As the Pacific struggles with obesity, its children are making the reasons clearer

By James C. Pearce

In 2024, the Pacific topped the world’s list of obese nations. Nine of the 10 fattest nations on earth were in the Pacific, with American Samoa at the top.

A year later, the problem has only gotten worse, affecting one of our most vulnerable groups: children. A Sept. 10 report by UNICEF found that there are more obese school-aged children than severely undernourished.

It is the first time in human history that a feat has ever been recorded. One-fifth of children aged 5-19 are overweight, and half are obese. The Pacific has the highest rates worldwide. A quarter of 5-9-year-olds and 10-14-year-olds in the Pacific are considered overweight, as are 18 percent of older teens.

Niue and the Cook Islands have the highest rates in the world. Nearly 40 percent of their 5-19-year-olds are obese.

UNICEF defines overweight as a body mass index that is one standard deviation above the World Health Organization’s median for healthy growth, and obese if it is more than two standard deviations above.

The WHO defines "overweight" as having a BMI equal to or over 25 and "obese" as equal to or over 30. While both are imperfect systems (they cannot account for muscle mass, for instance), they remain reliable indicators.

The Pacific’s weight struggles are attributed to a mix of biological, economic and social factors, but scientists are now understanding them better than ever.

High-calorie foods are a staple in the Pacific, where many people lead a more reclusive, low-energy lifestyle. Most children rarely eat fresh fruits and vegetables, and crucial proteins are often neglected. Highly processed foods have become a daily part of most children’s diets.

No single nutrient or food group is to blame, but items containing high proportions of refined wheat, sugar and vegetable oils are under the spotlight.

Highly processed foods, which are widely accessible and relatively inexpensive, are key culprits. Unhealthy foods are pushed heavily through advertising, while healthy foods are difficult to get and more expensive in the face of droughts, floods and rising seas.

Pacific island countries are heavily reliant on imported convenience food products, which contribute to diabetes and over a dozen types of cancer.

But other reasons are becoming clearer. In a survey of 20 poor and middle-income countries, UNICEF found that in 13, more than half of infants aged 6-23 months had consumed sweet drinks or sugary foods the day before. Ultra-processed foods are about 50 percent cheaper than fresh or minimally processed foods, according to the UN’s flagship report on food systems.

A 2024 global survey of large-scale school meal programs also found that 25 percent served processed meats, 21 percent served sweets, 19 percent served deep-fried food and 14 percent provided sugar-sweetened drinks.

Andrew Huberman, an associate professor at Stanford University, recently quipped, "Europeans eat dessert, but they eat it for dessert, not every meal."

Reversing this trend will require interventions from governments and international organizations. The options available are already being utilized, such as sugar tax, bans on advertising fast food and weight loss drugs. But these can only go so far and there are other problems in banning these foods or restricting access to them.

First, poorer countries are less well-equipped to deal with obesity. Yet, in poorer countries, obesity is also a middle-class problem (in rich countries, obesity is associated with poverty.

As incomes rise, more people become overweight. When in Rome, as they say. The Pacific culture also prizes size. Some of it is genetic, but much has to do with attitude, which can be hard to break because diet and size are also matters of personal choice and will.

Furthermore, the scientific and legal definitions of “ultra-processed foods” remain murky. The Nova classification allows no artificial ingredients, and the presence—regardless of the amount—of any chemical additive classifies a food as ultra-processed. This can lead to confusing health outcomes.

A recent Harvard University study found that some UPFs, such as sweetened drinks and processed meats, were associated with higher risks of heart disease, while others, like breakfast cereals, bread and yogurt, were linked to lower risks.

As for weight loss drugs, these are still very new, and the jury is still out. Developing them takes time and money. Access remains prohibitively expensive, and they are not a silver bullet, especially not for minors.

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