Ka Wai Ola - Office of Hawaiian Affairs, Volume 29, Number 3, 1 March 2012 — BATTLING OBESITY [ARTICLE+ILLUSTRATION]

BATTLING OBESITY

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After more than two decades of carrying extra weight, Geri Kaleponi is running out of options to solve her most vexing problem: shedding at least 30 unwanted pounds. The 52-year-old Pālolo Valley resident, whose taste buds are delightfully shocked by the grilled-cheese sandwiches with Spam that she eats regularly for breakfast, has tried walking 30 minutes a day, cutting back on plates of home-cooked pulled pork as well as eating smaller mounds of rice and portions of macaroni salads. None of these moves has helped the medical assistant drop the pounds she needs to lose to reduce her risk of weight-related health problems, such as high cholesterol, blood pressure and diabetes. Now she is readying to play one of her remaining cards: a weight-management program called Kūlana Hawai'i that is tied to an initiative at the Office of Hawaiian Affairs to help significantly reduce the obesity rate among Native Hawaiians. The weight-management program is one of two efforts that OHA is devoting a combined $1 million to as part of a wider strategy to help Native Hawaiians heeome more aware of the adverse heahh consequences of obesity and adopt healthier habits. "I believe that this new program will help me more than anything else that I've tried," said Kaleponi, who is turning to the Kūlana Hawai'i program to help her lose 30 pounds per year. "I will be assigned a personal trainer, a nutritionist and a heahh psychologist who could help me figure out why I eat the way I do." Kaleponi is one of an estimated 1,400 Native Hawaiians who, over the next two years, stand to benefit from the program's ability to help people fight the uphill battle to maintain a healthy weight. OHA is pumping $500,000 into the effort. "The Kūlana Hawai'i program is about helping

people live longer through modest weight-loss goals," said Aukahi Austin, Executive Director of I Ola Lāhui, whieh secured the OHA grant that helps fund the program. "We expect to be able to make losing weight matter enough to the 700 people a year we will accommodate, that they will want to keep losing 5 tol0 pounds annually and not put it back on." Another key partner in OHA's battle against obesity is the Partnerships to Improve Lifestyle Interventions (PILI) 'Ohana Program, whieh has set its sights on helping between 600 and 700 Native Hawaiians over a two-year period. With a $500,000 grant from OHA, the program is taking a community-based approach to halting and reversing the weight-gain trend in the Native Hawaiian community, said Keawe Kaholokula, Chairman of the Department of Native Hawaiian Health at the University of Hawai'i's John A. Burns School of Medicine. "Being overweight is not part of our culture," said Kaholokula, who played a key role in securing the OHA grant for the program. "But obesity is a big eoneem for our populahon and we are working closely with organizations that want to make a positive difference." The two programs get underway at a time when OHA has done research that shows obesity as one of the greatest threats to the heahh of Native Hawaiians. OHA's research also pegs the obesity rate among Native Hawaiians at 49.3 percent, whieh is more than double the statewide rate. In response, OHA is preparing to launeh a statewide initiative that calls for reducing the Native Hawaiian obesity rate to 35 percent by 2018. That would mean reducing by 24,655 the number of Native Hawaiians who are obese or overweight. Already, obesity-related medical expenses in Hawai'i are estimated at $329 million annually, according to the latest available figures from 2009 provided by the state Department of Health. To make matters worse, people

who are obese have a $1,429 higher medical cost per year than their counterparts with normal weight, according to the state Department of Health. With 75 percent of Native Hawaiians at risk of being obese or overweight, health-care costs in the state could soar as more Native Hawaiians develop weight-related problems such as diabetes, heart disease and some types of cancer. Even with so mueh at stake, the obesity problem among Native Hawaiians is not a heahh threat that ean be eliminated overnight, said Kealoha Lox, a researcher at OHA who is helping lead the organization's initiative to reduce obesity among Native Hawaiians. "This initiative will require OHA to overcome such challenges as the affordability and convenience of highcalorie foods," Lox said. "We are also aware that many Native Hawaiians may not have the time to be physically active or eat healthy foods because of long work hours, time spent commuting or responsibilities they are juggling." The good news is that efforts to encourage Native Hawaiians to adopt healthier behaviors coincide with heightened awareness about the need to eat healthier and exercise regularly, Lox said. "In fact, our research shows that people are changing their eating habits due to heahh concerns," she said. "They are looking for ways to satisfy fitness urges. They are also looking for food that ean help them stay healthier and prevent illnesses. And maintaining heahh and reducing the risk of disease is at the forefront of many people's minds as they age." This heightened sense of heahh consciousness provides OHA whh an opportunity to engage all segments of the community and all levels of government in coordinated efforts to help reduce the obesity rate in the Native Hawaiian community, Lox said. Those efforts are expected to be enhanced by such community partners as Kūlana Hawai'i, whieh is tar-

