Overweight and diabetes in American Samoa: the cultural translation of research into health care practice.

The US territory of American Samoa is 2600 miles southwest of Hawaii, about halfway between Hawaii and New Zealand. The independent country of Samoa lies just to the west. Together they form an island chain populated by the same ethnic group of native Pacific islanders. Before World War II residents used subsistence farming and fishing; diabetes was rare. More recently, non-communicable chronic disease rates are rising in both adults and children. Increases and changes in dietary intake and reductions in physical activity, the “nutrition transition,” began in earnest in both Samoas after World War II. These changes, which were rapid from 1970 –2000, led to levels of overweight and type 2 diabetes, especially in American Samoa, the more economically developed of the two polities. Adults in American Samoa and Samoa now suffer from a high prevalence and 4-year incidence of overweight, obesity, type 2 diabetes, hypertension and lipidemia and temporal increases in each location. These levels are higher in American Samoa, with >80% of men and >90% of women overweight, based on Polynesian BMI standards, BMI> 26 kg/m. Type 2 diabetes has reached epidemic proportions in American Samoa. The prevalence rate among men aged 25 to 54 years in 1990 was 12.9%, 17.2% in 2002. Among women of the same age range, the prevalence rate doubled from 8.1% in 1990 to 16.7% in 2002. Type 2 diabetes prevalence rates among adults aged 18 to 74 years in 2002 were 21.6% and 18.0% in men and women, respectively. Socio-economic status (SES) plays a role. Samoans of higher SES in American Samoa have more favorable profiles of obesity and chronic disease risk We speculate this is due to higher SES individuals and families learning about overnutrition and health and having more access to high quality health care. We have much to learn about how non-Samoan foods are related to social prestige, from the earliest imported canned meats in the 19 century to fast-food today. These rapid changes in obesity and associated health conditions occurred so quickly that health care systems, communities, families and individuals have not readily responded. Concepts such as the health risks of obesity, patterns of body image favoring substantial body size, and the low awareness of the need for lifetime management of chronic conditions, facilitate obesity and obesity-related disease such as diabetes.