Body size, body norms and some unintended consequences of obesity intervention in the Pacific islands

Abstract

Background: Pacific Islanders have experienced over 50 years of obesity interventions—the longest of any region in the world. Yet, obesity-related non-communicable diseases (NCDs) continue to rise. ‘Traditional’ body norms have been cited as barriers to these interventions.

Aim: In this study, we ask: ‘What is the relationship between health interventions, body norms and people’s experience of “fatness”? How – and why – have these changed over time?’ We study two nations with high rates of obesity: Nauru and Samoa.

Subjects and methods: Ethnographic fieldwork with people in everyday and clinical settings in Samoa (2011–2012; 2017) and Nauru (2010–2011).

Results: Body norms are not a single or universal set of values. Instead, multiple cultural influences—including global health, local community members and global media—interact to create a complex landscape of contradictory body norms.

Conclusions: Body norms and body size interventions exist in an iterative relationship. Our findings suggest that Pacific island obesity interventions do not fail because they conflict with local body norms; rather, they fail because they powerfully re-shape body norms in ways that confuse and counteract their intended purpose. Left unacknowledged, this appears to have (unintended) consequences for the success of anti-obesity interventions.

Keywords:

• Body norms
• obesity
• Pacific islands
• intervention
• social change

Notes

Ethics statement

Ethics approval for research and fieldwork in Nauru was granted by the University of Oxford’s Central University Research Ethics Committee (CUREC) and in Samoa was granted by the Brandeis University Institutional Review Board.

Acknowledgements

The authors are grateful to the people of the Pacific islands, particularly Nauru and Samoa, who informed the research in this paper through welcoming the researchers into their communities and generously sharing their lives and experiences.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Material from Samoa is selected from the author’s IRB approved research. Ethics approval for this research was granted by the Brandeis University Institutional Review Board. The proposal was also submitted to the Centre for Samoan Studies as the National University of Samoa. J.H. explained the research, risks and the ability of participants to refuse and withdraw at anytime. All clinic-based interviews included a signed consent form.

2 Some material in this paper is sourced from A.K.M.’s ethnographic research on Nauru. Ethics approval for the research was granted by the University of Oxford’s Central University Research Ethics Committee (CUREC) and people participated with a good understanding of the research intent. A.K.M. also carried out a thorough risk assessment for the School of Anthropology before commencing fieldwork, to identify and mitigate risks to both researcher and participant safety. Complete details are provided in McLennan (2013).

3 Pseudonyms are used throughout this paper in order to conceal identities.

4 Epidemiological surveys broadly support this; according to the 2007 WHO STEPS survey on Nauru, for example, BMI and waist circumference increase significantly between the 15–24 and 25–34 year age categories (p. 76).

Additional information

Funding

A.K.M.’s fieldwork in Nauru was supported by a John Monash Scholarship (General Sir John Monash Foundation, Australia) and a grant from St Edmund Hall (Oxford, UK). Fieldwork in Samoa was supported by the Wenner Gren Foundation, a Fulbright-Hays, Brandeis University and Pacific University.