How Has Obesity Affected Pacific Islanders?

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How Has Obesity Affected Pacific Islanders?

• Elizabeth Coblentz, sFNP
• Tammara Taylor, sCNEP
• Tiffany Washington, FNP-BC

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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)

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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)
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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-ho
spitals-in-hawaii-to-close-nearly.html
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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/integra
ted-care-for-asian-americans-native-hawaiians-and-
pacific-islanders-blueprint-for-action-issued/
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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)

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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).

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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).

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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)

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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.
• 
  (quickculturalreferen
  ce.com, n.d.)

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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.)

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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
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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 patients risk for
  coronary heart disease, hypertension, impaired
  glucose tolerance, type 2 diabetes, metabolic
  syndrome, and insulin resistance.

Hsu et al., 2012
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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
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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
  /

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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).

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Kem Louies 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

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Kem Louies 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.

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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.c
  om/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//quickculturalr
  eference.com/
• MinorityNurse.com. (2010). One name, many faces.
  Retrieved May 17,
• 2012, from http//www.minoritynurse.com/print
  /616

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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 10.1080/135578502200006073
  6
• The Nauru Project. (2009). Pacific Islanders and
  obesity rates Source
• BBC. Retrieved May18, 2012, from
• http//nauruproject.blogspot.com/2009/09/pac
  ificislanders-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/

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Questions Answer Session