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Holoiʻa ka papa, kau ʻia e ka manu. Where there is food, people gather.   

Food is central in every culture, fostering traditions and a sense of community, while also providing us with the nutrients we need to live. In ‘Ai Pono, we will explore the interconnectedness of Native Hawaiian food systems and access, nutrition, and sustainability. Through this series, we will attempt to draw connections between traditional Native Hawaiian food and health/well-being.

 

There are multiple considerations that go into why we make the food choices we do. While someare based off our preferences, much of what goes into the food choices we makedependon factors that are out of our control.

Kaui Baumhofer

An Assistant Professor of Indigenous Health Sciences at the University of Hawaiʻi West OʻahuKauʻiBaumhofer Merritt spoke about the biggest factors influencing our food choices.

She teaches it within the social ecological model illustrated by multiple layers asto why we eat the way we do. There are individual reasons like personal preferences and ʻohana reasons– eating the food your family and the people you live with like, but there are also larger reasons like physical environments – what grocery stores they live by, if they live by a farmers’ market, or if they have a car. There are also larger social cultural reasons why people eat the way they do.

The United Nations defines food security as when people have physical, social, and economic access to foods that are safe, nutritious, and that meet their dietary needs.¹ Achieving food security can be especially difficult for geographically isolated areas like the Hawaiian Islands, which heavily rely on imported foods. A 2020 study found that 27% of Native Hawaiians living in Hawaiʻi were food insecure.² 

In 2018, some of the biggest barriers people in Hawaiʻi experienced in achieving food access were: housing – being houseless or without the means to store or prepare food; a lack of transportation to access food or difficulty transporting groceries; difficulty finding time to shop for groceries amid busy schedules; not having the skills to prepare food; and being socially isolated.³

“For Native Hawaiians, the main barriers are, what's their physical environment, what's physically available to them, whether they have access issues, whether they have a car, issues of affordability, whether they can afford to get the kind of food that they want, and also time – working two to three jobs or having to commute long distances on the bus, and then having to sit down and cook a full meal,” Merritt said.

Merritt said the biggest barriers for Native Hawaiians are centered around three factors – affordability, accessibility, and acceptability.

Affordability is whether people can afford to get the kind of food that they want. Accessibility is the issue of if people have a car to get to restaurants and grocery stores, but also having the time to prepare that food, she said.

“The other issue is acceptability, … because the first two issues can be applied to really any low socioeconomic group. The last one speaks to more cultural ethnic minorities.Do the stores that you live by have the foods that are acceptable to you that you want to eat?” Merritt said.

As a result of these barriers, many may rely on fast food restaurants for their meals. In 2007, a study found that 56.5% of Native Hawaiian participants ate at a fast food restaurant at least once a week.⁴

“There's a big difference between, you choose to go to Starbucks as a treat once in a while … (and) having to eat at Wendy's or L&L every day, because that's what they can afford and that's what they have time to do.”

A study named Hawaiʻi the “Fast Food Capital of America,” estimating the state has 97.5 fast food restaurants per 100,000 people. For comparison, Alaska had the least amount of fast food restaurants per 100,000 people at 61.9.

In the state of Hawaiʻi, there are 64 7-11 locations,⁶ 74 McDonalds locations, and around 85 Starbucks locations.

Hawaiʻi is the fast food capital of the country. But if you look at places where Native Hawaiians are concentrated, that's even stronger. Those of us in those areas will say that Waiʻanae is the fast food capital of Oʻahu.And so if Hawaiʻi is the fast food capital of the nation and Waianae is the fast food capital of Oʻahu, that means Waianae is probably the fast food capital of the nation,” Merritt said. “The higher the concentration of Native Hawaiians in that population, in that community, the higher the density of fast food outlets, and the lower the density of full-service restaurants and full-service grocery stores.”

This is especially notable considering the high rates of chronic health conditions that Native Hawaiians face.  

In an editorialshe wrote for Honolulu Civil Beat, Merritt brought up the term dietary genocide, which she came across in an article by Rodney Jackson. The idea of dietary genocide refers to how the foods that people eat and have access to can contribute to negative health outcomes, such as the ones that disproportionately impact Native Hawaiians and Pacific Islanders.

