Burden of childhood obesity in Pacific Islands Countries and Territories.

Childhood obesity is a major and escalating health challenge in Pacific Island Countries and Territories (PICTs), where prevalence rates among children rank among the highest globally. This first paper in a three-part series synthesises evidence on the prevalence and sociodemographic distribution of overweight and obesity among children aged 2.0-11.9 years across 22 PICTs. Twenty-nine unique studies involving more than 33,000 children were included. Prevalence varied widely, from as low as 3.3 percent in the Marshall Islands to more than 50 percent in Wallis and Futuna and American Samoa, depending on population characteristics and the definitions used. Rates were highest in Polynesian and Micronesian countries, often severalfold above global averages. Across studies, prevalence generally increased with age and was frequently higher among boys than girls, though patterns varied. Children in urban settings or higher socioeconomic households were typically more likely to have overweight or obesity, reflecting rapid nutrition transitions marked by increasing consumption of imported, energy-dense foods and reduced physical activity. Ethnic disparities were pronounced, with Pacific Islander children at greatest risk. These findings indicate a region-wide epidemic driven by social, dietary, and environmental change, underscoring the need for strengthened surveillance, culturally grounded prevention, and coordinated regional action.