Travelling Dietitian in American Samoa- Lazy Society or Corporate Social Responsibility – What Would You Do?

Many people can relate when you say you feel like you are in another world in NYC…lets just say, I actually feel the same way about this place, but just in the completely opposite way.

In NYC you feel like you have everything you could possibly want at your disposal, and it is just about making your selection.
Here, I have felt like I have almost nothing that I could possibly want at my disposal, and the selection process has been at a bare minimum.

There are around 69,000 people who live in American Samoa, of which over 70% are classified as obese, and around 50% have diabetes. It has been amazing to see and hear the siren from the emergency service system vans driving up and down the streets multiple times a day (given there are so few people actually here!). I was told almost all of the triggers for these hospital admissions are lifestyle disease related…

There seems to be a cycle going on that I have picked up on; You have people only purchasing unhealthy products, but you also have retailers predominantly importing unhealthy products (i.e that is what is on offer). Given I have met multiple people who have voiced that they would like to lose weight and/or be healthy, I would be very interested to see what would happen, if there were more options readily available.

Speaking with the management team from the WIC program, and representatives from the Department of Health, it was interesting to hear the same comments around technological advances such as more cars and computer games being used, and less walking or playing outside, being seen as key drivers towards a more sedentary lifestyle…Sounds like something we have all heard before in our home countries..

From everything I have gathered, it feels there has been a bit of a change in pace in lifestyle for many of the people here, which they ultimately haven’t quite found their feet with. For those that grew up with the “old” Samoan lifestyle, they find there to be extra pressures of “modern day” life, working longer hours, or having both parents now working rather than one.

Parents ultimately were taking responsibility for feeding their children “junk” as they put it all the time, and they used the excuse (knowing it wasn’t a good enough excuse) of being exhausted at the end of the working day for this behavior.

Fast food predominantly consists of McDonalds and KFC, together with fish and chip shops, burgers, and mixed Asian fried dishes such as samosas or stir-fried pork.

These main meals retail for around $5.00 USD, which as you can imagine, becomes quite the tempting option for these families at the end of the day.

Besides the couple of expensive restaurants which are attached to the 3 main hotels (whose average dinner meal cost between $30 – $40 for a main), I managed to track down one, yes, one, healthy-ish take-away option. This was run by a group from the Philipines who served a range of stir-fries, but still also offered fried foods which seemed to be the most popular options (this venue closed at 5pm however, so if you finished work at 5pm or a bit after, this wasn’t really available).

A key issue is that parents don’t seem to be cooking at home anymore, and this I feel is being driven down into the next generation, with a lack of skills (or value in having the skills) being seen.

There are 2 “large” supermarkets (I don’t honestly think in the USA or Australia that you would be calling these large by anyones standards however), which have the most produce options. They are both on one side of the island, and therefore, for people that live on the other side, they would have to drive between an hour or two to get there (which would mean “planning” meals is extremely important), and it is doubtful at the end of the long work day that someone would actually make this commute to pick up a piece of steak or a chicken breast (which actually didn’t seem to be available fresh anyway!).

The only not frozen section with protein in the largest supermarket

I have seen one fish shop (for raw fish), one side market selling bananas and coconuts, and one little hut on the side of the road selling fresh vegetables…no butchers, no fruit and vegetable stores, definitely no health food stores, and no bakeries that made anything resembling a wholegrain option. Can you imagine never seeing any of these stores???

Put it this way, people rely on the mini-marts in their local areas (which stock refined cereals, highly preserved and high sodium canned goods, a lot of soft drinks, and fatty meat in the freezer section) for any last minute ingredients for meals…and with this in mind, I am not surprised one bit that the $5.00 take away option appeals more to them.

Unhealthy cereals galore with claims about being rich sources of vitamins or minerals because they have been fortified

Looking at the price of the “healthier” food in the supermarket, I found two high fibre wholegrain breads which were retailing for around $5.00 a loaf (in the freezer section), A whole BBQ roast chicken reasonably priced at $7.95, and fruits and vegetables seemed reasonable in light of everything else. Meat and fish is predominantly frozen, and not found in the fridge section.

The only high fibre wholegrain bread I saw my whole trip

I have tried my hardest to summarize the millions of thoughts and ideas I have had over the last week, and have reached these final conclusions (for the moment at least!) that need to be addressed:

1. People need to be educated properly on what actually denotes “healthy” food. When the government funded programs are showing people refined cereals that are fortified as the “healthiest” option, there is a real problem going on. People were focusing on switching their white bread to a whole-wheat (which is pretty much white bread with a gram or so of fibre and still highly refined, some with sugar added from the USA, and pretty much all high glycemic index), when there seemed to be bigger fish in the sea that really need to be caught i.e. including far more non-starchy vegetables, or finding lean protein sources that were not absolutely covered in skin and fried with a batter made of palm oil.

The decisions around what messages are being covered actually appear to be predominantly driven by information from the USA, rather than the management here coming up with it themselves; and it certainly wasn’t from them intentionally wanting to be doing the wrong thing by the citizens.

The education material outlining which foods are included as part of the food stamp program for disadvantaged new mothers.

I had to clarify that corn flakes would not be a good option for someone with high blood pressure due to the salt/sodium content, and that about 12 out of the 15 approved cereals for diabetics were refined and high glycemic index! Lets just say a new list of recommended products to be included for approval has been sent, and fingers crossed something is done about actioning it (or at least some of it!). I took the approach of providing suggestions from already approved suppliers to try and minimize the barriers to change. Baby steps, but positive nether the less.
2. Corporate social responsibility needs to be more harshly scrutinized. The pamphlets I found at fast food stores promoting their meals as “balanced”, and the nutritional claims being made on the food products that were being imported were beyond crazy! I honestly can say, they seemed less regulated than some of the claims I saw in the USA…and that is a big call! If this is the only information these people are receiving about what constitutes a healthy diet, they are in for one tough slog to halt, let alone reverse, their current epidemic.

