Sup. Name me the country with the highest obesity rate in the world.

What’s that, you said? “The USA”?

Congratulations, you correctly named the 18th highest country. But that wasn’t my question.

“The UK?”

Eww, an even worse guess… the UK sits in 43rd place.

I’m starting to realise that you have a slim chance of guessing where the real heavyweights are, so I’ll put you out of your misery. Surprisingly, of the 17 countries with higher obesity percentages than the United States, ten of them are Pacific Island nations, three are in the Caribbean, two are in the Middle East, one is in Central America, and one is in… Africa. (Yup, the continent so many want you to believe is filled only with starving people).

The International Monetary Fund (IMF) has a list of 36 countries that it considers to be “advanced economies”, and NONE of the 17 countries with higher obesity rates than the USA are on that IMF list. So if you thought that obesity is what happens when spoilt suburban kids in rich countries are allowed to eat pizza in their bedrooms while they play Xbox, well you’re right… but there are clearly other factors at play, too.

The consequences of obesity stretch well beyond the need for (or capacity of) elasticised pants. Obesity increases the risk of diabetes, heart disease, certain cancers, and results in shorter life expectancies. Indeed, 65% of the world’s population now lives in countries where overweight is killing more people than underweight. Obesity has become a significant problem in middle and lower income countries, and is therefore a public health challenge in countries that are trying to lift people out of extreme poverty. Because I love a catchy turn of phrase, think of it as being “overnourished” instead of undernourished.

Let’s take a look at some of the countries with surprisingly high obesity rates, and find out what’s going on here. I’ve numbered each country according to its obesity rank in this US Government data.

Unknown to the western world until 1722, American Samoa is a traditional Polynesian society that has been a US territory since 1899, and self-governing since 1967. The century of ties with the US has meant that plenty of American culture is present, and one of American Samoa’s most important exports (aside from tuna) is giant athletes who do very well in the NFL.

But the place that makes giant athletes has also been making giant non-athletes. American Samoa has the world’s highest obesity rate, with one local airline resorting to weighing each one of its passengers on scales, and making them pay according to their weight.

Fried foods and lavish family feasts are common throughout the Polynesian islands, and when combined with low levels of exercise, obesity commonly follows. American Samoa’s closer connections with a rich western country help to explain why its obesity rates are even higher than its island neighbours.

The American Samoan Government is actively trying to change the cultural habits that are behind this problem. Community exercise classes and education about diet and diabetes are also becoming more prevalent.

The only group of islands in the South Pacific to never be colonised by a western country, Tonga’s place this high on the list proves that it’s not just western occupation that causes obesity. Obesity is creating major problems in Tonga, with almost 20% of Tongan adults suffering from diabetes.

A diet heavy in carbohydrates (local root crops like taro, yam, and potato), fatty meat (“lamb flaps”, which are almost 50% fat, and fatty cuts of turkey, exported cheaply from North America), and packaged potato chips and sugary drinks (imported cheaply from Asia) prove that you don’t need a high income to overload yourself. 

Tonga is also famous for its church conferences, which are multi-day feasts of unbelievable proportions. I used to live in Tonga myself, and saw my 300 pound Tongan boss drop dead from a heart attack at his desk after lunch one day. At age 32, he left behind a wife and two young daughters.

While the local culture prizes fatness as a sign of wealth and beauty, the Tongan Government has been working hard to explain that these lifestyle choices are making people really sick. The Government has also introduced an “unhealthy choices” food tax, designed to reduce people’s hips by hitting them in the hip pocket.

Not a Pacific Island country at all, Kuwait is an Arab country in Western Asia, bordering Iraq and Saudi Arabia. Kuwait has had a turbulent history, with booms and busts based on trade and oil exports. Iraq invaded Kuwait in 1990, leading to the first Gulf War. The oil money that poured into Kuwait during the 20th century vastly improved the quality of life of its people, but it also triggered increased obesity.

Higher incomes meant cars when people previously walked, it meant being able to buy labour-saving devices, it meant being able to import high calorie food, and it meant that the amount that people ate was no longer limited by their budget. Ebba Al Hozairi, Assistant Professor of Medicine at Kuwait University, says that the rising level of obesity is “leading to a pandemic of diseases”.

The weather in Kuwait is often too hot for outdoor exercise during the day, and restaurants like McDonald’s and Burger King are much-loved by locals. Traditional Kuwaiti culture also compels people to eat, because if you eat less at someone’s house, you’re implying that you don’t like it, and that your host is not a good host.

While health education is taking place in the community, the high level of wealth has enabled the Kuwaiti response to its obesity crisis to have a different element than American Samoa’s; over 5,000 people in Kuwait had gastric bypass (stomach stapling) surgery in 2011. 

Far from the South Pacific and the Middle East, The Bahamas is situated just 100km (about 60 miles) off the Atlantic coast of Florida. A popular holiday destination for people from the USA, the Bahamas is also a hotspot for offshore banking, an industry which essentially aims to keep the tax and transparency of the world’s wealthiest individuals/companies at a minimum. 

In addition to being a haven for corporate fat cats, The Bahamas is also home to a lot of fat humans, with a 35% obesity rate amongst the population (which is predominantly of African origin). Almost half of deaths in the country are caused by diabetes or heart disease, both of which are closely linked to obesity. Women are significantly more likely to be obese than men, as are people on the more remote islands. 

The typical national dishes of peas and rice, macaroni and cheese, potato salad, corn, and plantain are all high in starchy carbohydrates, and contain stacks of calories. Unless someone on this type of diet is exercising regularly, the excess energy in the food is likely to be stored in the body as fat.

The Ministry of health is responding to the situation with education and awareness campaigns, healthy lifestyle seminars, public service announcements, and the creation of a Chronic Diseases Prescription Fund which will improve access to medications that help control the effects of obesity-related diseases.

Here’s the Africa one I promised you. Either the land of the pyramids is not following the healthy eating pyramid, or they think that the food pyramid is the same size as the iconic structures in Giza. Ok, that’s a bit harsh. I need to focus. With diabetes now affecting 11% of the Egyptian population, the obesity problem in the country isn’t really that funny.

While Egypt has recently experienced a period of political upheaval, the increased prevalence of fast food outlets has infiltrated local diets. Another issue in Egypt is misconceptions about exercise, with two thirds of the Egyptian population undertaking no exercise.

Giant, lower income cities like Cairo (20 million people) tend not to have a lot of public open space suitable for physical activity, adding to the challenge for the local people to strike the right balance in their lifestyles. The Egyptian Ministry of Health has recently launched a public education campaign on obesity, with large billboards carrying healthy eating and exercise messages.

Three of the five countries I’ve highlighted here are not high income places, yet their people are battling against obesity. Obesity-related diseases, early deaths, and the associated strain on under-resourced health systems and national budgets creates a genuine problem for developing countries. The bad news is that there isn’t a single country in the world that has managed to reduce its obesity rate over the past 30 years.