How Has Obesity How Has Obesity Affected Pacific Affected Pacific

Islanders?Islanders?

Elizabeth Coblentz, sFNPElizabeth Coblentz, sFNPTammara Taylor, sCNEPTammara Taylor, sCNEP

Tiffany Washington, FNP-Tiffany Washington, FNP-BCBC

Incidence and Prevalence Incidence and Prevalence of Obesity in Pacific of Obesity in Pacific

IslandersIslanders41% of adult Pacific Islanders (PI) 41% of adult Pacific Islanders (PI)

are obese having a body mass are obese having a body mass index of 30 or greaterindex of 30 or greater

According to some studies, Pacific According to some studies, Pacific Islanders have twice the number of Islanders have twice the number of overweight people than are found in overweight people than are found in

other developed countriesother developed countriesOver 72% of PI men and 54 % of PI Over 72% of PI men and 54 % of PI

women are obese women are obese (CDC, 2010)

Incidence and Prevalence of Incidence and Prevalence of Obesity in Pacific IslandersObesity in Pacific Islanders

• 46% of Pacific Islanders are obese46% of Pacific Islanders are obese

• Life expectancy is 68 yearsLife expectancy is 68 years

• Greatest health disparity of any Greatest health disparity of any population in the USpopulation in the US

http://www.hicore.org/20/research-publications(Novotny, 2009)

Associated Risks of ObesityAssociated Risks of Obesity

• Increased risk for chronic disease:Increased risk for chronic disease:oDiabetesDiabetesoGallbladder diseaseGallbladder diseaseoCardiovascular diseaseCardiovascular diseaseoHypertensionHypertensionoSleep apneaSleep apneaoOsteoarthritisOsteoarthritisoSome forms of cancerSome forms of cancer

(Novotny, 2009)http://billhicksisdead.blogspot.com/2011/12/hmc-hospitals-in-hawaii-to-close-nearly.html

Improving Health Outcomes Improving Health Outcomes in Pacific Islandersin Pacific Islanders

• Indigenous Pacific Islanders need to Indigenous Pacific Islanders need to be trained in research to bridge the be trained in research to bridge the gap between science and culturegap between science and culture

• Determining the changes that are Determining the changes that are needed depend on engaging the needed depend on engaging the population at their levelpopulation at their level

http://blog.hawaii.edu/uhmednow/2012/02/15/integrated-care-for-asian-americans-native-hawaiians-and-pacific-islanders-blueprint-for-action-issued/

(Palafox, Buenconsejo-Lum, Riklon, & Waitzfelder, 2002)

Cultural Beliefs and/or Cultural Beliefs and/or Practices that have Practices that have increased Obesity in PIincreased Obesity in PI

• Dietary changes from 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 Activity changes that included lots of walking, biking and water activities to a more Westernized sedentary lifestyle water activities to a more Westernized sedentary lifestyle inclusive of television watching, video games, cars and inclusive of television watching, video games, cars and computer time.computer time.

• (The Nauru Project, 2009)(The Nauru Project, 2009)

Cultural Beliefs and/or Cultural Beliefs and/or Practices 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).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, (Moy, Sallis and David, 2010).2010).

Evidenced-Based Strategies for Evidenced-Based Strategies for Incorporating Beliefs/Practices Incorporating Beliefs/Practices

into Care Planinto Care Plan

•Assist communities in dispelling Assist communities in dispelling myths that adopting a healthy myths that adopting a healthy

lifestyle will be impossible lifestyle will be impossible Encourage communities to Encourage communities to

substitute local 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)(Curtis, 2004)

Evidenced-Based Evidenced-Based Strategies for Strategies for Incorporating Incorporating

Beliefs/PracticesBeliefs/Practices Utilize community forums including Utilize community forums including

churches to provide hands-on education churches to provide hands-on education and literacy on healthy diets, active and literacy on healthy diets, active lifestyles, and prevention and early lifestyles, and prevention and early

treatment of obesity.treatment of obesity. (quickculturalreference.com, (quickculturalreference.com,

n.d.)n.d.)

