Endemic diabetes and obesity: a massive problem in the smallest country

Type Journal Article - BMJ
Title Endemic diabetes and obesity: a massive problem in the smallest country
Volume 340
Publication (Day/Month/Year) 2010
Page numbers c-c
Publisher British Medical Journal Publishing Group
URL https://www.bmj.com/content/340/sbmj.c2046
Can you envisage a time when having diabetes is normal, when most of the population are obese, and when because of this, life expectancy is among the lowest in the world?1 This isn?t a hypothetical situation on Nauru, the world?s smallest island republic, in the Micronesian South Pacific, where the island is only 21 square kilometres and flights arrive just twice a week.2 The indigenous Nauruan people have Micronesian, Melanesian, and Polynesian ancestry. The island remained undiscovered by Europeans until 1798,3 when it was named Pleasant Island because of its lush, green vegetation. Nauru was extensively mined for its natural phosphate reserves from the early 20th century onwards; it was also a base for Japanese soldiers during the second world war and prospered in the 1970s when the mining industry on the island was at its peak. The phosphate reserves have run out, however, and the prosperous period is over. Most foreigners have left, leaving behind a legacy of diet and lifestyle changes.

Ninety six per cent of Nauruan men and 93% of Nauruan women are overweight or obese, and more than 40% of adults have diabetes mellitus type 2.4 The mean body mass index is 31.6 kg/m2 for men and 32.3 kg/m2 for women, and is increasing 5; the normal range is between 18.5 and 25 kg/m2. This gives Nauru the world?s highest level of diabetes worldwide, and 78% of deaths are due to chronic diseases such as diabetes mellitus and kidney disease, or infections including measles and hepatitis B, with cardiovascular disease as the largest single cause.4 The top three causes of death in Nauru are coronary heart disease, stroke, and hypertension