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Symposium: Beliefs, Power and the State of Nutrition: Integrating Social Science Perspectives...

Macro- and Microlevel Processes Affect Food Choice and Nutritional Status in The Republic of the Marshall Islands^1,2

Joel Gittelsohn³, Heather Haberle^*, Amy E. Vastine, William Dyckman and Neal A. Palafox

Center for Human Nutrition, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, ^* Treatment Research Institute, University of Pennsylvania, Philadelphia, PA and Department of Family Practice and Community Health, University of Hawaii, Honolulu, HI

³To whom correspondence should be addressed. E-mail: jgittels{at}jhsph.edu.

Despite its relative isolation from the world stage and lack of resources, the Marshall Islands serve as an example of the interaction between global political power, macroeconomic forces and local cultural factors. At the national level, patterns of food importation and government programs encourage the consumption of high fat foods. These factors have fostered dependency on Western foods and a loss of traditional food practices. Beliefs come into play as microlevel factors that influence food choice and aspects of lifestyle. Nearly three quarters of women are overweight or obese in this setting. Obesity in women is associated with greater age, higher education and more imported food consumption. Over a third of children ages 1–5 y are stunted, with stunting associated with worse economic status, less active feeding, increased consumption of imported foods and urban residence. What can be done at the microlevel is constrained by macrolevel factors of disempowerment. In this way, issues of power and belief are played out in the bodies of individuals.

KEY WORDS: • power • culture • diet • nutritional status • Micronesia

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