American Samoa has one of the highest obesity rates in the world and almost one third of the population has diabetes. This week we investigate this epidemic, and ask how it got so bad?
In the heart of the South Pacific Ocean, Samoa is one of the most remote islands in the world. I've arrived here from New Zealand, a 5-hour flight. Samoans are embracing every aspect of modern life, but there are consequences - and the Samoan islands now have some of the highest rates of obesity and diabetes in the world.
To start my investigation into what's happening, I've come to a weight-loss boot camp in Samoa's capital, Apia. It's being filmed for a local TV show called Samoa's Biggest Loser. Tavita is the heaviest contestant. He's a former taxi driver and is so obese his blood pressure is dangerously high, which is damaging his kidneys.
SIOELI (Translation): Tavita, you are the heaviest in the group. Why have you chosen to join us?
TAVITA (Translation): I need to change fast. I want to live longer. I’ve now got this opportunity for a second chance in life and I must take it.
WOMAN: You can do it, you can do it!
The contestants are doing a fitness test, where they have to run faster and faster. Despite his best efforts, Tavita is one of the first to drop out. His wife, Sarah, is here to support him.
TAVITA: As a taxi driver, every day I ate too much and I drank soft drinks and a lot of the wrong food.
Tavita tells me, until recently, he was drinking two litres of sugar-packed fizzy drink every day.
REPORTER: Do you worry about your health?
TAVITA: I’m so worried for my life because I know I’m too heavy. I’m so worried because I really love my wife and my kids and my family.
I want to find out what Tavita - and others on this island - have been eating that's making them so overweight. He's about to do his weekly shop.
REPORTER: This is exercise for you!
Tavita's got two types of food on his shopping list - first, locally grown veg for his weight-loss diet. Then, the food he and his family prefer - all imported.
REPORTER: So what kind of meat do you like to get?
TAVITA: Lamb flaps.
In the last few decades, mutton flaps - from New Zealand - have become a Samoan favourite.
REPORTER: There's lot of fat...
I've heard this cheap offcut of sheep belly is over 40% fat. They don't eat it in New Zealand - they use it as dog food.
REPORTER: This meat isn't sold in other countries. Did you know that?
TAVITA (Translation): Our people love eating these cuts of meat, even though some say they are just waste.
While Tavita pays, I notice an entire aisle of another favourite Samoan food...
REPORTER: So this corn beef has over 20% fat, which is over double what you would find in the same product in the UK.
A lot of tinned food gets sent to Samoa because it's so remote. That night, Tavita takes us to dinner at his dad's farm, where he grew up. For himself, Tavita's cooking his fat-free dish of vegies.
TAVITA (Translation): What I’m making is a curry soup.
For everyone else - including me - it's mutton flaps. Regular family gatherings accompanied by big meals are an important part of Samoan life.
REPORTER: Is it cheaper, or is it more expensive, to eat healthily?
SARAH (Translation): It’s much easier for us to eat healthy foods from our own land rather than the food we have to buy.
REPORTER: So if Samoans can survive off local produce, why do they eat so unhealthily?
SARAH (Translation): I think it’s a personal choice. You get to the point where you need something different.
They tell me local food is often seen as inferior to imported food. Tavita's got his work cut out if he wants to see his kids follow his new diet and eat vegies.
TAVITA (Translation): He does not like it.
REPORTER: Eating really fatty food can be quite dangerous. Do you worry about your children falling into the same trap that you fell into?
TAVITA (Translation): I feel for them because they are eating sickness. They are eating what I loved to eat before but I know it made me sick.
I want to know more about the problems obesity causes. In Samoa - which only has a population of 200,000 - they've had to set up a diabetic foot clinic. It's run by Helene Stehlin. A new patient has just come in for an appointment. We've been given permission to film, but she doesn't want to be identified. Like 1 in 5 people in Samoa, 41-year-old Annie has type 2 diabetes caused by obesity. The disease damages nerve endings and restricts blood flow. She can't feel her feet, and now her left foot has collapsed.
DR. HELENE STEHLIN: It’s probably not going to heal until she loses some more weight. So I’m going to use this disposable scalpel blade.
The wound's got worse since Annie's last appointment, and the flesh around it has started to die.
DR. HELENE STEHLIN: I take it back to where I think most of the dead tissue is gone. And the more you get rid of, the better it is for the healthy tissue to grow.
REPORTER: It's really hard to get my head around the fact that you are scraping away her flesh without any anaesthetic.
Another side effect of Annie's obesity is a condition called sleep apnoea.
REPORTER: I notice she's falling asleep...?
NURSE: As you gain weight, you also get poor sleep cycles, so it means their sleep is not very effective, so they fall asleep a lot easier throughout the day. They're operating on a chronic level of fatigue. It also causes brain damage as well.
