About three-quarters of the U.S. territory's adult population is obese, the highest rate in the world with independent Samoa quickly catching up. Rates of type 2 diabetes top one in five and a recent study found that the elevated obesity rates are present even in newborns.

This pandemic began only a few decades ago and for much of that time Brown University epidemiologist Stephen McGarvey has applied a highly integrative brand of scholarship to the islands to investigate the mystery's one overriding question: How did all this happen?