Health Consequences of Modern Diets on Guam
Our food choices
As with most communities, the necessity for food is interwoven with cultural and social needs. For the people of the Mariana Island, food is, and always has been, central to the cultural practices and traditions that have shaped daily life in the community.
Historically, food has had a place in major life events, religious practices, village migration and social status. The interwoven nature of food and culture also dictates the dietary components of the daily diet (foods eaten) and the preparation of this food (cultural, socially accepted practice). Often, cultural and societal influences on diet, such as type of food, how much, and how often a food item is consumed, take precedence over the health implications these food components may have on the individual as well as the community.
Grounded in a foundation of beliefs and values, the people of Guam have, nonetheless, been changing with the times, as have cultural practices and daily life choices. In turn, the traditional diet for the people of Guam, although steady in certain components, cycles through constant change. The actual food items which make up the components of the diet, and food events at which these components are consumed, are products of decades of change.
Food events: Fiestas
Modern food events such as fiestas, church gatherings, or other social events may consist of calorie-dense, processed foods. While many foods associated with celebrations are high in calories, they do not provide many necessary nutrients, vitamins and minerals. In addition, the modernized cultural components of food events may promote an increase in the amount of food being consumed during food events. For example, a modern fiesta in Guam may have up to 34 different dishes with more than 100,000 calories available for consumption (Figure 1).
Among these dishes, as little as four vegetable dishes may be available as healthier food options. Additionally, alterations to these healthier vegetable options are often made, increasing the calorie and fat amounts. Of the vegetable dishes available, high-calorie modifications such as the addition of mayonnaise or cooking methods such as deep frying in oil, contribute substantially to the calorie amounts and negatively impacts the nutrient profiles of these vegetable options.
The fiesta setting is just one example of the modernization of the diet in Guam which has caused a nutrition transition. For example, traditional carbohydrate options such as local breadfruit and taro have been replaced at the fiesta table by store-bought potatoes or white rice. These replacements lack the nutrients and dietary fiber that would be available in the more traditional options. The major effect that these food choices and diet behaviors have in the long-term can have adverse health impacts for the community in Guam.
Health implications of Guam’s ‘modern’ diet
Guam’s shift towards Western, industrialized practices is paralleled by changes in dietary patterns. Processed foods and fast food chains have become widely available, and Guamanians have largely transitioned away from traditional foods (see Ancient CHamoru Food and Diet).
The current food landscape promotes a standard ‘Western’ diet: one that is high in trans and saturated fats, refined sugar, and salt, and low in fiber and micronutrients. These major shifts in nutritional practices have had consequences on health. High refined carbohydrate and sugar consumption contributes to high rates of obesity and non-communicable, chronic diseases.
Obesity is common
Roughly two-thirds of Guam’s population are either overweight or obese. Rates of obesity are highest among CHamorus and Micronesians. This high prevalence of obesity is attributable to high energy intake combined with low rates of physical activity. Obesity is a strong risk factor for chronic disease development such as Type II diabetes, cardiovascular disease, stroke, and cancer. Nearly 60 percent of deaths on Guam are caused by these four non-communicable diseases.
Diabetes prevalence has risen over the years and, as of 2010, is the fourth leading cause of mortality on Guam. The prevalence of the disease ranks among the top 10 within the Western Pacific Region, and ranges from 11 percent to 19 percent, though this may be underestimated due to underreporting from lack of diagnosis. Though Type II diabetes is rising worldwide, diabetes and its complications disproportionately affect Guamanians when compared to other US citizens.
This is due, in part, to the rapidity of change in dietary, lifestyle, and nutrition habits, but may also be explained by a genetic predisposition for diabetes among Pacific Islanders. Additionally, untreated diabetes directly contributes to heart disease, which is, by far, the leading cause of death on Guam. In addition to Type II diabetes, other risk factors for heart disease include high cholesterol, high blood pressure, and obesity, all of which are modifiable by nutritional changes.
Growing concern over chronic disease has increased efforts towards management and prevention. Focus on prevention will not only reduce healthcare burden, but the social and economic costs of chronic disease, as well. Minimizing risk factors can reduce the burden of chronic disease, though other means of improving health, such as increased access to healthy foods, opportunities for physical activity, and prevention education, also need to be addressed.
Growing awareness on nutrition
To combat the rise in nutrition- and lifestyle-associated diseases, efforts currently in practice include improving access to healthier food initiatives, public health measures, and community health projects. There is a growing demand for local and seasonal fruits and vegetables, farm-to-table food production, and a rise in farmer’s market events.
Policy and community changes that promote healthy lifestyles, and increased access to quality nutrition, are steps towards reducing the burden of chronic disease and health disparities. Returning to a less processed, whole-foods diet may have a positive impact on current dietary trends that have resulted from increased globalization and industrialization.
Kristi Hammond was a graduate student in the University of Guam’s MS Sustainable Agriculture, Food and Natural Resources (SAFNR) Program in 2018. Her interests are in nutrition and health, local food systems, and food security.
Remedios Perez was a student in the Sustainable Agriculture, Food and Natural Resources (SAFNR) graduate program. Born and raised in Guam she became more and more aware of the reality that Pacific Islander communities remain vulnerable populations, underserved and overlooked in the areas of food and nutrition. She aims to address this disconnect in her studies and research in the SAFNR program.
These authors were beginning graduate students in 2018 taking a course in scientific writing at the University of Guam. This article was assigned to provide the student with practice in communicating science to non-scientists. The student chose the topic which is related either to their thesis project or work experience. The instructor in the course is Dr. Laurie Raymundo, a UOG Marine Laboratory faculty member.
For further reading
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Grimm, Kirsten A., Jennifer L. Foltz, Heidi M. Blanck, and Kelley S. Scanlon. “Household Income Disparities in Fruit and Vegetable Consumption by State and Territory: Results of the 2009 Behavioral Risk Factor Surveillance System.” Journal of the Academy of Nutrition and Dietetics 112, no. 12 (2012): 2014-2021.
Guam Department of Public Health and Social Services and Non-Communicable Disease Consortium. Guam Non-Communicable Disease Strategic Plan 2014-2018. By Angelina G. Mummert, Christine D. Camacho, and Annette M. David. Mangilao: NCD, 2013.
Guam Department of Public Health and Social Services Behavioral Risk Factor Surveillance System Program. 1st Guam BRFSS Report 2007-2010. Edited by Alyssa A. Uncangco. Mangilao: BRFSS, 2012.
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Pobocik, Rebecca S., and Nancy S. Boudreau. “Nutrient Analysis of the Guamanian Diet: Acceptable Energy Distribution with Inadequate Nutrient Quality.” Pacific Health Surveillance and Response 12, no. 2 (2005): 65-77.
Snowdon, Wendy, Astika Raj, Erica Reeve, Rachael LT Leon Guerrero, Jioje Fesaitu, Katia Cateine, and Charlene Guignet. “Processed Foods Available in the Pacific Islands.” Globalization and Health 9, no. 53 (2013): 1-7.