My Way, My Life

諾魯人問我在哪裡工作時，我都會回覆說：「I work for Taiwan Technical Mission」，我想當地人會知道Taiwan，但應該一堆人會對Technical？Mission？很有大的疑問。因為我們既不是搞電腦的，也不是CIA之類的特務，為什麼要叫Technical Mission呢？在諾魯，台灣技術團(Taiwan Technical Mission)主要是提供農民種菜或養豬「技術上」的援助，目標為改善當地的基礎農業發展，而我只是計畫裡的一個小配角。

《WALL•E》電影中，未來世界有機器幫人類處理大小事，所以不再勞動的人類都變成胖子。諾魯曾是個富裕的國度(註1)，這裡的人們曾過著有錢萬能的日子，於是開始懶的勞動，靜態的生活習慣也使他們的體型開始往橫向發展。

(註1) 延伸閱讀＜諾魯與磷礦Phosphate in Nauru＞

這是我來諾魯前，在YouTube上找到的影片，標題下為「The Fattest Place on Earth」，影片中談到諾魯的飲食西化，造成諾魯的肥胖及糖尿病，但我不知道其中的數據都是從哪裡來的？可能就像台灣的新聞一樣，總是下一些誇張的標題來吸引人！本來以為諾魯隨處可見像麥當勞般的「西化」食物，其實到了諾魯才知道，中國餐廳的飯及商店的罐頭肉品才是諾魯人最常吃的食物。

世界衛生組織(World Health Organization, WHO)與美國食品藥物管理局(U.S. Food and Drugs Administration, FDA)已正式將肥胖(症)列為一項慢性疾病，容易導致糖尿病或心血管疾病發生，為現代文明病之一大隱憂。

2008 Estimated Prevalence of overweight and obesity among Pacific countries

Pacific Islander have greater risk for T2DM and the prevalence of Diabetes in Nauru

這兩張是我在「烹飪示範教學」營養課用的slides，主要是想傳達肥胖及糖尿病在諾魯的高盛行率，希望諾魯人能夠正視這個問題。根據2008年世界衛生組織(World Health Organization, WHO)的統計資料，大部分南太島國其過重(overweight)盛行率皆超過50%，諾魯更是高達90%以上，表示十個人裡面只有一個人的BMI小於25，幾乎是全世界之冠。東方國家，如中國或日本，其過重盛行率只有7%左右；諾魯之糖尿病盛行率也是全世界名列前茅，國際糖尿病聯盟(International Diabetes Federation, IDF) 2012統計資料顯示，糖尿病盛行率最高的五個國家都是南太島國，諾魯盛行率為30%，位居全世界第二名(台灣之盛行率是8%)，這些都是我被選來的原因了！

• Cooking demonstration

推廣蔬菜種植一直是技術團的本業。當然，要改善肥胖及糖尿病的盛行率可不是單單吃蔬菜就能解決的，更何況諾魯人吃菜的意願一直不高。而烹飪示範課的用意是，除了使諾魯民眾知道「如何料理蔬菜」外，還可順便「推廣蔬菜種植」。 而我的工作就是於烹飪示範前，給民眾一堂15至20分鐘的營養「指導」，主要用意是對社區民眾宣導吃蔬菜的好處。內容大概是介紹諾魯有哪些常見的菜，並順便提醒有一些植物含的澱粉較多要注意攝取量；蔬菜含有哪些營養素對身體健康有幫助，建議多攝取；最後在提一下肥胖及糖尿病在諾魯的高盛行率，大概就是這些！希望諾魯民眾有被我「提醒」而開始增加蔬菜攝取！

Nutrition instruction for Yaren district community at Buada Farm

剛開始由技術團方先教怎麼煮，不外乎是一些簡單的中式料理，如炒青菜、番茄炒蛋及炒飯等。接下來換社區民眾自己動手做料理，需要我們的時候再從旁協助。其實民眾都還蠻有慧根的，就算忘記步驟也可以自己推敲出一道有個人風格的料理。

After we taught, Nauruan cooked by themselves

The food Nauruan they made

Cooking demonstration at Location

但我想，大部分的民眾還是抱著有東西吃得心情來參加的，回家也不一定會照著我們教的煮，畢竟食材(蔬菜)的取得並不容易。至於栽種蔬菜的意願，每次辦完也沒什麼人主動與我們連絡，所以推廣蔬菜種植這條路還有很長一段要走。

• School feeding Program

此營養午餐計畫，是澳洲出資，用意是「提供原本沒有中餐吃的小朋友有東西攝取，且另一方面也可鼓勵學童上學，提升就學率」。而台灣技術團為了增添菜色變化及改善學童的營養狀況，則是提供免費的蔬菜及雞蛋讓當地的餐廳做午餐，提供給Infant School的學童。

