Walk for Hawai’i Filipinos’ Health
Let us celebrate the first Hawai’i Walk For Health!
Last August 11th, several Filipino organizations and supporters successfully held the Lakad Para sa Kalusugan, or Walk for Health, Hawai’i’s first “walk as a community” initiative.
In other U.S. states, Lakad Para sa Kalusugan has brought Filipinos together to promote physical activity and wellness within the warm embrace of community spirit.
Over a hundred Hawai’i Filipinos walked for a good cause and raised issues affecting the community’s health such as livable wages, migrant rights, and
affordable housing.
This event was organized by the University of the Philippines Alumni Association of Hawai’i (UPAAH), the National Alliance for Filipino Concerns (NAFCON), and the Hawai’i Workers Center (HWC).
The first two groups UPAAH and NAFCON advocate for the rights and welfare of Filipinos who form the majority of their members, while HWC is a non-profit center serving low-wage workers in Hawai’i, many of whom are Filipinos.
Walking with the community for health
The Walk promoted
walking as a healthy activity for the heart, lungs, muscles, brain, and mood. It is generally believed that a good walk is about 10,000 steps, and for most people, this is equivalent to ~8 kilometers, or 5 miles, per day.
Walking is easy, free, and accessible to almost everyone. Our Hawaii communities generally have walk-friendly spaces and we should use these spaces.
Walking activities are also ways to learn so much - about our bodies, our relationships with each other, and the community!
By walking, we get to meet new people! You see, walking is very beneficial!
Participants of the Walk also enjoyed the stretching and escrima activities that were planned.
“Our health is our most valuable asset. Without it, we can accomplish nothing in life,” said Johnny Verzon, a martial arts practi-
tioner who led the escrima session in the Walk.
“There is no such thing as “I do not have time.” We all have 24 hours in a day. It is what we do with our time. Make time to take care of our health – mind, body, and spirit.”
Another community member who took the bus from Kalihi to be able to join the Walk with his doctor shared his enthusiasm about the event.
“It is a great idea to promote walking as a good exercise, but it is really something else to do walking with the community who cares! Please hold another Walk next year!” he shared.
For Mylene Reyes, current president of the UPAAH, organizing the Walk was not a walk in the park but felt it was a worthwhile endeavor.
“When we organized the Walk, we were thinking of creating a family-friendly, community event that
will also help raise awareness about health issues faced by the Filipino community in Hawaii,” Reyes said.
Reyes also said that scouting the location for the event was just the first step.
“As soon as we decided that Central Oahu (Aiea) was a good choice, we immediately thought about designing the Walk’s path within the grassy part of the part. The Walk also featured creative stakes containing health-related information that was placed on the ground throughout the path,” she shared.
Dr. Rainier Bautista who is the current president of the Philippine Medical Association of Hawai’i, which helped sponsor the Walk, said: “We did the Walk not only for good physical health. Not a lot of our patients receive culturally sensitive care, and I believe the Walk brings this issue out in the open
by Dr. Arcelita Imasa
– that receiving culturally sensitive care can positively impact the health of Filipinos.”
Hawai’i Filipinos: Health status, determinants of health
The Walk also sought to highlight issues affecting the health of Filipinos in Hawai’i.
Sergio Alcubilla, executive director of Hawai’i Workers Center, stated: “Filipinos tend to neglect health because of the need to work multiple jobs. But why do we need to work multiple jobs? There are many reasons, starting with the high cost of living in Hawaii. While some of these reasons seem obvious, the Walk served as a time to pause to reflect.”
Filipinos are known to have the highest rate of physical inactivity among ethnic groups in the state. They are also known to have the highest rates of
high blood pressure and cholesterol, heart and kidney disease, and other chronic diseases.
Next to Native Hawaiians, Filipinos have the second highest rate of diabetes. Compared to other ethnic groups, Native Hawaiians and Filipinos also face higher mortality rates for coronary heart disease, according to the State’s Department of Health.
Filipinos also have the highest mortality rates for stroke among all ethnic groups.
“While studies say life expectancy is higher in Hawaii and surveys claim residents have improved health, that is not entirely the case for the Filipino community,” said Kit Z. Furukawa, who flew with her husband from Maui to participate in the Walk.
“We wanted to bring to light the reasons why our people generally have poor health - it’s the social
and economic factors such as employment, education, and lifestyle. Underlying issues of poverty, discrimination, stigma, and social justice all makeup reasons why we are walking - the Walk has been a way to talk about these,” she added.
The Walk also highlighted Hawai’i Filipinos’ mental health, especially in the aftermath of the tragic wildfire in Lahaina a year ago.
Signs that said, “I walk for Lahaina” were prominent along the Walk’s path. Many have been deep-
ly saddened by the news about wildfire survivor Nanay Edralina Diezon’s recent passing.
Many Filipinos who survived the wildfire are still under constant uncertainty about their future and are having a hard time bouncing back from the tragedy.
