Guest Editor's Message

Obesity is a serious and growing health problem in Hawai‘i. Yearly prevalence rates indicate that we are rapidly approaching a situation that will be difficult to reverse, particularly in certain sectors of our community where the rate of obesity is more than 35%. The purpose of this supplement is to start to look at and evaluate evidence of the burden of obesity in Hawai‘i and to present potential options for the management of obesity at the community level. It represents the efforts of local researchers, it provides an excellent overview of the obesity situation in Hawai‘i, and it helps us to elucidate some of the social factors influencing the rate of obesity in Hawai‘i. The importance of understanding the effect of community social factors in the prevalence of obesity is difficult to overestimate. Therapeutic interventions depend upon having a clear and vast knowledge of the factors responsible for the obesity epidemic. A central concept in understanding obesity is the recognition that obesity is in great part caused by societal factors that reside outside the control of a particular individual. The current approach of identifying isolated individuals risk factors and developing programs to change their individual behavior is only partially effective in decreasing the prevalence of obesity at the community level. Changes made at the level of the individual usually do not affect or modify society risk factors for obesity and as soon as one individual leaves the obesity pool another one will enter the pool. This cycle will continue to repeat until changes are made in the basic social structure that places the individual at risk. Poverty, inadequate access to healthy food, and marginal health education are some of the community social determinants that have been associated with obesity. I believe that the time has come for us to make changes and to stop having a Marie Antoinette kind of attitude (“let them eat cake” or in the case of obesity, “let them eat fast food”); that we should put most of our efforts into creating a coalition of community members, politicians, researchers, business persons, and health insurance representatives to look at the problem; not only at the level of the individual but as a global societal problem, and ask the coalition to be responsible for producing sound health policies that empower the community and that will result in a decrease in the burden that society places on the sector of our population with limited health resources. Perhaps then, we will see a real change in the prevalence and a subsequent decrease in the morbid conditions associated with obesity. It will take time, money, and considerable human effort, but the alternative of doing nothing is not very appealing. The editors are in debt to the reviewers for their thoughtful comments, to the Hawai‘i Medical Journal for permitting us to publish this supplement and to the HMSA Foundation for their continued support.