Ka Wai Ola - Office of Hawaiian Affairs, Volume 28, Number 2, 1 February 2011 — Native Hawaiian health study earns OHA grant [ARTICLE+ILLUSTRATION]

Native Hawaiian health study earns OHA grant

Queen's offers 2 weight-loss surgeries

By Melissa Moniz

On Dec. 29, 2009, Jonathan Kuahiwi Moniz walked out of Queen's Medieal Center's Comprehensive Weight Management Program's office declaring that he would never eome back weighing 403 pounds. He kept that promise. "I didn't know how mueh I weighed and when I stepped on that scale, I was embarrassed," says Moniz. "I had no idea that I weighed that mueh. The last time I weighed myself, I was about 311." Just over a year later, this January, he walked into the office weighing 228 pounds. He lost 175 pounds. "I don't remember ever weighing this little," says Moniz, a 1992 graduate of Wai'anae High School and 1999 graduate of the University of Hawai'i-Mānoa in Hawaiian Studies. "I do remember in the eighth grade I was going to a banquet and we went to get a pair of slacks and I had to go to the big men's department. I had to get a size 42 pants. That was in the eighth grade and I'm a size 36 now." In fact, Moniz weighed 10 pounds when he was born. "When I say I was always big, I was really always big. The story goes when I was born I was given to my dad and my dad was just amazed at how big I was so he said, when this boy grows up, he's going to be as big as a mountain. So my grandmother said, that's going to be his name, Kuahiwi. Kuahiwi means mountain. Hawaiian words have a way of clinging with characteristics in people." Moniz (no relation to this writer) describes himself as always being hungry and after many unsuccessful diet attempts, he found himself steadily gaining weight. When he was diagnosed with sleep apnea about two years ago, the dangers of his weight heeame more apparent. "I sought help froma number of Native Hawaiian organizations," says Moniz. "And a friend of a friend of a friend told me about Queen's Comprehensive Weight Management Program." CWMP is a specialty metabolic and bariatric surgery program established March 2004 that is intended for people with obesity who want to lose weight, resolve weight-related heahh problems and improve their quality of life. In 2009, Queen's Native Hawaiian Heahh Pro-

gram received a Kaiāulu (Community) Grant of $100,000 from OHA to provide funding support to a elinieal research study to compare and better understand two types of obesity operations in curing or improving morbid obesity and obesityrelated heahh problems in Native Hawaiians, including type 2 diabetes. One surgery is laparascopic roux-en Y gastric bypass, whieh, in part, creates a small poueh for food at the upper portion of the stomach and connects it to the small intestine, bypassing the rest of the stomach; the

other is laparoscopic sleeve gastrectomy, a fairly new procedure whieh removes about 75 percent of the stomach. The grant covers costs for patients that usually aren't covered through medical insurance, including for pre- and post-op, and the entire procedure for the sleeve gastrectomy. Moniz says, "I didn't even know I had diabetes until my blood test taken in the evaluation. When they told me I had to be put on medicine, I was scared. And I made up my mind that either way I

was going to get the operation." Moniz is the first patient to receive the laparoscopic sleeve gastrectomy through the study. CWMP is looking to enroll 39 others who are of Native Hawaiian ancestry, who are morbidly obese as defined by body mass index, who are diabetic and on medications, and between the ages of 25 to 60. "To qualify for the study there's a bit more of a rigorous screening process," says Dr. Cedric Lorenzo, the study's principal investigator and

the physician who performed Moniz's procedure. "And there's a bit more testing after in terms of follow-up visits because part of what the study is looking at is how the hormones that are created in the gut are modulated. Because aside from the physical change there's change in hormones that we believe help drive weight loss as well as decrease hunger. On top of that we think that the hormones play a role in getting rid of diabetes. With the gastric bypass the hormones have SEE HEALĪH STUDY ON PAGE 24

Want more information? Interested participants must attend an information session, whieh is held twice a month at Queen's Conference Center. Additional sessions will be held on Neighbor Islands as follows: > Feb. 18, 6:30-8:30 p.m., Kaua'i County Offices, Moikeha Building, Rooms A and B > March 18, 6-8 p.m., Unele Billy Hilo Hotel's Leilani Room > Apiil 15, 6-8 p.m., Neighborhood Plaee of Kona, Kaiwi Square For information, eall 537-7546 (SLIM).

