A recent health study which revealed that nine out of 10 countries with the most number of people obese people in the world are from the Pacific means "the notion of being big is beautiful" is no longer the case, RNZ's Tonga correspondent says.
The research published in The Lancet ranked American Samoa as the most obese nation in the world, followed by Tonga, which has the highest number of obese women.
According to the study, involving 1500 researchers worldwide, more than a billion people are living with obesity around the world, including about 880 million adults and 159 million children.
The study has found American Samoa, Samoa, Tonga, Tokelau, Tuvalu, Cook Islands, Niue, Nauru, Marshall Islands, and the Federated States of Micronesia are nations that have the highest rates of people who are overweight or obese.
RNZ's Tonga correspondent Kalafi Moala said obesity, and diseases related to it, has become "the number one killer among islanders".
Moala told First Up more than 80 percent of Tongan women over the age of 20 are living with obesity, which is up 23.3 percent from 1990.
"It's a major health threat that we're confronting here in the Pacific," he said.
"You know there was a time when the notion of being big is beautiful among Pacific islanders; it was an admirable notion," he said.
"In Tonga, for example, over 70 percent of deaths come from non communicable diseases, almost all obesity related."
"But in over three decades... obesity and diseases related to it has become the number one killer among islanders."
In the cook Islands, over 30 percent of children have obesity and official say the statistics are concerning.
Health secretary Bob Williams told Cook Islands News screening done last year for schools on Rarotonga and the Southern Group Islands mirrored the recent statistics.
Williams said sugary drinks and processed or unhealthy food were the main drivers of obesity.
Pasifika health leader and associate dean Pacific and a research director at Auckland University's medical school, Sir Collin Tukuitonga, said while the obesity figures were not new, the results for children were especially concerning, noting that "two-thirds of young Pacific girls are obese, overweight".
He said the problem is "difficult to tackle, and it's all to do with our food systems, how people are not as active as they used to be".
According to the World Obesity Federation, half of the world's population is on track to be obese or overweight in the next decade.