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Is Samoa's Obesity Epidemic A Harbinger For Other Developing Nations?

A view of the lush Samoan vegetation in American Samoa, Tutuila Island.
LCDR Eric Johnson
National Oceanic and Atmospheric Administration
A view of the lush Samoan vegetation in American Samoa, Tutuila Island.

The tiny Samoan islands have among the highest rates of obesity and Type 2 diabetes in the world — and diet and weight-related health issues have been rising in these Pacific nations since the 1970s. Now 1 in 3 residents of American Samoa suffers from diabetes.

Of course, the Samoan islands aren't the only countries coping with increasing rates of obesity and diabetes. A pair of studies published this month in The Lancet found that rates of diabetes all over the world have gone up by 4 percent since 1980. While about 100 million people around the world had diabetes in 1980, that number quadrupled by 2014.

In the Samoan islands, these trends have been especially pronounced. The average Samoan's weight has shot up — and health declined — so steeply that these islands have caught the attention of epidemiologists around the world.


Some researchers have speculated that genetics are a factor. But Stephen McGarvey, a co-author of the two Lancet papers and an epidemiologist at Brown University who has spent more than two decades working in the region, says what happened in the Samoas isn't so different from what's happening all over the world.

Unhealthy, imported foods flooded supermarkets and Samoans developed a taste for cheap fast food. And as these countries' economies modernized, more and more Samoans started working desk jobs. Cars and buses replaced walking.

Because the Samoas are so tiny, these economic and cultural changes took hold especially quickly. "What's happening there is really a harbinger for other parts of the world," McGarvey says.

We asked McGarvey to tell us a bit more about what's happening in the Samoas, and the lessons these islands can teach the rest of the wold.

The interview has been edited for length and clarity.

Interview Highlights

How has Samoan diet changed over the past 30 years?

Samoans used to — and still do — grow their own food. Their traditional diet consisted of mostly taro, breadfruit, coconut, bananas and seafood — very healthy stuff.

But more recently, on top of those foods, people started buying foods that were coming from the outside. And these foods tended to be lower-quality foods — they're cheaper and more calorific.

A large amount of frozen poultry started coming in from the North American and U.S. industries. At the same time, imported vegetable oil became more commonly and cheaply available. So there was this rise in the number of family-run establishments where you can buy some cheap fried chicken.

And [cheap, really fattycuts of] frozen lamb started coming in from New Zealand. [Other fatty offcuts, like turkey tails, also flooded in. It was more meat than Samoans were used to consuming.]

We hear about the same sort of thing happening in countries like India and Brazil, where economic changes and global trade have brought in unhealthy food.


These changes happened in the Samoas relatively quickly and penetrated rather rapidly because of their small population.

In a large place like India or Brazil, it takes a much longer time for people to be exposed to this new nutritional environment that results from globalization. And mind you, in many of these developing nations where obesity and Type 2 diabetes is becoming more of a problem, they are also still dealing with infectious diseases, maternal mortality. In some countries, while obesity is a problem in the richer, urban areas, undernourishment and malnourishment are problems among poorer, rural populations.

It's a much more complicated picture.

Are there any lessons that other countries can learn from Samoa?

Samoans, and the Samoan governments, now know that they've got a problem and they're working to fix it.

I think these countries where the obesity isn't as severe as it is in Samoa — yet — need to start recognizing that they still have a problem and start taking proactive steps to address it.

There has to be proper nutrition education in schools for children, but adults need to be educated about proper diet and exercise habits as well. And politicians need to get educated, so they can make smart policies around this health issue.

What are Samoans doing to address the problem?

They're still in the infancy of developing interventions that are well done from a scientific perspective. But they have tried a few things.

Mostly the authorities are thinking of how they can promote local agricultural production of South Pacific vegetables and fruits, and encourage more people to buy and them.

Any changes will take a while — it's just hard.

Poor people, people who are busy trying to feed everyone in their family and making ends meet, will be drawn to foods that are cheaper and are faster to buy or prepare.

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