A Persistent Case of Diabetes Mellitus in Guam

By Amanda Ungco

Proud of their culture and successes, Americans have soaked up the American dream and have broadened their wings to influence the rest of the world. Many of these influences manifest themselves as good deeds, bringing students, volunteers and various charity organizations to third world countries in an attempt to better the universal quality of life. Americans in some ways hold themselves as the older brother taking care of other countries and underdeveloped areas that need the guiding hand of a gentle and loving older sibling.

The American influence however has not always been a positive one. Rising rates of obesity and chronic sedentary disease seem to have also been spread to various American territories. In the age of supersized fries and the infamous Big Gulp, Americans themselves seem to be growing as wide as their influence. This increase in chronic disease due to unhealthy lifestyle choices has been particularly prevalent in the American Territory of Guam.

The island of Guam has a rich history and culture dating back 4000 years. The original inhabitants and the natives to the island are known as Chamorros, but the island is now home to several other ethnicities as well, including Filipinos, Malaysians and Caucasians. The US gained control of the island in the Treaty of Paris ending the Spanish American War. Less than fifty years later, the Japanese invaded the island in December 1941. Until recent decades, the Chamorros enjoyed a diet mainly consistent of their native plants and fish from their surrounding waters. They survived largely through subsistence farming.

The end of the Second World War changed everything for the Chamorro diet and lifestyle. During the war, US soldiers were sent rations of processed meats and imported foods that were high in sodium and preservatives in order to make the long trip across the ocean. Along with the soldiers, the local people also began to eat the processed food. After the end of the war, the lives of Guam natives completely changed from subsistence farming to a wage based economy that spiked the reliance on imported food and goods (Kuberski & Bennet 1980).

Guam's climate is very hot and humid which has contributed to the sedentary lifestyle that many people in this region now lead. It is difficult, not to mention dangerous, for Chamorrods to exercise outside due to risk of overheating and heat stroke. As a result many individuals lead lifestyles of very low physical activity. The lack of exercise, abundance of unhealthy foods and Chamorros' genetic predisposition to type II diabetes is most certainly the creation of a perfect storm (Kuberski & Bennett 1980). In a normal healthy body, the pancreas produces insulin to break down sugars and carbohydrates to keep blood sugar levels even. Individuals with diabetes, however, have a condition in which the insulin is not being produced adequately enough or not at all. Insulin dependent diabetes mellitus, also known as Type I diabetes is genetic and requires patients to inject themselves with insulin regularly. Type II diabetes however can be onset by lifestyle habits. It is often onset by overweight individuals whose fat inhibits the reception of insulin to the target cells.

After a study done in 2009, only 41.9% of Chamorro citizens were considered to be normal weight, leaving 36.2 % and 21.9 % of the population to be overweight and obese respectively (Guerrero et al 2009). These rates have risen in tandem with American statistics of overweight individuals. However the main difference in the two statistics is that Chamorros are found to have more children and adolescents who suffer from these weight changes as well. These heavy gains have contributed significantly to the death toll that Guam faces; 60% of deaths in Guam were linked to poor lifestyle habits. Low activity and a diet rich in salt and fat laden foods are taking their toll. Sweetened beverages loaded with sugar also make up about 9% of Chamorros' dietary intake (Guerrero & Workman 2002). The spread of western culture to the people of Guam has been quite detrimental.

Children in particular have fallen victim to the spread of poor dietary habits in Guam, with even worse statistics than in America. A study was carried out in a middle school and high school and found that, alarmingly, 26% of middle school children in Guam eat fast food at least three times a week, 53.3% of students drink at least two cans of soda a day, and the most shocking: 75.3% of students have consumed less than one fruit or vegetable serving per day. Imagine an environment with no high school students biting into a juicy red apple or grabbing a banana for a rushed breakfast. None of the high school students surveyed had eaten the correct (FDA recommended) amount of five servings of fruits and vegetables a day and only 24.7% of students consumed any type of produce at all. What's more, only 37.7% of students have participated in strengthening exercises like weight lifting, pushups or sit-ups.

These lifestyle habits put Chamorro adolescents at high risk of a whole slew of chronic sedentary illnesses including type II diabetes--not something any young person wants to deal with. The scary part of adolescent diabetes and poor lifestyle habits is that these kids will grow up and continue to live in this way. Chronic exposure to poor health habits ensures these kids a life of health problems and chronic disease. The average age of individuals in Guam is only 18.9 years, younger than a majority of college kids, so the prevalence of lifestyle diseases among younger citizens is expected to escalate.