3. Product availability needs to be modified with a switch in some of the options that are being offered. As an example, there were two yoghurts I found the whole time I was here, and both had copious amounts of added sugar. Besides at the one large supermarket, the healthiest cereal I could find was Sultana Bran…and the USA version of this they have has sugar as the second ingredient listed on the ingredients list..

Soy bean oil from the USA which is likely to be GM

It was interesting, I always knew that some of the bigger brands formulate their products differently based on the market they are selling into, i.e. they use higher quality ingredients or less sugar if they are selling to some of the European markets instead of the US; However, what I saw here actually took it to a new extreme. A branded product that is available in the USA and Australia, based on the ingredients list here, looked like nothing I would be able to recognize!

I know this is a cost cutting exercise from the company’s perspective, but I would hope someone somewhere is having trouble sleeping at night knowing they are approving these products to be sold for human consumption here.
4. Parents and children together need to learn how to cook! Suggestions were provided around implementing programs that went back to basics, using traditional food that is not overly expensive and readily available in the country. Confidence needs to be instilled in the kids whilst they are young, and the parents providing them with take away every night is not a recipe for success (clearly!). I pointed the health department in the direction of some programs that have been run in the UK and Australia to assist their understanding on what is currently out there around this topic.

Delicious simple meals the chef prepared me using vegetables and protein that could be sourced locally.

I could see at the school holiday program for teenagers that I visited, along with the health department team, that there really are people trying to do their best to get the message out there of the importance of a healthy diet and lifestyle. It seems that these services around education are focused on those “at risk” rather than just the community as a whole (even though I suppose with rates as they are, almost the whole community will fit into the “at risk” population one way or another!).

Attempting to educate about and provide teenagers with “healthy” choices…there is just quite a bit of room for improvement that needs to be looked into..

The sad truth is, the current systems are definitely not reflecting these peoples voices. Speaking with children that attended the public schools (whom are fed breakfast and lunch at school), the meals definitely did not fit into any sort of healthy eating model.

Breakfast consisted of a very small serving of each of the following ingredients: refined cereal, sugary yoghurt, watered down scrambled eggs (I’m guessing made from one of the highly processed egg mixes), a tiny serve of mixed fruit and/or juice, and whole-wheat toast with butter. My mind pretty much analyses this as a blood glucose level spike!

Lunch was often cheese pizza (sometimes with peperoni), a burger smothered in mayonnaise, some small potato gems, or white rice. You don’t need the dietitian here to do any analysis for you..I think you can paint the picture of how this sits nutritionally…

Sugary yoghurts and small pieces of fruit (these were being provided as a snack to teenagers)..and this sounded like the healthiest part of what the younger kids said they were being provided during the semester at school..

With one registered dietitian (who is in more in a clinical role), and one nutritionist in the community centre, something tells me the ratio of need : availability is completely screwed out of whack. Given this is a US territory, it might be wise for one of the US RD’s to put their hand up for this challenge of looking into some of the food systems / menu options at public schools and food programs that are in place in this country…

There is so much more I could share with you all, but I am aware that it could just be me who cares about this, and I could be boring you to bits (if you are still reading that is!), so I’ll stop there and leave you with something extra to think about (just incase there wasn’t enough already).

It makes me churn inside watching the conversations that take place online among our developed countries, looking at if it is dangerous to eat a nut just because it is not activated, or if consuming a teaspoon of coconut oil a day will be the life savior or killer..

There are people in this world who are being fed their nutritional information through McDonalds; ones that are being taught that a fortified refined high glycemic index breakfast cereal is a healthy option (and all because this is the company that has a partnership with a government funded program and gets the opportunity to distribute their products and nutritional claims along side it); there are people that do not have access to something as simple as a natural yoghurt without added sugar, let alone coconut flour, almond meal, acai berries or the like.

Next time you witness one of these conversations, please remember this article, and remember to put things back into perspective.

Yes the activated nut is more beneficial for your gut health than the plain one; yes the coconut oil does taste good and isn’t going to cause you to have a heart attack (I think!), and yes, the acai berry is a very dense source of nutrients…but in the off chance that you can’t access them…the plain nut, the olive oil, or an apple, will suffice…and I can almost guarantee that you will be okay consuming them too.

I found scambled eggs with multigrain toast at one of the restaurants for breakfast each day, the bread wasn’t my first pick, so I simply didnt eat it all..I made do with what I had access to, and it really wasn’t the end of the world.

I will continue to analyse the science around these hot topics for you all so as to clarify all the misinformation that circulates in our media, and hopefully provide you with the information you are wanting; I am a fan of consuming these super nutritionally dense power houses that we are fortunate enough to have at our disposal. However please just remember, it’s not worth feeling overwhelmed about all the information out there in the scheme of things.. There are people who have it a lot worse.

I would love to hear peoples thoughts and ideas on everything covered in this post (I know there was a lot),

There are photos galore on Facebook for those of you that are interested!

Thank you to those of you that are here reading this post, or conversing with me on Facebook, I genuinely value and appreciate being able to share and discuss this all with you. It feels rather useless speaking to myself!

I fly back to Samoa tomorrow, so will post again soon,

For now,

Travelling Dietitian x