Obesity and physical activity among Native Hawaiian adults

Abstract

Obesity poses a significant health concern globally, with Native Hawaiians showing notably high prevalence rates. Historically, physical activity was integral to Native Hawaiian culture. However, modernization has led to sedentary lifestyles, exacerbating obesity rates and health disparities. This Three Article Dissertation (TAD) presents three studies in a cohesive body of work to explore and unravel the topic of obesity and physical activity among Native Hawaiian adults to understand its current state, the disconnects and connections to the past, and how this knowledge can be used to inform future social work practice, policy, research, and education. Study #1 conducts a quantitative secondary analysis of data from the 2017 Hawaiʻi Behavioral Risk Factor Surveillance system. This study aims to describe the relationship between obesity and physical activity among Native Hawaiian adults. The results indicate that physical activity and sex were significantly linked to overweight/obesity among Native Hawaiian adults in the sample, while age, marital status, education, income, employment, and island of residence showed no significant association. Native Hawaiians reported higher rates of obesity, lower levels of physical activity, and those who engaged in physical activity were less likely to be overweight or obese compared to those who did not. Study #2 reviews culturally focused interventions utilizing physical activity to address obesity among Native Hawaiian adults. The purpose of this study is to (a) review the existing literature that focuses on obesity related interventions for Native Hawaiian adults, (b) evaluate the incorporation of culture and physical activity within these interventions, and (c) identify limitations and gaps to promote future research. This study identified nine interventions, revealing wide variations in their descriptions, aims, participants, methods, measures, results, cultural components, and integration of physical activity. It highlighted the necessity for disaggregation and targeted efforts to increase Native Hawaiian involvement and tailored approaches for elder populations, to decrease gender disparities, and to expand statewide locations. Additionally, the study underscored the need for further research on integrating culture into interventions and understanding engagement in physical activity within culturally focused programs. Study #3 aims to explore (a) physical activity facilitators, barriers, motivators, and other factors for Native Hawaiian adults, and (b) recommendations for how physical activity be more available, accessible, and appropriate for Native Hawaiians to achieve health, healing, and wellbeing, by utilizing key informant interviews with community experts. Subthemes include all six dimensions of the Kūkulu Kumuhana framework (i.e., waiwai, ʻāina momona, pilina, ‘ōiwi, and ke akua mana). Suggestions for future actions occurred on all levels of influence 'ohana, community, organizational, and policy. This dissertation can enrich the field of social work by identifying strategies to promote positive patterns of physical activity and understanding how physical activity can be made available, accessible, and appropriate for Native Hawaiians, thus advancing the development of culturally-focused interventions to improve health and wellbeing for Native Hawaiians.