Lunch boxes from Anibare Restaurant

Lunch boxes from The Bay Restaurant

我的工作則是到餐廳去「關心」是否有將技術團提供的蔬菜及雞蛋加入午餐盒中，順便寒暄一下，最近送餐有沒有什麼事發生。有時候會跟著餐廳一起去送餐，除了關心送餐情形外，還會詢問學校老師或是健康推廣人員有關營養午餐的反應，這樣可以適時地將所見所聞反映給上級或當地的營養師討論。

Delivered the lunch boxes to infant school

Met lots of kids at Meneng Infant School

2013年四月開始，諾魯政府撥預算，讓餐廳供應全島所有學生約2800多份免費午餐，這是一件相當不容易的事。但是學生們對食物方面的教育還需要加強，例如，學生將不喜歡吃的蔬菜丟棄在地上的現象，還是相當普遍。

• Naoero Public Health Centre

Naoero Public Health Centre

在公衛中心有一間營養室，基本上每個星期二、四是糖尿病門診時間。另外，營養室也有舉辦減重比賽，參賽者每兩個星期三要回到營養室測量體重，看是否有達到2%減重目標，我有時候也會來這邊，看當地營養師有沒有什麼需要幫忙的。這邊「健康」食物並非隨手可得，食物得靠貨櫃船或飛機補給，而且價格變動過大。因此衛教的方式不像台灣是告訴病人該怎麼吃或吃些什麼，而是了解他們吃些什麼，教他們如何減量分餐的技巧以及減少調味料的使用等，以助改善肥胖及糖尿病的病情。

Nutrition Unit

有時候碰到特殊情形，例如家庭訪視或是幫小朋友打疫苗，我也會跟去看看。家庭訪視是針對行動不便的病人，固定時間去測量他們的血壓及血糖，並關心他們的用藥及飲食狀況。但那些行動方便的媽媽們，卻懶得帶自己的小孩到公衛中心打預防針，有些甚至就住在公衛中心的對面，還是需要護士挨家挨戶的去拜訪。

Home visiting

Baby immunization

但說實在的，大部分糖尿病病人還是不太願意面對真相，真正照會營養師並諮詢飲食技巧的人真的很少。不知道是懶惰不想來？還是不知道糖尿病(併發症)的可怕？

• MWINEN KO

《MWINEN KO》是諾魯唯一的國家刊物，於2010創刊。MWINEN KO為諾魯話，英文翻譯是「Let’s talk about the issues」；中文即是「讓我們談論吧！」。內容通常是有關當地政府或是社區的文宣或時事，並以月刊的形式發行。

   

其實，只要你有興趣談論，都歡迎投稿。從2012年12月開始，我了寫一些在諾魯所見的營養相關議題(註2)，每個月都可以看到我的專欄The Nutrition Corner。有趣的是，朋友看到我的文章也會跟我討論，甚至會唸一小段給我聽！

(註2) 延伸閱讀

＜諾魯月報第三十三版-營養專欄 The Stages of Change Model＞

＜諾魯月報第三十四版-營養專欄 Talking about Eating Vegetables＞

＜諾魯月報第三十五版-營養專欄 You Are What You Drink＞

＜諾魯月報第三十六版-營養專欄 Preventing Obesity and Diabetes in Nauru＞

＜諾魯月報第三十七版-營養專欄 Control Your Blood Pressure＞

• RON Hospital 

RON Hospital的「RON」是「Republic Of Nauru」第一個字母的縮寫。RON Hospital是諾魯唯一的醫院，基本上諾魯人享有免費的醫療待遇，社會福利非常的好！

RON Hospital

每星期二早上不定期會請醫院的醫生講課，如果遇到我有興趣的題目，我也會去聽。例如，腎臟有關課程，其實諾魯除了糖尿病盛行率高之外，腎臟病的比例也不低，因為諾魯高糖及高鹽的飲食習慣，也是引起腎臟病的原因。

Slides of lectures

每星期五早上也會有大查房，有時候也會跟著去，隨著醫師的解說就可以知道住院病人的狀況並且供應什麼膳食。但醫院我實在不常去，能報告的也只有這麼多！

• Cooking Class in Nauru College

Nauru College

除了全民醫療免費外，學生的教育也是免費。2013年三月中後，諾魯中學校長幫我安排至九年級(國三)的Sewing/Cooking (S/C)課上任教，於是我就與原本的烹飪老師一起上課。

還記得第一堂課上的是「吃蔬果的好處」，上課前我請教學生們在家中吃蔬果的情形，他們一致回答在家中不吃蔬菜，不是因為貴買不起，而是因為不喜歡蔬菜的味道；但水果甜，他們喜歡吃。接著打開投影片講了一些有關攝取蔬果對人體健康的基本概念後，再問他們：「是否願意開始吃菜或勸父母買一些菜來煮？」，大部分的人還是給予我否定的答案。