Evidenced-Based Strategies Evidenced-Based Strategies for Incorporating for Incorporating Beliefs/PracticesBeliefs/Practices • Assess patient/community knowledge of Assess patient/community knowledge of

obesity obesity

• Perform a comprehensive dietary assessment Perform a comprehensive dietary assessment of cultural foods and lifestyle assessment to of cultural foods and lifestyle assessment to see how cultural practices can be preserved see how cultural practices can be preserved with modification as needed for increased with modification as needed for increased health and wellnesshealth and wellness

• Be nonjudgmental when assessing patient Be nonjudgmental when assessing patient cultural beliefs or ritualscultural beliefs or rituals

• (quickculturalreference.com, n.d.)(quickculturalreference.com, n.d.)

Evidenced-Based Strategies Evidenced-Based Strategies for Incorporating for Incorporating Beliefs/Practices into Care Beliefs/Practices into Care PlanPlan• How Much Does Culture Impact How Much Does Culture Impact

Pacific Islanders?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 Evidenced-Based Strategies for Incorporating for Incorporating Beliefs/Practices into Care Beliefs/Practices into Care PlanPlan• Obesity and Diabetes in Pacific IslandersObesity 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 Ways APRNs Can Bridge GapsGaps

•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

Ways APRNs Can Bridge Ways APRNs Can Bridge GapsGaps

• Share helpful reference materials for Share helpful reference materials for other providers to use to help them other providers to use to help them to provide more culturally sensitive to provide more culturally sensitive carecare

• Helpful Website- Helpful Website- http://quickculturalreference.com/http://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 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.

ReferencesReferences

• 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. Brox, D. (2008, Spring). MinorityNurse.com. Raising our voiceRaising our voice. Retrieved. Retrieved• May 18, 2012, from May 18, 2012, from http://www.minoritynurse.com/asian-american/raising- • our-voice.our-voice.

• CDC 2010. CDC 2010. Health behavior of adults: United States. 2005-2007Health behavior of adults: United States. 2005-2007. Figure 6.3. Retrieved May 18, 2012, from . Figure 6.3. Retrieved May 18, 2012, from • http://www.cdc.gov/nchs/data/series/sr_10_245.pdfhttp://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.). Kubik, S. (n.d.). Quick cultural referenceQuick cultural reference. Retrieved May 18, 2012, from . Retrieved May 18, 2012, from http://quickculturalreference.com/• • MinorityNurse.com. (2010). One name, many faces. Retrieved May 17,MinorityNurse.com. (2010). One name, many faces. Retrieved May 17,• 2012, from http://www.minoritynurse.com/print/6162012, from http://www.minoritynurse.com/print/616

• Moy, Sallis and David. (2010). Moy, Sallis and David. (2010). Health indicators of native Hawaiian and Pacific Islanders in the United StatesHealth indicators of native Hawaiian and Pacific Islanders in the United States. J . J • Community Health. Community Health. 35:81-92.35:81-92.

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 Palafox, N.A., Buenconsejo-Lum, L., Riklon, S., & Waitzfelder, B. (2002). Improving health outcomes in diverse in diverse

• populations: Competency in cross-cultural research with indegenous Pacific Islander populations. populations: Competency in cross-cultural research with indegenous Pacific Islander populations. Ethnicity & Ethnicity &

• Health, 7Health, 7(4). doi: (4). doi: 10.1080/1355785022000060736

• The Nauru Project. (2009). Pacific Islanders and obesity rates: Source: The Nauru Project. (2009). Pacific Islanders and obesity rates: Source: • BBC. Retrieved May18, 2012, from 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. WHO (2005). Chronic Diseases and Health Promotion program, country specific information sheets. Retrieved May Retrieved May

• 18, 2012, from 18, 2012, from http://www.who.int/chp/chronic_disease_report/media/impact/ en/index.html. Retrieved May 18, 2012, from http://quickculturalreference.com/. Retrieved May 18, 2012, from http://quickculturalreference.com/

Questions & Answer Session