“The Western diet is really wiping out Native Hawaiians, Pacific Islanders, and, to a larger extent, other indigenous peoples across the world. … Mainly because of dietary issues and the chronic illnesses related to those dietary issues. … That's the kind of basis of that whole dietary genocide. We're not being killed by infectious diseases like we were ... 150, or 200, or 400 years ago. But we're still dying at just incredibly high rates due to dietary-related diseases.”

Native Hawaiians have the second-highest prevalence of obesity among other race/ethnicity groups in Hawaiʻi at 43%, according to a study done from 2015-2017.¹⁰In 2014, around 12.8% of Native Hawaiians in Hawaiʻi were estimated to have diabetes, compared to 5% of white residents.¹¹

Policy can be another big barrier to achieving food security and access.

“How zoning impacts ... our physical environment, in our neighborhoods, and then if you go even beyond that, there are really big historical factors. And for Native Hawaiians, that goes back to colonization and the … Māhele,” Merritt said.

In 2011, the legislature enacted Senate Bill 101, which allowed producers to sell hand-pounded poi, not requiring that they process poi in a certified food-processing establishment²

“Up until maybe, I think like 10 years ago or 12 years ago, it was illegal to sell hand-pounded poi in a retail setting. The only way to get hand-pounded poi was if you knew someone who pounded for you, and that was not super common. You couldn't even sell it at a farmers market, and it had to do with food safety,” she said. “That's an example of institutional racism. Here's this really nutritional super awesome food, this cultural food, that was illegal for us to sell and make money off of and made it very difficult to get.”

Merritt said there are multiple ways that people can take action and interact with their policymakers. People can go to their neighborhood board meetings or run for neighborhood board.Onopening day at the legislature – which is usually in mid-January – the public see any legislator in charge, introduce themselves, and tell them what they’re interested in. People can also submit online testimony, pick up a phone and call legislators, and even go to testify in person.

“Other ways that you can support Hawai‘i agriculture and food security and food policy if you don't want to interface with the system either in getting involved in the neighborhood board or actually talking to your legislators is just to vote with your dollars. That's probably one of the most immediate and powerful ways that we can support ‘ai pono and local food is voting with your dollars.

 ~ Na Maris Tasaka, Communications Assistant

----- 

KauʻiBaumhofer Merritt was born and raised in the ahupuaʻa of ʻAiea. She is an Assistant Professor of Indigenous Health Sciences at the University of Hawaiʻi West Oʻahu. She received her doctorate of science in society, human development, and health from Harvard University, her MPH in health behavior and health education from the University of Michigan Ann Arbor, her master's in Pacific Islands studies from University of Hawaiʻi at Mānoa and her BA in ethnic studies from Mills College. Her research focuses on public health to reduce Native Hawaiian health disparities as they relate to social justice. 

Further Readings/Media

Resources

Citations

  1. “Water and Food Security.” United Nations, www.un.org/waterforlifedecade/food_security.shtml#:~:text=What%20is%20food%20security%3F,a%20productive%20and%20healthy%20life
  2. Stuplebeen, David A, et al. University of Hawaiʻi Office of Public Health Studies, 2020, pp. 1–22, Food Insecurity in Hawaiʻi Using a Population-Based Sample: A Data Brief.  
  3. “The Fast Food Capitals of America.” NiceRxwww.nicerx.com/fast-food-capitals/.   
  4. Ahedo, A. M., T. W. Lee, J. Pan, K. M. Heinrich, S. Keller, and J. Maddock. “Factors Affecting the Consumption of Away-from-Home Foods in Hawai`i Residents”. Californian Journal of Health Promotion, Vol. 5, no. 2, June 2007, pp. 1-12, doi:10.32398/cjhp.v5i2.1227.
  5. “The Fast Food Capitals of America.” NiceRx, www.nicerx.com/fast-food-capitals/.    
  6. “Locations.” Seven-Eleven Hawaiʻi, 2020, 7elevenhawaii.com/locations/.
  7. Hill, Tiffany. “Talk Story: Brad Miles of McDonald’s Restaurants of Hawaii.” Hawaii Business Magazine, 11 Jan. 2019, www.hawaiibusiness.com/talk-story-brad-miles/
  8. “Starbucks Store Locator.” Starbucks. https://www.starbucks.com/store-locator?map=39.635307,-101.337891,5z.
  9. Baumhofer, N. Kaui. “Hawaii's Moment Of Critical Consciousness Raising.” Honolulu Civil Beat, 18 June 2020, www.civilbeat.org/2020/06/hawaiis-moment-of-critical-consciousness-raising/.
  10. Look, M.A., Soong S., Kaholokula, J.K. (2020). Assessment and Priorities for Health and Well-Being in Native Hawaiians and Pacific Islanders. Honolulu, HI. Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i.https://www2.jabsom.hawaii.edu/native/docs/community/APNHPP/2020_NHOPI_Assessment_and_Priority_Rpt.pdf.
  11. Uchima, Olivia et al. “Disparities in Diabetes Prevalence Among Native Hawaiians/Other Pacific Islanders and Asians in Hawai'i.” Preventing chronic disease vol. 16 E22. 21 Feb. 2019, doi:10.5888/pcd16.180187.
  12. 2011. https://www.capitol.hawaii.gov/session2011/bills/SB101_CD1_.htm.
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Ai Pono Banner 9.58.25 AM