REPORTER: She can't exercise 'cause she can't stand up 'cause her feet are bad 'cause of diabetes, so she can't lose the weight so she's getting worse - she's gaining weight. It's just...
NURSE: When someone's such a large weight, you might be swimming is a really good thing for her, but she can't swim because of her wounds. So what options does she have? They're very limited...
In the last 30 years, the number of Samoans with type 2 diabetes has risen dramatically.
DR. HELENE STEHLIN: So the singing you can hear is the funeral chapel for the hospital. Yeah. I guess we can shut the window for a bit.
NURSE: As lovely as it is.
Academic studies suggest Samoa's at risk of becoming one of the few countries where life expectancy is falling. The situation in Samoa is bad, but a short flight to the east, I've heard it's the worst in the world. American Samoa was colonised by the United States in 1900. 93% of adults here are overweight or obese. It's thought to be the fattest place on earth. I've been in contact with a maternity unit that treats obese pregnant women. I've arranged to meet one of their patients.
REPORTER: Hi, I'm Sophie.
LAURIE MAY: I'm Laurie May.
Laurie May helps run a Sunday school at a Mormon church. She's got type 2 diabetes. 1 in 3 people in American Samoa have the disease. I want to find out how it affects her - particularly now she's pregnant.
REPORTER: How pregnant are you?
LAURIE MAY: I'm 11 weeks, and I feel like it's been a year.
Doctors are telling Laurie May that, if she doesn't cut down on sugar, she risks losing her baby.
REPORTER: Have you changed your diet since you've had diabetes, then?
LAURIE MAY: Hmmmm. To be honest, I don’t think so… I don’t think so.
Diabetes is already affecting her eyes.
REPORTER: How's your eyesight, Laurie May?
LAURIE MAY: Gone. So I can’t see anything on this side. But this one I still have a little hope in it. I can see with this eye, but not a 100%. It’s just like I can say 50. Yeah.
After church, she invites me home for the family Sunday lunch.
REPORTER: Hello... What are you making?
SISTER: Turkey tails.
REPORTER: Turkey tails. I've heard a lot about turkey tails.
Turkey tails are the fattiest part of the bird - a gland that produces oil for feathers. They're imported from America, and are a firm favourite in Laurie May's family.
REPORTER: Do you eat vegetables?
LAURIE MAY: Before pregnancy I hardly did like if I see vegetables I’ll cry. I would literally cry if I look at veggies.
REPORTER: When you have your baby, do you think that you would want to feed him or her vegies?
LAURIE MAY: Oh, I guess with my experience I would love to make sure my baby knows not to go through what I went through at a very young age that I am right now, going through all this. Yeah.
REPORTER: 'Cause you're only 28, aren't you?
LAURIE MAY: Yeah, I'm only 28.
Laurie May saw her mother die young, at just 48. She had diabetes too, and died from a heart attack. Her dad, Colmani, also has diabetes. He now uses a wheelchair, and needs constant medication.
REPORTER: Have you changed your diet since you've been diagnosed with diabetes?
COLMANI: Sometimes but us Samoans enjoy eating food. I’m trying to, but it’s too late. After playing football or rugby I could come and take about 3 or 4 cans of soda at one time. I think that’s the problem.
REPORTER: So this is...? What's this?
SISTER: Stir-fried turkey tail.
Laurie May is meant to keep her blood-sugar levels under control for her baby's safety. But she's struggling to cut back on sweet drinks.
LAURIE MAY: Soda was my addiction. If I don’t want to eat as long as I have soda I’m good.
Because of the risks to her baby, Laurie May has to go for weekly medical check-ups. Her doctor's done a blood sugar test and, after Sunday's feast, I'm worried the results could be bad.
DR. FRANKEL CHIPONGIAN: And you don’t have any allergy to any medications?
LAURIE MAY: No.
She's seeing gynaecologist Dr Frankel Chipongian.
REPORTER: How are the results of the tests for her today?
DR. FRANKEL CHIPONGIAN: Hers is all fine, except for the blood sugar, which she knows she’s diabetic, so that’s a big problem actually.
REPORTER: How does the blood sugar affect the baby?
DR. FRANKEL CHIPONGIAN: Well, it affects both the mum and the baby. For the baby, 1) the worst scenario you can have - you can lose the pregnancy. Later on you can have what we call an intra-uterine death, the baby can die without you and me knowing it. The baby can grow so big to the point we might need to do a C-section from it.
REPORTER: In all honesty, have you not had any sugar since you've been pregnant?
LAURIE MAY: With candies and stuff, no, I haven’t. But I know I drink juice and fruits. So yeah, I do.