The Walk promises to be a regular activity in Hawai’i, as the state has the highest concentration of Filipinos among U.S. states. Of Hawai’i’s 1.4 million population, roughly one-fourth are Filipinos, and a significant 80,000
were born in the Philippines.
It is said that 3,500 Filipinos have arrived in Hawai’i every year since the 1970s. Around 56% or a majority of Filipinos in Hawai‘i are immigrants, and we all know that migrants face cultural, language, and communication challenges in migrant-receiving countries.
At the same time, 85% of Filipinos in Hawai’i are Ilocanos who either directly descended from, or have relatives among, the older generation of seasonal agricultural workers called sakadas.
Working as a primary care physician in a small clinic in Kalihi, I attend to the healthcare needs of patients who are mostly migrant Filipinos.
Kalihi is known to be heavily populated by Filipinos, and a predominantly Filipino neighborhood in Oahu, next to Waipahu,
(continue
(Walk....from S1)
according to the U.S. Census.
It became a working-class community after immigrant laborers who worked in Hawai’i’s plantations settled in the area and transformed it from agricultural land to an urbanized area.
Interestingly, my patient population is largely composed of seniors (age 65 and higher) who are continuously employed in their 70s and 80s. One wonders, what are their motivations to continue working despite being at retirement age?
To find some answers, one needs to look at what’s called social determinants of health or SDOH.
A population’s SDOH refers to non-medical factors that influence their health outcomes –such as the conditions in which its members are born, grow, live, work, and age, and the wider set of forces shaping their daily lives.
In short, health and diseases are intimately related to income, employment, and education. SDOH significantly shapes Hawai’i Filipinos’ health and quality of life.
How stable are their economic conditions based on their income and employment? What can be said about their access to quality education and lifelong learning opportunities?
Only a minority of Filipinos are seen as belonging to the upper strata in Hawai’i. Not too many among them succeeded economically or were able to complete higher education.
Why are Filipinos mostly in low socioeconomic status and the working class?
A strong correlation exists between low educational attainment and low income.
While 12.6% of Filipinos who are 25 years or older across the U.S. have no diploma, in Hawai’i, the figure is 23.9% – the highest percentage across the U.S.
While 33.9% of Filipinos who are 25 years or older across the U.S. have a bachelor’s degree, in Hawai’i, the figure is only 14.1% – the lowest percentage across the U.S.
Indeed, a big majority of working Filipinos in Hawai’i are found in factories and the service industry, with 30% working as hotel workers, housekeepers, service policemen, and healthcare
workers – jobs that typically provide the lowest pay.
An estimated 60-65% of tourism industry workers are Filipinos, mostly found in housekeeping departments, reputedly the lowest paid in hotels.
Other aspects of SDOH are just as important: access to, and quality of, healthcare, housing, healthy food and social support, and exposure to environmental hazards and levels of discrimination.
Social stigma and other cultural factors play major roles in many Filipinos’ mental health. Many Filipinos also tend to normalize taking on multiple jobs, prioritizing work over rest and recreation, refusing to rest from stress, and neglecting their healthcare needs – all of which adversely impact their health.
They need to send money to families back home in the Philippines, grapple with the high cost of living in Hawai’i, and cope with the lack of insurance or under-insurance that is common among many new migrants.
Addressing SDOH factors in general is crucial to improving Hawai’i Filipinos’ health as these disproportionately affect them as a disadvantaged population.
Studies show that among all ethnic groups, the lower the income, the higher the rate of physical inactivity – showing how low income often creates an unhealthy and sedentary lifestyle.
Creating social change: Promoting Filipino health and wellness
It is my observation that Hawai’i Filipinos are hardworking and very resilient amidst adversities. They also have a mindset of finding solutions collectively, as a people, and for the benefit of everyone.
Concepts like bayanihan and pakikipagkapwa are alive. I agree with what Kami Yamamoto, national education officer of NAFCON, shared:
“The Walk reflected an outpouring of support from the community. The Walk served as a venue to prop up our culture and heritage as Filipinos.”
Since elections are coming up, I hope that Hawai’i politicians with Filipino heritage will champion the health of Filipinos as a people by supporting the 2024
Filipino-American Agenda and by passing legislation that benefits Hawai’i Filipinos.
The Agenda builds upon Filipinos’ rich history of collective action, amplifies the concerns and demands of Filipino communities in the U.S., and fosters unity and empowerment to hold public officials responsible for meeting the needs of the Filipino community even after elections.
I previously wrote an article in the Hawaii Filipino Chronicle about the FAA; it can be found here: https://thefilipinochronicle. com/backup/2024/04/07/the-filipino-american-agenda-in-2024/.
Local politicians in Hawai’i can pass laws increasing funds for care homes and healthcare programs directly affecting most Filipinos in the state and can advocate for better pay.
Healthcare remains an important issue for many Filipino voters. Apart from the reasons mentioned above, a high percentage of Filipinos are employed in caregiving services, a phenomenon in many parts of the world but has a particular resonance in Hawai’i.
