Diabetes Prevention in Marshall Islands in Their

Diabetes Prevention in Marshall Islands

In their 2001 article published in Health Education and Behavior, Cortes, Gittelson, Alfred, and Palafox presented the findings of their formative research conducted in the Marshall Islands concerning attitudes, beliefs, and statistics impacting the growth of diabetes in that population. The purpose of the study was to provide informed guidance in the development of a diabetes education and prevention program in the Marshall Islands. While the study was substantively enlightening and methodologically sound, some gaps in both substance and method call into question the viability of its practical implications.

The article was relatively thorough in its presentation of the background information justifying the study. It offered the necessary information concerning the rise of both obesity and diabetes in the general Marshallese population, and cited studies medically linking obesity and diabetes. However, more specific information on the causal relationship between diet, obesity, and diabetes may have been more effective in proving that a change in diet and attitudes concerning diet would have a long-lasting effect on diabetes prevention. For instance, the article separately states that both obesity and diabetes have increased in the Marshall Islands, that obesity is a known causal factor in the development of diabetes, and that dietary fat and preserved foods have increased in the Marshall Island diet concurrently with the rise in obesity and diabetes. However, it only implies that an increase in dietary fat and preserved foods contributes directly to diabetes; no studies addressing this specific link were presented. Additionally, an interesting paradox was presented in the article but not sufficiently addressed: that the increasing Westernization of the Marshall Islands has led to both a diet that encourages obesity and a cultural norm that discourages it. The authors do not address whether the changing societal view of obesity in the Marshall Islands has had any effect on the diet or the rise of diabetes.

The study suffered from one major methodological fault: the lack of quantitative data. While quantitative data was gathered concerning adult BMIs, and the frequency and methods with which some foods were prepared, most of the other data collected in the study and used as a basis for recommendations was qualitative. While the authors rightly noted that there has been a gap in scholarship concerning the role of belief systems and cultural norms in diabetes prevention, they did not sufficiently lay out the case that these factors are sufficient in and of themselves as a foundation for diabetes prevention -- an assumption that they seem to make in presenting their findings. In my opinion, a more thorough analysis of the nutritional profile of the Marshallese diet and lifestyle, including vitamin sufficiency, non-anecdotal lifestyle data, and a more in-depth medical profile of the typical Marshallese adult, would have provided the subsequent qualitative information with a more sound and informed foundation. Another gap that I found particularly troublesome given the study's findings was the lack of information regarding the beliefs and cultural attitudes of children. The study finds that children suffer from undernourishment and contradictory guidance from adults concerning food, but the authors did not gather any data concerning the attitudes of the children themselves towards food and health. Since diabetes seems to be appearing at younger and younger ages among the Marshallese, an informed view of the typical child's experience with and attitudes towards food may be an effective tool in formulating a prevention and education program.