HICORE Background / History

In 2008, a group of individuals, representing different sectors of the local community met for a series of meetings to discuss the idea of developing a collaborative effort in Hawaii to address childhood obesity. Groups represented included members of the University of Hawaii John A. Burns School of Medicine, Department of Pediatrics, Department of Public Health Sciences, Department of Complementary and Alternative Medicine, University of Hawaii School of Nursing, Hawaii State Department of Health, Hawaii State Department of Human Services, Hawaii Medical Association, American Academy of Pediatrics-Hawaii Chapter and several other community organizations. The group recognized the work on the State Department of Health and the Hawaii Physical Activity and Nutrition Plan and agreed that efforts should continue within the framework of this plan in collaboration with the Nutrition and Physical Activity Coalition. The group endorsed the creation of an institute within the University of Hawaii John A. Burns School of Medicine Department of Pediatrics and to be lead collaboratively with the following mission and goals.

The mission of Hawaii Institute for Childhood Obesity Research and Education (HICORE) will be to provide leadership of a collaborative, multi-disciplinary effort in research and education on childhood and adolescent obesity in Hawaii.
The goals of HICORE are the following:

1. To serve as a repository of childhood and adolescent obesity research projects conducted in Hawaii,
2. To provide guidance to granting agencies and foundations regarding research priorities in the area of childhood and adolescent obesity for the state of Hawaii,
3. To serve as a center for the education of community members, medical students, residents, physicians and others in the area of childhood and adolescent obesity in Hawaii,
4. To conduct research on childhood and adolescent obesity relevant to people of Hawaii.

Statement of Need:

The prevalence of obesity in adolescents and children has increased dramatically over the last three decades in the United States. The latest National Health and Nutrition Examination Surveys (NHANES) analysis, combining data from the 2003 to 2006 reported that an estimated 16.3% children and adolescents ages 2-19 years were obese and 31.9% were overweight (Ogden, 2008). Among children in Hawaii, recent data suggests that obesity problem may be even more critical. A study of the 10,199 children entering kindergarten, from 2002-2003, in Hawai’i public schools found that 28.5% of the children were overweight or obese (Pobutsky, et al., 2006).  Although there is little data on obesity in Hawaii’s children, reports suggest that the problem may be worse among some ethnic and socio-economic groups. A study of preschool children in Hawai‘i, 27% of Samoan children 2-4 years old were overweight compared with 12.4% of Filipino children (Baruffi et al, 2005). In a large study of mostly low-income children attending a rural health center on Oahu (Okihiro et al, 2006) the prevalence of childhood overweight and obesity was much higher than that found by NHANES; 26% of children 2 to 19 years were obese and 16.5% were overweight. By 13-19 years of age, 24% of teens were obese by adult classification (BMI >= 30) and 6.6% had a BMI in the range considered to be severe obesity (BMI >= 40).

The consequences of childhood obesity are well known and include type 2 diabetes mellitus, hypertension, cardiovascular and liver disease as well as social and psychological consequences such as discrimination, stigmatization and low self-esteem (Freedman, 1999 Dietz, 1998, Gortmaker et al., 1993; Stunkard & Burt, 1967). Concurrent with the rising prevalence and severity of childhood obesity have been reports of a rise in the prevalence of high blood pressure and type 2 diabetes mellitus in children, diseases once thought to be seen only in adults (Sorof et al, 2004, Mayer 2008). These trends underscore the urgency of addressing the obesity epidemic.

The socio-ecologic model recognizes the complex interplay between individuals, relationships to others, community and society in the development, prevention and treatment of many chronic diseases associated with lifestyle including obesity. The model recognizes that the most effective approach leading to healthy behaviors is a combination of efforts at all levels of society – individual, interpersonal, organizational, community and public policy. In an extensive review of childhood obesity, the Institute of Medicine (IOM) used the ecologic model in their national action plan to address childhood obesity and recommended that approaches informed by this model are essential to effectively addressing the very complex and challenging issues of childhood obesity (Koplan et al, 2005). Numerous national and international organizations, including the IOM, International Obesity Task Force, and the World Health Organization have emphasized a multi-level, multi-sector approach to obesity based on this model (Koplan et al, 2005, WHO 2000).

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