Nearly one-third of employed registered nurses or RNs and nearly half of employed licensed practical nurses or LPNs in Hawai’i are Filipinos.
Although data is not available, it is widely believed that Filipinos also dominate the nurse assistant profession in the state.
Other low-income jobs in the healthcare industry employing Filipinos include nursing, psychiatric aides, and home health aides, physical/occupational therapy aides, medical transcriptionists, dental assistants, pharmacy aides, phlebotomists, medical assistants, massage therapists, and other healthcare support workers. If a Filipino is not employed as a caregiver or domestic worker, the Filipino is the employer, as 95% of care homeowners or operators in Hawai’i are Filipinos.
As for Filipinos voting in the upcoming elections, I sincerely hope that they, individually and as a community, will support candidates who will truly represent the issues and concerns of Hawai’i Filipinos and champion measures that address their health issues.
Weight of the World: Obesity’s Heavy Toll on Women
By Dr. Rainier Bautista
Obesity is a significant public health issue, particularly for women, who are disproportionately affected.
According to the 2017-2018 NHANES data, among adults aged 20 and older, there was no significant difference in the overall prevalence of obesity between men and women.
However, the data revealed that severe obesity (defined as a BMI of 40 or higher) was much more common in women, affecting 11.5% of women compared to 6.9% of men.
The impact of obesity on women’s health is profound and multifaceted.
Obese women are at a significantly higher risk of developing cardiovascular diseases, with studies showing that they are more than twice as likely to suffer from conditions such
as heart disease and stroke compared to their nonobese counterparts.
Additionally, obesity in women is strongly linked to an increased risk of certain cancers, including endometrial, breast, and ovarian cancers.
These risks are compounded by the fact that obesity often exacerbates other health conditions such as diabetes and hypertension, creating a complex web of health challenges that can significantly reduce the quality of life and increase mortality rates among women.
Addressing obesity is not only crucial for improving overall health outcomes but also for reducing the burden of these life-threatening diseases.
Specific health challenges
Obesity also plays a significant role in conditions unique to women, such as polycystic ovary syndrome (PCOS).
PCOS is a common endocrine disorder that affects up to 10% of women of reproductive age, and obesity is a major contributing factor. Women with obesity are more likely to develop insulin resistance, a key component of PCOS, which can exacerbate symptoms such as irregular menstrual cycles, infertility, and excessive hair
growth.
Furthermore, obesity worsens the hormonal imbalances associated with PCOS, making it more challenging to manage and increasing the risk of developing type 2 diabetes and cardiovascular disease in the long term.
Another critical area where obesity impacts women’s health is during pregnancy.
In Hawai‘i, nearly 1 in 6 women (15.8%) are obese before conception, and 1 in 5 women (21.4%) are overweight.
Certain populations are particularly affected, with Samoans having the highest rate of preconception obesity at 50.2%, followed by Other Pacific Islanders at 27.7% and Hawaiian mothers at 23.3%.
Maternal obesity is associated with a higher risk of adverse outcomes for
both the mother and the fetus, including gestational diabetes, preeclampsia, and an increased likelihood of requiring a cesarean section.
These conditions not only complicate pregnancy but also pose significant health risks during delivery and postpartum.
For the fetus, maternal obesity increases the risk of congenital anomalies, preterm birth, and macrosomia (excessive birth weight), which can lead to complications during delivery and increase the likelihood of childhood obesity and metabolic disorders later in life.
The intergenerational impact of obesity underscores the importance of managing weight before and during pregnancy to improve outcomes for both mother and child.
(continue on S5)
What Are the Signs of Colic in Babies?
By Dr. Flora Medina-Manuel
Acrying baby nonstop for hours especially at night can be stressful and exhausting to both the mom and dad.
Colic or “kabag” is common, especially in the first six weeks of life, and can last up to three to four months.
However, when persistent crying is associated with high fever, vomiting, diarrhea, or other signs of an illness, you should call your doctor or even bring your baby to the emergency room at Kapiolani Women and Children’s Medical Center.
What is colic?
Colic is a very intense crying of a healthy baby or when the baby cries more than three hours a day, three times a week, and may last for three weeks.
What causes colic?
There is no one reason for colic, but colic or “kabag” can be from too much-swallowed air or immaturity of the gastrointestinal tract.
Another cause is an imbalance of the good bacteria (lactobacillus acidophilus) and bad bacteria in the intestine. At times, colic is due to a milk allergy.
How to manage colic?
Below are ways to manage colic in babies.
Burp the baby twice at the middle and end of feedings. Position the baby face-down on your lap and gently rub the baby’s back. You can also put the baby in an upright position on your shoulder and gently rub the baby’s back.
Check if the baby’s diaper is wet or soiled.
Dr. Brown’s nipple and
Tailored strategies for women
Treating obesity requires a multifaceted approach that considers both lifestyle modifications and, in some cases, medical or surgical interventions.
