On Guam, a dynamic group of public health officials and community volunteers has made fighting obesity fun for all ages. Their popular campaign is called Sustantia (pronounced soos-TAHN-sia), which translates as “nutritious” from the native Chamorro language. Its core message—to eat healthy and exercise—reaches every corner of the island through a catchy, danceable jingle broadcast on radio and TV, as well as through energetic volunteers who educate supermarket customers in person on the busiest food-shopping day of every month.
The traditional diet on Guam once included large amounts of fish and fresh fruits and vegetables. But today, says Zenaida Napa Natividad, a government health department administrator who also serves as technical consultant on the Sustantia Project, “We are one of the world’s largest per capita consumers of Spam,” referring to the popular canned pork product.
As on many islands, most of Guam’s food is imported. High in fat, salt and sugar, these processed foods from the United States and other countries—combined with an increasingly sedentary lifestyle—have contributed to alarmingly high rates of obesity and related conditions such as diabetes and heart disease.
Sustantia’s jingle, an irresistible Pacific Islander melody accompanied by guitar, was composed by a local high school student but carries an urgent and specific set of public health messages: You gotta eat up all your veggies, gotta get up and play, drink a lot of water, put the soda away. Get a good night’s rest and learn to eat the right things, and you’ll find out what healthy livin’ brings.
The Sustantia campaign is teaching 10-year-old Jhenela, a fifth grader, how to stay healthy. “I learned that eating fruits and vegetables instead of junk food, and drinking water instead of soda, will help me avoid being obese,” she says. “Doing physical activities will make me strong and burn calories.”
Such insights are critical for Jhenela and her peers. When the Guam public school system began collecting students’ body mass index (BMI) data in 2007, it found two out of three elementary school students were overweight or obese.
“The survey is not yet complete, but the pattern is already clear,” says Natividad, who has a background in research and statistics. “Childhood obesity is an epidemic on Guam.”
The idea for the Sustantia project originated with the Guam Seventh Day Adventist Church, but has expanded to embrace a broad spectrum of faith communities, including Baptists, Catholics, Jews and agnostics. Sustantia is one of 21 faith-based coalitions supported by a Faith-based Advocacy: Galvanizing Communities to End Childhood Obesity grant from the Robert Wood Johnson Foundation (RWJF).
What children eat is determined in part by their parents’ choices at the grocery store, which in turn are affected by cost. Sustantia therefore took its concerns directly to store owners, developing a memorandum of agreement with Payless Markets, Inc., Guam’s largest chain of grocery stores, and several other large grocery stores.
A working mother who has herself struggled with weight issues and high blood pressure, Natividad says, “Our goal was to make it easier for low-income families to recognize and choose affordable yet nutritious food items.”
With the stores’ cooperation, Sustantia-trained volunteers reviewed the nutrition information labels for every product costing three dollars or less to identify which foods met the program’s health criteria. Those products were then identified on the grocery-aisle shelf by a sign with Sustantia’s smiley-face logo; and their UPC barcodes were scanned and entered into a computer, so every healthy food sale would be registered by the store and marked with an “S” (for Sustantia) on the customer’s printed receipt.
“Each healthy food sale is tracked,” says Natividad, “and customers who buy seven or more healthy items receive a free Sustantia T-shirt on their way out.”
In addition, the stores collect all the data and share it with Sustantia on a monthly basis. “We will do an analysis to help us measure the long-term impact of our campaign,” Natividad explains, but in the meantime she does what she calls an “ocular inspection” of the data. Comparing each new report to the last month’s numbers, she says, “I’m like, wow!”
On the first of every month, a popular shopping day, Sustantia volunteers are out in full force. As they pass out fliers and survey customers about their food-shopping and physical-activity habits, the volunteers’ positive attitude is infectious.
“The stores are so crowded, it’s skin to skin,” says Natividad, “and that’s when we go in to reach our target population. We’re animated, wearing our colorful T-shirts, playing our jingle and dancing. Everyone gets in the spirit with us.”
Thanks to Sustantia’s influence, tastes and eating habits are changing.
“Now I always ask my mom to cook me vegetables,” says Jhenela. Her favorites are petchay and kangkong (locally grown leafy greens), along with broccoli, carrots and squash. Her father no longer allows soda at home, but Jhenela says she has lost her taste for it anyway. “My mouth felt like it was burning one time I tried to sip soda. It tastes yuck!”