Overweight, obesity, and food consumption in Galapagos, Ecuador: a window on the world

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Overweight, obesity, and food consumption in Galapagos, Ecuador: a window on the world Wilma B. Freire, William F. Waters* , Diana Román, Elisa Jiménez, Estefania Burgos and Philippe Belmont

Abstract Background: In order to understand why rates of overweight and obesity are so high in the Ecuadorian province of Galapagos, this study analyzes changes in household food expenditures and perceptions and practices related to food consumption patterns. Galapagos is understood as an unusual but not unique case because conditions there graphically illustrate trends observed in communities and countries worldwide. A mixed methods approach was employed: a quantitative component was based on expenditures for foods classified according to the NOVA system, and a qualitative component utilized focus group discussions, key informant interviews, and structured observations. Results: Galapagos residents increased consumption of processed and ultra-processed foods and decreased consumption of unprocessed and minimally processed foods. Perceived barriers to healthy diets include price, availability, and quality of fresh produce, as well as easy access to industrialized processed and ultra-processed foods. Conclusions: Changes in consumption patterns represent both local conditions and global trends; in that sense, the factors that affect Galapagos residents are not unique. Hence, these findings help elucidate processes observed in communities around the world. Keywords: Diet, Overweight and obesity, Mixed methods, Ecuador

Background Overweight and obesity represent a critical global public health problem; worldwide, the rate of obesity has tripled since 1975 [1]. As is the case in most countries, Ecuador is currently faced with the overweight and obesity pandemic, which affects all age groups beginning in early childhood [2]. Located 600 miles west of mainland Ecuador’s Pacific coast, Galapagos is best known for its unique natural environment, but it is currently home to 25,244 residents [3]. This figure contrasts with 1,350 residents in 1950; 9,785 in 1990; and 18,640 in 2001. Population growth was mainly a product of national migration, which is now regulated. On the other hand, while around 2,000 visitors toured the islands in the 1960s (mostly on boats), 224,745 registered tourists visited in 2015, many staying in hotels [4–6]. The challenges of balancing the benefits and pressures of tourism and conserving this World Heritage * Correspondence: [email protected] Institute for Research in Health and Nutrition, Universidad San Francisco de Quito, Diego de Robles y Pampite s/n, Cumbayá, Quito, Ecuador

Site’s land and marine environment are daunting; moreover, local and national authorities must also attend to the health and nutrition of the islands’ residents [7]. While tourism is the major economic activity associated with the province, public administration and privately sector services are also important sources of employment. Recent regulations on the use of plastic reflects the importance of envorime