Holo iʻa ka papa, kau ʻia e ka manu. Where there is food, people gather.   

Food is central in every culture, fostering traditions and a sense of community, while also providing us with the nutrients we need to live. In ‘Ai Pono, we will explore the interconnectedness of Native Hawaiian food systems and access, nutrition, and sustainability. Through this series, we will attempt to draw connections between traditional Native Hawaiian food and health/well-being.

 

Now more than ever, plant-based eating seems to be growing in popularity. 

Jodi Matsuo

More and more people are Googling “plant-based” and the topics related to it. In 2020, plant-based food sales increased by 27%, and more than half of all U.S. households had purchased plant-based foods at some point.¹

The traditional Native Hawaiian diet was largely plant-based. Dr. Kekuni Blaisdell found that the diet consisted of around 78% carbohydrates, 12% protein, and 10% fat, with poi, ʻuala,ʻulu, green leafy vegetables, and seaweed making up most of the carbohydrates

"For Hawaiians, and I guess for a lot of local cultures in general, they think that eating meat was part of the culture.Some people think pork laulau and kalua pig was part of it, and it wasnt. It was a plant-based culture," said registered dietitian and certified diabetes educator Dr. Jodi Leslie Matuso.

Matsuo, who was also a graduate of the Native Hawaiian Health Scholarship Program, talked about eating plant-based and how it is beneficial for both personal health and the health of the environment. 

"You dont have to be vegan to be plant-based. You can allow for the inclusion of fish and some other foods at least part of the time, as long as the majority of your diet is – I usually tell patients 80% to 85% of your diet is plants – then that other 10% to 15% you can use for special occasions – for birthdays, for when you're socializing with friends, or at a party, or eating out, then you can allow some flexibility for that," she said.

Dr. Claire Kuʻuleilani Hughesresearch found that there were also several benefits to the traditional Native Hawaiian plant-based diet. She found that consuming soy products, fiber, fruits, and vegetables daily, along with reducing the consumption of eggs, whole milk, and red and processed meats, was associated with reducing the risk of cancer.²

 "A lot of studies have shown is that a plant-based diet has been helpful in reducing risk of early death, reducing risk of getting heart disease, of cancer, diabetes and a number of other diseases. A plant-based diet has even shown to be helpful in reversing some diseases that people thought were irreversible like MS, lupus, rheumatoid arthritis," Matsuo said.

On top of that, many traditional Native Hawaiian foods were also highly nutritious.

"Taro leaves are really huge. ... If were talking about Hawaiian diet, seaweed was a big source of a lot of different nutrients. Even in the root vegetables itself, like the sweet potato, and the taro root, and the breadfruit, there were a lot of nutrients in there," Matsuo said.

For those looking to begin transitioning into eating plant-based, Matsuo said a good way to start is by using plant-based meats.

"There was a study that was done that compared someone who ate plant-based, veggie meats to people who had eaten regular meat and they actually found that people who had the veggie meats had better health outcomes at the end of the study than the ones who stuck with the chicken and the beef," she said.

In fact, researchers at Stanford Medicine found that switching out red meat for plant-based meats helped lower some risk factors for cardiovascular disease.

While people may choosing to eat plant-based for their health, many also elect to go plant-based for the health of our ʻaina.

"Eating plant-based ... is one of the biggest things that you can do in terms of helping to make an impact on climate change," Matsuo said. "In terms of, say, animal ethics, a plant-based diet is a way to go. … In terms of climate – being good for the environment, good for the planet – its also the way to go. Because it's low of what you call carbon footprint, that it makes a low environmental impact. 