REPORTER: 'Cause yesterday at lunch, we had concentrate juice, which has lot got a lot of sugar in it.
LAURIE MAY: It was half water with that, so.. Yeah. That’s why, but I didn’t finish it. Alright, I’m going doctor.
REPORTER: I can't help but think that Laurie May might be not being totally honest about what she's eating. I think she's eating some sugar.
DR. FRANKEL CHIPONGIAN: Yeah. A lot of people are in denial, denial stage. I don’t know. Well, for me I learned it first-hand basis. My daughter is diabetic, so it’s really hard. It’s hard to know that at a younger age she has diabetes and she has to stick by what’s supposed to be done, but it’s really hard. It’s easier said than done.
The consequences of being in denial are extreme. The doctors tell me, if I want to get a sense of how bad things are, I should go to the morgue. Fagaalu's the mortician. He's been working here for 20 years. During that time, he's seen a huge change.
FAGAALU, MORTICIAN (Translation): This coffin in front of us is 3ft wide. That’s a very large coffin.
This 3-foot wide coffin can hold a body weighing up to 35 stone, but Fagaalu tells us, often the bodies coming through here are so big, a special coffin has to be made.
FAGAALU (Translation): A lot of the bigger bodies tend to be under 40 or 50 years old, very young indeed. Now I see the old burying their young. We need to go back to the old traditional ways. We are people of the land, we were built that way. That’s what made us strong.
I'm back in Samoa and heading to the diabetic foot clinic. They've got a new patient, Sina. She's not obese, but she's overweight, and she has type 2 diabetes. According to the World Health Organization, since 1980, the global percentage of people with diabetes has more than doubled to 9%. Sina has two dangerously infected wounds on her right foot. Helene has just taken a photograph of them.
DR. HELENE STEHLIN: Two separate on the surface, but underneath they’re tunnelling, that means they’re just sort of connecting with each other.
REPORTER: Wow. That is so deep. It looks really deep.
DR. HELENE STEHLIN: Yeah, yeah, it is, unfortunately, yeah.
If the doctors can't control the infection, they may have to amputate.
SINA: I’m worried because of my foot. I don’t want to take off my foot. Yeah.
Despite her situation, Sina doesn't seem to know exactly what diabetes is - or why she has it.
SINA: I really want to know what caused diabetes. I think it’s from food or..
REPORTER: You've got excess sugar in your blood. From eating.
SINA: Food. Okay.
DR. HELENE STEHLIN: Most of our diabetic clients were pretty much having to start from the beginning on education and getting them to be aware of nutrition.
The clinic walls are covered with government posters warning of the dangers of junk food. But despite her poor health, Sina's family bring her a plate of chips and mutton flaps for lunch.
REPORTER: Is it frustrating for you to see your patients sitting outside eating the foods that are on the warning posters inside the clinic to not eat?
DR. HELENE STEHLIN: Well, I told her off already. I said to her okay, that’s the last time you’re going to eat fries, you’re not allowed to eat fries.
In the next bed, a patient has had their foot removed after an infection started to spread. Helene's assistant is dressing the wound.
REPORTER: You know how cigarette packets have warning signs of, like, really horrible cancerous lungs or mouths or teeth or whatever - I feel like sweet packets should have warning signs of amputated feet...
ASSISTANT: That would be a really good one, but honestly, I don’t think Samoan people would look at it. They would just buy it and then eat it.
I'm curious to see how Tavita's getting on. He's back at The Biggest Loser TV boot camp.
ESERA POLIKO, TRAINER ‘SAMOA’S BIGGEST LOSER’: Let's go! Pain is only temporary. We all have pain. It's how you deal with that pain...
Esera Poliko is the fitness expert who'll be presenting the latest update on TV this week.
REPORTER: In your experience, how many people do actually keep the weight off once they've lost it?
ESERA POLIKO: Not very many. Less than 1% of people that participate in these sort of programs maintain the actual weight that they lose.
REPORTER: Only 1%? That's low! It's really low...
ESERA POLIKO: We need to find real purpose for doing things. Losing weight is a very artificial thing to do. The purpose is not real. You can't sustain it. After the eight weeks, it's going to all go back to normal.
Tavita realises the boot camp's just the start. He's made a life-changing decision. He's moving back to his family farm to live off the food he grows.
TAVITA (Translation): Here on the plantation you are constantly working and moving around which means I get to exercise and strengthen my body. The truth is, before I couldn’t even walk down here to the plantation, but now I can. My dream is to start a new plantation.
What's happening in the Samoan islands shows how obesity is no longer an issue that affects only wealthy countries. It's a global health crisis. A recent study estimated that, by 2025, around 1 in 5 adults on earth will be clinically obese.
19th September 2017