Polynesia • Samoa • Tonga • Tuvalu • Cook Islands
The Cook Islands face a severe burden of obesity and diet-related noncommunicable disease, but they also retain a diverse taro heritage and a national food-and-nutrition policy that can support recovery. The central challenge is to make nourishing local foods and safe water easier to obtain than heavily marketed products high in added sugar, sodium and refined starch.
Key takeawaysThe country has conducted repeated WHO STEPS surveillance, including a 2022 survey; quantitative claims should identify the specific survey and year.Taro is the most important starchy staple, with more than 20 cultivated varieties reported by FAO.The national Food and Nutrition Policy aims to create environments that support healthy diets and prevent further increases in overweight and obesity.Geography, tourism, freight, employment and colonial-era social change all shape the modern food environment; individual blame is not an adequate explanation.
The Cook Islands comprise volcanic islands and raised or low-lying atolls spread across a large ocean area. Rarotonga contains most of the resident population and commercial activity, while outer islands face different transport, water, agricultural and health-service constraints. A national strategy must therefore be flexible: what works for a supermarket and school on Rarotonga may not fit a northern atoll dependent on irregular freight and locally maintained crop varieties.
WHO’s Cook Islands surveillance page lists STEPS surveys for 2003–2004, 2013–2015 and 2022. Repeated surveillance is a major asset because it permits trends in blood pressure, glucose, cholesterol, body size, diet and physical activity to be evaluated rather than inferred from regional averages.
A historical analysis published in Public Health Nutrition noted that the Cook Islands and Nauru experienced exceptionally rapid increases in mean BMI between 1980 and 2008. The authors argued that geographic isolation or genetic susceptibility alone could not explain the change. Cash economies, changing work, land use, colonial institutions, social values and imported-food systems all influenced how people ate and moved.
This framing is important and respectful. Cook Islanders did not suddenly lose knowledge or discipline. The available choices changed. Tourism and paid employment can reduce time for cultivation and preparation, while imported foods offer convenience and consistent supply. Prevention must improve the market, institutional and agricultural environment—not merely repeat advice to individuals.
The FAO One Country One Priority Product initiative identifies taro as the Cook Islands’ priority crop. FAO reports that taro is cultivated across all 12 inhabited islands and that more than 20 varieties are maintained, with northern atolls preserving distinctive cultivars and preparation traditions. Preliminary 2021 agriculture-and-fisheries census data cited by FAO recorded about 99 acres and 131,400 kilograms of taro cultivation.
Wetland taro on Rarotonga and giant swamp taro in northern islands carry different ecological and culinary roles. Cassava, sweet potato, banana, coconut, breadfruit, pandanus, fruit trees and fisheries add resilience. Protecting this diversity requires clean water, drainage, planting material, soil care, cyclone recovery, biosecurity, transport and dependable markets.
Taro remains a carbohydrate food, so portion, preparation and meal composition matter. Yet an intact boiled or baked staple eaten with fish and vegetables is not metabolically equivalent to a sugar-sweetened drink or continuously eaten refined snacks. See the site’s guides to root crops, sugary drinks and ancestral foods.
Te Marae Ora, the Cook Islands Ministry of Health, published a Food and Nutrition Policy intended to support healthy diets across population groups and prevent further increases in overweight and obesity. That provides a framework for action across schools, government workplaces, procurement, retail, agriculture and communications.
Implementation should be judged by measurable outcomes: drinking-water access, prices of healthy and unhealthy products, school-food compliance, local purchasing, sugary-drink intake, fruit and vegetable consumption, blood pressure, glucose control and equity between Rarotonga and outer islands. Public reporting can distinguish an active policy from a document that exists only on paper.
A workplace study of Cook Islands government employees found a high prevalence of obesity and hypertension, but it was not a nationally representative survey. Its broader lesson remains useful: body weight alone does not reveal who has diabetes, hypertension, dyslipidemia or fatty liver disease. Accessible primary care should combine appropriate measurements of body size with blood pressure, glucose or HbA1c, lipids, kidney function and liver assessment when clinically indicated.
The Cook Islands can approach metabolic health as a food-system and cultural-renewal project. Taro knowledge, island agriculture, fisheries and community institutions are not relics; they are practical foundations for a healthier, more resilient modern food environment.
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