To Live And Die on Molokai
By Ken Ige, Star-Bulletin
Roy Horner has lost 46 pounds since starting on a new weight
management program for native Hawaiians on Molokai.
Horner once weighed 466 pounds.
Their loss
is Molokai’s gain:
11 Hawaiians blaze
a healthy trail
This group is losing pounds
By Helen Altonn
and gaining pride under a special
weight management program
Star-BulletinKAUNAKAKAI, Molokai -- When some of this island's most visible citizens began daily walks around Kaunakakai, it was the talk of the town.
Their average weight was 411 pounds.
"This group is like an example to the community," said "Aunty" Aulani Maliu. "Since all these people have been walking ... now we have a long line."
"A lot of people come out just to see us," said Buster Hubbard. "They want to see how long we'll last," added George Gramberg.
Hubbard and Gramberg are among 11 enthusiastic native Hawaiians -- nine men and two women -- who initiated a high-risk weight management program here.
They've lost pounds and inches and gained self-esteem and pride in their Hawaiian heritage.
The program was designed by Dr. Blane Chong, family practice and sports medicine physician and lead doctor at the Queen's Health Care Center in Hawaii Kai on Oahu.
By Ken Ige, Star-Bulletin
The long, steep hill leading to Molokai General Hospital was a
goal for the walkers. Kahealani Maliu, 32, attacked the hill
morning and evening, each time getting a little higher.
After six days, she made it to the top. She has lost 36
pounds from her starting weight of 523.
He teamed up with retired Molokai firefighter Herbert Hoe, who advocates traditional Hawaiian food and teaches food preparation.Their target: native Hawaiians with high-risk medical problems such as obesity, diabetes, high blood pressure and cholesterol.
They screened the Native Hawaiian Health System registry for "the highest-risk people, who made a lot of contributions to the community, who could set an example," Chong said.
Roy Horner, 47, an insurance broker and part-owner of the Mule Ride to Kalaupapa, weighed 466 pounds. "My health was getting so bad, I detailed my funeral plan," he said.
"I could hardly move around. My wife was going to all functions without me ... I told her, 'You go, bring me home a plate.'"
Horner dropped 46 pounds with walking, swimming, weight lifting and traditional Hawaiian foods such as poi, taro, breadfruit and sweet potatoes.
The difficulty comes in maintaining a healthy lifestyle, but studies show exercise makes a difference, Chong said. "All 11 are still here after two months."
Hubbard, 42, said he weighed 393 pounds and was diagnosed with diabetes when the program began. "The only exercise was fork to plate to my mouth."
He's down to 370 pounds; his blood sugar and blood pressure are normal, and his horse is happier when he's atop it. Before, he said, after 3-1/2 hours hours helping ranchers round up cattle, "the horse's legs were shaking."
Hubbard's wife and two sons joined him on the walks and Hawaiian diet. He said Hoe told them if they have a craving, "Go for it." So once a month his family "plans on where to splurge eating." Hubbard has his roast pork and ice cream, and "the craving is gone."
The 11 started walking in the parking lot by the building that houses the program, called Lamalama Ka O'iwi, meaning "a glowing physique." At first there was a lot of groaning, the walkers said, but in three weeks they were making it three or four times up a steep hill by Molokai General Hospital.
They're no longer ashamed to be seen. "It used to be, when there was picture-taking, I'd be in the back," Hubbard said. "I'd always try to hide."
Chong said the program is more successful than he expected, and he credits the participants.
A Kamehameha Schools graduate, competitive weight lifter and Hui Nalu canoe paddler, Chong became interested in the effects of weight lifting on obesity while on a fellowship at the University of California at Davis.
Then, working in Molokai General Hospital's emergency room, he said, "I saw all these people come in with diabetes, kidney failure, on dialysis.
"I knew what exercise could do ... but I didn't know nutrition until I met Herbert Hoe. The two fit perfectly."
