AN OVERVIEW OF OBESITY AND DIABETES IN THE DIVERSE POPULATIONS OF THE PACIFIC Background: Pacific Islanders (PI) have some May Okihiro, MD; Rosanne Harrigan, EdD, MS, APRN-Rx of the highest prevalence of obesity and type 2 diabetes in the world. Data related to PI are often reported as though the group is an INTRODUCTION prevalence of obesity and obesity-related aggregate; however, PI are a group of very diverse peoples. illnesses underscore the importance of The obesity epidemic is a significant understanding the problem of obesity, Objective: To explore the obesity problem in global public health issue. In the United its correlates and precursors, and the PI by: 1) characterizing the major ethnic States, the prevalence of overweight in health disparities experienced by Pacific groups in the Pacific; 2) describing the most children six to 19 years of age has Island peoples. recent US census data on PI and their recent immigration patterns; and 3) synthesizing the tripled in the last 20 years. Among There are several issues complicating literature on obesity in PI and type 2 diabetes adults, 65.1% are either overweight or our understanding of the health issues mellitus. obese; 30.4% are obese, and 4.1% and health disparities experienced by are extremely obese.1,2 Worldwide Pacific Island peoples. The first is the Methods: Census information and anthropo- there are more than one billion people term itself - Pacific Islanders. Data logic resources on the Pacific Islands and its peoples were obtained through an Internet who are overweight and one third of related to the health status of PI, 3 search. Literature on obesity, diabetes, and these are clinically obese. Closely including reports on the prevalence of body composition in PI were obtained through following this increase in obesity has obesity and diabetes are often presented a systematic analysis of citations listed on been a sharp rise in the prevalence of as though this group is an aggregate. Medline. type 2 diabetes, the most common Such aggregation implicitly homoge- Results: Pacific Islanders (PI) are diverse chronic disease associated with obesity. nizes these related but diverse people people, culturally, biologically, and linguisti- In 2002, 6%–8% of US adults had and creates an obstacle in itself to 4 cally. Polynesians and some Micronesians have diabetes. Pacific Islanders (PI) have understanding correlates of complex a very high prevalence of obesity and diabetes. some of the highest reported prevalence health issues such as obesity. Melanesians are among the most diverse of obesity and type 2 diabetes in the Another issue is that health data on ethnic groups in the world. Body mass index 5,6 (BMI) cut-point values for Polynesians may be world. PI is sparse. Many obesity studies on PI inaccurate. Pacific Islanders (PI) make up were conducted years ago and have not a small but increasing portion of the been updated. In addition, some Pacific Conclusions and Recommendations: The US population. Increasing numbers of Island groups, such as islanders of cause of obesity and diabetes in PI is unclear. PI are migrating to the United States as Nauru, have been studied extensively Some factors involved are related to urbaniza- tion and migration. Obesity research should well as to New Zealand and Australia. while others, such as the Melanesians, distinguish between island ethnicities and not According to the 2002 US Census have received little attention. aggregate all PI together. Research is needed to update, of the total US population of The overall aim of this review is to define body fat distribution of Polynesians in 288.4 million, 942,000 people reported explore the problem of obesity and relationship to obesity co-morbidities, to de- that they were Native Hawaiian or other diabetes in Pacific Island peoples. The termine normal growth of Polynesian children, 7 to determine the relationship between growth PI, an increase of 4% in just 2 years. three main objectives to achieve this are: abnormalities and adult obesity, and to de- The 2001 New Zealand Census re- 1) to characterize the major ethnic termine the impact of immigration on PI. (Ethn vealed that, of the total New Zealand groups in the Pacific within the three Dis. 2005;15 [suppl 5]:S5-71–S5-80) population of 3.7 million, 6.2% or geographic areas of Polynesia, Micro- 231,798 people reported being PI.8 nesia, and Melanesia; 2) to describe the Key Words: Diabetes, Ethnicity, Obesity, Pacific Islander Increasing PI out-migration, increased Pacific Island countries most closely modernization and urbanization of associated with the United States in Pacific Island countries, and the high the context of their current political relationship with the United States, the most recent US Census data, and