Kūlana Hawai'i Weight Management Program
- Need: To improve the health status and overall well-being of Native Hawaiians and other medically underserved populations in rural areas of Hawaii.
- Intervention: A comprehensive weight management program led by an integrated team of health professionals who work with participants on making sustainable, lifelong changes.
- Results: Patients reported statistically significant reductions in weight, BMI, blood pressure, and chronic disease and pain, along with increased physical activity and health knowledge.
Many weight management programs focus exclusively on nutrition and exercise without giving much thought to potential barriers and challenges a person encounters in trying to make changes. These barriers may include:
- Increasing and maintaining motivation
- Finding accurate advice
- Creating manageable goals
- Prioritizing and balancing health efforts with other life responsibilities
- Understanding how to make changes compatible with specific health conditions
- Navigating societal, family, and peer pressures
Kūlana Hawai'i, located on the island of Oahu, is a comprehensive weight management program that addresses these issues. The word kūlana refers to a person’s stature, attitude, or the way a person carries oneself. If internal changes occur in a person, they naturally reflect on the outside.
Led by a team of health professionals including health psychologists, registered dietitians, and certified fitness instructors, Kūlana Hawai'i does not use shame or guilt to try to bring about weight loss change. Rather, the program focuses on making positive, small changes that are realistic for a client to keep. Treatment is tailored to each client. The team from Kūlana Hawai'i works closely and collaboratively with each participant’s primary care provider in order to determine the best course of action to achieve desirable health outcomes.
Funding for Kūlana Hawai'i initially came from a two-year grant from the Office of Hawaiian Affairs; this grant had to be matched. The match came from the largest third-party payer in Hawaii, HMSA (Hawaiian Medical Services Association-Blue Cross Blue Shield of Hawaii). Kūlana Hawai'i then received a second two-year grant from the Office of Hawaiian Affairs and is now up for consideration for a third grant. Kūlana Hawai'i has continued to receive funding from HMSA, meeting every two years to discuss further financial support.
Currently, participation in the program is covered by HMSA for one year. After that, it becomes a self-pay program based on a sliding fee scale according to participants’ income.
- An initial intake with a psychologist, dietitian, and a fitness instructor
- Personal goal setting and detailed treatment planning
- Support and encouragement
- Expert guidance on health and wellness
- Exercise classes and training groups
- Stress management techniques
- Interactive group sessions
Since 2012, Kūlana Hawai'i has assisted 1,200 Native Hawaiians and other medically underserved populations improve their health status. Participants, who have an average of three chronic diseases each, have demonstrated positive changes:
- Weight loss in over 75% of participants
- Statistically significant BMI (body mass index) and blood pressure improvements
- Increases in weekly exercise
- Expansion of health knowledge
- Reduction of chronic diseases and chronic pain
While it cannot be measured scientifically, participants have recognized a strengthening of kūlana in themselves.
Health providers and participants also gave high satisfaction ratings to the program, noting changes to lifestyle and overall functioning. Participants also reported improved communication with their doctors and a higher level of confidence in their ability to make and sustain health changes.
You can read more about this program in the Rural Monitor article Hawaiian Weight Management Program Aims for Healthy, Happy Lives.
A potential challenge for a new organization considering a program like Kūlana Hawai'i is acceptance within the health community. The organization needs to position itself well within the health system from the start and develop relationships that drive word-of-mouth recommendations, which are integral in rural communities.
Pivotal to the success of a program like this is sustainability of funding. From the start, the Kūlana Hawai'i team knew they wanted to develop a program that would continue to exist after grant funding had ceased. That is why they approached HMSA at the outset of the program. Since HMSA views this type of weight management program as a preventive care health benefit, HMSA has been willing to provide funding support for it. Discussions have now begun with other third-party payers in Hawaii so more people can participate without payment being an issue.
When promoting Kūlana Hawai'i, the team learned that individuals need at least two “touches” before they might take action to learn more about or enroll in the program. One “touch” may be seeing a commercial or a video on YouTube. Another touch may be a recommendation from a doctor or a loved one. Relying solely on one source of advertisement to promote the program may not get the enrollment results desired.
Geri Kaleponi, Program Manager
I Ola Lāhui
American Indians, Alaska Natives, and Native Hawaiians
Obesity and weight control
Wellness, health promotion, and disease prevention
April 20, 2015
May 3, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.