Uli'eo Koa Program: incorporating a traditional Hawaiian dietary component

Traditional Hawaiian Diet (THD) programs were developed over the past 15 years as a culturally appropriate community intervention for improving the health status of Native Hawaiians. THD programs are generally three weeks in length and incorporate a diet regimen of foods traditional to the Hawaiian culture, coupled with an education component that emphasizes cultural beliefs and practices that support health and wellness. In accordance with traditional practice, THD meals consist mainly of vegetable foods, with controlled amounts of protein. THD programs have demonstrated high success in weight reduction of severely overweight individuals, as well as reductions of serum cholesterol, triglycerides, glucose, and blood pressure. THD programs, to date, have focused on the reduction of these risk factors. The Uli'eo Koa Program, Warrior Preparedness Program, is a pilot study that incorporated a traditional Hawaiian diet component to ascertain its effects on a group of moderately active, non-obese Native Hawaiian adults--specifically the diet's contribution to wellness and physical fitness. Other components of the Uli'eo Koa Program were a physical exercise regimen and a traditional healing component. The purpose of the dietary component of the Uli'eo Koa Program was to provide the nutritional support needed to sustain nutritional requirements for increased physical activity within this group. The year-long Uli'eo Koa Program consisted of three phases. In Phase I, exercise was conducted twice a day and three meals, including snacks, were provided for participants over a three-week period. During Phase II, structured exercise time and meals were decreased to three times a week and two times a week, respectively, for eight weeks. Participants were responsible for maintaining these regimens on their own outside of the structured activities. In Phase III (in progress at the time of this manuscript preparation), the remainder of the program year, participants were solely responsible for structuring their own physical and dietary behaviors. The nutrient composition of the meals followed a traditional Hawaiian diet, which was typically high in complex carbohydrates, low (< 10%) in total dietary fat and limited in protein (as compared to a standard American diet). Dietary assessments were conducted at the onset (baseline) of the program, using a 24-hour dietary recall methodology. When the post-dietary assessments, conducted at the end of Phase II, were compared to the baseline assessments, positive results were indicated by the reported increases in intakes of all major nutrients, including key vitamins and minerals required for exercise. A final dietary assessment will be conducted at the end of the program year (Phase III) to determine maintenance of positive dietary habits. Implications and future research are discussed.