How paradise became the fattest place in the world

By Meera Senthilingam, for CNN

Updated 0944 GMT (1744 HKT) May 1, 2015

The Pacific islands are home to nine of the top 10 countries for obesity globally. Rates of obesity range from 35% to 50% in the region and one in five children are estimated to be obese.
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The Pacific islands are home to nine of the top 10 countries for obesity globally. Rates of obesity range from 35% to 50% in the region and one in five children are estimated to be obese.
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The obesity epidemic began with locals turning their backs on traditional diets of fresh fish and vegetables and replacing them with highly processed and energy-dense food such as white rice, flour, canned foods, processed meats and soft drinks imported from other countries. Pictured, a supermarket in Tonga.
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The obesity epidemic began with locals turning their backs on traditional diets of fresh fish and vegetables and replacing them with highly processed and energy-dense food such as white rice, flour, canned foods, processed meats and soft drinks imported from other countries. Pictured, a supermarket in Tonga.
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Once a source of their own food, fishermen are today selling their catch to buy large quantities of processed and canned foods, including canned tuna.
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Once a source of their own food, fishermen are today selling their catch to buy large quantities of processed and canned foods, including canned tuna.
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Increasingly sedentary lifestyles have aided the rise in obesity. Obesity is a risk factor for conditions including type II diabetes and diabetes rates have risen dramatically in the region, with almost half of the population diabetic in the Marshall Islands.
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Increasingly sedentary lifestyles have aided the rise in obesity. Obesity is a risk factor for conditions including type II diabetes and diabetes rates have risen dramatically in the region, with almost half of the population diabetic in the Marshall Islands.
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Physical activity was previously linked with work as people worked on plantations and took to the seas to catch fish. The idea of leisure-time activity is relatively new and is being promoted in new health policies.
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Physical activity was previously linked with work as people worked on plantations and took to the seas to catch fish. The idea of leisure-time activity is relatively new and is being promoted in new health policies.
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The beautiful Cook Islands are now the world's fattest country, with more than half the adults classified as obese.
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The beautiful Cook Islands are now the world's fattest country, with more than half the adults classified as obese.
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obesity on pacific islandsprocessed food and obesity in the Pacific islandspacific island fisherman paddle outpacific island obesitylack of exercise in the Pacific islandsRarotonga cook islands

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(CNN)They're remote and beautiful. A place many long to escape to for sun, sea and serenity. But the Pacific islands have another reality for the residents living there -- a life based on imported food, little exercise and remote access to healthcare.

The result? The most obese nations in the world.

'A deadly epidemic'

    "One third of the world is either overweight or obese right now," says Emmanuela Gakidou, professor of Global Health at the Institute for Health Metrics and Evaluation. Gakidou's recent paper used data from countries across the world to identify the global burden of obesity and trends seen in different populations. "The Pacific islands have a lot of countries with very high levels of obesity," she adds.
      Among the top 10 most obese countries or territories globally, nine are Pacific islands, according to the World Health Organization (WHO), making this paradise the fattest region of the world.
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      "Up to 95% of the adult population are overweight or obese in some countries," says Temo Waqanivalu, program officer with the WHO's Prevention of Non-communicable Diseases department. As a Fijian Native, Waqanivalu has worked on the issue for over a decade and seen the epidemic evolve first-hand, aided by the cultural acceptance of bigger bodies as beautiful. "In Polynesia the perception of 'big is beautiful' does exist," he says. "[But] big is beautiful, fat is not. That needs to get through."
      Percentages for obesity range from 35% to 50% throughout the islands, according to the WHO. The Cook Islands top the ranks with just over 50% of its population classified as obese.
      "It's a deadly epidemic," says Waqanivalu.

      Measuring up

      Obesity is measured through an individual's body mass index (BMI) and a measurement above 30kg/m² is defined as clinically obese.
      Pacific islanders tend to have a naturally big build, says Jonathan Shaw, associate director of Baker IDI Heart and Diabetes Institute, Australia. "With Pacific islanders, their frame is typically bigger," he explains, "but that still doesn't account for the obesity we see."
      Poor diets and reduced exercise have become a major public health concern for the region as they are not only a cause of obesity -- associated diseases are also rife, such as heart disease, stroke and diabetes, the latter of which has a known genetic basis among locals.
      "This is a population with a genetic predisposition and when exposed to Western lifestyles results in high rates of diabetes," says Shaw. "[This is] undoubtedly caused by high rates of obesity."
      The epidemic began through the tropical region turning its back on traditional diets of fresh fish and vegetables and replacing them with highly processed and energy-dense food such as white rice, flour, canned foods, processed meats and soft drinks imported from other countries. One of the root causes of the change is the price tag.
      "All over the world, poor quality and highly energy-dense food is the cheapest," says Shaw. As demand for healthier alternatives remain low, their market is small.
      This is exemplified by fishermen often selling the fish they catch to in turn purchase canned tuna. "[You] can buy a few meals with what you get selling fish," says Waqanivalu.
      The new food environment locals find themselves living in has accelerat