Behavioral risk factors for obesity during health transition in Vanuatu, South Pacific.

UNLABELLED: The South Pacific archipelago of Vanuatu, like many developing countries, is currently experiencing a shift in disease burdens from infectious to chronic diseases with economic development. A rapid increase in obesity prevalence represents one component of this "health transition." OBJECTIVE: To identify behaviors associated with measures of obesity in Vanuatu. DESIGN AND METHODS: Five hundred and thirty four adults from three islands varying in level of economic development were surveyed. Height, weight, waist, and hip circumferences; triceps, subscapular and suprailiac skinfolds; and percent body fat (%BF) by bioelectrical impedance were measured. Diet through 24-h dietary recall and physical activity patterns using a survey were assessed. We analyzed prevalence of obesity and central obesity based on multiple indicators (body mass index, %BF, waist circumference, and waist-to-height ratio), and analyzed differences among islands and associations with behavioral patterns. RESULTS: Obesity prevalence was lowest among rural and highest among suburban participants. Prevalence of central obesity was particularly high among women (up to 73.9%), even in rural areas (ranging from 14.7 to 41.2% depending on the measure used). Heavier reliance on animal protein and incorporation of Western foods in the diet-specifically, tinned fish and instant noodles-was significantly associated with increased obesity risk. CONCLUSIONS: Even in rural areas where diets and lifestyles remain largely traditional, modest incorporation of Western foods in the diet can contribute to increased risk of obesity. Early prevention efforts are thus particularly important during health transition. Where public health resources are limited, education about dietary change could be the best target for prevention.

Patterns of childhood and adolescent overweight and obesity during health transition in Vanuatu.

OBJECTIVE: Rapid economic development and subsequent changes in lifestyle and disease burdens ('health transition') is associated with increasing prevalence of obesity among both adults and children. However, because of continued infectious diseases and undernutrition during the early stages of transition, monitoring childhood obesity has not been prioritized in many countries and the scope of the problem is unknown. Therefore we sought to characterize patterns of childhood overweight and obesity in an early transitional area, the South Pacific archipelago of Vanuatu. DESIGN: We completed an anthropometric survey among children from three islands with varying levels of economic development, from rural areas (where adult obesity prevalence is low) to urban areas (where adult obesity prevalence is high). SETTING: The islands of Ambae (rural), Aneityum (rural with tourism) and Efate (urban). SUBJECTS: Boys and girls (n 513) aged 6-17 years. RESULTS: Height-, weight- and BMI-for-age did not vary among islands, and prevalence of overweight/obesity based on BMI was low. However, girls from Aneityum - a rural island where the tourism industry increased rapidly after malaria eradication - had increased central adiposity compared with girls from the other islands. This is contrary to adult patterns, which indicate higher obesity prevalence in urban areas. Multiple factors might contribute, including stunting, biological responses after malaria control, sleeping patterns, diet and physical activity levels. CONCLUSIONS: Measures of central adiposity highlight an emerging obesity risk among girls in Vanuatu. The data highlight the synergistic relationship among infectious diseases, undernutrition and obesity during the early stages of health transition.

Behavioral changes associated with economic development in the South Pacific: health transition in Vanuatu.

UNLABELLED: Health patterns are changing in developing countries; as diet and activity patterns change with economic development, chronic disease prevalence increases, which is a characteristic of health transition. The islands of Vanuatu (South Pacific) have varying rates of economic development and provide a natural experimental model of health transition. OBJECTIVES: To characterize behavioral changes associated with modernization. METHODS: We surveyed 425 children and 559 adults on three islands varying in degree of economic development. We assessed diet (24-h dietary recall), physical activity (mode of transport, work activities, and recreation), substance use, and other behavioral patterns. RESULTS: Spending patterns and access to Western foods followed modernization gradients in our sample, whereas occupational patterns and ownership of technological goods were poor markers of modernization. With increasing economic development, participants consumed more animal proteins and simple carbohydrates. Physical activity levels were high; most participants were active in gardening, and sports were popular, especially in urban areas. However, urban participants spent more time in sedentary recreation. Men's use of alcohol and tobacco increased with economic development, but we observed marked differences in substance use patterns between two rural islands-one with and one without tourism. CONCLUSIONS: Economic development in Vanuatu is accompanied by nutrition transition and increased sedentary recreation, although physical activity levels remain high. Differences in substance use patterns between rural islands with and without tourism indicate a need for more research in rural areas. These findings might inform research in other communities in the early stages of health transition.

Relationships between body size and percent body fat among Melanesians in Vanuatu.

Obesity is a global epidemic, and measures to define it must be appropriate for diverse populations for accurate assessment of worldwide risk. Obesity refers to excess body fatness, but is more commonly defined by body mass index (BMI). Body composition varies among populations: Asians have higher percent body fat (%BF), and Pacific Islanders lower %BF at a given BMI compared to Europeans. Many researchers thus propose higher BMI cut-off points for obesity among Pacific Islanders and lower cut-offs for Asians. Because of the great genetic diversity in the Asia-Pacific region, more studies analyzing associations between BMI and %BF among diverse populations remain necessary. We measured height; weight; tricep, subscapular, and suprailiac skinfolds; waist and hip circumference; and %BF by bioelectrical impedance among 546 adult Melanesians from Vanuatu in the South Pacific. We analyzed relationships among anthropometric measurements and compared them to measurements from other populations in the Asia-Pacific region. BMI was a relatively good predictor of %BF among our sample. Based on regression analyses, the BMI value associated with obesity defined by %BF (>25% for men, >35% for women) at age 40 was 27.9 for men and 27.8 for women. This indicates a need for a more nuanced definition of obesity than provided by the common BMI cut-off value of 30. Rather than using population-specific cut-offs for Pacific Islanders, we suggest the World Health Organization's public health action cut-off points (23, 27.5, 32.5, 37.5), which enhance the precision of assessments of population-wide obesity burdens while still allowing for international comparison.