Health, 2016, 8, 1616-1629
http://www.scirp.org/journal/health
ISSN Online: 1949-5005
ISSN Print: 1949-4998

Identifying Factors of Obesity in Papua New
Guinea: A Descriptive Study
Andrew Pus1, Michiko Moriyama2, Mariko Uno1, Md Moshiur Rahman2*
Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan1
2

How to cite this paper: Pus, A., Moriyama,
M., Uno, M. and Rahman, M.M. (2016)
Identifying Factors of Obesity in Papua New
Guinea: A Descriptive Study. Health, 8, 16161629.
http://dx.doi.org/10.4236/health.2016.814158
Received: September 12, 2016
Accepted: November 22, 2016
Published: November 25, 2016
Copyright © 2016 by authors andScientific Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access

Abstract
Obesity and overweight are complex phenomena due to causes and consequences asthese are the predisposing factors for developing lifestyle-related diseases. In the recent times, obesity and chronic diseases are being taken very seriously than everbefore. Once upon a time, obesity was considered as a problem only in developed
countries, now it is of a serious concern in low- and middle-income countries. In
Papua New Guinea (PNG), a few studies have been conducted on obesity-related
issues. However, there is not enough data on obesity to clearly understand about theleading contributing factors. Our research group designed this study to assess the influencing factors of obesity and as well as to identify the principal cause. It is a descriptive study, used structured and semi-structured interview and survey questionnaire. This study was conducted in the capital city of PNG, Port Moresby, and recruited 87 adults aged 30 - 50 years. According to interview and analysis findings, thecontributing factors of obesity are less physical movement, unhealthy diet, lifestyle,cultural value system, low education and social system. Government strategies andinitiatives are not strong enough to educate and motivate the community people.
This study suggests developing an effective coordination among all stakeholders toensure quality education and increase awareness to prevent obesity and its complications. The standard health policies and strategies are also recommended at the local,
national and international level with strong commitment.

Keywords
Obesity, Papua New Guinea, Factors, Cultural Value, Life Style

1. Introduction
Overweight (body max index (BMI) ≥ 25) or obesity (BMI ≥ 30) [1] has been a growing
DOI: 10.4236/health.2016.814158