geting physicians whe refer their patients tc program. It has also enl key support from Ha' Medical Service Assock a major provider of he care coverage in the stati is promoting the pro; among its employees. "We want people to in here and feel like th understood," said Ai "We want them to feel we really get it - like thi them make the changes To achieve that, the pn professionals to help pr weight-loss goals. A he and certified fitness ins a year to help them avoi to gain weight. Lor people who drinl one week might mean he intake as well as cutting walking to the mailbox reducing two sodas a e the hloek. "We're taking the s Austin said. "What weT are ineffective strategies can't be sustained. Inste; ogy. We practice in a e relevant to Native Haw£ At the same time, the ] in direct response to eoi environment are worki Hawaiians who are ofū finances than eating rigl

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s is a plaee that ean really help they want to make." 3gramis relying on three health tients reach small, reasonable alth psychologist, nutritionist tructor work with patients for d the forces that drive patients : four or five sodas a day, that lping them increase their water back on one of those sodas and ; the next week it could mean ay and taking a walk around aame out of losing weight," e found is that guilt and shame for losing weight because they id, we practice heahh psycholulturally mindful way that is iians." 3ILI "Ohana program is largely icerns that many factors in the ag against overweight Native ;n more focused on work and it and exercising.

But even in this difficult environment, Kaholokula expressed confidence that it's possible for programs like PILI "Ohana to help Native Hawaiians avoid becoming obese or even heavier. **This program ean be a game changer," Kaholokula said. **We are developing the capacity for communities to empower people by helping them lose weight." Founded by four community organizations and the Department of Native Hawaiian Heahh at UH's medical school, the program is expanding to include five new partners who will use their collective reach and access to engage Native Hawaiian communities on Moloka'i, Maui, Kaua'i and O'ahu in the battle against obesity. **The purpose is to provide effective communitybased interventions aimed at eliminating obesity in Native Hawaiians to reduce their risk for diabetes, hypertension, heart disease and certain cancers," Kaholokula said. Among the communities gearing up for the intervention is Wai'anae Valley Hawaiian Homestead Community Association, said Puni Kekauoha, who will be playing a lead role in PILI *Ohana's efforts to combat obesity there. She has been tapped by Kula no nā Po*e Hawai'i, a nonprofit organization formed in 1992 by a group of concerned women, to help empower families

to make changes in their diet and healthy lifestyle choices. **It's great anytime you ean help people make better choices," said Kekauoha, a member of the Hawaiian Homestead eommunities of Papakōlea, Kewalo and Kalāwahine. "But what I'mreally excited about is that this is not a stand-alone project. It builds skills and capacity in communities that want to address the obesity problem." Donna Palakiko, the Administrator for Ke Ola Mamo, whieh is another community partner for the PILI "Ohana program, said word has started to spread about the weight-loss training. She will have a visible behind-the-scenes hand in weight-control efforts at the North Hawai'i Medical Group Native Hawaiian Heahh Clinic. "Communities on the Neighbor Islands have heard about the program and want to join," Palakiko said. "They have seen the positive impact we've had in communities on O'ahu." For her part, Geri Kaleponi expects the Kūlana Hawai'i program to help her become more aware of how all the calories and fat are adding up from the processed food she buys.

"When you get up at 4 a.m. every day, everything has to do with convenience," Kaleponi said. "I have just been too busy to exercise, eat properly and get enough rest. But I really feel like the weight-loss goal that I have set for myself is doable with this program." ■

HOW T0 PARTICIPATE Kūlana Hawai'i • (808) 525-6255 Weight-management program involving a health psychologist, nutritionist anel certified fitness instructor designed to help up to 1,400 Native Hawaiians on O'ahu counter health risks associated with obesity. PILI 'Ohana • (808) 692-1047 Community-based intervention expected to help up to 700 Native Hawaiians on Kaua'i, Maui, Moloka'i and O'ahu with weight control.

Spearheading the two obesity programs are, from left, Department of Native Hawaiian Health Chairman Keawe Kaholokula, Ke Ola Mamo Administrator Donna Palakiko and I Ola Lāhui Executive Director Aukahi Austin. Geri Kaleponi, who is helping to manage the Kūlana Hawai'i program is also a participant. - Photo: John De Mello