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Kosraens: an analysis of the fattest people on Earth From Tuvalu to Tahiti, Pacific islanders have been putting on weight for decades as lifestyles and diets changed, and are generally recognized as the world's fattest people. Almost two-thirds of adults on some islands are obese, by international standards, compared with one in three in the United States. Tadao Wakuk, a traditionalist, looked forward to a down-home dinner this tropical evening. "We're going to eat taro, fish soup, banana and coconut." But as for his neighbors, the rest of Kosrae's wide-bodied population, "this has become an island of turkey tail, corned beef, and Spam," lamented the 60-year-old nature guide. "They're eating this imported stuff. They like fast food, and it's making them sick." And, most of all, it's making them fat. A former U.S. territory, 2,900 miles southwest of Hawaii, Kosrae is hardly unique. Mountainous and reef-ringed, Kosrae is a green dot in the blue mid-Pacific, a place where slender peaks reach to 2,000 feet, where skinny palms bend to the breeze, where sleek fish dart through the lagoons and where the people have ballooned to a size that has won them headlines in international medical journals. The World Health Organization warns of an "emerging epidemic" of diabetes, hypertension and other conditions associated with obesity in Kosrae and the rest of the Federated States of Micronesia. Meanwhile, villagers from this ramshackle, sleepy but beautiful island are flocking to the United States to find medical treatment on welfare. Studies by New York's Rockefeller University have detailed the heavyweight status of adults among Kosrae's 8,000 residents, finding more than two-thirds to be obese. A total of 82 percent are overweight. One in eight adults has diabetes. The woman in charge of noncommunicable diseases for the island's health service is cautious about the "why" of Kosraean obesity. But "basically we eat a lot of food," Dr. Vida Skilling said in an interview at Kosrae's little hillside hospital. "We eat servings that are two or three times what are served in the United States." The eating habits are on display in the aisles of Thurston's general store, where the few shelves are packed with big cans of Crisco, corned beef and Spam, jars of mayonnaise, boxes of heavily sugared cereal, 50-pound sacks of rice, and no fresh vegetables. "They like Spam, pork 'n beans, peaches in the can," said store clerk Ruth Arthy, 44. "They fry Spam slices, or mix it with canned spaghetti." A middle-aged man, severely obese, waddled up to her counter and slammed down two pounds of bacon. "I really don't want to talk about it," he said when a visitor brought up the subject of food. But 16-year-old taxi dispatcher Willis Siba, spilling over a chair in a corner of Thurston's, wanted to. "I'm eating too much. Rice and meat," said the teenager, who carries 208 pounds on a 5-foot-6 frame. "I've got to exercise." Micronesians "have rice in the morning, at noon, and all day," said the lean, fit Wakuk, who takes visitors on outrigger canoe tours and mountain hikes, and who tries to follow the old ways, growing taro, a root crop, and tending breadfruit trees, source of another nutritious staple. But except for funeral ceremonies, few Kosraeans bother with such time-consuming foods anymore. Most want their meals preprocessed- fast and cheap. Frozen imported turkey tails, the extremely fatty rump of fowl that's highly popular here, cost under $1 a pound. Other factors further expand the Kosraean waistline. For one, more and more people have sedentary government office jobs in a tiny, stultified economy. For another, the only real road, a dirt strip almost encircling the flowery 42-square-mile island, was finally paved two years ago, encouraging more driving and less walking. Dr. Livinson Taulung, hospital chief of staff, recalled that children used to walk miles to school. Old photos show a leaner, muscled look on Kosraeans a generation ago, he said. But looking back can confuse that picture, too. French explorers who discovered Kosrae in 1824 recorded that the women had "a tendency to become fat." In fact, islanders even today admire plump women, seen everywhere here in billowing big T-shirts over long skirts, with plastic flip-flops on their feet. "In this society, people believe fat is beautiful," said nurse Matchugo Talley, the hospital's chief of preventive services. "Yes, it's true," said Delita Tilfas, who had brought her diabetic mother to the hospital for treatment. "But I want to lose weight," said the heavyset 30-year-old. She had seen enough of obesity's ill effects. Every two or three weeks, a Kosrae diabetic's toe, foot or leg is amputated because of the disease's depredations, Skilling said. "Diabetes is the second- or third-leading cause of death on Kosrae," Taulung said. "And it's probably underreported. They die of something else heart or kidney failure and perhaps the underlying problem is diabetes." But efforts are being made to change things. Kosraean-language radio and word of mouth are bringing islanders, especially women, together for exercise walking groups and afternoon volleyball. The hospital staff is circulating a model diet based on local foods from reef fish and sea cucumber to papaya and breadfruit. "I'm pleased to say the importer told me he's selling 10 percent less turkey tail," Skilling said. U.S. financial aid, vital since Micronesia gained independence in 1986, is shrinking under a renewed 20-year "compact of free association" with Washington. The needed funds may not be there. Kosrae's health dollars are so short that diabetics are not given individual devices to measure blood sugar at home, and the island has no dialysis unit to support failed kidneys, a common consequence of diabetes. But the "compact" gives Micronesians permanent visas to the United States, and a good number move to Honolulu or Seattle for kidney dialysis, signing up for welfare as soon as they arrive. And there may be no end in sight because there is already an alarming amount of obesity among Kosraean children. Dr. Cinque's comments: I think it's the Spam, the corned beef, and the fatty turkey tails that are doing this to the Kosraeans, although I realize that the low-carb crowd is going to say it's the rice. But if that were true, then the Chinese would be the fattest people on Earth, because they eat more rice than anybody. And the Japanese would be the second-fattest. Yet those two peoples are among the world's thinnest, and the Japanese are the longest lived. Don't get me wrong: I'm not here to glorify eating white rice. Obviously, it's a refined grain with little to offer besides starch. The very first vitamin (thiamine) was discovered early in the 20th century because of a deficiency disease (beriberi) that resulted from a diet heavily laden with white rice. So, I assure you, there is no chance of my becoming a spokesperson for Uncle Ben or Rice-a-roni. However, if the most fattening thing the Kosraeans ate was boiled white rice, believe me, they would not be obese. No way, no how. They'd have to boil the rice in lard for that to happen. E-mail to a friend Next Article |