For women, certain unique factors must be taken into account when developing an effective treatment plan. Hormonal fluctuations, particularly those associated with menstrual cycles, pregnancy, and menopause, can significantly impact weight management efforts.
For instance, women often experience weight gain during menopause due to a decrease in estrogen levels, which can slow metabolism and lead to an increase in visceral fat.
Tailoring treatment plans to address these hormonal changes is essential for long-term success.
Additionally, women may face psychological and social challenges related to obesity that differ from those experienced by men.
Societal pressures and stigmatization can lead to body image issues and disordered eating patterns, such as binge eating or emotional eating, which need to be addressed as part of a comprehensive treatment plan.
Mental health support, including counseling and therapy, plays
bottle set is highly recommended and designed to prevent colic in babies.
Overfeeding can cause colic in a baby.
A simple guide to calculate how many fluid ounces a baby needs per feeding is to:
Add the baby’s age in months + 2 = the total fluid ounces of milk/feeding every 3-4 hours.
For example:
• A 1 month old baby + 2 = 3 oz of milk per feeding
• A 2 month old baby + 2 = 4 oz of milk per feeding
a crucial role in helping women overcome these barriers and develop healthier relationships with food and their bodies.
In terms of specific treatments, lifestyle interventions, including diet, exercise, and behavioral therapy, remain the cornerstone of obesity management.
However, for those who struggle to achieve significant weight loss through these methods alone, pharmacotherapy or bariatric surgery may be considered.
When choosing these treatments, it is important to consider the potential impacts on reproductive health, such as the effects of weight-loss medications on fertility or the implications of surgery for future pregnancies.
Collaborative care involving primary care providers, specialists, and mental health professionals is essential to address the complex needs of women battling obesity and to support them in achieving and maintaining a healthy weight.
DR. RAINIER BAUTISTA is a board-certified physician specializing in both Obesity Medicine and Family Medicine. He currently practices at the Primary Care Clinic of Hawaii and serves as the president of the Philippine Medical Association of Hawaii.
• A 3 month old baby +2 = 5 oz of milk per feeding
• A 4 month old baby + 2 = 6 oz of milk per feeding
• A 5 month old baby + 2 = 7 oz of milk per feeding
• A 6 month old baby + 2 = 8 oz of milk per feeding
At 6 months and over, 8 ounces of milk is the maximum amount you can give per feeding. Usually, your baby will tell you when he is full.
If the baby’s colic is due to milk allergy, you can
change the formula from cow’s milk to soy milk. There are special formulas called Enfamil Gentlease and Similac Sensitive Infant Formula made for gassy and fussy babies.
A dimly lit room and soothing music can calm a colicky baby.
You can wrap the baby in a swaddle blanket and walk around the room to comfort him.
Over-the-counter medications for colic are not advisable. A healthy baby that cries a lot can be a sign of colic.
However, a sick baby that has colic could be a sign of pain or an urgent matter that needs immediate medical attention. Please contact your doctor.
FLORA MEDINA-MANUEL, MD is a pediatrician of more than 25 years and former ly worked at Kapiolani Women and Children’s Medical Center NICU/Nursery.
(Weight....from S4)
The Challenges Of Weight Loss
By Dr. Marel Ver
The obesity epidemic has been around much longer than other world health crises like SARS and COVID.
However, we may not fully recognize being at a healthy weight as a major world health priority, as we often accept weight gain as a natural part of living.
The 2023 update of the Obesity Medicine Association states that:
“Obesity is defined as a chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
A convenient way to measure weight is by a number called the BMI, or Body Mass Index.
The BMI is calculated with the formula kg/m2. The normal BMI range is 18 to 25. A BMI of 26 to 29 is considered overweight. BMI 30 to 34 is obese class 1. Obese class 2 is BMI 35 to 39. Obese class 3 is BMI 40 and over.
Health problems, like hypertension (high blood pressure) or prediabetes
(elevated blood sugar) usually start when patients are overweight.
When the BMI hits over 40, the risks of developing health problems go up exponentially.
These conditions include heart disease, Type 2 diabetes, cancer, hypertension, stroke, liver and gallbladder disease, respiratory problems, and osteoarthritis.
In fact, the chances of developing diabetes or heart problems are 20x higher in BMI >40 compared to a normal BMI person.
Obesity is now considered a disease. Therefore, if you have a higher BMI, your doctor may document overweight or obesity in your medical chart as a medical problem.
In the United States, health and life insurance companies use the BMI number as a predictor of overall health. Being obese carries significant economic costs due to increased healthcare spending and lost earnings.
A limitation is that the BMI is just a raw number. It does not take into consideration the body’s percentage of fat versus muscle mass.
Athletic celebrities like
Dwayne “The Rock” Johnson or John Cena, have “overweight” BMIs due to high muscle mass, but are in top health.
Also, under-appreciated and not well known, is that in Asia, there is another BMI scale, in which the ranges are lower. Normal BMI is 18 to 22. Overweight is 23 to 26. BMI >27 is obese.