November 25, 2016

A. Pus et al.

health issue in the world. The global obesity has dramatically changed between 1980
and 2013, with the proportion of adult obesity rising from 28.8% to 36.9% in men and29.8% to 38.0% in women [2]. According to World Health Organization (WHO) estimates, the worldwide prevalence is more than doubled between 1980 and 2014 [1].
Since 1980, the rate has elevated 3-fold or more in the Middle East, the Pacific Islands,
Australia and China [3]. The WHO also shows that obesity is increasing in the developing world at an alarming rate among the people who are of more than 115 million of
those suffering from obesity-related complications. By 2030, these disorders will be thenumber one cause of death among underprivileged people [3]. A recent study published in The Lancet found that now two-thirds of people with obesity live in developing countries [2]. Therefore, obesity is related more of a burden to developing than developed countries, and a significant public health concern.
The association between obesity and a series of adverse health outcomes are also remarkable. There are many studies, which attract the attention of health professionals
nationwide about obesity, that are highly associated with cardiovascular disease, diabetes mellitus, arthritis, high-risk pregnancy, some types of cancer, depression and increase mortality [4] [5] [6] [7]. WHO also alerts that in the future, the burden of obesityand diabetes will affect developing countries, and projected as the incidence of diabetes
run into hundreds of million within the next 2 decades [8]. About the interrelation between obesity and malnutrition, a group of researchers have stressed on the paradoxical
coexistence of adult obesity with childhood malnutrition [9]. So, the issue of malnutrition in childhood, whether acting as a predisposing factor to later obesity is difficult toevaluate due to the lack of future cohorts in developing countries. A serious attention isneeded sooner to halt the increasing prevalence of obesity in developing countries.
Overall, obesity reflects energy imbalance, closely related to dietary intake and energy
expenditure [10]. A recent Lancet series identified physical inactivity as a major contributor to death and disability [11]. The global growths in obesity prevalence, alongwith high mortality attributed to obesity, have led to forecasts of lowered future life expectancy [12]. As in developed countries, factors influencing obesity are mostly lifestyleor dietary [13] due to advance technology whereas in the developing countries obesity
is being influenced by transition and adaptation of western lifestyle by dwellers and therapid change of dietary pattern [14]. Media, economic boom, and high-tech related factor
are influencing obesity in developed countries [15], whereas in the developing countries, obesity is seen as a crossover issue at most. Over the last three decades, particularly in developing regions, several studies showed the similar results as obesity prevalence has been influenced by a sedentary lifestyle, demographic changes, geographic
patterns, socio-economic and environment factors [16] [17] [18] [19]. However, there
are not enough empirical researches conducted on the determinants of obesity in developing world. So, it is particularly important to identify the factors that influence theprevalence of obesity in developing countries.
In general, modernization of the lifestyle in Papua New Guinea (PNG) has taken placesince World War II [20]. Although in PNG, obesity does not have any valid statistics
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available, but it has been reported that obesity is also being influenced by nutritionaltransition [21] and urbanization or westernization [22] as a normal crossover producer
of developing countries. Even so, in PNG, most people use changes brought by so-called
western lifestyle as a platform to gain self-cultural ambition since the country is culturally oriented. Due to the tradition and type of cultural value or belief system of thecountry, people think as being tubby or overweight is healthy with a mentality that fat
people are rich or wealthy in the society.
In most studies, the main focuses were on one particular factor and tried to explain
how that factor contributed to obesity and missed identifying the foremost contributor
to obesity within the factors themselves. The purpose of this study is to examine thefactors contributing to obesity and identify the leading factor within all factors as being
the major cause of obesity in PNG.

2. Methods
2.1. Sample and Sampling
The samples were collected in Port Moresby, the capital city of PNG and the Suburbs.
As this is a descriptive study, the maximum possible numbers of samples were decided
based on the allocated research period. Theory-based and the snowball sampling waschosen. The researcher relied on his own established networks, and connections andselected a friend as the first subject, the friend introduced his or her friend to the researcher as the second subject, and the process continued until the targeted sample isreached to be considered that covered all kinds of population. The recruitment of theparticipants was done through the informal network. To achieve theoretical maturation, the study has aimed to interview up to 100 participants of age between 30 and 50,
male/female, single/married, living alone/living with family and friend, educated/uneducated, employed/unemployed, formal/informal, high/low income, city/rural of the four
regions (Highland, Momesa, Island and Southern) of PNG who are working and living
in Port Moresby and the Suburbs, and willing to participate in the survey. The reason
for setting age range was that obesity is usually an issue of working population, increases after 30 years old. Life expectancy of PNG is 60 years old for male and 65 forfemale [23]. In addition, the reasons for adopting this sampling method and choosing
the capital city are that people in PNG do not belong to companies and/or organizations, and community administrative system is not strong to reach them easily. Moreover, in the countryside, there are many tribes. Therefore, it is difficult to capture thepopulation smoothly.

2.2. Methods and the Contents of the Survey
This study used structured and semi-structured interview and survey questionnaire.
The interview was conducted one on one, and it takes about 30 to 60 minutes of theirtime during March to April 2014. The questionnaire was developed in August 2013 by
the researchers based on Pender’s Health Promotion Model [24], literatures review, andresearchers’ discussion regarding PNG culture and lifestyle. The questionnaire was1618

A. Pus et al.

tested with some selective participants in PNG through email communication before
finalization. With the specific feedback and recommendations, the questionnaire wasrevised. During the interview, noninvasive measurements including height, weight andabdominal circumference were chosen, and BMI was calculated to assess the magnitudeof overweight and obesity. Invasive measurements including blood sugar, cholesterol
and triglyceride were excluded because of the difficulty of taking blood sample. All factors were categorized into five main groups as environmental (working environment &stationary position, rural urban migration, diet information, residential area, obligation,family, social network, employment), behavioral (taste preference, food choice, eatingstyle, activity, substance intake, junk food, soft drinks), biological (gender and genes),
cultural value system (leader, wealth, gaining respect), and general thoughts about obesity and government policies, plus demographic data. Questions were formulated according to the factors.