The onset of diabetes has been shown to begin earlier for Chamorros with the majority of diabetic inflicted individuals around the age of 45, over twenty years younger than the U.S. mainland average of 68 years old. Diabetes is the fourth leading cause of death in Guam and directly influences the first two causes--heart disease and stroke. Diabetes is also linked to blindness, kidney failure, and amputation among other unfortunate illnesses.

This disease places a huge financial strain on Chamorro healthcare especially because many individuals do not have private health insurance. The treatment of these chronic illnesses come from government funding and tax dollars. Although it would entail a significant starting investment, changes must be made to the Chamorro lifestyle in order to ensure a healthier, happier population in the future.

In an attempt to improve Chamorro lifestyle, small efforts have been made to improve diabetic health. As always, awareness has become the most successful and far-reaching resource thus far, educating adolescents and adults alike, in preventing and controlling diabetes. As highlighted by the Guam Diabetes Association there is awareness for the need of more healthy options in the school cafeterias and the implementation of physical education classes and sports in school to help fight this engrossing disease.

Although it may be rough waters now, programs that have been created in the last few years are being implemented into Chamorro society that in the future will lead to a healthier society and smooth sailing up ahead.

Author's Bio: Amanda Ungco is a rising sophomore at the University of Southern California majoring in Environmental Science and Health.

Editor's note: Scientific Research Diving at USC Dornsife is offered as part of an experiential summer program offered to undergraduate students of the USC Dana and David Dornsife College of Letters, Arts and Sciences through the Environmental Studies Program. This course takes place on location at the USC Wrigley Marine Science Center on Catalina Island and throughout Micronesia. Students investigate important environmental issues such as ecologically sustainable development, fisheries management, protected-area planning and assessment, and human health issues. During the course of the program, the student team will dive and collect data to support conservation and management strategies to protect the fragile coral reefs of Guam and Palau in Micronesia.

Instructors for the course include Jim Haw, Director of the Environmental Studies Program in USC Dornsife, Assistant Professor of Environmental Studies David Ginsburg, Lecturer Kristen Weiss, SCUBA instructor and volunteer in the USC Scientific Diving Program Tom Carr and USC Dive Safety Officer Gerry Smith of the USC Wrigley Institute for Environmental Studies.


Guerrero, Racheael T Leon, PhD, Yvette C. Paulino, PhD, and Suzanne P. Murphy, PhD. "Diet and Obesity among Chamorro and Filipino Adults on Guam."National Institues of Health. N.p., 19 Oct. 2009. Web.

LeonGuerrero, Rachael T., and Randall L. Workman. "Physical Activity and Nutritional Status of Adolescents on Guam." Pacific Health Dialogue. N.p., 2002. Web.

Kuberski, Timothy T., and Peter H. Bennett. "Diabetes Mellitus as an Emerging Public Health Problem on Guam." American Diabetes Association. N.p., Mar.-Apr. 1980. Web.

Pobocik, Rebecca S., PhD, Jennifer J. Richer, and Barbara K. O'Donnel, PhD. "Foods Most Frequently Consumed by Fifth Grade Children on Guam." Pacific Health Dialogue. N.p., n.d. Web.

Annette M., MD, Joel Marc C. Rubio, MD, Patrick S. Luces, Rose V. Zabala, MSW, and J Petter Roberto, MSW. "Getting the Patients' Perspective: A Survey of Diabetes Services on Guam." National Institues of Health. N.p., June 2010. Web.

Previously in this series:

The 2013 Guam and Palau Expedition Begins

A New Faculty Member on the Team

An Analysis of Sargassum Horneri Ecosystem Impact

Marine Protected Areas and Catalina Island: Conserve, Maintain and Enrich

Northern Elephant Seals: Increasing Population, Decreasing Biodiversity

The Relationship Between the Economy and Tourism on Catalina Island

Guam and Palau 2013: New Recruits and New Experiences

Bringing War to the "Island of Peace" - The Fight for the Preservation of Jeju-do

Dreading the Dredging: Military Buildup on Guam and Implications for Marine Biodiversity in Apra Harbor

Is the Commonwealth of the Northern Mariana Islands Doing Enough?

The Status of Fisheries in China: How deep will we have to dive to find the truth?

The Philippines and Spratly Islands: A Losing Battle

The Effects of Climate Change on Coral Reef Health

The Senkaku/Diaoyu Island Dispute in the East China Sea

The UNESCO World Heritage Site Selection Process

Before and After the Storm: The Impacts of Typhoon Bopha on Palauan Reefs

An interconnected environment and economy- Shark tourism in Palau

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