The makings of health in Small Island Developing States: exploring the persistence of obesity in The Bahamas

Background: Obesity is persistent in The Bahamas. Quantitative evidence from 1989 – 2019 suggests that prevalence varied according to how gender and the island place (or islandness) intersected. There is, however, poor understanding of how wider social determinants, including cultural constructions of obesity, influence obesity persistence. Similarly, despite policy responses, little is known about how they approach gender and islandness or influence behavioural responses to obesity. Purpose: This research uses an intersectionality approach to explore how micro-, meso-, and macro-social factors intersect to shape the persistence of obesity in The Bahamas. Methods: This multi-method qualitative case study was conducted between 2019 and 2021 on three islands of The Bahamas (namely New Providence, Eleuthera and Long Island). It combined a review of policy documents and newspaper articles, secondary analysis of national surveys, analysis of public social media information, overt observations, and 40 semi-structured interviews with local policymakers, health workers, scholars and members of the public. An intersectionality-based policy analysis and the food environment concept were used to deepen understanding of obesity and its prevalence in The Bahamas. Findings: The prevalence of obesity dropped in men between 2012 and 2019, but it continued to increase in women. Black women faced pressure for larger body sizes due to cultural beauty standards. Food preparation and consumption styles intersected with the importance of expressing Bahamian national identity in food practices. Due to food system challenges, such as a lack of an agricultural industry of scale, there is unequal access to healthy foods. Despite policy responses becoming increasingly comprehensive, wider macrosocial trends such as the globalisation of the food industry, the colonial history of the country, and the local political and socioeconomic influences undermine these responses. This study offers a theoretical contribution of island and gender studies to facilitate more nuanced understandings of health in island contexts.