2.3. Statistical Analyses
The contents were analyzed by descriptive statistics. The results from the semi-structured
interview were described, and the factors associated with obesity were extracted. Then,consideration was made through combining with descriptive statistics and the results of
the interview. The questions asking medical diagnosis and biological factors regarding
family history of obesity-related diseases were eliminated because of inaccuracy of thedata. In environmental factors, employer’s strategies related to health were very limited;
therefore, those answers were not analyzed. Additionally, all subjects reported that the
church doctrine forbid alcohol intake; as a result, the question category of alcohol-use
was not analyzed.

2.4. Ethical Consideration
Approval was obtained from the ethics committee of Hiroshima University, Japan. The
participants were advised that their involvement in the study was completely voluntary,and they may choose to withdraw at any time without fear of prejudice or penalty. The
survey was anonymously conducted with data collected from the participants are kept
strictly confidential and promised not to use outside of this study. After the information was compiled, the original demographic data and answers were sworn to be destroyed. The identity of the participants remained anonymous.

3. Results
During the research period, 87 subjects of the projected population were recruited andsuccessfully interviewed except one subject who withdrew before the completion due totime factors. Therefore, data from 86 subjects were valid and analyzed (valid response
rate: 98.9%). All subject interviewed was able to read the questionnaire by themselves.

3.1. Sample Description: Demographic Information
The demographic data of subjects are presented in Table 1. The table showed that there
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Table 1. Demographic characteristics of this study.
Items

N

%

GenderMale/Female

49/37

57.0/43.0

Age

Range 30 - 49

Mean ± SD

33.79 ± 2.72

Marital status

Single/Married

38/48

44.2/55.8

Living arrangements

Living alone

37

43.0

Living with family

48

55.8

Living with friends

1

1.2

Working status

Working/Not working

47/39

54.7/45.3

Types of job (N = 47)

Office

20

42.5

Field

1

2.1

Informal Sector

26

55.3

Below average

49

57.0

Average33

38.4

Above average

4

4.6

Grade 10 or lower

46

53.5

Grade 10 or above (11 & 12)

20

23.3

Diploma7

8.1

Bachelor Degree

13

15.1

Economic status

Educational qualification

Economic status: below average = around minimum wage (2000 PGK) per month,
average = around 6994 PGK, and above average = around 11,476 PGK per month

were more male (57.0%), married (55.8%), living with family (55.8), working (54.7%),
below-average-economic status (57.0%), and education of grade 10 or lower (53.5%)
subjects participated. Reflecting the country’s situation in this study, 45.3% of the subjects were not working. The subjects who were overweight (BMI ≥ 25) were 77 (89.5%).

3.2. Contributing Factors of Obesity
3.2.1. Environmental Factors
Table 2 includes physical activity. Since business activities are limited, most people
work in informal sectors (55.3%) such as selling betel nuts on streets, or as a taxi driverin PNG. Working environment is very different from developed countries. In 47 works,
the majority (76.6%) of subjects reported physical activity was very limited because ofjob pattern, for example, selling nuts in standing and/or sitting in the same place, andcommuting means was mostly automobiles because they felt danger walking outside.
Daily shopping is available in neighborhood; therefore, 68.6% of subjects reported byless walk.
3.2.2. Eating Style and Taste Preference (Table 3)
PNG’s eating habits and daily foods are also different from the developed countries.
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A. Pus et al.
Table 2. Environmental factors and physical activity patterns.
Items

N (%)

Physical involvement at work (N = 47)
Very often/often

11 (23.4)

Rarely2 (4.3)Not often/not at all

34 (72.3)

Means of going and returning from work (N = 47)
Walking

8 (17.0)

By bus/car/bike

39 (83.0)

By bicycle

0 (0.0)

