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Exporting Obesity: Micronesia as a Microcosm

By Elise Green

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Changing diets and physical activity patterns are driving a nutrition transition across global populations.1 Amid such rapid change, the United States is culpable of exacerbating poor diets in developing nations. Urbanization, economic growth, technological change, and cultural shifts have led to decreased physical activity and increased consumption of fat, sugar, and processed foods.2 The 2017 Global Nutrition Report highlighted the interconnectedness of nutrition to several of the UN Sustainable Development Goals and, with over 2 billion overweight or obese adults and 41 million overweight children in 2016, the world is falling short of global nutrition targets.3 Through billions spent on foreign aid, free trade, and private-sector expansion into emerging global markets, the United States contributes significantly to skyrocketing obesity rates worldwide. Analyzing the U.S. role in the nutrition transition in Micronesia highlights the imperative for the United States to recognize the health consequences of globalization and take increased preventative and remedial action against obesity and diet-related diseases.

As the primary champion of Micronesian sovereignty and economic advancement, the United States exercises strong influence on over 2,000 Pacific islands. The 1945 United Nations Trust Territories of the Pacific Islands and 1986 Compact of Free Association (COFA) established the United States as a significant donor in Micronesia, namely in the Federated States of Micronesia (FSM), Palau, the Republic of the Marshall Islands (RMI), and the Mariana Islands. Today’s COFA, renewed in 2003, maintains grants to the FSM and RMI through the U.S. Department of the Interior’s Office of Insular Affairs. By the year 2023, the FSM and RMI will have received about $3.5 billion4 for advancing their economic self-sufficiency through building private- and public-sector capacity, with priority on education and health.5 Although that amount is dwarfed by U.S. grants to other developing nations, it nevertheless asserts U.S. authority in the region. Without this economic role in Micronesia, another power would likely supplant the United States6 or the islands would struggle to stay afloat.

While COFA promotes health through building capacity, infrastructure, and programs, the agreement has catalyzed a transition to nutrient-poor diets and a significant burden of diet- related diseases in Micronesia.7 The diplomatic partnerships fostered by COFA have facilitated an influx of U.S. commodities into Micronesia that, perhaps for the practicalities of shelf life and transportation, include many processed junk foods. Frozen turkey tails, which are deemed “inedible” in the United States because of their high fat percentage, slip into Micronesian markets where they are sold for under $1 a pound.8 Deprived of a comprehensive high school lunch program on Kosrae (FSM), students commonly consume a mixture of uncooked ramen noodles and powdered drink mix. Malnutrition, reduced agricultural activities, and increasingly sedentary lifestyles9 are key reasons why obesity rates reach 53.2 percent for adults in the FSM,10 and why raised blood glucose, high blood pressure, and obesity rank as the greatest risk factors for adult health in the RMI.11 Absent of health-conscious planning and obesity prevention measures, U.S. investments in Micronesia will continue to prove self-undermining by accentuating the transition to nutrient- poor, energy-dense foods.

Absent of health-conscious planning and obesity prevention measures, U.S. investments in Micronesia will continue to prove self- undermining by accentuating the transition to nutrient-poor, energy-dense foods.

As the world’s largest economy and the provider of the greatest sum of official development assistance, the United States is in a unique position either to perpetuate the obesity pandemic or take significant action against it. Because Micronesia exhibits the highest obesity rates in the world, relies overwhelmingly on the United States for development aid, and has a small population, the islands are an ideal region to implement, accelerate, and scale-up influential nutrition programs and policies. While the United States already provides some support to Micronesia, such as through the Centers for Disease Control and Prevention and the Peace Corps (ending in June 2018),12 the sharp increase in the islands’ obesity rates over the past 40 years shows that the United States can beef up its effort.13

In Micronesia, the United States should take action against obesity through nutrition-sensitive programs, fiscal policies, and research. The Children’s Healthy Living Program (CHLP), sponsored by the U.S. Department of Agriculture, includes steps for preventing child obesity and expanding existing research on nutrition in U.S.-affiliated Pacific Islands.14 CHLP and similar programs should be implemented and expanded, particularly if cultural sensitivity and collaborations with local stakeholders to promote community ownership, empowerment, and program sustainability can be included. Recognizing the inherent cultural differences between individual islands is important because, while the Micronesian islands share the Western Pacific Ocean, they have drastically different traditions, languages, and norms that may impact the success of a health program.

Additionally, social and development impact bonds and taxes on tobacco, sugar, and sweetened beverages, such as those that have proven successful in Mexico15 and Brazil,16 could help curb consumption in Micronesia while increasing government revenue for health initiatives. Furthermore, despite current and past research initiatives in the islands, the sheer lack of data to complete the country profiles within the 2017 Global Nutrition Report demonstrates the need for further investigative research efforts.

Because of U.S. leadership in Micronesia and in emerging economies more broadly, the onus is on the United States to reevaluate its foreign policies with a focus on dietary health. Especially with COFA expiring in 2023 and discussions of renewal already underway, Micronesia provides a practical opportunity to exhibit U.S. leadership through context-specific health programs, policies, and research. Beyond Micronesia, the United States should analyze its nutrition responsibility in other developing nations like Mexico, Brazil, and China. The U.S. role in the North American Free Trade Agreement, for instance, faces criticism for increasing high-fructose corn syrup exports to Mexico by more than 1,000 percent between 1996 and 2012.17 U.S. soda companies, additionally, have shifted their portfolios to increase revenue and calories per capita sold in Brazil and China,18 while obesity rates in those countries continue to soar. U.S. policies and private-sector expansion engender potentially costly and complex health consequences not only in Micronesia, but worldwide.

By scrutinizing the health impacts of its global presence, the United States can create an enabling environment to keep the global community on-track for achieving the UN’s Sustainable Development Goal of achieving food security and improved nutrition, and promoting sustainable agriculture. Worldwide, the diets of populations in developing countries are changing faster than existing health systems can accommodate, and an incessant expansion of obesity rates may impede economic progress. The United States needs to step up to the table and mitigate the detrimental effects of the nutrition transition.

Elise Green was an intern with the Global Health Policy Center at CSIS.

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