Fighting childhood obesity in Tonga: Creating supportive environments for kids to lead healthier lives

Clad in a red, white and black jersey, Ilifeleti Pongi is enthusiastically passing a rugby ball to and from his siblings and dad in Tonga’s capital of Nuku’alofa. Ilifeleti, 11 years old, is a young rugby star player in Tonga. While he admits that, at first, he didn’t really like rugby, he saw a game and thought it looked entertaining.

“My dad, all my uncles, and also including my dad's dad have been playing rugby,” says Ilifeleti. “Now I've been playing for two years.”

Ilifeleti hopes to become a professional rugby player when he grows up. To reach his goal, he makes sure he trains often. As he explains, “I practise from 3:00 PM on Monday to Thursday and then, on Friday, we have a competition.”

^{Ilifeleti, 11 years old, kicks a rugby ball during training. Photo: WHO/Renagi Taukarai}

For children and teenagers aged 5-17 years like Ilifeleti, the World Health Organization (WHO) recommends at least an average of 60 minutes per day of moderate-to-vigorous intensity of physical activity across the week. Unfortunately, not many children and adults are getting enough physical activity like Ilifeleti does.

Overweight and obesity in the Pacific

The Pacific is home to the most overweight and obese people in the world. Based on data from the WHO Global Health Observatory, Pacific island countries and areas (PICs) make up all of the top 10 countries with the highest prevalence of obesity among adults globally^[1] as well as the top 10 with the highest prevalence of overweight among children and adolescents aged 10 to 19 years old globally^[2].

Obesity at a young age sets children up to become obese when they grow up. This leads to an increased risk of developing noncommunicable diseases (NCDs) such as heart disease and stroke, type 2 diabetes, some cancers, and musculoskeletal disorders. The associated health complications can lead to disability and  premature deaths due to NCDs when they become adults. For children who are overweight or obese, the quality of life also diminishes. They can experience health issues like hypertension, difficulty breathing, insulin resistance, early signs of heart disease and psychological effects such as clinical depression, anxiety and other mental disorders.

But the obesity epidemic can’t simply be solved by imploring people to exercise more. Multiple factors are at play affecting why we are seeing rising cases of obesity among children and young people in the Pacific. The drivers of obesity are complex. Some of these factors include broader social, environmental and commercial factors, behavioural factors, biological factors, and demographics and socio-economic factors.

Healthy living starts at home

Children in the Pacific like Ilifeleti are exposed to various unhealthy choices, such as easy access to high-calorie and low-nutrient foods, limited access to affordable nutritious foods, aggressive marketing and advertisements of unhealthy foods and sugar sweetened beverages, and social and cultural norms in food preferences and serving sizes.

In Ilifeleti’s home country of Tonga, for example, there are long-established cultural traditions around feasting and beauty standards which see many people believe that ‘bigger is better’. In other Pacific island countries like low-lying Tuvalu and Kiribati, climate change and salt-water intrusion means that it is increasingly difficult to grow healthy and affordable food locally. Forced to rely on what arrives by boat, people face the choice between affordable but ultra-processed foods with low nutrient and high energy  and the limited amount of more expensive fresh produce which survives the weeks-long journey.

“I feel like I don't want to eat more junk food, but when there's no more rugby, I start to eat junk food, which is not good,” says the 11-year-old.

“The environment is affecting the children,” says Vao Pako Pongi, Ilifeleti’s dad.

That’s why Vao Pako strongly encouraged his son to eat healthy and get into sports. For him, parents have a big role in ensuring that their kids remain healthy.

“The parents need to support their children. If I don’t support my son, what’s he going to be in the next 5 to 10 years? Physical and mental health, and spiritual health too, that’s what I try to teach my children, to be a good example in the future when I'm gone,” adds Vao Pako.

^{Ilifeleti (centre) with his father and three siblings behind him. Photo: WHO/Renagi Taukarai}

Enabling environments that make healthy choice an easy choice

Creating enabling environments which makes it easy for people to make healthier choices is critical to decreasing the obesity burden in the Pacific. In Tonga, where over half of children and teenagers are estimated to be overweight, health leaders are cognizant of the important part they play to tackle the drivers of obesity in the country.

“NCDs are not just a health problem. It is a problem for the whole of society,” explains Dr Ana Akauola, then Acting Chief Executive Officer at the Tonga Ministry of Health.

Collaboration with other sectors is an important aspect of their work. Dr Akauola says, “In fact, this problem will have to be addressed from all aspects. But it would also need those in government and those who are in position to make policies and regulations, to be also on board so that we can try and make healthy eating [and lifestyle] an easy choice.”

“In Tonga, we have been leading in the Pacific in introducing policies such as the sin tax for sugary drinks. We work with Health Promoting Schools, Health Promoting Church partnership, and also the Health Promoting Workplace,” she adds.

These efforts are helping Tongan children like Ilifeleti make healthier choices for themselves so the risk of overweight and obesity can be reduced.

“I train a lot, eat less junk food and eat more vegetables,” he says. “I want to stay healthy and be strong.”