Leisure time and body use (N = 86)
Working at the back yard

47 (54.7)

Watching TV

28 (32.6)

Doing nothing

10 (11.6)

Playing computer games

1 (1.2)Means of going for shopping
By car/bike/bus

21 (24.4)

Walking

59 (68.6)

Others6 (7.0)Involvement in physical exercise (yes)52 (60.4)

Type of exercise
Go for walk

47 (54.7)

Running

1 (1.2)Go playing

1 (1.2)Others3 (3.5)Afternoon walk habit (yes)80 (93.0)

Engagement in sports activities (yes)29 (33.7)

More than 80% reported that they ate when they felt hungry or at any time. Taste is difficult to assess. When showed structured categories in the questionnaire, 77.9% of subjects pointed high salt and fat taste. Including “very greasy”, more than 80% eat high-fat
food.
The daily food item is also limited, and most people eat chicken. Therefore, morethan 30% reported their favorite food as chicken and chips, which taken every day. Including “thrice/twice a week”, almost all subjects eat same food frequently. Quantity of
the food amount is also self-reported, and over 60% of subjects chose “average”.
Limited numbers of fast food restaurants are available in PNG. When we showed thecategories, 68.6% chose restaurant’s foodstuffs more than twice a week. Around 40% of
subjects chose “sleep” after overeating.
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A. Pus et al.
Table 3. Eating style and taste preference assessed in this study.
Items

N (%)

Eating style
Eat when feeling hungry

42 (48.8)

Eat any time

31 (36.0)

Eating thrice a day

13 (15.1)

Common dishes prepared at home (Family’s taste)
High salt & fats

67 (77.9)

Very greasy

5 (5.8)Low salt & less fat

11 (12.8)

Low fat

2 (2.3)Don’t know

1 (1.2)Chicken & chips

26 (30.2)

Lamb flaps

13 (15.1)

Beef stew

13 (15.1)

Lamp chops

9 (10.5)Fish

7 (8.1)Chicken stew

3 (3.5)

Favorite FoodPork

1 (1.2)Others14 (16.3)

Frequency of eating favorite foodEvery day34 (39.5)

Twice a week

44 (51.2)

Thrice a week

7 (8.1)

Not applicable1 (1.2)

Quantity of food eating daily
Average52 (60.5)

More food33 (38.4)

Less food

1 (1.2)Frequency of visit fast to food restaurant
Every day

23 (26.7)

Twice a week

33 (38.4)

Thrice a week

3 (3.5)Once a month

26 (30.2)

Not applicable1 (1.2)

Activity after overeating

1622

Go for walk40 (46.5)

Sleep

33 (38.4)

Watching TV

9 (10.5)

Do some work on computer

3 (3.5)

Others1 (1.2)

A. Pus et al.

3.2.3. Soft Drinks
Table 4 shows high consumption of soft drinks in PNG, most subjects (97.7%) reported
that they loved drinking soft drinks containing higher calories. Regarding the daily
consumption of soft drinks, 79.1% reported that they loved buying 500 ml of softdrinks, while only 10.5% took 350 ml. There are 1 liter and 1.5 liter soft drinks available
in PNG, but none of the subjects reported drinking of 1.5 liter. In PNG, the alternative
option of soft drink is very limited. Water at shops was not being purchased as frequently as Coca-Cola due to poor taste and people’s thoughts as buying water is wasting money.
Thirteen subjects of higher health consciousness reported that they took zero calorie
drinks. A custom to read the nutritional label on the soft drinks provided awareness ofthe high calorie; however, only 26.7% read it. The reason of this unread label was expressed differently. About half of them (46.5%) said that they could not read the nutritional label because they did not understand the meaning.
3.2.4. Cultural Value System (Table 5)
Cultural value system is one of the major influential factors of people’s behavior. The
98.8% of subjects evaluated a leader by their physical outfit, capital, knowledge/skills,
properties, and a good speaker. There are many reasons observed why a leader should
be big and strong in society, almost all subject said, “keeping the community in orderand peace”. Wealth is also related to body outfit. The majority (97.6%) answered that
fat and people with obesity are the symbols of wealth. It is very interesting that reasonsof becoming fat are being respected and felt beautiful. Oppositely, being skinny represents
less respected, powerless and discrimination such as being thought about having HIV/
AIDS. When asked a level of respect of a fatty person, 100% of subjects marked very
respectful or respectful.
Table 4. Drinking tendency of soft drinks observed in this study.
Items

