The tailoring of a community-based approach to reduce obesity among Samoans in Hawaiʻi

Abstract

Western colonization of the Samoan archipelago resulted in economic, cultural, and behavioral transitions leading to increases in the prevalence of obesity in Samoans over the past 40 years. Currently, a third of men, and half of women in Samoa, and 60% of men and 73% of women in American Samoa are considered obese. Samoans maintain high rates of migration, with nearly one third of Samoans in US. Obesity persists in these migrants, and obesity-related disease contributes to Samoans having the lowest life expectancy of the seven largest ethnic groups in Hawaiʻi. Interventions have addressed obesity in Samoans; however there are few reported interventions tackling obesity with Samoans living in Hawaiʻi. Chapter one provides background on the dissertation. Chapter two provides a review of the scientific literature on studies conducted with Samoans, identifying political, institutional, cultural, and behavioral obesogenic factors, including the introduction of market economies, changes in vocations, prominence of processed foods, and transition from agrarian to urban lifestyles. Constructs from the Social Ecological Model of Health (SEM) provided an organizing framework for knowledge on Samoan diet and health, and these constructs can inform the creation of interventions. Chapter three presents results from interviews with Samoans in Hawaiʻi confirming information in the scientific literature on Samoan obesogenic factors. The investigation identified faith-based institutions as appropriate settings within which to reach Hawaiʻi's Samoans. Interviewees suggested culturally-appropriate intervention strategies, including leveraging the Samoan social hierarchy, re-adopting healthy traditional foods and preparation methods, and conducting group-based intervention activities. Chapter four presents a secondary analysis of dietary data obtained from more than 1,400 Samoans living in American Samoa, Hawaiʻi, and California. Samoan diets were characterized by high daily intake of calories, and saturated fat. Samoan dietary patterns suggest an increase in dietary diversity with acculturation, with healthy consumption patterns obscured by overconsumption of animal food products and processed foods. Interventions to address obesity in Hawaiʻi's Samoan community should target the relevant obesogenic socio-economic, cultural, and behavioral factors for this group. The adaption of evidence-based interventions that incorporate these factors may prove successful in reducing obesity and chronic diseases in the population.