Of the Pacific Island nations, American Samoa had the highest national prevalence of diabetes in 2014, with over 30% of Samoan men and women affected, and the country is also the one where women have the highest mean body mass index (BMI) in the world, notes Stephen McGarvey, PhD, of Brown University, Providence, Rhode Island, an anthropologist with extensive research experience on Samoa, who contributed to both the Lancet papers on diabetes and obesity.

“The Samoans started early and went to very high levels…but there are some other nations, or even parts of nations, whose rate of change recently has [also] been very rapid,” Dr McGarvey observes in a press release from his institution.

Dr McGarvey cites the “nutrition transition” — a move away from traditional diet to a more Westernized diet characterized by high-calorie, high-fat processed and prepared foods — as playing a large role in what has happened in American Samoa and elsewhere in the developing world.

Also, modernization has meant travel by car and bus has replaced walking, and work has become less physically demanding and more sedentary, he adds.