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

Abstract

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.

Ownership of consumer electronics is associated with measures of adiposity during health transition in Vanuatu

“…In 2007, TV viewing and radio listening were associated with less risk for obesity on the three islands sampled (Ambae, Aneityum, and Efate), an unexpected result compared to findings in other countries (Dancause et al, 2013). However, this study relied on estimates of total daily time spent watching TV and listening to radio.…”

“…Research conducted by the Binghamton University Health Transition Research Team has been utilizing a "natural experiment model" (Garruto, Little, James, & Brown, 1999) to study risk factors and impacts of chronic diseases. In 2007, an initial survey was conducted on the islands of Ambae, Aneityum, and Efate, revealing several behavioral factors for obesity (Dancause et al, 2013). Among them, TV viewing and radio listening were unexpectedly associated with less risk for obesity.…”

Impact of modernization on adult body composition on five islands of varying economic development in vanuatu

“…In 2007, the research team collected anthropometric measurements, and conducted an extensive behavioral survey of 1,140 males and females from infancy to adulthood on the islands of Ambae, a rural island with no tourism, Aneityum, a rural island frequently in contact with tourists, and Efate, an urban island and hub of tourist activity in Vanuatu, where the capital of Port Vila is located. Women demonstrated the highest prevalence of obesity on all islands, and on Efate in particular (Dancause et al, 2013). These behavioral risk factors are in turn associated with the reported high prevalence of obesity on Efate, the most modernized island in the sample (Dancause et al, 2013).…”

“…A more comprehensive understanding of health transition in the Pacific is needed, particularly in populations of Melanesian origin, which have been less extensively studied than populations of Polynesian origin (Curtis, 2003). What research has been done indicates that urbanizing Melanesian populations are at particular risk for increasing obesity (Dancause et al, 2013;Furusawa et al, 2010), although even small changes in diet and lifestyle may increase risk in rural populations (Dancause et al, 2013).…”

“…Research conducted by the Binghamton University Health Transition Research Team, utilizing a "natural experimental model" (Garruto et al, 1999) of economic development and its impacts on chronic disease risk (Dancause et al, 2011a), has established that Vanuatu is undergoing a rapid health transition as a result of modernization (Dancause et al, 2011a(Dancause et al, , 2011b(Dancause et al, , 2013. These behavioral risk factors are in turn associated with the reported high prevalence of obesity on Efate, the most modernized island in the sample (Dancause et al, 2013). Briefly, the results of this initial field survey demonstrated that economic development is associated with changes in behavioral risk factors for chronic disease, specifically those related to diet and physical activity, including increased consumption of simple carbohydrates and animal proteins, and increased sedentary activity (Dancause et al, 2011a).…”