins of adult health and disease: the role of periconceptional and foetal nutrition. Basic Clin Pharmacol Toxicol. 2008;102:82–9.CrossRefPubMedGoogle Scholar
  73. 73.
    Gluckman PD, Hanson MA, Cooper C, et al. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359:61–73.CrossRefPubMedCentralPubMedGoogle Scholar
  74. 74.
    Rozek LS, Dolinoy DC, Sartor MA. Epigenetics: relevance and implications for public health. Ann Rev Public Health. 2014;35:105–22.CrossRefGoogle Scholar
  75. 75.
    Ringrose H, Zimmet P. Nutrient intakes in an urbanized Micronesian population with high diabetes prevalence. Am J Clin Nutr. 1979;32:1334–41.PubMedGoogle Scholar
  76. 76.
    Brewis AA, McGarvey ST. Body image, body size, and Samoan ecological and individual modernization. Ecol Food Nutr. 2000;39:105–20.CrossRefGoogle Scholar
  77. 77.
    Pollock NJ. Cultural elaborations of obesity—fattening practices in Pacific societies. Asia Pacific J Clin Nutr. 1995;4:357–60.Google Scholar
  78. 78.
    Brewis A, McGarvey S, Jones J, et al. Perceptions of body size in Pacific Islanders. Int J Obes. 1998;22:185–9.CrossRefGoogle Scholar
  79. 79.
    Brewis AA, Wutich A, Falletta-Cowden A, et al. Body norms and fat stigma in global perspective. Curr Anthropol. 2011;52:269–76.CrossRefGoogle Scholar
  80. 80.
    Ricciardelli LA, McCabe MP, Mavoa H, et al. The pursuit of muscularity among adolescent boys in Fiji and Tonga. Body Image. 2007;4:361–71.CrossRefPubMedGoogle Scholar
  81. 81.
    Swami V, Knight D, Tovee MJ, et al. Preferences for female body size in Britain and the South Pacific. Body Image. 2007;4:210–23.Google Scholar
  82. 82.
    Williams LK, Ricciardelli LA, McCabe MP, et al. Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls. Body Image. 2006;3:275–87.CrossRefPubMedGoogle Scholar
  83. 83.
    Yates A, Edman J, Arguguete M. Ethnic differences in BMI and body/self-dissatisfaction among Whites, Asian subgroups, Pacific Islanders, and African-Americans. J Adolesc Health. 2004;34:300–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Teevale T. Body image and its relation to obesity for Pacific minority ethnic groups in New Zealand: a critical analysis. Pacific Health Dialog. 2011;17:33–52.PubMedGoogle Scholar
  85. 85.
    Hardin J. Everyday translation: health practitioners’ perspectives on obesity and metabolic disorders in Samoa. Critical Pub Health. 2014; epub ahead of print.Google Scholar
  86. 86.
    Wong V, Taoka S, Kuartei S, et al. Cancer in the republic of Palau (Belau). Pacific Health Dialog. 2004;11:64–9.PubMedGoogle Scholar
  87. 87.
    Capstick S, Norris P, Sopoaga F, et al. Relationships between health and culture in Polynesia—a review. Soc Sci Med. 2009;68:1341–8.CrossRefPubMedGoogle Scholar
  88. 88.
    Choi JY. Seeking health care: Marshallese migrants in Hawai’i. Ethnicity Health. 2008;13:73–92.CrossRefPubMedGoogle Scholar
  89. 89.
    Pacific Islands Forum Secretariat (PIFS) and Secretariat of the Pacific Community (SPC). Addressing inequalities: the case of small island developing states in the Pacific. 2012. www.worldwewant2015.org/fr/file/291977/download/316558. Accessed Dec 10 2014.
  90. 90.
    Abbot D, Pollard S. Hardship and Poverty in the Pacific. 2004. http://www.paddle.usp.ac.fj/collect/paddle/index/assoc/adb004.dir/doc.pdf. Accessed Dec 10 2014.
  91. 91.
    Binns C, Hokama T, Low WY. Island health: hope and challenges for pubic health. Asia Pacific J Public Health. 2010;22:19–24.CrossRefGoogle Scholar
  92. 92.
    Yamamoto TS, Sunguya BF, Shiao LW, et al. Migration of health workers in the Pacific Islands: a bottleneck to health development. Asia Pacific J Public Health. 2012;24:697–709.CrossRefGoogle Scholar
  93. 93.
    Health Services and Resource Administration. Designated health professional shortage areas. 2013. http://www.hrsa.gov/shortage/. Accessed Dec 12 2014.
  94. 94.
    Russell L. Issues to consider in discussion, debate and policy development. 2009. http://ussc.edu.au/s/media/docs/publications/0904_pacificislandspaper_russell.pdf. Accessed Dec 12 2014.
  95. 95.
    DePue J, Rosen R, Batts-Turner M, et al. Cultural translation of diabetes self-management interventions: the American Samoa experience. Am J Public Health. 2010;100:2085–93.CrossRefPubMedCentralPubMedGoogle Scholar
  96. 96.•
    DePue J, Dunsinger S, Seiden A, et al. Community health worker and nurse team improve diabetes control in American Samoa. Diabetes Care. 2013;36:1947–53. DePue et al. describe the implementation and efficacy of a community health worker intervention to address diabetes control in American Samoa. This is an important example of an efficacious secondary prevention strategy specifically adapted for this Pacific population. CrossRefPubMedCentralPubMedGoogle Scholar
  97. 97.
    DePue J, Rosen R, Seiden A, et al. Implementation of a culturally tailored diabetes intervention with community health workers in American Samoa. Diabetes Educator. 2013;39:757–67.CrossRefGoogle Scholar
  98. 98.•
    Snowdon W, Thow AM. Trade policy and obesity prevention: challenges and innovation in the Pacific Islands. Obes Rev. 2013;14:S150–8. Snowden and Thow review the opportunities for population-level NCD prevention using taxation and subsidies on food. CrossRefGoogle Scholar
  99. 99.
    Thow A, Swinburn B, Colagiuri S, et al. Trade and food policy: case studies from three Pacific Island Countries. Food Policy. 2010;35:556–64.CrossRefGoogle Scholar
  100. 100.
    Powell LM, Chaloupka FJ. Food prices and obesity: evidence and policy implications for taxes and subsidies. Milbank Q. 2009;87:229–57.CrossRefPubMedCentralPubMedGoogle Scholar
  101. 101.
    Thow AM, Jan S, Leeder S, et al. The effect of fiscal policy on diet, obesity and chronic disease: a systematic review. Bull World Health Organ. 2010;88:609–14.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Chronic Disease Epidemiology, School of Public HealthYale UniversityNew HavenUSA
  2. 2.International Health Institute, Department of Epidemiology, School of Public HealthBrown UniversityProvidenceUSA

Personalised recommendations