The Gambia is in the early phases of demographic transition. Globalization is changing diets and lifestyles. Rural livelihoods have become virtually unsustainable following the collapse of groundnuts as a cash crop owing to external competition. This encourages urban drift and transnational migration. Sedentary occupations and plentiful high-fat diets are causing burgeoning obesity in urban areas. Even in remote rural areas remittance payments from those in the city or abroad have increased purchasing power, and cheap imported vegetable oils are a major commodity in local shops. Obesity—at one time confined to the area chief and his wives—is now rapidly spreading throughout the countryside. And this pattern is being repeated throughout the developing world—bringing with it a new burden of debilitating and costly chronic diseases.