Date of Award

January 2016

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola Hawley


Introduction: Over 90% of females and over 80% of males in Samoa are either overweight or obese. The continuing economic and nutrition transition in Samoa has contributed to a sharp rise in prevalence. Excess weight affects both the younger and older generation of Samoa. With little evidence of decreasing prevalence in overweight or obesity, the country needs to make weight loss/prevention of weight gain a public health priority. This paper will look at the behaviors of healthy positive weight deviants in Samoa to inform targetable changes the population can make.

Setting/Participants: 3,475 participants were eligible for this study from four census regions in Samoa. Of those participants, 301 were healthy positive weight deviants, defined as normal weight (BMI<26 kg/m2), non-diabetic, and having no more than one of the following metabolic syndrome components: high triglycerides, hypertension, and high total cholesterol.

Methods: The data were collected as part of a genome-wide association study for obesity from February to July 2010. A combination of ANOVA, chi-square, t-tests, and Kruskal-Wallis analyses were conducted to identify modifiable risk factors that were significantly different between the healthy positive weight deviant group and the rest of the population. Logistic regression analyses were conducted to identify the factors associated with being a healthy positive weight deviant that stayed statistically significant after controlling for other variables.

Results: Concentrating only on modifiable behaviors, among males, being a plantation worker (OR = 3.14 [1.75, 6.17]) or being unemployed (OR = 2.42 [1.24, 5.04]) increased the odds of being a healthy positive weight deviant compared to those in professional jobs, as did being a current smoker (OR = 1.54 [1.10, 2.18]). Among females, increased vegetable consumption increased odds of being a healthy positive weight deviant (OR = 1.10 [1.00, 1.19]).

Conclusions: Evidence suggests that occupation may be a proxy for physical activity in this setting. Those who work in the plantation fields are getting more exercise than those working in professional jobs, suggesting a need for population-level interventions targeting physical activity. Results also suggest that vegetable consumption should be targeted in the effort to increase the health of the Samoan population.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/07/2018