N (%)

Types of soft drinks taken most of the time
Fanta/Pepsi/Coca-Cola/Sprite

84 (97.7)

Fruits juices

2 (2.3)

Amount of drinks per day (ml × times)
350 ml9 (10.5)500 ml68 (79.1)

1L

9 (10.5)

Knowledge of soft drink sugar content (yes)18 (20.9)

Take zero calories drinks (yes)13 (15.1)

Reading the nutritional label on the soft drinks (yes)23 (26.7)(Reason not reading nutritional level)
Never thought about this23 (26.7)

Read but don’t understand the nutritional content

40 (46.5)

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A. Pus et al.
Table 5. The influence of cultural value system estimated in this study.
Items

N (%)

LeaderInterpreting community leader
All of them (physical outfit, capital, knowledge/skills, properties,
public speaker)

85 (98.8)

Why need big and strong leader
Powerful man to control

2 (2.3)

Keeping community in order80 (93.0)

All of them (for community safety, protection against enemies,
powerful man to control, keeping community in order)

3 (3.5)

WealthWhy rich people are always fat in PNG
Showing wealth through body outfit

45 (52.3)

Fatness as a sign of richness

39 (45.3)

How rich person can be told
Properties owned

2 (2.3)All of them (by looking at their body, type of cloth worn,
capital power, properties owned)

83 (96.5)

Gaining respect

Why people want to become fat
Want to be respected

47 (54.7)

Want beautiful body38 (44.2)

Treatment of skinny people in PNG
All of them (less respected, discriminated, powerless,isolated, missing out on community events)

82 (95.3)

None of them

4 (4.7)

Zero and one scored answers were deleted.

3.2.5. General Thoughts about Obesity
Interesting discrepancy was found that although the subjects connected people withobesity to power, beauty, and attractiveness, they (95.3%) responded differently thatobesity was a health problem when asked. Moreover, the subjects could be able to list
the negative aspects of people with obesity (Table 6).
3.2.6. Government Strategies
When asked their government strategies regarding obesity, all subjects except one answered “no strategies conducted” and “no concern”. Subjects of 36.0% replied about thereason that obesity was generally accepted. Nevertheless, again 100% of subjects answered that health education regarding obesity is strongly needed in PNG.
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Table 6. General thoughts about obesity of the adult people of Papua New Guinea.
Item

N (%)

What can you say about fat people?
They are healthy

0 (0.0)

They look beautiful

62 (72.1)

They look attractive

24 (27.9)

They look strong and powerful

0 (0.0)Is obesity a health problem?
Yes

82 (95.3)No

4 (4.7)

Why is obesity a health problem? (n = 82)
Because it makes people grow old very fast

36 (43.9)

Because it reduces the life span of people

31 (37.8)

Because it puts people in danger of other life style disease

13 (15.9)

Because body fat makes people inactive in doing things

2 (2.4)

