Pacific islanders struggle with health-wrecking obesity

KOSRAE, Micronesia – Tadao Wakuk, traditionalist, looked forward to a down-home dinner this tropical evening. “We’re going to eat taro, with Kosraean soup – you know, fish, banana, coconut.”

As for his neighbors, the rest of Kosrae’s wide-bodied population, “this has become an island of turkey tail, corned beef, Spam,” the 60-year-old nature guide lamented. “They’re eating this imported stuff. They like fast food, and it’s making them sick.”

And, most of all, making them fat.

Mountainous and reef-ringed, Kosrae is a green dot in the blue mid-Pacific, a place where slender peaks reach to 2,000 feet, where skinny palms bend to the breeze, where sleek fish dart through the lagoons – and where the people have ballooned to a size that has won them headlines in international medical journals.

The World Health Organization warns of an “emerging epidemic” of diabetes, hypertension and other conditions associated with obesity in Kosrae and the rest of the Federated States of Micronesia. Meanwhile, villagers from this ramshackle, sleepy but beautiful island – it’s pronounced KOSH-rye – are flocking to the United States to find medical treatment on welfare.

A former U.S. territory, 2,900 miles southwest of Hawaii, Kosrae is hardly unique.

From Tuvalu to Tahiti, Pacific islanders have been putting on weight for decades as lifestyles and diets changed, and are generally recognized as the world’s fattest people. Almost two-thirds of adults on some islands are obese, by international standards, compared with one in three in the United States.

Studies by New York’s Rockefeller University have detailed the heavyweight status of adults among Kosrae’s 8,000 residents, finding more than half to be obese. A total of 82 percent are overweight. One in eight adults has diabetes.

The Rockefeller scientists are still studying causes, particularly genetic underpinnings of overeating, overweight and diabetes.

The woman in charge of noncommunicable diseases for the island’s health service is cautious about the “why” of Kosraean obesity. But “basically we eat a lot of food,” Dr. Vida Skilling said in an interview at Kosrae’s little hillside hospital.

“We eat servings that are two or three times what are served in the United States.”

The eating habits are on display in the aisles of Thurston’s general store, where the few shelves are packed with big cans of Crisco, corned beef and Spam (fat per serving: 140 of 180 calories), jars of mayonnaise, boxes of heavily sugared cereal, 50-pound sacks of rice, and no fresh vegetables.

“They like Spam, beans, peaches in the can,” said store clerk Ruth Arthy, 44. “They fry Spam slices, or mix it with canned spaghetti.”

A middle-aged man, severely obese, waddled up to her counter and slammed down two pounds of bacon. “I really don’t want to talk about it,” he said when a visitor brought up the subject of food. But 16-year-old taxi dispatcher Willis Siba, spilling over a chair in a corner of Thurston’s, wanted to.

“I’m eating too much. Rice and meat,” said the teenager, who carries 208 pounds on a 5-foot-6 frame. “I’ve got to exercise.”

Micronesians “have rice in the morning, at noon, and all day,” said the lean, fit Wakuk, who takes visitors on outrigger canoe tours and mountain hikes, and who tries to follow the old ways, growing taro, a root crop, and tending breadfruit trees, source of another nutritious staple.

Except for funeral feasts, however, few Kosraeans bother with such time-consuming foods anymore. Most want their meals preprocessed – though cheap. Frozen imported turkey tails, the extremely fatty rump of fowl that’s highly popular here, cost under $1 a pound.

Other factors further expand the Kosraean waistline. For one, more and more people have sedentary government office jobs in a tiny, stultified economy. For another, the only real road, a dirt strip almost encircling the flowery 42-square-mile island, was finally paved two years ago, encouraging more driving, less walking.

Dr. Livinson Taulung, hospital chief of staff, recalled that children used to walk miles to school. Old photos show a leaner, muscled look on Kosraeans a generation ago, he said.

But looking back can confuse that picture, too. French explorers who encountered Kosrae in 1824 recorded that the women had “a tendency to become fat.” In fact, islanders even today admire plump women, seen everywhere here in billowing big T-shirts over long skirts, with plastic flip-flops on their feet.

“In this society, people believe fat is beauty,” said nurse Matchugo Talley, the hospital’s chief of preventive services.

“Yes, it’s true,” said Delita Tilfas, who had brought her diabetic mother to the hospital for a checkup. “But I want to lose weight,” said the heavyset 30-year-old. She had seen enough of obesity’s ill effects.

Every two or three weeks, a Kosrae diabetic’s toe, foot or leg is amputated because of the disease’s depredations, Skilling said.

“Diabetes is the second- or third-leading cause of death on Kosrae,” Taulung said. “And it’s probably underreported. They die of something else – heart or kidney failure – and perhaps the underlying problem is diabetes.”

Some weight is being shed, slowly.

Kosraean-language radio and word of mouth are bringing islanders, especially women, together for exercise walking groups and afternoon volleyball. The hospital staff is circulating a model diet based on local foods – from reef fish and sea cucumber to papaya and breadfruit.

“I’m pleased to say the importer told me he’s selling 10 percent less turkey tail,” Skilling said.

Hard-pressed doctors and nurses know that much more needs to be done to monitor and treat diabetics, and to get the message out on obesity.

“I need help,” said Carston Talley, lone nurse-coordinator for noncommunicable diseases. “With more nurses, we could go door to door.”

Health officials propose adding two nurses and two coordinators to cover Kosrae’s four villages. But U.S. financial aid, vital since Micronesia gained independence in 1986, is shrinking under a renewed 20-year “compact of free association” with Washington. The needed funds may not be there.

Kosrae’s health dollars are so short that diabetics are not given individual devices to measure blood sugar at home, and the island has no dialysis unit to support failed kidneys, a common consequence of diabetes.

The compact allows Micronesians permanent entry into the United States, and “a good proportion moved to Honolulu and Seattle for kidney dialysis,” Skilling said. “They put themselves on welfare. In one village I know, 17 people left. Multiply that by four villages.”

Meanwhile, people worry about the next island generation. “It seems from school records, we have a high incidence of obesity among children,” Skilling said.

Wakuk, the old taro-eater, isn’t surprised. His children are growing impatient with eating like their ancestors.

“If we’re on the local food for a while, I hear it from my kids: ‘Dad, can’t we have something else?’”

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