This study is part of the Children’s Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2–8 years) were recruited via community-based sampling from select communities in Guam. Children’s demographic and health behavior information; dietary intake; and anthropometric measurements were collected. Logistic regression, odds ratio, t-tests, and chi-square tests were used to determine differences and assess covariates of OWOB. The results indicate that 58% of children were living below the poverty level, 80% were receiving food assistance, and 51% experienced food insecurity. The majority of children surveyed did not meet recommendations for: sleep duration (59.6%), sedentary screen-time (83.11%), or fruit (58.7%) and vegetable (99.1%) intake, and consumed sugar sweetened beverages (SSB) (73.7%). OWOB affected 27.4% of children. Children affected by OWOB in this study were statistically more likely (p = 0.042) to suffer from sleep disturbances (p = 0.042) and consume marginally higher amounts (p value = 0.07) of SSB compared to children with healthy weight. Among Other Micronesians, children from families who considered themselves ‘integrated’ into the culture were 2.05 (CI 0.81–5.20) times more likely to be affected by OWOB. In conclusion, the OWOB prevalence among 2–8-year-olds in Guam was 27.4%; and compared with healthy weight children, children with OWOB were more likely to have educated caregivers and consume more SSBs. Results provide a basis for health promotion and obesity prevention guidance for children in Guam.

Guam, an unincorporated territory of the United States, is one of the ten (10) US Affiliated Pacific Islands. The geographic location in the western Pacific Ocean, as well as the ties to the US position Guam as a strategic hub between the continental US, Asia, and the Pacific region. Health disparities in Guam and the Micronesian region are significant, and the non-communicable disease crisis is worsening, threatening the existing poor health infrastructure on the islands. Migration of islanders from the Micronesian region, whose countries also suffer health disparities, adds to the burden of the weak health care system on Guam. A critical nursing workforce shortage plagues the health care community, and strong nursing leadership is needed to address the problems. Nurse leaders, through many organizations, are working to implement strategies to address the issues facing the islands. Increased collaboration with partners on the island, on the US mainland, and globally, are necessary to effectively address Guam's health care concerns.

The Western Pacific region, including Guam, has the highest prevalence of prediabetes and type 2 diabetes mellitus, which are associated with metabolic syndrome (MetS)—a cluster of preventable risk factors. Children with parents with MetS are likely to develop MetS in the future. MetS prevalence in Guam and the impact of MetS on children are unknown. Data from the Pacific Islands Cohort on Cardiometabolic Health (PICCAH) study in Guam were analyzed to determine MetS in adults and MetS risk in children using the International Diabetes Federation criteria and sex- and age-specific waist circumference values for abdominal obesity, respectively. MetS Z-scores were calculated. MetS or MetS risk indicators, including MetS Z-scores, were examined by lifestyle risk factors (parent and child: physical activity and sleep; parent only: sedentary behavior and stress; child only: screen time). The relationship between adult MetS Z-scores and child MetS Z-scores was evaluated using linear-regression analyses. Child–parent risk for MetS was directly correlated in this population. The high prevalence of adult MetS in Guam demonstrates a critical need for interventions involving both parents and children. Expanding the analysis to assess the relationships between other lifestyle factors, like diet, in parent–child dyads is necessary to refine such intervention programs.