A carbon footprint is the total greenhouse gases that get emitted as a result of a certain activity.

Farms dedicated to raising livestock account for 1/3 of the world’s total land and more than 2/3 of agricultural land. On top of this, around 40% of crops grown globally are used to feed livestock. Scientists estimate that anywhere from 18% to 51% of global greenhouse gas emissions are caused by the livestock industry. Livestock production is also the leading agricultural cause of water pollution.³The Intergovernmental Panel on Climate Change estimated that a global shift toward eating plant-based could help reduce greenhouse emissions bygigatonsannually, which is more greenhouse emissions than the U.S. emits annually. 

"I think plant-based diet can be considered a type of sustainable eating. Theres a lot less environmental impact on the planetfrom growing crops, growing vegetables, versus raising livestock for food," Matsuo said. "Sustainable eating to me, in a nutshell, is eating foods that are good for you and good for the planet. Its beneficial both ways."

At the Kukui Lifestyle Medicine clinic, which Matsuo and her husband Dr. Leon Matsuo founded, she runs a nine-week program called the Pono Program, in which she offers cooking demonstrations and health education. Through her classes, Matsuo shows that eating plant-based does not have to be restrictive. 

When selecting recipes for the program, there are several factors she takes into consideration. 

"It had to be simple, it had to be liked by local people. So it has to suit local people's tastes, and, of course, it had to be healthy and plant-based. So, with that in mind, I would choose simple recipes," she said. "Ingredients-wise, because it can be expensive, ... it has to be affordable as well."

Matsuo said she has three tips for those looking to eat plant-based. The first is tothink of what people can add to theidiet – the ways they can add more fruits and vegetables.

"I think just start by thinking about what foods you can add to your diet. People think that when you hear the word diet, you think of being so limited and taking away from what you normally eat, but maybe looking at it from the opposite way and saying, 'What can I add to my diet to become more plant-based?'"

Her second tip is to gradually build up to including more fruits and vegetables so that 50% of your meal is fruits and vegetables. This could be in the form of a stir fry or something distinct like having a vegetable soup or salad.

Her last tip is to take recipes people already use and substitute the meat with either tofu, beans, or more vegetables. 

"You can use the same spices, you can use the same flavorings, but just switch out the meat for tofu, or for beans, or just more vegetables. So, start off with dishes that are easy," she said. "If there's familiar dishes, then they’re probably more likely tstick to it," she said. "Ill make a veggie luʻau, like how they have chicken luʻau or squid. ... For the meat replacement, Ill use either veggie chicken, or taro, or sweet potato. Sometimes I do like a tofu poke, instead of regular poke."

Despite getting comments about people never having seen a Hawaiian vegetarian before, she said plant-based eating is part of the Native Hawaiian culture. 

"Its not going against your cultural norm to go plant-based; its actually going back. Itactually what would be the opposite, in a sense. Youre actually reverting back to your cultural ways by going plant-based."

Na Maris Tasaka, Communications Assistant

-----

Dr. Jodi Leslie Matsuo was born and raised in Kona. She graduated from Konawaena High School and attended the University of Hawaiʻi at Mānoa where she received a masters and a doctorate in public health. She is a registered dietitian and certified diabetes educator, with training in integrative and functional nutrition, and alumna of the Native Hawaiian Health Scholarship Program. Along with her husband, Dr. Leon Matsuo, she founded and runs the Kukui Lifestyle Medicine clinic in Kailua-Kona. She also writes the Mālama I Kou Kino column for Ka Wai Ola.

 

Further Readings/Media

 

