Overhaul of policies in Tonga to combat obesity

Transcript

The Tongan government says it is overhauling its policies in a bid to deal with what it says is the biggest killer in the region - obesity.

The Global Burden of Disease Study shows half of the adult population in Tonga is obese, making it the most obese country in the world.

It also says half of the men in Tonga, and half of the women in Kiribati, Federated States of Micronesia, Tonga and Samoa are obese.

Mary Baines filed this report.

A University of Otago health and nutrition professor, Jim Mann, says the high rate of obesity in the Pacific is a crisis, and should be treated by governments as a dangerous epidemic.

JIM MANN: If one was dealing with a comparable epidemic of infectious disease, you'd have teams of people from the World Health Organisation coming in to try and see how we can deal with this problem and yet we are actually dealing with a problem that's every bit as great as an epidemic of infectious disease, it's just happening a little bit more slowly so it's not quite so obvious.

The chief executive officer for the Tonga Ministry of Health, Siale Akauola, says health issues caused by obesity are putting a huge strain on the public health system. Dr Akauola says Tonga only has the funds and resources to treat people who have non-communicable diseases in the early stages, and serious cases have to be referred overseas.

SIALE AKAUOLA: The final complications of non-communicable diseases, either you have renal failure where you need dialysis or where you have blockage of your coronary arteries, you need bypass surgery. We cannot provide [them] locally because they're very expensive, and even in the near future I don't think we will be in a good position to expand the services to have them available in Tonga.

A specialist anaesthetist at Auckland Hospital, Nigel Robertson, says obese patients in New Zealand could soon be asked to lose some weight before elective surgery. Dr Robertson says obesity is associated with conditions such as high-blood pressure, diabetes, heart disease and impairs breathing during sleep, which all increase risk at the time of surgery.

NIGEL ROBERSTON: We worry about airway management and breathing both during the operation and post-operatively. Positioning, trying to position a very large person who's unconscious for this surgery can be a major challenge. The recovery from surgery and anesthesia means that they may be more likely to have complications such as heart attacks, chest infections, wound infections and urinary tract infections.

The Tonga Civil Society chairman, Drew Havea, says economic pressure, reliance on imported food and a culture where being of a large size is seen as positive have all contributed to high obesity rates. Mr Havea says more emphasis needs to be put on encouraging healthy eating and exercise.

DREW HAVEA: There's a lot of work that still needs [to be] coordinated. From awareness to motivation to understanding our health, looking at taxing excess, looking at food policy, encouraging just living healthy.

The director of the Women and Children Crisis Centre in Tonga, Ofa Guttenbeil-Likiliki, says power and control in relationships is also a contributing factor to obesity. Ms Guttenbeil-Likiliki says recent research done by the centre shows 57% of women need to ask permission from their partners before seeking healthcare services.She says 87% of women need to tell their partners where they are going to be at all times before leaving the house, which may restrict them from doing exercise.She says data collected by Kau Mai Tonga, an organisation which sets up netball teams and tournaments around the country, shows many women do not take part because their husbands don't want them to.

OFA GUTTENBEIL-LIKILIKI: I think this is an area where we really need to buckle down and start looking at family relationships, relationships between intimate partners and this issue about power and control. How much power and how much control exists in relationships in Tonga and how is this affecting the physical status of women.

Ms Guttenbeil-Likiliki says 80% of food products sold in Tonga are imported, many of which are high in salt or fat. She says many families cannot afford fresh, locally grown produce.

OFA GUTTENBEIL-LIKILIKI: The average family cannot afford to eat fish more than once a fortnight, the average family cannot add vegetables to their daily meals because it's too expensive. So if we look at it that way in terms of the cost of living, of healthy foods, there's a huge issue in terms of food security as well.

Siale Akauola says the government is committed to turning the situation around. He says the ministry plans to appoint a secretariat, who will specifically monitor the outcomes of projects fighting obesity, alongside the Non-Communicable Diseases Committee. And he says different government ministries will be tasked with fighting issues related to obesity.

SIALE AKAUOLA: The Ministry of Agriculture will deal with food, the Ministry of Internal Affairs will deal with community participation, the Ministry of Education will deal with childhood obesity, will look at ways to support young people learn about good eating habits. The resources will be more efficiently utilised, cut across a whole lot of people. With that reform, we will slowly, slowly see improvement.

Dr Akauola says as a pilot, the government has increased tax on five unhealthy foods, including some fizzy drinks and sweets. He says it now knows it is not breaching trade agreements by increasing tax on those five foods, so is looking to apply the tax more widely. He says the Government also has in place a policy which means fast food cannot be sold near schools.