How Has Obesity Affected Pacific Islanders?

1. How Has Obesity Affected Pacific Islanders? Elizabeth Coblentz, sFNP Tammara Taylor, sCNEP Tiffany Washington, FNP-BC

2. Incidence and Prevalence of Obesity in Pacific Islanders 41% of adult Pacific Islanders (PI) are obese having a body mass index of 30 or greater According to some studies, Pacific Islanders have twice the number of overweight people than are found in other developed countries Over 72% of PI men and 54 % of PI women are obese (CDC, 2010)

3. Incidence and Prevalence of Obesity in Pacific Islanders • 46% of Pacific Islanders are obese • Life expectancy is 68 years • Greatest health disparity of any population in the US http://www.hicore.org/20/research-publications (Novotny, 2009)

4. Associated Risks of Obesity • Increased risk for chronic disease: • Diabetes • Gallbladder disease • Cardiovascular disease • Hypertension • Sleep apnea • Osteoarthritis • Some forms of cancer (Novotny, 2009) http://billhicksisdead.blogspot.com/2011/12/hmc-hospitals-in-hawaii-to-close-nearly.html

5. Improving Health Outcomes in Pacific Islanders • Indigenous Pacific Islanders need to be trained in research to bridge the gap between science and culture • Determining the changes that are needed depend on engaging the population at their level (Palafox, Buenconsejo-Lum, Riklon, & Waitzfelder, 2002) http://blog.hawaii.edu/uhmednow/2012/02/15/integrated-care-for-asian-americans-native-hawaiians-and-pacific-islanders-blueprint-for-action-issued/

6. Cultural Beliefs and/or Practices that have increased Obesity in PI • Dietary changes from fresh fish, meat and local fruits and vegetables to a more refined diet consisting of rice, sugar, flour, canned meats, canned fruits and vegetables, soft drinks, fast food and beer. • Activity changes that included lots of walking, biking and water activities to a more Westernized sedentary lifestyle inclusive of television watching, video games, cars and computer time. • (The Nauru Project, 2009)

7. Cultural Beliefs and/or Practices • Pacific Islanders have strong ethnic identities that incorporate a mix of traditional native island heritage with Western-influenced contemporary life-styles and beliefs. • Even though PI were colonized by Westerners hundreds of years ago, retaining their cultural identity is still important to them. Unfortunately it has been increasingly difficult to erase some of the more negative influences of the Western more sedentary lifestyle from the Pacific islanders. • Moy, Sallis and David, (2010).

8. Cultural Beliefs and/or Practices • Westerners often believe that individuals are responsible for their own health and wellness or lack thereof whereas Pacific Islanders (PI) may look to their immediate community for support and guidance. • Socioeconomic factors drive health practices in the PI region and due to limited resources, Pacific Islanders are often hindered in seeking nutritional and medical assistance. • (Moy, Sallis and David, 2010).

9. Evidenced-Based Strategies for Incorporating Beliefs/Practices into Care Plan Assist communities in dispelling myths that adopting a healthy lifestyle will be impossible Encourage communities to substitute local foods for imports to decrease food costs and increase PI in living off of the fruits and vegetables in abundance on their own land (Curtis, 2004)

10. Evidenced-Based Strategies for Incorporating Beliefs/Practices Utilize community forums including churches to provide hands-on education and literacy on healthy diets, active lifestyles, and prevention and early treatment of obesity. (quickculturalreference.com, n.d.)

11. Evidenced-Based Strategies for Incorporating Beliefs/Practices • Assess patient/community knowledge of obesity • Perform a comprehensive dietary assessment of cultural foods and lifestyle assessment to see how cultural practices can be preserved with modification as needed for increased health and wellness • Be nonjudgmental when assessing patient cultural beliefs or rituals • (quickculturalreference.com, n.d.)