This is significant in Hawaii, as our Asian population is over 37%. Although physically ‘smaller,’ Asians have higher health risks at a lower BMI.
Genetically, Asians have a higher percentage of body fat mass, which lowers the threshold for developing health problems.
Filipinos make up 25% of the population in Hawaii. Hawaii Health Data Warehouse reports that in 2020-2022, 21.4% of Filipinos were considered obese. 41% of Native Hawaiians were obese.
The Hawaii Department of Health (DOH) reports that 19% of Filipinos and 13% of Hawaiians have diabetes. Also reported is that Filipinos and Japanese have the highest prevalence of high blood pressure.
The DOH health initiatives including the Hawaii Health Disease and Stroke Plan 2030 and the Hawaii Diabetes Plan 2030 are published online at https:// hhsp.hawaii.gov .
We all know that it is not easy to lose weight. It is even more challenging to maintain a healthy weight.
Moreover, when the BMI reaches the obese range, the body’s metabolism ‘resets’ as the body’s chemistry changes to ‘protect’ the body at a higher BMI, thus making weight
loss even harder.
Although globally seen as one of the healthiest states, living in Hawaii has its challenges too. Hawaii’s culture of social gatherings with a variety of savory foods contributes to increased caloric intake. Working multiple jobs and being stuck in Hawaii traffic contributes to decreased exercise.
High-stress levels, lack of restful sleep, and not eating on a schedule all increase stress hormone levels, again pushing the body to ‘protect itself’ from starvation, and so the body prefers to store rather than burn calories.
As we learn and know more about the science of obesity, the saying “eat less, exercise more” may not be as significant.
Simply, the food we eat is broken down into chemicals and nutrients and alters the biochemical signaling and metabolism of the body.
Therefore, when recommending a ‘diet,’ I ask providers to identify the primary goal they are trying to achieve for that individual patient. There are several types of diets out there for different goals.
For instance, the Ornish diet focuses on heart health. The Atkins diet and ketogenic diet focus on weight loss. A diabetic diet aims to lower blood sugar levels.
Diets are only one aspect of weight loss which is a billion-dollar industry. There are diet plans, exercise programs, health coaching, and other options available.
With the expansion and ease of the online market, there is increased access to programs, specialized foods and vitamins, and medications.
One of the newest class of medications is the GLP1 agonists. These drugs mimic the action of a hormone called glucagon-like peptide 1 (GLP-1), which stimulates the body to pro-
duce more insulin which lowers blood sugars after eating.
GLP-1s also stimulate other biochemical signaling pathways that decrease inflammation and improve the efficiency of other organs.
Weight loss is a known side effect of these medications. Weight loss is from decreased hunger and overall improved metabolism. With weight loss and decreased BMI, overall health improves.
These GLP-1 medications include Dulaglutide (Trulicity), Exenatide (Byetta), Semaglutide (Ozempic), Liraglutide (Victoza, Saxenda), and Semaglutide (Rybelsus). With the exception of oral semaglutide, these medications are weekly or daily self-administered injections.
These brand medications are protected by multiple patents and are very expensive. Subsequently, many health insurance companies have limited coverage to diabetics only. Otherwise, out-ofpocket costs can be as high as $500-$1,400 for a month’s supply. Weight loss is an off-label use for these medications.
Because of the somewhat decreased access to GLP-1 medications due to cost and prescription, the latest trend is the availability of compounded formulations.
These medications are marketed online and through smaller health clinics as a weight loss prescription. They may be more ‘affordable’ but still have significant costs. Compounded medications are made by specialty pharmacies and are not FDA-approved. The prescription and use are not regulated so I advise caution when choosing to take compounded medications. One can expect to lose about < 20% of excess weight with the GLP-1 meds.
Dosing needs to be titrated up slowly. While most patients tolerate these (continue on S8)
No Ifs, Ands, or Butts!
By Dr. Jon Avery Go
Colon cancer is a major global health issue and a lethal disease affecting millions of individuals each year. It is among one of the most prevalent cancers worldwide and is the leading cancer cause of mortality.
In the United States, more than 150,000 new cases are diagnosed annually.
The incidence of colon cancer was observed to be higher in developed countries compared to developing ones.
This variation is often attributed to differences in lifestyle, dietary habits, and healthcare access.
Notably, colon cancer incidence rates and mortality are higher among Native American, Native Hawaiian, other Pacific Islander, and African populations.
Several factors increase the risk of developing co-
lon cancer. Age is a significant factor, with the risk rising after age 50.
A family history of colon cancer or polyps, especially with hereditary conditions such as Lynch syndrome and familial adenomatous polyposis (FAP), also elevates the risk.
Dietary habits play a crucial role, as diets high in red and processed meats, high in saturated fats, and low in fiber are associated with an increased risk of colon cancer.
