The Teouma site, on Efate in central Vanuatu, was uncovered during quarrying in 2003 and has proved to be one of the most significant discoveries to date for the colonisation of Remote Oceania. Not only did it bring to light a fine assemblage of the famously diagnostic Lapita ceramics, but a cemetery of more than 25 individuals along with the pots. The skeletons offer an opportunity to investigate the origins of the ‘Lapita people’ who first appeared in the Bismarck archipelago around 3300 years ago and rapidly moved through island Melanesia and Western Polynesia over the next few centuries.

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.

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.” We sought to identify behaviors associated with measures of obesity in Vanuatu. We surveyed 534 adults from three islands varying in level of economic development. We measured height; weight; waist and hip circumferences; triceps, subscapular and suprailiac skinfolds; and percent body fat (%BF) by bioelectrical impedance. We assessed diet through 24-hour dietary recall and physical activity patterns using a survey. We calculated 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. 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. 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.

We conclude that Vanuatu is undergoing an uneven and rapid health transition resulting in increased prevalence of obesity, and that women are at greatest risk for developing obesity-related chronic diseases in urbanized areas 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.