The cuisine of Pacific Islander Americans varies slightly from culture to culture and is a blend of native foods and European, Japanese, American, and Asian influences. As with many cultures, food plays a central role. Pacific Islander Americans typically eat three meals a day. Breakfast is usually cereal and coffee; traditional meals are eaten for lunch and dinner; and fruits, fruit juices, vegetables, and nuts (e.g., peanuts and macadamia) are eaten in abundance. Milk and other dairy products are uncommon and there is a high prevalence of lactose intolerance among Pacific Islander Americans. Thus, calcium deficiency is prevalent.
The Pacific Islands contain 789 habitable islands and are divided into three geographic areas: Polynesia, Melanesia, and Micronesia. According to the 2010 U.S. Census, there are over a million Pacific Islanders in the United States, most of whom live in California, Hawaii, Washington, Utah, and Texas. Pacific Islander ethnicities in the United States include Carolinian, Fijian, Guamanian, Hawaiian, Kosraean, Melanesian, Micronesian, Northern Mariana Islander, Palauan, Papua New Guinean, Ponapean, Polynesian, Samoan, Solomon Islander, Tahitian, Tarawa Islander, Tongan, Trukese (Chuukese), and Yapese. Prior to 1980, Pacific Islander Americans (except Hawaiians) were classified with Asian Americans under the classification of “Asian and Pacific Islander American.” Today, the U.S. Census Bureau includes Pacific Islander Americans under the classification of “Native Hawaiian and Other Pacific Islander.” Pacific Islanders are a racially and culturally diverse population group, and they follow a wide variety of religions and have an array of languages.
Starchy foods are the foundation of the traditional diet. For example, the traditional Hawaiian diet is 75%–80% starch, 7%–12% fat, and 12%–15% protein. Starch in the traditional diet comes primarily from root vegetables (e.g., taro, cassava, yam, green bananas, and breadfruit). In addition, the traditional diet is plentiful in fresh fruits, juices, nuts, and greens. Traditional meals include poi (boiled taro), breadfruit, green bananas, fish, or pork. Many dishes are cooked in coconut milk, and seaweed is often used as a vegetable or a condiment.
Many Pacific Islander Americans now eat an Americanized diet consisting of fast foods and highly processed foodstuffs such as white flour, white sugar, canned meat and fish, butter, margarine, mayonnaise, carbonated beverages, candies, cookies, and sweetened breakfast cereals. Rice is now a staple food, having surpassed yam and taro in popularity in the 1980s and 1990s. This nutritional transition has resulted in an increase in cardiovascular disease (e.g., coronary heart disease, stroke, hypertension), obesity, and type 2 diabetes.
Nutrition education is needed to expand nutritionrelated indigenous knowledge and to promote the consumption of traditional nutrient-rich local foods as a more healthful alternative to fast foods and processed foods. There is also an urgent need for increased awareness of the health perils of obesity, especially among individuals with low socioeconomic status. Many health professionals are now emphasizing eating traditional “native” foods and encouraging residents to get back to a healthy lifestyle and to their cultural roots. Language can be a major barrier to health education and medical interventions, however.
Accurate mortality and morbidity statistics for this population are limited, mainly because data on Pacific Islander Americans were classified with Asian Americans until a few years ago. Pacific Islander Americans have a high rate of obesity, and Native Hawaiians and Samoans are among the most obese people in the world. Dietary and lifestyle changes, as well as a likely genetic predisposition to store fat, are possible causes for this high rate. Lifestyles have changed from an active farming- and fishing-based subsistence economy to a more sedentary lifestyle. Pacific Islanders may be genetically predisposed to store fat for times of scarcity (the “thrifty gene” phenotype), and there is evidence that prenatal undernutrition modifies fetal development, predisposing individuals to adult obesity and chronic diseases.
Besides obesity, Pacific Islander Americans have high rates of diabetes, hypertension, cardiovascular disease, and stroke. Data collected from 1996 to 2000 suggest that Native Hawaiians are 2.5 times more likely to have been diagnosed with diabetes than white residents of Hawaii of a similar age. Guam's death rate from diabetes is five times higher than that of the U.S. mainland, and diabetes is one of the leading causes of death in American Samoa. Overall, Pacific Islander Americans have much lower rates of heart disease than other minority groups in the United States, but it is still the leading cause of death within this population. Risk factors for and mortality from heart disease are high partly because of higher rates of obesity, diabetes, and high blood pressure. The poor health status of Pacific Islander Americans is also linked to socioeconomic indicators—Native Hawaiians have the worst socioeconomic indicators, the lowest health status, and the most diet-related maladies of all American minorities.
Bender, David A. A Dictionary of Food and Nutrition. 4th ed. Oxford Reference Online. Oxford: Oxford University Press, 2014. Kindle edition.
Counihan, Carole, and Penny Van Esterik, eds. Food and Culture. 4th ed. New York: Routledge, 2018.
Jones, Keith. Diet and Nutrition Sourcebook. 5th ed. Detroit: Omnigraphics, 2016.
Galanis, D. J., et al. “Dietary Intake of Modernizing Samoans: Implications for Risk of Cardiovascular Disease.” Journal of the American Dietetic Association 99, no. 2 (February 1999): 184–90.
Novotny, Rachel, et al. “US Acculturation Is Associated with Health Behaviors and Obesity, but Not Their Change, with a Hotel-Based Intervention among Asian-Pacific Islanders.” Journal of the Academy of Nutrition and Dietetics 112, no. 5 (May 2012): 649–56.
Wang, C. Y., et al. “Ideal Body Image and Health Status in Low-Income Pacific Islanders.” Journal of Cultural Diversity 9, no. 1 (spring 2002): 12–22.
Loope, Lloyd L. “The Status and Trends of the Nation's Biological Resources: Hawaii and the Pacific Islands.” U.S. Geological Survey, Biological Resources Division. http://www.nwrc.usgs.gov/sandt/Hawaii.pdf (accessed April 16, 2018).
Office of Minority Health. “Diabetes and Native Islands/Pacific Islanders.” U.S. Department of Health and Human Services. https://minorityhealth.hhs.gov (accessed April 16, 2018).
Office of Minority Health. “Obesity and Native Hawaiians/Pacific Islanders.” U.S. Department of Health and Human Services. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=85 (accessed April 16, 2018).
Office of Minority Health & Health Equity (OMHHE), U.S. Centers for Disease Control and Prevention (CDC), Mail Stop K-77, 4770 Buford Hwy, Atlanta, GA, 30341, (770) 488-8343, Fax: (770) 488-8140, OMHHE@cdc.gov, http://www.cdc.gov/minorityhealth/index.html .
Delores C. S. James
Revised by Laura Jean Cataldo, RN, EdD