Citations

  1. Orlando, Brian. “Retail Sales Data.” Plant Based Foods Association, 7 Apr. 2021, www.plantbasedfoods.org/retail-sales-data/
  2. Hughes, Claire  Ku'uleilani. “Culturally Appropriate Health Intervention Programs for Native Hawaiians.” Asian American and Pacific Islander Journal of Health, vol. 6, no. 2, 1998, pp. 174–179.
  3. Dopelt, Keren et al. “Environmental Effects of the Livestock Industry: The Relationship between Knowledge, Attitudes, and Behavior among Students in Israel.” International journal of environmental research and public health vol. 16,8 1359. 16 Apr. 2019, doi:10.3390/ijerph16081359.
  4. Worland, Justin. “If We Want to Stop Climate Change, Now Is a Moment of Reckoning for How We Use the Planet, Warns U.N. Report.” TIME, TIME USA, 8 Aug. 2019, time.com/5646787/ipcc-climate-change-land-report/.
  5. Armitage, Hanae. “Plant-Based Meat Lowers Some Cardiovascular Risk Factors Compared with Red Meat, Study Finds.” Stanford Medicine News Center, Stanford Medicine, 11 Aug. 2020, med.stanford.edu/news/all-news/2020/08/plant-based-meat-versus-animal-meat.html.
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 1 mt KAHOOLAWE SIGNOVER D 5 7 94May 7, 1994, at Palauea, Maui. Throughout the day hundreds, thousands of people arriving by car, bus, boat, on foot. Kānaka on the beach, on the lawn, in the house. Someone set up a stage and a sound system. Musicians toting their instruments.  Military personnel in dress whites. Kūpuna seated in the shade. Pū practice at the shoreline. Keiki playing in the water. Canoes offshore. On the horizon, an island. Kaho‘olawe. Kohemālamalama o Kanaloa.

The ceremony had begun. Not regalia, pomp, and circumstance, but the ceremony of numerous humans engaged in discrete tasks, at different paces, with a singular purpose, converging in harmony. Lōkahi.

Congress convened the Kaho‘olawe Island Conveyance Commission, or KICC, in 1991 following the end of the bombing of the island to make an assessment and recommendations as to the future of this island. The U.S. was going to fund the cleanup of ordnance and rehabilitate the island to a useable status. Smartly, a conveyance of control from the U.S. Navy to the State of Hawai‘i to hold in trust for a future Hawaiian sovereign entity was planned before the 10-year cleanup was to commence. Had it been devised to occur upon certification for safe use following the cleanup, the island would still be in military hands today.

This week, we are reminded that less than 10% of the land surface was cleared to a depth of 4 feet, far short of the goal of 30%; 75% of the island is surfaced cleared, much less than the agreed upon 100%.  Access to uncleared areas is restricted and free roam areas are explicitly marked.

Someone had a master plan that day in May. I just showed up with all my weekend needs in a dry bag and a willingness to kōkua. A few people had rooms at a nearby resort the preceding Friday night; every corner had sleeping bodies. I spent the morning shredding kalua turkey chatting with a familiar-looking guy named Charlie. In the afternoon, I served water and lunch plates to the kūpuna under the tent. Music was non-stop.

2 mt KAHOOLAWE SIGNOVER 5 7 94Soon, Dr. Noa Emmett Aluli, Governor John Waihe‘e, Undersecretary of the Navy William J. Cassidy, and a couple of others were on stage signing deeds to the island on a table from the Ke‘anae kitchen of Uncle Harry Mitchell.  A line of pū blowers the length of Palauea Beach faced Kanaloa Kaho‘olawe and blew those shells 100 times. Canoes neared shore to take 100 people to continue the ceremony on island. Somehow, I made the cut. I talked story with Uncle Les and the kāne kia‘i.

The ceremonies continued in Hakioawa, commitments were made over ‘awa at Hakioawa, and Kaho‘olawe belonged to the people. Belongs to the people.

That day signaled renewal. Self-determination. The first ‘āina belonging to the future Hawaiian sovereign entity. “One down, seven to go.” 

Understanding the underlying causes of the Kanaka Maoli plight identified by Dr. Kekuni Blaisdell—depopulation, the threat of being a minority in one’s own homeland; the loss of lands due to colonization; cultural conflict; despair and self-destruction; and racism—the return of Kaho‘olawe to the people of Hawai‘i from the strongest military power in the world was empowering.

Jeff Akaka Kekuni Hakioawa 2000

New work commenced, new technologies were innovated. We were hopeful and energized. Huaka‘i, visits to the island, continued for cultural, educational, religious, and scientific purposes.

A young social worker named Julie took a women’s group she was working with to Kaho‘olawe, encouraging them to participate in the revegetation activities during the day, identify the lessons the island has to offer, and maintain their journals at each day’s end. The women, all in different stages of healing, immediately recognized the island—which had been bombed for nearly 50 years—as a metaphor for one’s personal recovery from trauma and abuse. Not much later a Hawaiian psychologist took a group of men, who experienced similar sensations, same outcomes.