Hoe has run a 21-day Ai Pono ("eating right" or "righteous eating") Program for about five years. A wellness program, it emphasizes "what we eat and how we look at ourselves," he said.
His model for "lifestyle change" is Vanda Hanakahi, who weighed nearly 500 pounds when the Ai Pono Program began and is now about 250, he said. She is volunteer coordinator of Lamalama Ka O'iwi.
Chong also participated in Hoe's program about three years ago. "We knew if he ate these foods, he would be in shape to paddle the channel," Hoe said. "It turned out to be true."
Chong and Hoe launched their program May 16 with a one-year Queen Emma Foundation grant and support from Drs. Emmett Aluli and Phillip Reyes, Molokai General Hospital's co-executive medical directors. Healthy eating and nutrition, education and cultural identity are coupled with stretching, walking, weight lifting and swimming. An outrigger canoe also was modified to fit the group members for paddling.
"All at least doubled their exercise tolerance in three weeks," Chong said.
Hoe prepared meals with low-fat, high-fiber and high-complex-carbohydrate foods. Protein was limited to two four-ounce servings daily.
The Lamalama program and Na Pu'uwai, the Native Hawaiian Health System, installed 1,000-pound scales so larger folks didn't have to go to the wharf or airport to weigh themselves.Family members and other supporters joined group activities in an extended ohana that's still intact with weekly potluck dinners and other events.
They made an Ai Pono breakfast for several hundred cancer walkathon participants Aug. 8 instead of the usual Spam and eggs.
Among the supporters is Aunty Aulani, who encourages her son, Solomon (Kahea) Maliu, granddaughter, Kahealani Maliu, and nephew Horner, the part-owner of the Mule Ride.
Solomon, a Maui Electric operator, had paddled across the Molokai Channel before his weight climbed to 501, Aulani said. Now he's down to 473.
"When he got on the canoe especially made for big people, it brought memories back and pushed him to do more," Gramberg said.
Kahealani, 32, a kitchen helper at Molokai General, lost 36 pounds from a starting weight of 523. "Spam, eggs, sweets, soda -- all those no-good things" are out, she said. "Now it's all water, fruits and vegetables."
Though not one of the 11, advocate Addie Delos Reyes, 45, the hospital's dietary services supervisor, lost 18 of her 246 pounds and is striving to get off diabetes medication.
Delos Reyes said she wanted to introduce traditional Hawaiian foods to hospital employees but didn't know how to prepare them. "It was easy, just watching Uncle Herb."
Employees are "ecstatic" with her Hawaiian menu three days a week, she said.
Horner, motivated by his wife and six children, had the greatest weight loss in the group in 21 days. But he said he was "the worst of everybody" at the start.
A former Maui policeman and chief investigator for the prosecuting attorney, Horner said he weighed 248 pounds when he moved here in 1984. "The stress level started in 1992. I would just eat and work, no exercise."
He said he was drinking five cans of soda every day, and "fat people don't eat lettuce; they pick up a doughnut."
"We knew how to make Spam 20 different ways," he said, describing one: "Lay the rice, smash mayonnaise over it, design with ketchup, then Spam."
The program taught him control, Horner said. "It's awesome."
Gramberg, 46, assistant chef at Hotel Molokai, bike rider, swimmer and fisherman, was the most active person entering the program, Chong said.
Gramberg said he had been on the diet earlier and had given up. He stuck with the new program because of the exercise and weight lifting, "which everybody loves," he said.
He went from 340 pounds to 328 by working out a month before the program started. Now it's 315 and aiming for 250. A diabetic, he said his blood sugar count has fallen below 150 from more than 300, and he hopes eventually to toss out his pills.
Lincoln Keanini, 50, is so excited about his weight loss that he's at the pool every morning when it opens at 7. And he walks everywhere, he said. "I don't care what the public says."
He was previously on a diet, starting with 510 or 515 pounds, and was down to 490 in May, he said. Now he weighs about 440.