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Dr. Cedric Lorenzo and palienl Jonathan Kuahiwi Moniz, the study's first participant. - Photo: Melissa Moniz

Jonathan Moniz on Dec. 29, 2009, the turning point in his life when he changed his eating and exercise habits after learning he weighed 403 pounds. - Photo: Courtesy of Jonathan Moniz

HEALĪH STUDY

Continued from page 8 been studied, but not enough testing has been done with the sleeve." Moniz's journey from a size 5X shirt to a size large, began with what he explains to be the most difficult part of the entire process, the pre-op. "The pre-op was a lot of discovery for myself because it was changing the way I ate, changing my physical habits - 1 had to change period," says Moniz. "I knew that if I kept the way I was going that I was going to be in the ground very shortly. So I changed." He started with 15- to 20-minute walks and by his second visit he lost 8 pounds. "Eating is a very social thing in Hawai'i and I needed to correct myself and leam how to approach that in the work environment and at home," he adds. "In the four months leading up to the surgery, I lost 43

pounds on my own. And that was through changing my eating habits and being a little more active." Of the 40 study participants, 20 will receive the sleeve and 20 will receive the gastric bypass. Like a Hip of a eoin, there's a 50 percent ehanee the participant will be placed in either group. "I'm Hawaiian, so my Hawaiian values that I've learned as a child naturally kicked in, so before I even drew an envelope (whieh specified the procedure) I asked the staff if I could pule," says Moniz. "I was thinking they would leave and give me time to myself, but they grabbed my hands and joined me in the pule. So that was already very special for me. The first thing I did was acknowledge Ke Akua and asked for guidance. I left it up to his hands whether I would get the gastric or the sleeve. There was a lot that fell into plaee. That day was my mom's 10-year anniversary since her passing. I pulled envelope No. 10. So there were a lot of things that made me feel there was a higher being

with us and Akua had his hands on my shoulders and was guiding me through this process." Moniz received the operation on April 27, 2010. "Really his stomach is now a tube about the width of a thumb that limits the amount of food he ean take in," says Dr. Lorenzo. "This is different from the usual gastric bypass where you make the stomach into a poueh the size of a ping pong ball and take the small intestine and reroute the passageway of food." Nine months since his operation, Moniz has increased his physical activity from 20-minute walks to 2-mile runs with 8-pound weights in the morning and evening. "I was always so big that I could never fit into a paddling eanoe, however, I've always wanted to paddle," says Moniz. "By July my weight loss was so significant that I could fit into a eanoe. So now I'm able to go paddling. I'm doing things I really wanted to do before but couldn't. I also started hiking.

And I've made it a point that every weekend I would go on a hike." Moniz will graduate with a master's of education in teaching in May from the Ho'okulāiwi College of Education University of Hawai'i. He is currently the coordinator trainer in Wai'anae for the Kamehameha School Enrichment Department. "Being that I was patient No. 1 for this, I took it as there's a lot on my shoulder because my outcome would determine the future for other Native Hawaiians that will eome after me," says Moniz. "Now that I've gone through this a lot of my family and friends see that if I ean do it that they ean do it. So many of them have gone to the informational sessions themselves." In addition to the weight loss, Moniz hasn't needed or taken any diabetes medication since the surgery. "I haven't had any complications or negative side effects," he adds. For Moniz, this past year has been about setting a goal, reaching

to accomplish it and then striving to take on another. He has climbed many mountains and has proven that reaching the summit is only the starting point for another great adventure. "My one-year goal is to be under 200 and from there I want to get to 170," he adds. Perhaps the story that Moniz tells of his birth when his dad picked him up declaring that he would be as big as a mountain meant that he would someday be climbing mountains, not be as big as one. ■ Meīissa Moniz is a Contributing Writer for Ka Wai Ola. A former Associate Editor at MidWeek she has chosen a new career path as a fuU-time mom to spend more quality time with her husband and two young daughters.

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