If a diabetes policy of diet and exercise keeps failing, is it time for a new approach? | Amy McLennan

On the Pacific island of Nauru the disease has been addressed in the same way for 50 years, but evidence of other factors - from poor air to stress - challenge old assumptions

Fifty years ago, a diabetes survey in the Republic of Nauru concluded that a third of Nauruans had type 2 diabetes. It was the first time the relatively uncommon disease was found to be widespread in a national population, and it led researchers to raise the alarm about a potential global diabetes epidemic".

At the time, there was little other research about population-scale diabetes, so the researchers made some assumptions to explain their data and propose a way forward. First, they said that diabetes in Nauru was probably caused by a genetic predisposition of islander populations to diabetes (a hypothesis later critiqued by its original author, and which remains unsupported by data - archaeological, anthropological or genetic); modernisation of islander lifestyles leading to a high-calorie diet (a theory my colleagues and I have since challenged); and reduced physical activity, and obesity. Second, they suggested these causes could be best addressed by nutrition and lifestyle education.