His family supports his efforts, and his wife "is right next to me doing everything," Keanini said. "We're all eating the same except the older boy (19). He still loves his Spam. He'll come around."
Besides running a Loomis Fargo security business, Keanini is a high school coach. He said he used to think, "They (students) stretch. Why should I stretch?"
Now that he's working out, he said a lot of former students tell him they're glad they graduated because "it's gonna get harder" on teams he coaches.
At a glance
The key to the weight-loss programthat targets native Hawaiians with high-risk medical problems:
Diet: Traditional Hawaiian foods such as poi, taro, breadfruit and sweet potatoes
Dialysis presents a special
By Helen Altonn
problem, and Molokai struggles
Star-BulletinKAUNAKAKAI, Molokai -- Fely Borden watched her husband deteriorate after he had chronic kidney failure in April of last year. He needed dialysis three times a week.
He was forced to stay on Oahu, returning home once a month -- "if we could afford it," she said.
"His heart was going downhill because he longed to come home. It was more depression and self-pity because he wasn't here with me."
Henry Borden, 57, is among about 400 Molokai residents listed on a diabetes registry and about 213 known to have kidney deficiencies.
To manage and prevent such diseases -- a health priority on the island -- a Kidney Health/Diabetes Case Management Program was launched in January under Molokai General Hospital.
Program Manager Judy Mikami said diabetics account for about half of patients on the renal registry, and more than 60 percent of those on dialysis.
One patient on dialysis costs about $60,000 a year, she said. "So, if you delay one person even from going on dialysis for one year, it's $60,000 in savings, not to mention air travel and the hardship on the family."
Six Molokai patients and their aides -- including the Bordens -- have been trained at St. Francis for at-home dialysis treatment under a state grant of $120,000 for four years. This is the last year of the grant.
Six patients also are on self-care renal treatment, but 12 to 15 patients have had to move to Oahu because Molokai has no dialysis facility, Mikami said.
Community and Molokai Dialysis Support Group members recently met with officials of St. Francis and its Renal Institute to discuss improving dialysis services here -- including a possible dialysis center.
To build and equip such a facility would cost an estimated $400,000, not including operational and personnel costs, Mikami said.
Also, more education is needed to control diabetes before signs of kidney, eye, foot, nerve or heart problems show up, Mikami said.
"The challenging thing is, most of these things can be prevented or delayed with good education and management and patient compliance."
The Bordens are among residents fighting for a dialysis center on their island. "We need one desperately for people who want to come home, and for visitors," Fely Borden said.
"It would relieve stress for me," she said. She is working part-time at her job as Kaluakoi Hotel's personnel director to care for her husband.
He has diabetes and had a heart bypass, she said. Then his kidneys failed, requiring dialysis three times a week.
"Our problem on Molokai is the cost of flying to Oahu because we can't afford it," she said. "Ground and air (transportation) and accommodations take a toll. The spouse has to work to pay for the insurance."
Her husband must have a shot that costs $524, and one dialysis treatment can cost $400 to $800, depending how long it takes, she said.
Three of their four daughters live on Oahu, so he could stay with them, she said. "But just his absence from home made him depressed. We got together and agreed we'd all chip in money so he could come home once a month.
"There is a big difference between Oahu and Molokai," she pointed out. "He can't walk all over the place. Everything is concrete there.
"As soon as he comes home, he changes clothes and he's out in the garden, or he's on the deck. Our home faces the mountain and ocean. He likes sitting on the porch, just looking out."
The couple built and moved into a new home in January that would accommodate dialysis, she said. They began home dialysis in May after five weeks' training at St. Francis.
"It's not that hard, but it's just scary because of things that can happen," she said.
She said she and her husband have received a lot of support from Mikami and her husband, St. Francis people, and two Molokai friends also on home dialysis.
"A lot of our other friends, eventually they died. Just going back to Oahu three times a week, it took a toll on them."