The Native Hawaiian Health & Wellness Summit, hosted by Papa Ola Lōkahi in 1998, offered each island the opportunity to hold ‘aha, island gatherings, to bring the people together to identify the priorities for health and wellness. Kaho‘olawe—the smallest, least populated island—held three ‘aha, identifying the characteristics and practices of well-being, some of which are:

  1. On-island co-existing: experiencing rites of passage not often undertaken in modern times, ‘ohana or kauhale communal living, kōkua and laulima, substance-free environment, history that provides into the lives of po‘e kahiko; cultural protocol and other practices; and resource management
  2. Wahi pana, wahi kapu: encouraging focus, particularly during specific ceremonies such as Makahiki; kapu kai, a cleansing of body, mind, and soul; self-reflection and renewal; and different types of rites of passage
  3. Stewardship training provides Kaho‘olawe as a model for how places on our home islands can be protected. Healthy environments derive healthy people.
  4. Leadership training. The Protect Kaho‘olawe ‘Ohana is a living model for grassroots organization bringing people together from all islands as an ‘ohana with a common cause. Organized intergenerationally and a history of unprecedented kūpuna support, thus a built-in spiritual base. The ‘Ohana continues to mentor and produce new generations of leaders.

DeeAnn Martina Emmett Hakioawa Kahoolawe April 2021

Kaho‘olawe Healing was recognized and we made more intentional efforts to develop curricula featuring the lessons of the island. In 2000, we took the first group of Hawaiian health professionals to camp at Hakioawa with similar results. Each huaka‘i has had a theme, cross-disciplinary teachings and a convergence of shared understandings of different healing and environmental practices. Just this week a group of Hawaiian physicians is championing regular trips with medical students to lay a foundation for their budding careers. A solid foundation.

I am an advocate of facilitating huaka‘i for those who are on the fringe, in the margins, who are seeking, searching, healing, mending. I have found that it isn’t necessary to tell people what the island has to offer, because each will have her or his own personal—usually deep and profound—experiences. Absent the clutter of modern life, the lessons of Kanaloa Kaho‘olawe surface immediately.

On May 7, 1994, a tiny, abused, sacred, recovering island was returned to Hawaiian hands, providing inspiration to the lāhui to thrive, to reclaim the lōkahi and well-being of our ancestors. Forests are planted one seed at a time. Lands are reclaimed one island at a time.

Healing an island, healing a people, healing a nation.

~ Na Kim Ku‘ulei Birnie

 

 

Photos:

  1. Maui News
  2. Maui News
  3. Drs. Jeffrey Akaka & Kekuni Blaisdell, swimming to shore, Kahoolawe, 2000.  Photo by KKBirnie
  4. Drs. Dee-Ann Carpenter, Martina Kamaka, Noa Emmett Aluli, Hakioawa, Kahoolawe, April 2021.  Photo courtesy Dee-Ann L. Carpenter.
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Holo iʻa ka papa, kau ʻia e ka manu. Where there is food, people gather.  

Food is central in every culture, fostering traditions and a sense of community, while also providing us with the nutrients we need to live. In ‘Ai Pono, we will explore the interconnectedness of Native Hawaiian food systems and access, nutrition, and sustainability. Through this series, we will attempt to draw connections between traditional Native Hawaiian food and health/well-being.

When we think about nutrition, we may not necessarily consider how our present health may have been impacted by our health as young as when we were infants

During infancy, nutrition is especially important, as it is a period that can be linked with healthduring later stages of life. Studies have shown that early feeding practices can play a significant role in preventing diseases and promoting health.¹

thumbnail IMG 8722Marie Kainoa Fialkowski Revilla, an associate professor in the Department of Human Nutrition, Food, and Animal Sciences at the University of Hawai‘i at Mānoa, spoke about the importance of good nutrition during infancy. 

The likelihood for being overweight, when (babies are) older, can be influenced by, their diet during infancy. ... There's just lots of evidence that suggests that, through healthy complementary feeding, having a diverse diet, it's going to improve their health outcomes, reduce their likelihood for chronic disease, she said. 

The World Health Organization (WHO) defines complementary foods as the solidfoods that guardians introduce when infants reach a stage in which breast milk or formula can no longer provide them with all the nutrients they need. They are complementary because they are solid foods that guardians introduce along with breast milk or formula

As the foods that infants are eating to help them grow into healthy children, there are four important considerations that the WHO suggests guardians take into account when selecting and preparing complementary foods for their infants.

“We should … think about the best diet, the best foods. We want to be setting them up for success,” Dr. Fialkowski Revilla said.

