Introduction

As elsewhere in the Pacific, the population of the Cook Islands is characterized by the rapid increase of obesity, hypertension and type 2 diabetes, as well as profound out-migration across the past 40 years or so. Cook Islander migrations to New Zealand, and subsequently Australia, began in the 1950s, but have proceeded at such a rate that Cook Islander migrants now outnumber indigenes on the Cook Islands by about two to one (Ulijaszek 2005). The effects of economic modernization on blood pressure, body fatness and type 2 diabetes have been largely attributed to commonly measured risk factors, including dietary change associated with increased penetration of the world food system, and reduced physical activity associated with increased mechanization of life. Highly palatable and energy-dense foods are available, affordable and widely consumed in the Cook Islands (Ulijaszek 2002), and explanations invoking dietary change (Ulijaszek 2001a, 2002) and reductions in physical activity (Evans and Prior 1969; Ulijaszek 2001b) have been put forward for the high prevalence rates of obesity there.

In this chapter, trends in blood pressure, body size and diabetes status across recent decades are described for adult Cook Islanders living on Rarotonga, the most economically developed of the Cook Islands. Relationships between their blood pressure, body mass index (BMI) and fasting blood glucose are also described. These are then related to their diet, physical activity and different modernization factors in multiple regression models.