Obesity in Hawaii: Epidemic Proportions

“As a nation, we need to respond as vigorously to this (obesity) epidemic as we do to an infectious disease epidemic…National efforts are needed to encourage physical activity and better nutrition and to conduct research to identify effective educational, behavioral, and environmental approaches to control and prevent obesity."
                                                                                                    Dr. Jeffrey P. Koplan, Director
                                                                                                    Centers for Disease Control and Prevention

The oldest depiction of female divinity on earth is the Goddess of Willendorf, a heavy-breasted, large-bellied clay mother figure more than 30,000 years old. Like other ancient goddess figures, her largeness symbolizes the fertility and juiciness desired for both procreation and bountiful harvests. In ancient cultures, the energetic spirit, if not the physical form of the fertility goddesses was something to aspire to. In those cultures, which included some in the Pacific Islands, a person's spiritual power was measured by the size of their girth.

Obesity is characterized by an excessively high amount of body fat or adipose tissue. This condition is increasingly common in the McDonald's/Kentucky Fried world, but the ramifications of the condition vary from individual to individual. In April 2002, the Honolulu Star-Bulletin reported the results of a 5-year study that revealed that more than 23 percent of children in the Hawaiian Islands are overweight -- about twice what it is on the mainland. This is a dangerous omen, in light of the significant health conditions brought on or exacerbated by obesity. These conditions include stroke, heart disease, cancer, gallstones and diabetes. And one just needs to look around to see that obesity is not limited to children in Hawaii. Although the types and amounts of food a person eats are most responsible for excess pounds, other factors contribute to and complicate the problem.

The Food Connection

The most obvious link to obesity is food. Many families living in Hawaii eat voluminous, calorie-laden meals rich in starch (like pasta and poi) and saturated fats (like pork, beef and fried foods). The fast-food industry is booming here, and fat and starch make up a significant portion of its offerings.

A May 2002, conference at the University of Hawaii's East-West Center focused specifically on Hawaii's childhood obesity problems. At the conference, Kelly Brownell, professor of psychology, epidemiology and public health and director of the Yale Center for Eating and Weight Disorders, described the nation's "toxic food environment" by saying, "It is absolutely astounding what we're allowing to happen to our children."

Brownell said the food industry "has run amok." Poor nutritional foods are inexpensive and available everywhere, including "places where you never thought you could eat, such as gas stations," he said. They are also offered in "supersize" portions -- like what McDonald's calls "Super Value Meals." Brownell added, "Our children are being taught that more is better."

A distressing fact is that French fries (containing both starch and fat) make up one-fourth of all vegetables eaten in the United States, and advertising portrays French fries as being a fun, trendy, young people's food. Furthermore, advertising dollars for health-promoting foods is negligible compared to that for fast foods and soft drinks. For example, McDonald's spends $1.1 billion annually on marketing and Coca-Cola spends $866 million while the National Cancer Institute's budget to promote healthy eating is $1 million.

"We've let one industry (food) escape scrutiny and the other (tobacco) not," Professor Brownell said. He recommends regulating TV fast-food ads aimed at children, banning fast foods and soft drinks from schools, restructuring school lunch programs, subsidizing healthy foods at a national level and, if money is needed to do those things, "taxing bad foods."

Perhaps the most troubling statistic is that more than 5,000 schools in the United States, including some in Hawaii, have fast-food outlets in their cafeterias, and most schools serve their own fast-food versions of offerings at popular junk-food chains. Schools also sign exclusive contracts with soft-drink companies to sell only their products.

In response to the data on childhood obesity in our State, the Hawaii legislature recently passed a resolution authorizing the Department of Education and the Department of Health to gradually introduce healthier snack choices to Hawaii school children. It suggested that these departments negotiate with the companies operating the vending machines on Hawaii school premises to provide at least one healthy juice and one healthy snack such as fresh fruit or trail mix in each machine. The legislature also requested that the Department of Education submit a report to the Legislature by September 1, 2003, on progress made in negotiating healthier choices in the vending machines on Hawaii school premises.

The Genetic Factor

We all know someone who really tries to lose weight but who experiences limited success or loses weight only to gain it all back over time. More than 80% of those who lose weight will gradually regain it unless a life-long weight management program is implemented. Why is it that some people are able to lose weight easily and keep it off while others struggle so? The answer may be genetic factors that influence energy metabolism and result in an inborn susceptibility to gain weight.

Although genes may in part predict weight gain and obesity, the impact of individual lifestyle may be much stronger. In most chronically obese people there exists an imbalance between food intake and physical activity. In short, we do not know yet how to change our genes, but we can change our behavior patterns.

It May Be Hormonal

Valerie Harper, in one of her old "Rhoda" shows, looked longingly at a piece of chocolate cake and said, "why should I bother to eat it? Why don't I just slap it on my thigh, that's where it's going anyway."

Many people are unable to lose weight simply because they have an undiagnosed hormonal imbalance which slows down their metabolic processes. The most common hormonal imbalance connected with weight gain is hypothyroidism. Hypothyroidism is easily diagnosed by a blood test and natural treatment is often quite effective in reversing the condition.

To recognize that obesity may be due to a metabolic condition rather than a flaw in character is important both for the people who are affected and for society as a whole.

Exercise is Essential

We live in a convenience culture. New inventions and devices (like automobiles, elevators, and remote controls), while simplifying our lives, also are often geared to reduce our amount of physical exertion in accomplishing tasks.

If a person wants to lose weight, they must exercise. There is no "easy" way, no miracle pill. Exercise is the key component of any weight loss program. It helps speed up metabolism, burn calories and may also reduce appetite. Most important: if you are new to exercise, please consult with a health professional before beginning any new regime.

Understanding physiological and modern environmental causes of the high obesity rates in Hawaii is only part of the data that is needed to develop an approach to the problem. What is only hinted at in this article is that part of the situation is rooted in the cultures and traditional foods of Pacific Islanders. In centuries past, people worked hard physically to eke out survival. Calories were burned. In the present, with the addition of fast foods and sedentary lifestyles, obesity crosses all cultural and racial lines. The final answer may lie with relentless education and behavior modification techniques.