Despite a fall in diabetes prevalence from around 35% in 1975 to 16% in 2004, obesity and non-communicable diseases, including type 2 diabetes, remain the primary threat to health and well-being confronting Nauru in the 21st century. Nauru has few natural resources and, with a population of only 10,000, does not have the critical mass to support manufacturing. Nor, with a tiny land mass of 21 km² and unfavourable topography and soil conditions, can it support farming. Since the decline in phosphate reserves due to over-mining, Nauru has little left to trade and is highly dependent on foreign assistance. Access to healthy food is limited both by its scarcity and its cost. These problems are reflected in high rates of overweight and obesity (82.2%), and other non-communicable disease risk factors, such as smoking (52.9%), alcohol consumption (46.2%) and physical inactivity (16.5%). Si Thu Win Tin reports on nationwide efforts to turn the tide against the non-communicable disease burden in Nauru.