WELLINGTON (AFP) — Glossy photographs in tourist brochures showing lean, fit and muscular Pacific islanders fishing with spears from canoes in azure lagoons and shimmying up coconut palms hide an ugly truth.
Pacific islands are in the midst of a crisis of obesity and its associated dangers of diabetes, strokes and heart disease.
A diet which used to be dominated by fish, root crops, green leaves, coconuts and fruit is now heavily reliant on fatty imported meats, rice, and sugar and fat-laden processed snack foods.
Many islanders are now urbanised and drive to the local shop to buy tins of corned beef, spam, cooking oil and rice instead of tending crops and gathering seafood in the lagoon and surrounding ocean.
"What we have in this country is a raging epidemic. We have 6,000 to 8,000 cases of diabetes out of a population of 53,000 people," says Carl Hacker, the Marshall Islands director of economic policy, planning and statistics.
"What is unfolding here is a physical disaster and a fiscal disaster," he told AFP.
The pattern is being repeated through the Pacific. World Health Organisation (WHO) figures show Pacific Island nations make up eight of the world's 10 most obese countries.
Nauru, once prosperous through exports of now nearly exhausted phosphate deposits, heads the list with 94.5 percent of people older than 15 defined as obese.
It also heads world tables for diabetes rates, which in Nauru is estimated to afflict as many as 45 percent of all adults.
Hospital wards from the Marshall Islands to Nauru and Tonga and throughout the region are bulging with patients suffering non-communicable diseases (NCDs) that are a direct result of obesity -- diabetes, stroke and heart disease.
Hacker says treating a single patient over the 15-30 year span of type two diabetes -- which usually strikes in adulthood and is caused by poor diet and inactivity -- can cost his poor country hundreds of thousands of dollars.
The symptoms of advanced diabetes include kidney failure, blindness and, in extreme cases, the amputation of limbs.
The cost of long-term rehabilitation for stroke victims is another huge burden, says Dr Jan Pryor, director of research at the Fiji School of Medicine.
"In the past it was unusual for anyone to have a stroke under 50, now people are having strokes in their 20s and 30s, you see it every day," he said.
The battle against bad health is hampered by the traditional perception of obesity as a sign of beauty and status in the Pacific Islands. In the past, traditional diets and lifestyle ensured that generally only senior chiefs and their families grew fat.
"When I was a child, there was less imported food, we would eat local food, which was high carbohydrate, low sugar and high fibre," says Dr Malokai Ake, chief medical officer for public health in Tonga.
"Usually we would only have pork or chicken on Sundays and fresh fish was a regular part of our diet along with other seafood. We would walk or ride on a horse to work in the plantations and spend a lot of time fishing, swimming or diving.
"The way we lived meant any excess calories were used up during the day. The amount of calories people have every day now, we used to only have on feast days."
Urbanisation means fewer people grow their own food or go fishing and in the Marshall Islands for example about 70 percent of the population of around 53,000 live on two crowded urban islands.
Population growth also means there is more pressure on natural resources, especially seafood.
The village of Votua, near Ba in the north of Fiji's main island of Viti Levu in January banned fishing in its traditional fishing grounds for five years to restore fish stocks.
Chief Ratu Pio Naulu was quoted by the Fiji Times saying that there had been a sharp decline in the number of fish in local water due to overfishing, including the use of dynamite.
The problem of obesity has been getting worse over the last 30 years and it is no longer confined to urban areas.
"Even if you go into a store in a remote village, you'll find shelves of spam and corned beef," says Pryor.
Researchers have suggested Pacific Islanders have a genetic disposition to obesity and its associated health problems. They say their metabolism has learned to cope over thousands of years with times of plenty and periods of famine by adapting to quickly store any surplus calories as fat.
But education about the importance of a healthy diet has been going on for 20 years among many island communities.
In Tonga, the late King Taufa'ahau Tupou, once renowned as the world's heaviest monarch, led attempts to improve the lifestyle of his subjects by taking up -- in his seventies -- regular bicycle rides up and down the runway of the country's international airport.
Education has not been enough however to curb the growth of obesity and most experts put this down to economics.
It's cheaper to buy fatty mutton flaps from New Zealand and Australia or turkey tails from the US than fresh local fish, or white rice rather than the local root crops.
"There is plenty of fresh fish in Tonga but fishermen have raised the price beyond the purchasing power of most people," Ake says.
Experts agree that governments in the region have to take the lead, coordinating a response through all their agencies and imposing "sin taxes" on unhealthy imports.
Some countries have tried banning some unhealthy imports. Fiji for example banned the importation of mutton flaps in 2000 and Samoa last year banned imports of turkey tails.
But most of the action has been piecemeal and many people just do not have access to cheap healthy food.
"Where is the leadership on these kinds of issues?" Hacker said.
"We have to have leadership to at least acknowledge these problems exist."
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