The first consideration the WHO notes is timing – when to introduce complementary foods to infants. Typically, babies are ready for complementary foods when they are around 6 months old. Timing is important as it can impact the infant’s likelihood of becoming overweight or obese at later stages in life, as well as their growth and development. ²

The second is ensuring that the foods are providing adequate nutrition, energy, protein, and micronutrients.² Fialkowski Revilla said it's important that complementary foods are high in iron and zinc, as breastmilk and formula do not provide enough at the 6-month stage.

“With complementary foods, you really want to focus on the vegetables – poi, starchy roots,” she said.

The third consideration is ensuring that the foods are safe – stored and preparedhygienically.² 

The final consideration is ensuring infants are being fed enough and in the right frequency for their needs and age. The WHO recommends starting off with mashed foods or semi-solid when babies are between 6-8 months old, and that guardians feed babies from two to three times a day, increasing to feeding them three to four times a day when they are around 9 months old. By the time infants are around 1 year old, the WHO recommends introducing children to the foods the family is eating. ² 

On top of the WHO's considerations, Fialkowski Revilla notes that the diversity of complementary foods is especially important.

You're more likely to meet your nutrient needs if you're eating a diverse group of foods, Fialkowski Revilla said. Encoura(ge) exploration. If you're exploring, and you're exploring with your keiki, they're going to be more likely to be adventurous. That's the other thing too, is that you want your kids to be adventurous eaters. And the only way they're going to be adventurous is if you expose them to lots of different flavors. And so that they're willing to try.We want them to be willing to try. And if they're willing to try, then they're more likely to like the food.”

Traditional Native Hawaiian foods hold a lot of nutritional benefits for babies, along with having cultural value.

We have a lot of really great traditional foods here, and we want to make our babies ʻono for those foods, Fialkowski Revilla said. Those cultural foods are very meaningful. They carry a lot of value and spiritual benefit, and, with the idea too of the mana and food and things like that, it's such a shared experience.

Some examples of traditional Hawaiian complementary foods caninclude ʻuala (breadfruit), poi, mashed kukui nuts, sauces made with opihi, ʻaʻama (crab), and vegetables and herbs.³

Our traditional foods, like when we think about lūʻau – the green leaves – I mean, that is packed (with) so many nutrients. It's so good – vitamins, the fiber – and it just tastes ʻono, she said.

In one of her studies, Fialkowski Revilla found that poi was an especially popular first food among moms. Poi is a good example of a complementary food because it's versatile, its consistency can be modified based on the baby's development, and it's nutrient-dense with minerals, vitamins, and fiber, Fialkowski Revilla said. She also noted that some moms mixed poi with breast milk or formula, others with sweet potato or rice cereal. 

As important as nutrition is for infants, Fialkowski Revilla noted how nutrition is very much a family effort.

“We say that we want babies to be eating diverse diets, I think it goes the same for families,” Fialkowski Revilla said. “If they see mommy eating it, they see daddy eating it, they see brother and sister eating it, they see grandma eating, if they see everybody eating it, then they're going to be more likely to want to eat it. So, I would say it's not something that's in isolation. If everybody's working together, it's much easier to live that healthy lifestyle.”

In one of the studies Fialkowski Revilla did, she found that many mothers were seeking feeding advice within their own families – their moms, mothers-in-law, sisters, or aunties.

“We need to really think about our families, and the communities that our families live in, the policies that influenced the communities that our families live in.  I think it's not just a simple strategy to ensuring that our babies are eating well. Our families have to eat well, our mommies have to eat well, our communities have to have access to be able to eat well, everything is all connected,” she said. “The more we can involve everyone, so the whole family is involved in kind of preparing the meal and putting it together, everybody has kuleana.”

While it's important for babies to eat diverse diets, Fialkowski Revilla notes that exploring food doesn’t have to be exclusive to babies

“You want them to pick up and be exposed to lots of different textures. It's kind of like they're playing with their food, they're exploring with your food, and so why can't we also explore foods, explore different pairings, or explore different ways to make food? Just don't be afraid.Sometimes it'll come out great, and sometimes it may not come out that great, but it's OK, right? Because we're having fun with her food,” she said. 

One way Fialkowski Revilla suggested experimenting with foods is by modernizing traditional Native Hawaiian foods.