Lifestyle factors, including an inactive lifestyle, obesity, smoking, and excessive alcohol consumption, further contribute to this risk. Additionally, chronic conditions such as inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, can also raise the risk.
Symptoms of colon cancer can be subtle and
vary depending on the tumor’s size and location. Early-stage colon cancer often does not have any symptoms, which can delay diagnosis.
Colon cancer usually presents in three ways: suspicious symptoms, asymptomatic individuals discovered by screening, and emergency admission with an intestinal obstruction or perforation.
When symptoms do occur, the most common one is a change in bowel habits. Other symptoms may include diarrhea or constipation, blood in the stool, abdominal pain or cramping, unexplained weight loss, and fatigue. Regular screening is
crucial for early detection and effective management.
The United States Preventive Services Task Force (USPSTF) recommends routine screenings to start at age 45 to at least age 75 for average-risk individuals.
This is different from high-risk patients which include patients that have had colon cancer, an adenomatous polyp, inflammatory bowel disease, abdominal radiation for childhood cancer, family members with colon cancer, or a documented advanced polyp.
Colonoscopies are the recommended screening option by many expert groups since it is the most accurate and versatile diagnostic test for colon cancer.
Additionally, a biopsy may be performed during a colonoscopy to analyze suspicious tissue and confirm the presence of cancer.
Colonoscopies can also find precancerous polyps that can be removed. Other screening methods include fecal occult blood tests (FOBT), fecal immunochemical
medications, common side effects include nausea, vomiting, food intolerance, and gastroparesis (slow stomach emptying).
Long-term health effects and complications of GLP-1s are still unknown because these medications are so new.
Weight loss plateaus in 12-18 months. If stopped, patients typically regain the weight lost within the year.
Therefore, maintenance dosing may be necessary to keep the weight off. In the long run, the use of GLP-1s for weight loss is not cost-effective.
In one large study, only 27% of patients remained on the GLP-1 after one year.
When using a GLP-1 medication for weight loss, I always recommend dietary and lifestyle counseling, which may or not be provided by the prescriber.
tests (FIT), stool DNA tests, and others.
Colon cancer is considered a relatively slow-growing cancer, with benign polyps typically taking an average of 10-15 years to develop into cancer. Treatment for colon cancer depends on the stage of the disease and may involve several approaches such as surgery, chemotherapy, and immunotherapy.
Preventive strategies for colon cancer include several key approaches, one of which is routine screening.
Having a diet with lots of fruits, vegetables, and whole grains, along with engaging in regular physical activity can also help reduce the risk of developing colon cancer.
As colon cancer often does not show symptoms early on, it makes the importance of regular screening more significant. Remember, screening saves lives. No ifs, ands, or butts about it!
DR. JON AVERY GO is a board-certified Internal Medicine physician. He practices as a primary care doctor at the Primary Care Clinic of Hawaii.
(The Challenges....from S6) (continue
If efforts for proper eating habits and a healthier lifestyle were not made, then weight regain is faster, and then we’re back to the original problem.
Obesity medicine physicians advocate for a Food is Medicine (FIM) approach for weight loss maintenance after GLP-1 meds are stopped.
Bariatric (weight loss) surgery is a surgical option covered by most insurance companies for patients BMI >35 with significant medical conditions including diabetes or sleep apnea and for patients BMI >40 with or without medical problems.
The most common bariatric surgeries performed in the US are the sleeve gastrectomy (GS) and the Roux-en-Y gastric bypass (RNYGB). These surgeries are performed laparoscopically through small incisions.
If insurance coverage runs out or a patient decides to stop taking the meds, optimally, the patient has reached a healthier BMI for maintenance.
Most centers keep patients in the hospital post-surgery for 1-2 days. Some centers even send patients home on the same day after surgery.
Empower Your Health: Navigating the World of Continuous Glucose Monitoring Devices
By Dr. Anna Melissa Lo
Managing diabetes has become more advanced and convenient with the advent of Continuous Glucose Monitoring (CGM) devices.
These devices provide real-time insights into your glucose levels, helping you take control of your health like never before.
What is a CGM device?
A CGM device is a small, wearable sensor that tracks your glucose levels throughout the day and night.
Unlike traditional finger-stick tests that provide a single glucose reading, CGMs continuously monitor glucose levels in real time, offering a more comprehensive view of your glucose patterns and trends.
There are over 20 years of data supporting the safety of surgery and improved health and health maintenance of bariatric patients in the short and long term.
In 2017, my mentor from the Cleveland Clinic, Dr. Philip Schauer authored the groundbreaking manuscript that the Roux-en-Y gastric bypass surgery surpasses intense medical therapy for the treatment of diabetes.
Hawaii is one of the few states where HMSA covers an RNYGB for BMI >30 with diabetes.
Preoperatively, patients will need to complete mandated assessments and therapies with dieticians and behavioral health to meet insurance approval. Additional specialist consultations, like sleep medicine or gastroenterology, may be requested.
Preop requirements take several months to
Why choose a CGM?