4. Discussion
In fact it is very difficult to conduct this research in PNG. The illiteracy rate (35.8%) of
this country is yet high as reported in 2015 [25]. We are lucky enough to get the people
who can read well and understand our questionnaire. However, it is still very difficult
to get suitable answers since the questionnaire was developed by the researchers fromdeveloped country. Even though a researcher from PNG is included in this study, weneed to know more about their culture and social systems. Our study result is limited toonly an urban city of PNG.
When we look at dietary facts in PNG, most people don’t have the specific time foreating. They like high-fat foods with high salt and very greasy. Some people even like tosleep after overeating. There is a limited choice of daily food items, and it is difficult tohave vegetables and many kinds of cooked dishes. Therefore, many people eat frequently chicken, lamb, beef and chips. Lack of proper knowledge is also a big issue in
PNG. They cannot easily understand the meaning of nutritional label and ignore toread it. Many people don’t know the right calorie intake and mal-effects of a large
amount of soft drinks and greasy food. They love soft drinks of high calories except a
few those like zero calorie drinks or bottle water. They think purchasing of a waterbottle is a kind of wastage of money. The eating and drinking habit is strongly rooted intheir culture and probably related to water safety. Since no government involvement isobserved, health education is mostly missing. This is the biggest part of unhealthy population.
Majority of the people in PNG noticed that they have limited physical activities dueto their traditional working environment. Most of the time they work in standing/or
sitting position at the same place. Lots of people mentioned that they don’t have enough
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recreational facilities and physical involvement at work. Their usual commuting modes
are automobiles except a few those like walking. They expressed their notions, as they
feel insecure to walk outside. Even people are not too much motivated to use the bicycle
to ensure physical movement also. In PNG, the social systems are not safe for outdoor
walking or cycling, and the working environment is reflecting different from developed
countries.
The cultural value system is the most influencing factor on people’s perception andbehavior in PNG. Mass people commented that a leader would be evaluated by physicalstrength and vocal capacity. They think the big and strong leader can keep the community in right order. The fat person is very much respectful in the society of PNG. The
perception regarding fat people is looking beautiful and attractive also. In contrast to
this concept, the skinny people in the society treated as less respected, discriminated,
powerless and isolated. Sometimes skinny people are toughened as having HIV/AIDS
and missing out from community events. However, there is a bit contradictory statement from this community. Although most of the people in PNG are in favor of obesity, at the same time, they also commented as obesity or overweight is a health problem.
It could be explained as it’s due to low literacy and knowledge gap.
There are several important limitations in our study. We couldn’t collect accurate
data regarding the family or genetic factors related to obesity. And we couldn’t include
samples from all corners of PNG due to geographical constraints and weak administrative system that limits wider reflection. In this study, we investigate the factors of obesity in PNG. Even though fewer statistics are available in PNG, as well as other developing countries, obesity-related chronic diseases are increasing [26]. Short life expectancy,
people describe “sodden death/unknown cause of death in 50 s” is assumed that undiagnosed cardiovascular diseases could be hidden. A number of studies revealed therelationship between obesity and developing chronic diseases [4] [5] [6] [27]. Ultimately,
increasing chronic diseases in PNG could be expected on the basis of overweight andobesity. However, as a multifactorial chronic disease, factors influencing obesity can beseen at a broader perspective with factor variation among developed and developing
countries.
Health policies are very weak and no standard strategies in PNG as like as the otherdeveloping countries. This is the biggest issue to improve the health system. Even so,
the church community is strong there. It is wise to use this community system for motivating the people with the necessary information. The Lancet series 2011 mentioned,“The obesity epidemic will be not reversed without government leadership” [28]. Highlevel political commitment, more national leadership from countries and the international organizations such as the United Nations will be essential to solve this greatchallenge of the global obesity and need to provide global leadership to develop thehealth policies and standard strategies [29].
In summary, the cultural value system is a giant influencing factor in PNG. The safety is a major issue because fights and conflicts are the daily stuff. In order to maintainsafety and peace, strong male leadership is requested. Therefore, safety and stability
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may relate to this issue. In addition, because of infectious diseases such as HIV/AIDs
are still a major health issue in PNG [30], people are afraid of being observed as having
those diseases, which also drives people being fat.

5. Recommendation
Further researches are needed to be conducted in the other parts of PNG, including rural area and involving a large number of samples. To increase health awareness, engaging with schools and churches, teaching might bring better combination of food habit
and study. Special attention needs to be given to the increasing prevalence of obesity indeveloping countries with some sort of preventive measures to reduce its complications. Nevertheless, the most important phenomena is education to raise public awareness with clear message that physical and mental strength is different from obesity.

Conflict of Interest
The authors declare that they have no conflicts of interest.

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