“So, our traditional foods – instead of eating (just) poi, add it with some fruit, throw some granola on there. You can kind of modernize some of the foods, too, so that you can incorporate them into your diet in multiple different ways,” she said.  

Currently, Fialkowski Revilla is doing a study that tracks through photos that moms upload to a mobile app what babies eat throughout their first year. She hopes her study will provide pertinent data and information that comes from the community and ensures that foods and support programs, health promotion events, and activities are being delivered in an appropriate and acceptable way that addresses the needs of the community.

Ultimately, I want a thriving lāhui. I want a healthy lāhui. I want our babies to grow up to be healthy adults, she said. “Ithink we could all learn from babies, right? If we can all eat diverse we're going to do pretty good if we can drink water, we're going to do pretty good.

~ Na Maris Tasaka, Communications Assistant

----- 

Marie Kainoa Fialkowski Revilla is an associate professor in the Department of Human Nutrition, Food and Animal Sciences at the University of Hawai‘i at Mānoa's College of Tropical Agriculture and Human Resources. Her research focuses on nutrition and health in indigenous populations and infant nutrition. Fialkowski Revilla grew up in Waiāhole Valley and graduated from Maryknoll School. She got her undergraduate degree from Dartmouth College and received her master's degree and PhD from Purdue University.  

 

If you are interested in participating in Fialkowski Revilla's current study, are 18 years old or older, Native Hawaiian, and an Oʻahu resident, you can contact 808-375-3785 for more information or email This email address is being protected from spambots. You need JavaScript enabled to view it.

Further Readings/Media

Citations

  1. Fialkowski, Marie K et al. “Type, Timing, and Diversity of Complementary Foods Among Native Hawaiian, Pacific Islander, and Filipino Infants.” Hawaiʻi Journal of Health & Social Welfare vol. 79,5 Suppl 1 (2020): 127-134. 
  1. “Complementary Feeding.” World Health Organizationwww.who.int/health-topics/complementary-feeding#tab=tab_1
  1. Fialkowski, Marie K, et al. “Native Hawaiian Complementary Feeding Practices as Told by Grandparents: A Transgenerational Experience.” Current Developments in Nutrition, 26 May 2020, doi:10.1093/cdn/nzaa086.
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I ka ‘ōlelo no ke ola, I ka ‘ōlelo no ka make.

Words can heal, words can destroy.                                                 

~ Pukui, #1191

 

 

 

 

 

 

Why are Native Hawaiians and Pacific Islanders hesitant to get the COVID-19 vaccine?  

We are asked this repeatedly. Ironic, because the medical practitioners and epidemiologists asking this question are themselves taught to assess and evaluate [1, 2] before recommending a certain treatment, prescription, strategy or action.

Why then are communities of color not afforded the same respect for inquiry into the vaccines as are others? [3]

The term vaccine hesitancy indicts the individual [4] for asking questions.  Is it not smart to to seek as much information as possible before making a decision, especially about something as important as what might be injected into your body or that of a family member? That's caution. Care. That's assuring our families are protected.

ThrowNet

The Native Hawaiian resource management community has in recent years articulated the ages-old practice of kilo [5]. Farmers, fishers, wayfinders, gatherers, even warriors first gather information by scanning the environment and observing patterns before making decisions to take action.  That's traditional wisdom.

We are all striving to stem the daily reports of infections and deaths. As clinicians, researchers, social workers, public health administrators and communicators, what is gained by blaming our people--or worse, those people--for being hesitant?  We should be asking ourselves, what I can I do to assure my families, my communities have the confidence in the vaccines and vaccination process? 

Am I hearing the questions being asked? Can I provide accurate and timely information? Who is best to deliver the information:  community advocates, faith leaders, doctors and scientists from my own community, Uncle Kalani at the family BBQ, or me? Are my tactics direct, my messages easily understood?

Let us stop accusing those we serve of being hesitant and take responsibility for inspiring confidence.

~ na Kim Ku'ulei Birnie

 

 Horizontsl 1

1. Rapid Community Assessment Guide, CDC

2. Health Impact Assessment, CDC

3. Strategic Approaches to Communicating About Health Equity and Disparities [VIDEO:  57:20], Society for Health Communications

4. Vaccine Hesitancy is a Scapegoat for Structural Racism, JAMA

5. Kilo as Practiced by Our ‘Āina Stewards‘Āina Stewards, Hawai‘i Land Trust

Photo:  Hawaiian Fisherman @1915.  Commons Wikimedia.

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