What is making Pacific islanders fat? Page 2

Dr. Livinson Taulung, hospital chief of staff, recalled that children used to walk miles to school. Old photos show a leaner, muscled look on Kosraeans a generation ago, he said.

But looking back can confuse that picture, too. French explorers who encountered Kosrae in 1824 recorded that the women had "a tendency to become fat." In fact, islanders even today admire plump women, seen everywhere here in billowing big T-shirts over long skirts, with plastic flip-flops on their feet.

"In this society, people believe fat is beauty," said nurse Matchugo Talley, the hospital's chief of preventive services.

"Yes, it's true," said Delita Tilfas, who had brought her diabetic mother to the hospital for a checkup. "But I want to lose weight," said the heavyset 30-year-old. She had seen enough of obesity's ill effects.

Every two or three weeks, a Kosrae diabetic's toe, foot or leg is amputated because of the disease's depredations, Skilling said.

"Diabetes is the second- or third-leading cause of death on Kosrae," Taulung said. "And it's probably underreported. They die of something else — heart or kidney failure — and perhaps the underlying problem is diabetes."

Some weight is being shed, slowly.

Kosraean-language radio and word of mouth are bringing islanders, especially women, together for exercise walking groups and afternoon volleyball. The hospital staff is circulating a model diet based on local foods — from reef fish and sea cucumber to papaya and breadfruit.

"I'm pleased to say the importer told me he's selling 10% less turkey tail," Skilling said.

"I don't eat turkey tails anymore," said teacher Leroy Ittu, 24, as he watched a volleyball match. But thus far he's lost only three of his 215 pounds.

Hard-pressed doctors and nurses know that much more needs to be done to monitor and treat diabetics, and to get the message out on obesity.

"I need help," said Carston Talley, lone nurse-coordinator for noncommunicable diseases. "With more nurses, we could go door to door."

Health officials propose adding two nurses and two coordinators to cover Kosrae's four villages. But U.S. financial aid, vital since Micronesia gained independence in 1986, is shrinking under a renewed 20-year "compact of free association" with Washington. The needed funds may not be there.

Kosrae's health dollars are so short that diabetics are not given individual devices to measure blood sugar at home, and the island has no dialysis unit to support failed kidneys, a common consequence of diabetes.

The compact allows Micronesians permanent entry into the United States, and "a good proportion moved to Honolulu and Seattle for kidney dialysis," Skilling said. "They put themselves on welfare. In one village I know, 17 people left. Multiply that by four villages."

Meanwhile, people worry about the next island generation. "It seems from school records, we have a high incidence of obesity among children," Skilling said.

Wakuk, the old taro-eater, isn't surprised. His children are growing impatient with eating like their ancestors.

"If we're on the local food for a while, I hear it from my kids: 'Dad, can't we have something else?'"

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