Real-time data: CGM devices give instant access to your glucose levels, allowing you to make informed decisions about your diet, exercise, and insulin use.
Improved A1C: With continuous data, CGMs can help you identify patterns and make adjustments that lead to better A1C control over time.
Alerts and alarms: Many CGMs are equipped with customizable alerts that notify you when your glucose levels are too high or too low, helping you avoid dangerous situations.
Less finger-sticking: While calibration may still require occasional finger sticks, CGMs significantly reduce the need for multiple daily tests, making diabetes management less
complete, but if compliant, the patient will lose weight in the process.
Bariatric surgery is also considered metabolic surgery since it changes the body’s chemical signaling. Interestingly, one of the effects is stimulating the body’s GLP-1 signaling.
At one year post-surgery, the average is about 60% of excess weight lost. This means that if a person is 100 pounds over from a BMI of 25, then they will lose an average of 60 pounds.
Maintenance is key after two years post-surgery as the body will reset again, hopefully to a near-normal BMI.
Overall weight loss improves diabetes, sleep apnea, and heart health since these are considered weight-related diseases. There is also less inflammation in the body which improves conditions in-
painful and more convenient.
How does it work?
The CGM sensor is typically placed on your abdomen or arm, where it measures glucose levels in the interstitial fluid just beneath your skin.
The sensor sends data to a display device, such as a smartphone or dedicated reader, where you can view your glucose levels in real time.
Most CGMs also allow you to share this data with your healthcare provider, making it easier to manage your condition together.
cluding gout, asthma, fatty liver, and depression.
Cancer risks also go down. It is reported that there is resolution or at least improvement >90% in weight-related diseases. 10-year mortality is decreased by 30-40%. It is also reported that quality of life is improved in 95% of patients. These percentages are reproducible and consistent with my patients in my bariatric program.
On a side note, as the only female bariatric surgeon in Hawaii, I have a handful of referrals from ObGyn specialists. Fertility is decreased with obesity and immediately improves with weight loss.
I welcome consultations for younger women so that they have healthier child-bearing years.
There are six bariatric surgery programs in the state of Hawaii. Our pro-
Popular CGM devices
Dexcom G7: Known for its accuracy and user-friendly interface, Dexcom G7 offers real-time glucose monitoring with customizable alerts for up to 10 days (about 1 and a half weeks).
Freestyle Libre 3: This device features a small sensor and a reader that provides up to 14 days (about 2 weeks) of continuous glucose readings, making it a popular choice for those seeking simplicity and reliability.
Tips for getting the most out of your CGM
Calibrate as
needed:
Some CGMs require occasional calibration with a blood glucose meter. Follow the manufacturer’s guidelines to ensure accuracy. Analyze trends: Review your data regularly to identify patterns, such as how certain foods or activities affect your glucose levels. This can help
viders collaborate with the Hawaii Bariatric Society. We have varying experiences with increased or decreased referrals for surgery due to the emergence of GLP-1 medications.
In my practice, I welcome the use of the GLP1s to enhance pre- and post-surgery outcomes.
In summary, obesity is a multifaceted disease in which genetics, environment, psychological, and behavioral factors come into play. Tackling obesity is not as simple as taking a medication or doing a diet.
Successful weight loss and maintenance requires lifestyle changes and should be taken through a multidisciplinary approach.
you make proactive adjustments.
Stay informed: Technology and features are always evolving. Keep up with the latest updates and tips from your CGM manufacturer to ensure you’re getting the best possible results.
CGM devices are revolutionizing diabetes management by offering continuous, real-time glucose monitoring.
Whether you’re new to CGM or a seasoned user, these devices provide invaluable insights that can help you achieve better control over your diabetes and live a healthier, more informed life.
ANNA MELISSA LO, MD is board certified through the American Board of Internal Medicine, both in Internal Medicine and Endocrinology, Diabetes, and Metabolism. She is currently practicing as a full-time endocrinologist at the Primary Specialty Clinic of Hawaii across different islands including Oahu, Lihue, and Hilo.
Self-motivation is key. I recommend to my patients to start with little healthy doable changes. If at a party, consider filling the smaller plate instead of the big one.
When this seems more ‘normal’ and easy, then later, work on better food choices. It can be hard to find and make time for formal exercise given busy everyday work. Therefore, increase movement by doing things like taking the stairs rather than the elevator, parking the car further away, or paying attention to the pedometer on the cellphone.
Making these small healthy changes is easier to accept and make a routine to sustain a healthier living.
For Filipinos who have a high genetic risk for disease, this should be recognized and action taken earlier in life.
MAREL VER, MD is a general surgeon specializing in bariatric surgery and is the previous PMAH president.
(The Challenges....from S8)
What is Coronary Thrombosis?
By Dr. Ian Guerrero
Coronary thrombosis in general terms is the blockage of blood flow and circulation to the coronary arteries that supplies essential nutrients and oxygen to the muscles and surrounding structures of the heart.