the Address correspondence and reprint immigration patterns to the United From the Department of Pediatrics requests to May Okihiro, MD; Assistant States; and 3) to synthesize the literature (MO), Department of Complementary and Professor of Pediatrics; University of Ha- on obesity and type 2 diabetes mellitus Alternative Medicine (RH), University of waii, John A. Burns School of Medicine; Hawaii, John A. Burns School of Medicine; 651 Ilalo St; Honolulu, HI 96813; 808-235- in PI. The emphasis will be on Poly- Waianae Coast Comprehensive Health 9501; 808-692-1247; okihirom001@ nesians, including Native Hawaiians, Center (MO), Honolulu, Hawaii. hawaii.rr.com since many obesity studies on PI include Ethnicity & Disease, Volume 15, Autumn 2005 S5-71 PACIFIC ISLANDERS,OBESITY AND DIABETES - Okihiro and Harrigan Polynesians. Body composition studies on PI will be discussed in order to highlight the controversy about BMI cut-points for obesity in Polynesians. METHODS Sample Data were obtained using three methodologies. Census information and anthropologic resources on PI were found through an Internet search using the search terms Pacific Islander, ori- gins, pre-contact, migration, and Cen- sus. Information from reliable and verifiable sources was obtained through Internet web sites. Research literature Fig 1. Oceania, showing the geographic areas of Polynesia, Melanesia and relating to obesity and diabetes was Micronesia. Permission for reprint granted from Kirch PV. On the Road of the found by a Medline search of articles Winds: an Archeological History of the Pacific Islands before European Contact. Los through October 2004. Search terms Angeles, CA: The Regents of the University of California. 2000 used included obesity, overweight, body Analyses Melanesians.10 Although still common- composition, body mass index, diabetes, Search data were entered into a ma- ly used today, these groupings have lost Pacific Islander, Hawaii, Polynesia, trix and analyzed for thematic threads their historical importance as research Micronesia, Melanesia, and ethnic. using constant comparative analyses.9 has shown they obscure important The search was supplemented by man- Themes generated included ethnic genetic, linguistic, and cultural relation- ual searching of references from appro- groups in the Pacific, US-associated ships. The labels provide ‘‘geographical priate papers. Forty-four publications Pacific Islands, Pacific Islanders in the referents’’ but should not be used to were reviewed. United States, obesity in Polynesians, meaningfully subdivide segments of Native Hawaiians, body composition of cultural history. Inclusion and Exclusion Criteria Polynesians, BMI cut-points, Polyne- Studies show that Polynesian culture Studies that could be reviewed in sian children, Micronesian, and Mela- and language derived from a common their entirety were included; however, nesians. Findings related to each of ancestral root over a period of about studies that did not define obesity or these categories are described below. 2,500 years. Research in biological an- type 2 diabetes were excluded. Studies Epidemiologic population surveys con- thropology has supported the homoge- that did not distinguish among Pacific ducted in Pacific Island countries were neity of Polynesian populations; mor- Island ethnic groups were also generally used to identify prevalence of obesity phologic features of Polynesians excluded, since this assumes that differ- and diabetes. including large body size, and genetic ent ethnic groups have similar risks. features such as a characteristic nine- base-pair deletion in the mtDNA, are Methodological and Conceptual CHARACTERIZING THE found in extremely high frequency Issues MAJOR ETHNIC GROUPS IN throughout Polynesia.10 One of the challenges of reviewing THE PACIFIC WITHIN THE The islands of Polynesia are found and comparing this historical database THREE GEOGRAPHIC AREAS within a triangle formed by Hawaii to of articles is the changes in definitions of OF POLYNESIA, the north, New Zealand to the south- overweight, obesity and diabetes in MICRONESIA, AND west, and Easter Island to the southeast adults. The definition of overweight MELANESIA (Figure 1). Ethnographically Polynesia and obesity in children has also can be subdivided into two major changed recently from weight-for- In 1932, the French explorer Du- divisions, Western Polynesia including height percentiles to BMI percentiles mond d’Uruville divided indigenous Tonga, Samoa, Wallis, and Futuna and for age and sex. Definitions for each Pacific Islanders into the three racial Eastern Polynesia including the Cook study have been included. groups: Polynesians, Micronesians, and Islands, the Society Islands (Tahiti), the S5-72 Ethnicity & Disease, Volume 15, Autumn