12. Evidenced-Based Strategies for Incorporating Beliefs/Practices into Care Plan • How Much Does Culture Impact Pacific Islanders? • A recent study looked at the perceptions of Pacific Islanders with diabetes in relation to diet and exercise. Through descriptive analysis, researchers identified the themes of depression, denial, and lack of self-control in relation to current diet and exercise practices. Factors that influenced diet were social events and food portion sizes. The amount of physical exercise was impacted by family values in sports activities and traditional gender role expectations. Braginsky, Inouye, Wang, & Arakaki, 2011

13. Evidenced-Based Strategies for Incorporating Beliefs/Practices into Care Plan • Obesity and Diabetes in Pacific Islanders • Diabetes Mellitus type 2 is associated with the risk factors of being overweight (BMI greater than 25), obese (BMI greater than 30), sedentary lifestyle, inflammatory processes, and insulin resistance. • Pacific Islanders have the additional hurdle of being predisposed to obesity and visceral fat distribution on the body. Research is showing that visceral fat presentation acts like an endocrine organ and increases patient’s risk for coronary heart disease, hypertension, impaired glucose tolerance, type 2 diabetes, metabolic syndrome, and insulin resistance. Hsu et al., 2012

14. Ways APRNs Can Bridge Gaps • So How Can We Teach Pacific Islanders About Dietary Changes? • Decrease sweet beverage intake (soda and fruit juice) • Reduce portion sizes by eating off of smaller communal plates • Bake, broil, and sauté foods • Decrease television time • Reduce sodium to 2300 mg/day (frozen instead of canned or pickled vegetables) Hsu et al., 2012

15. Ways APRNs Can Bridge Gaps • Share helpful reference materials for other providers to use to help them to provide more culturally sensitive care • Helpful Website- http://quickculturalreference.com/

16. Who is Kem Louie? • Kem Louie is a Registered Nurse with a PhD. • She is an associate professor in the Department of Nursing at William Paterson University in Wayne, N.J. and the founding member of the Asian American/Pacific Islanders Nurse Association (AAPINA).

17. Kem Louie’s Work • As the founder of the AAPINA, Kem Louie and other members set the stage for change in their communities and for their culture by setting the following as their four mission objectives:

18. Kem Louie’s Work • • To identify and support the health care needs of API people in the United States and globally; • • To implement strategies to act on issues and public policies affecting the health of APIs; • • To collaborate with other interdisciplinary health and professional organizations; and • • To identify and support professional and nursing concerns of API nurses in the U.S. and globally through active networking and empowerment.

19. References • Braginsky, N., Inouye, J., Wang, C., & Arakaki, R. (2011, September). Perceptions related to diet and exercise mong Asians and Pacific Islanders with diabetes. Hawaii Medical Journal, 70, 196-199. • Brox, D. (2008, Spring). MinorityNurse.com. Raising our voice. Retrieved • May 18, 2012, from http://www.minoritynurse.com/asian-american/raising- • our-voice. • CDC 2010. Health behavior of adults: United States. 2005-2007. Figure 6.3. Retrieved May 18, 2012, from • http://www.cdc.gov/nchs/data/series/sr_10_245.pdf • Curtis, Michael. (2004). Journal of Development and Social Transformation. 37-42. • Hsu, W. C., Boyko, E. J., Fujimoto, W. Y., Kanaya, A., Karmally, W., Karter, A.,...Tavake-Pasi, F. (2012, May). • Pathophysiologic differences among Asians, Native Hawaiians, and other Pacific Islanders and treatment • implications. Diabetes Care, 35, 1189-1198. • Kubik, S. (n.d.). Quick cultural reference. Retrieved May 18, 2012, from http://quickculturalreference.com/ • MinorityNurse.com. (2010). One name, many faces. Retrieved May 17, • 2012, from http://www.minoritynurse.com/print/616 • Moy, Sallis and David. (2010). Health indicators of native Hawaiian and Pacific Islanders in the United States. J • Community Health. 35:81-92.

20. References • Novotny, R., Williams, A., Vinoya, A., Oshiro, C., & Vogt, T. (2009). US acculturation, food intake, and obesity • among Asian-Pacific hotel workers. Journal Of The American Dietetic Association, 109(10). doi: • 10.1016/j.jada.2009.07.013 • Palafox, N.A., Buenconsejo-Lum, L., Riklon, S., & Waitzfelder, B. (2002). Improving health outcomes in diverse • populations: Competency in cross-cultural research with indegenous Pacific Islander populations. Ethnicity & • Health, 7(4). doi: 10.1080/1355785022000060736 • The Nauru Project. (2009). Pacific Islanders and obesity rates: Source: • BBC. Retrieved May18, 2012, from • http://nauruproject.blogspot.com/2009/09/pacificislanders-and-obesityrates.html • WHO (2005). Chronic Diseases and Health Promotion program, country specific information sheets. Retrieved May • 18, 2012, from http://www.who.int/chp/chronic_disease_report/media/impact/ en/index.html. Retrieved May 18, 2012, from http://quickculturalreference.com/

21. Questions & Answer Session