Overweight in the Pacific: links between foreign dependence, global food trade, and obesity in the Federated States of Micronesia

Globalization and Health BioMed Central Research Open Access Overweight in the Pacific: links between foreign dependence, global food trade, and obesity in the Federated States of Micronesia Susan Cassels* Address: Center for Studies in Demography and Ecology, University of Washington, Box 353412, Seattle WA 98195, USA Email: Susan Cassels* - * Corresponding author Published: 11 July 2006 Globalization and Health 2006, 2:10 doi:10.1186/1744-8603-2-10 Received: 28 February 2006 Accepted: 11 July 2006 This article is available from: http://www.globalizationandhealth.com/content/2/1/10 © 2006 Cassels; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The Federated States of Micronesia (FSM) has received considerable attention for their alarming rates of overweight and obesity. On Kosrae, one of the four districts in the FSM, 88% of adults aged 20 or older are overweight (BMI > 25), 59% are obese (BMI > 30), and 24% are extremely obese (BMI > 35). Recent genetic studies in Kosrae have shown that obesity is a highly heritable trait, and more work is underway to identify obesity genes in humans. However, less attention has been given to potential social and developmental causes of obesity in the FSM. This paper outlines the long history of foreign rule and social change over the last 100 years, and suggests that a combination of dietary change influenced by foreigners, dependence on foreign aid, and the ease of global food trade contributed to poor diet and increased rates of obesity in Micronesia. The last section of the paper highlights the Pacific tuna trade as an example of how foreign dependence and global food trade exacerbates their obesity epidemic. 1. Background Obesity and overnutrition are becoming major global health issues. In 2000, the World Health Organization stated that overeating is the "fastest form of malnutrition", and estimates that the number of people worldwide that are overweight and malnourished equals the number of people that are underweight and malnourished, at 1.1 billion people [1]. Body Mass Index (BMI) is the most common measure of body fat; BMI equals an individual's weight in kilograms divided by their height in meters squared. Nearly one in three Americans is obese (BMI > 30) and obesity rates have risen steadily over the last 40 years, from 13.3% to 30.5%. While such growth is concerning, these rates are not the highest in the world. On the island of Kosrae, a district in the Federated States of Micronesia (FSM), 88% of adults aged 20 or older are overweight (BMI > 25), 59% are obese (BMI > 30), and 24% are extremely obese (BMI > 35) [2]. Kosrae has received international attention for their alarming rates of obesity and has become the keystone study site for trying to identify genetic causes of obesity [25]. A census of the entire adult population of Kosrae has recently been completed, which included individual DNA samples, individual-level data on height, weight, blood pressure, and glucose levels, as well as information about the identity and medical status of family members. The goal of this ongoing work is to establish the possible relationship of genetic variation to human obesity. However, these studies note that Kosraean's have not always been overweight, and hint that changes in lifestyle and environment on Kosrae were coincident with increases in obesity. Much less attention has been given to these possible fac- Page 1 of 8 (page number not for citation purposes) Globalization and Health 2006, 2:10 http://www.globalizationandhealth.com/content/2/1/10 tors of obesity in the FSM. Most likely, changing social and environmental context along with unlucky genes are the main causes of Micronesia's obesity epidemic. The objective of this paper is to highlight potential contextual causes of obesity in Micronesia, specifically how a combination of dietary change influenced by foreigners, dependence on foreign aid, and the ease of global food trade contributed to poor diet and increased rates of obesity in Micronesia. cially in the last fifty years, the population has been significantly influenced by the U.S., particularly in regards to diet. They have been and still are extraordinarily dependent on foreign nations for development and imported food. And finally, they are one of the most – if not the most – overweight populations in the world. Thus, Micronesia is an interesting place to study the links between foreign dependence, global food trade, dietary change, and obesity. Micronesia, a country comprising of more than 600 islands in the Central Western Pacific, has a long history of foreign influence and dependence. (See Figure 1 for a map of Micronesia). Spain was the first nation to colonize Micronesia; they arrived in 1886 and controlled the islands until Germany took over in 1899. The Japanese arrived 15 years later and built a thriving economy in Micronesia up until WWII. In 1945 the United States occupied the islands and soon became the "administering authority" of the U.N. Trust Territories of the Pacific Islands (i.e. Micronesia). The Federated States of Micronesia (FSM) did not become an independent nation until 1986. However, they continued to receive considerable aid from the U.S. through an agreement called the Compact of Free Association. Between 1986 and 2003, the FSM received US$1.5 billion in aid from the U.S. The Compact was renewed in 2004, and the FSM has been promised US$2.1 billion in aid and assistance over the next 20 years. Worldwide, developing nations have experienced dietary change associated with modernization and development. The next section is a review of these links. Following that section, the focus returns to the Pacific to identify the associations between dietary change, foreign influence and trade, and obesity in Micronesia, especially over the last fifty years. The last section of the paper details the Pacific tuna trade to highlight these links between global food trade, foreign dependence, diet and obesity in Micronesia. The state of the Pacific tuna industry contributes to Micronesia's increased reliance on imported food, unhealthy diet, and population health problems. Micronesia was isolated for a long time, but then experienced significant changes in the last hundred years. Espe- 2. Modernization and dietary change in developing countries Many have studied the role of modernization in dietary change and obesity in the developing world [6-10]. These studies have suggested that rapid changes in diets resulting from modernization (i.e. improved standards of living and continued development) and market globalization have had a significant impact on the nutritional status of populations. For instance, some work has show (...truncated)