How Has Obesity Affected
Pacific Islanders?
Elizabeth Coblentz, sFNP
Tammara Taylor, sCNEP
Tiffany Washington, FNP-BC
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)
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
(Novotny, 2009)
http://www.hicore.org/20/research-publications
Associated Risks of Obesity
• Increased risk for chronic disease:
o Diabetes
o Gallbladder disease
o Cardiovascular disease
o Hypertension
o Sleep apnea
o Osteoarthritis
o Some forms of cancer
(Novotny, 2009)
http://billhicksisdead.blogspot.com/2011/12/hmc-hospitals-in-hawaii-to-close-nearly.html
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/
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)
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).
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).
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)
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.)
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.)
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
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
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
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•
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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
Ways APRNs Can Bridge Gaps
• Share helpful reference materials for other
providers to use to help them to provide
more culturally sensitive care
• Helpful Websitehttp://quickculturalreference.com/
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).
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:
Kem Louie’s Work
• • To identify and support the health care needs
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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.
References
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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.
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Brox, D. (2008, Spring). MinorityNurse.com. Raising our voice. Retrieved
May 18, 2012, from http://www.minoritynurse.com/asian-american/raisingour-voice.
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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
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Curtis, Michael. (2004). Journal of Development and Social Transformation. 37-42.
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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.
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Kubik, S. (n.d.). Quick cultural reference. Retrieved May 18, 2012, from http://quickculturalreference.com/
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Moy, Sallis and David. (2010). Health indicators of native Hawaiian and Pacific Islanders in the United States . J
Community Health. 35:81-92.
MinorityNurse.com. (2010). One name, many faces. Retrieved May 17,
2012, from http://www.minoritynurse.com/print/616
References
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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
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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
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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
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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/
Questions & Answer Session