This can be caused by almost anything that can narrow it most commonly from fatty buildup, uncontrolled hypertension causing spasms of the coronary arteries, metabolic abnormalities like diabetes, high cholesterol levels, and less common ones like blood disorders with high platelets and high red blood cells causing very highly sticky or viscous blood.
The common result of this is cutting off
the very essential nutrients and oxygen that the heart needs leading it to fail eventually and cause someone to suffer from heart attack and heart failure.
The symptom of coronary thrombosis includes most commonly chest pain at rest and in activity, less commonly shortness of breath, getting tired easily even when walking, and abdominal pain which are common among women.
Coronary artery thrombosis can be either chronic or acute (sudden). Chronic means the arteries have been blocked for several months to years while acute means it happened suddenly leading to acute heart attack, from minutes to hours and less
than a week.
Whether it is acute or chronic the symptoms will be the same. It is especially important to recognize the symptoms of coronary thrombosis and immediately seek medical attention.
If left unattended, this might lead you to de-
velop a heart attack leading to heart failure and worst, even death. The complication of coronary thrombosis like acute heart attack is the leading cause of ED visits hospitalization and even death in the US and worldwide. The treatment of coronary thrombosis would
include medications like aspirin, metoprolol, and cholesterol pills just to name a few. It can be mechanically treated by putting a coronary stent, and coronary artery bypass surgery. But what is more important and to be emphasized is prevention.
This can be accomplished by employing a healthy diet and lifestyle including exercise, making sure diabetes and hypertension are under control, and having regular wellness checks with your primary care physician.
As the famous adage says, “An ounce of prevention is more than a pound of cure.”
DR. IAN GUERRERO is a board-certified Internal Medicine physician and current President of the Ohana Medical Mission, Inc.
Chronic Kidney Disease: Bean In Danger?
By Dr. Valerie Tan
The kidneys are two bean-shaped organs each about the size of a fist which are located just below the rib cage, with one kidney on each side of your spine.
The kidneys are composed of 1 million structural and functional units called nephrons that filter the blood to remove waste and excess water-producing urine.
The kidneys also remove acid that is produced by the body’s cells and are responsible for maintaining a healthy balance of water, salts, and minerals (like sodium, calcium, phosphorus, and potassium) in your blood.
The kidneys also produce hormones that help regulate blood pressure,
make red blood cells, and keep bones healthy.
If the kidneys don’t work properly, other tissues and organs in the body may then not work normally.
Chronic kidney disease or CKD is a condition of having decreased kidney function for at least three months associated with evidence of kidney damage.
CKD ranges from mild (CKD stage 1-2) to moderate (CKD stage 3a-3b) to severe (CKD stage 4), to kidney failure or End Stage Renal Disease (CKD stage 5).
According to the CDC, as of 2023, about 36 million people, or more than 1 in 7 adults, are estimated to have CKD and of those with CKD, as many as 9 in 10 don’t know they have it.
For those 65 and older, as much as 34% have CKD.
Risk factors include hypertension, diabetes, hypercholesterolemia, cardiovascular disease, obesity, and smoking.
In Hawaii, Native Hawaiians and Asian Americans have a higher risk for CKD than non-Hispanic whites during the early stages of CKD because Native Hawaiians and Filipinos have the highest risk profile versus non-Hispanic whites.
Filipinos are at higher risk than Native Hawaiians, Chinese, and Japanese populations in Hawaii.
The diagnosis of CKD can be made with a simple blood and urine test.
The blood test is to check for your creatinine and estimated glomerular filtration rate (eGFR) which corresponds to your kidney function, while the urine test is to test for blood and protein in the urine which could indicate kidney damage.
CKD increases the risk of heart disease, stroke, and early death. It is the 10th leading cause of death in the US.
Lifestyle-related medical comorbidities such as diabetes, hypertension, and obesity are the more common causes of CKD as opposed to intrinsic kidney conditions.
Diabetes mellitus (both Type 1 and Type 2), and hypertension remain the most common causes of CKD.
As much as 1 in 5 adults with hypertension may have CKD. As for diabetics, as much as 1 in 3 adults with diabetes may have CKD and diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases needing dialysis in the United States.
CKD is generally a progressive disease. People with early kidney disease don’t know they have it because it usually has no symptoms until the late stages. Oftentimes, it is detected on routine blood
and urine tests.
The rate of progression depends on age, the underlying cause, and the individual patient’s lifestyle and characteristics.
Simple but important ways to help manage chronic kidney disease include maintaining a healthy weight and exercising regularly, eating a low-salt diet, stopping smoking, and controlling hypertension, diabetes, and other comorbidities.
There are medications that help preserve renal function and when coupled with the above strategies under the guidance and supervision of a medical provider, it is possible to slow down kidney decline and help one avoid progressing to end-stage renal disease.
DR. VALERIE TAN is a board-certified physician in both Internal Medicine and Nephrology. She practices as a Nephrologist at Hawaii Nephrologists, LLC.
