Building health infrastructure to prevent childhood obesity and related diseases in Samoa

May/June 2025 | Volume 24 Number 3

by Amanda Stearns

For families in the Pacific region, cardiometabolic diseases, such as diabetes, stroke, and diseases of the heart, kidneys and liver, are a leading cause of premature and preventable deaths. Dr. Courtney Choy studies chronic diseases including obesity, diabetes, cancer and hypertension in Samoa, a small Pacific Island nation with a rich culture and a high prevalence of these and other chronic diseases. She seeks to understand risk factors and protective factors to help prevent obesity and its related cardiometabolic conditions.

For 10 years Choy, a two-time Fogarty Fellow and postdoctoral fellow at the Yale School of Public Health, has been engaged with the Ola Tuputupua’e (“Growing Up”) study. “The project has evolved into a longitudinal observational cohort that is uniquely situated to understand child growth and development.” She follows a cohort made up of Samoan children and their primary caregivers, who entered the study in 2015 at ages 2 to 4 years old, in order to study what healthy growth and development look like for children, what factors are associated with good and with poor health, and how the how the health of families is changing. “How can we best make sure that children are well-positioned to be at minimal risk of developing obesity, which is connected very much to other chronic diseases and conditions later in the life course?”

Choy has seen these children enter school and start to become their own people, and, as she learns more about their lives, she’s begun to think about ways to better support their health and well-being over time. “As scientists, we tend to focus on the things putting them at risk, yet they are still very resilient.” She hopes that eventually her team will be able to track health across the life course and across generations, and that her work will lead to better programs and interventions, since the current offerings are not enough. 

What is needed is not only research, but a translation of the data into action and solutions that bridge services, not only in public health, but across education, judicial systems, commerce, industry, agriculture, communication, and information technology, Choy says. “I love the work that I do because every day we're always thinking not only about public health but also sharing knowledge with each other so that there can be greater capacity to address the high and rising burden of chronic diseases. That's a big part of what Fogarty taught me.”

Photo courtesy of Courtney ChoyStudent trainees measure a child in the Ola Tuputupua'e cohort.

Choy says her Fogarty fellowship led to publication of her findings in several peer-reviewed journals, while her research has also been highlighted in the community, on the radio and in the local newspaper. She's given presentations at national and international meetings and won an NIH Pathway to Independence award.

Her work is also used in programs to improve school nutrition and health promotion in Samoa, to try to better understand the burden of disease, to identify opportunities to intervene, and to encourage healthier lifestyles for children. 

The Fogarty fellowship was tailored to her specific career interests and helped her build networks and collaborations to achieve real impact, she believes. The fellowship also gave her time for development as an individual and public health professional, with an exceptional mentorship team, strong community partnerships and pathways to move her research forward. 

“Individuals who have that passion, drive, and are willing to listen, learn, and work collaboratively have the best experiences as a Fogarty fellow. Photo courtesy of Courtney ChoyDr. Courtney Choy trains a community health worker. It's that open mindset that allows someone to also have an open heart and bring in not only their lived experiences and knowledge but also be able to engage in a way that creates this beautiful synergy of work.”

Although Choy conducts research in the Blue Pacific Continent, a heavy burden of chronic disease also exists in the U.S. and worldwide. “We’ve all seen how a child affected by obesity and these related chronic diseases may have a harder time paying attention in school, their energy level changes to the point where it impacts their activity, engagement, and even their social skills.” Choy believes that "we have a responsibility" to serve our communities by working together to sustain programs that address the needs of different communities in the U.S. and worldwide.

“That’s part of what makes America great. We’ve always risen to the challenge of doing better than what’s been done before.”

Updated June 2, 2025

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