(後記)第一次教他們時，有個小趣聞。我的投影片中有提及諾魯肥胖盛行率及糖尿病盛行率是世界第一及第二，而學生卻是反問：「全世界？那有沒有列入金氏世界紀錄？」由此可見，諾魯學生對於健康的問題仍無警覺性。

攝取蔬菜這件事，對年輕人來說也是相當困難的一件事，更何況是長久以來沒這個習慣的成人。在平日的生活習慣(文化)及教育中，原本就沒有攝取蔬菜概念的諾魯人，想當然爾，農技團於蔬菜種植推廣方面，諾魯人自然也是興趣缺缺。

Nutrition Lecture for Nauru College students

而且光上營養教育，學生沒興趣且回應也不佳，使得我這樣教下來很沒有成就感。於是我就從技術團拿一些菜跟蛋到課堂上示範如何料理中式料理；有時候也教他們做Scone或Cup cake等西式的糕點，學生反而有興致多了(但也僅只於在吃)。

Maybe this is their first time to cut and cook cabbage

Students felt happy when they got food to eat

在中學教書的日子發現了一些很有趣的現象：

1. 有些學生以前根本沒吃過蔬菜，對蔬菜的接受度不高。
2. 男學生對蔬菜及口味的接受度大於女學生。
3. 無論男女學生，對於營養知識及飲食觀念上還算及格，但永遠口是心非。

以上是我在諾魯大致上的工作心得。如果有耐心看完的話，其實不難發現諾魯人慵懶，很難主動積極改變現況。若要藉由改善諾魯人的飲食習慣來減緩慢性疾病(肥胖、糖尿病及腎臟疾病)的盛行率，不太可能會在短時間內看見成效。但其實諾魯也是一點一點的在進步，因為每天下午在機場運動的人變多了，所以改變也不是不可能的事，只是再給它幾年努力吧！

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May 2013 諾魯月報-第三十八版封面

The Nutrition Corner

Kidney disease, not kidding!

The kidneys are pair bean-shaped, fist-sized organs that are located below the rib cage near the middle of the back. Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to regulate the amount of water and electrolytes in the body such as sodium, potassium and phosphorous. In adults they filter around 190 liters of blood every day to remove waste products that result from the normal activities of tissues in the body.

Chronic kidney disease (CKD) is defined as having some type of kidney abnormality, or "marker", such as protein in the urine and having decreased kidney function for three months or longer. There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure whilst in Nauru diabetes is the leading cause of CKD, which accounting around 90%.

What Are Main Causes of Chronic Kidney Disease?

Diabetes is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. This results in a high blood sugar level, which can cause problems in many parts of your body. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood. Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

High blood pressure, also known as hypertension, is another common cause of kidney disease and other complications such as heart attacks and strokes. High blood pressure occurs when the force of blood against your artery walls increases. High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It's a dangerous cycle. When high blood pressure is controlled, the risk of complications such as chronic kidney disease is decreased.

How is Chronic Kidney Disease detected?

Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

1. Blood pressure measurement
2. A test for protein in the urine. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
3. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have. To access the GFR calculator, click here.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

• are older
• have diabetes
• have high blood pressure
• have a family member who has chronic kidney disease

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested. Once kidneys fail, dialysis (have regular blood-cleansing treatments) is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. 

Diet

When you have chronic kidney disease, you need to make changes in your diet, including:

• Limiting fluids
• Eating a low-protein diet (this may be recommended)
• Restricting salt, potassium, phosphorous, and other electrolytes
• Getting enough calories if you are losing weight

Your recommended diet may change over time if your kidney disease gets worse, or if you need dialysis. Just remember to screen for kidney disease once a year.

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April 2013 諾魯月報-第三十七版封面

The Nutrition Corner

Control Your Blood Pressure

7th April, World Health Day, on which is celebrated to mark the anniversary of the founding of World Health Organization in 1948. Each year a theme is selected for World Health Day that highlights a priority area of public health concern in the world. However, the theme for 2013 is high blood pressure. Blood pressure is a measure of the pressure or force of blood against the walls of your blood vessels. The top number represents the pressure when your heart contracts and pushes blood out (systolic) and the bottom number is the lowest pressure when the heart relaxes between beats (diastolic). Blood pressure that is consistently more than 140/90 mm Hg will be considered as high blood pressure. Normal blood pressure is less than 120/80 mm Hg. If your blood pressure is between 120/80 mm Hg and 139/89 mm Hg, you might have pre-hypertension, which is more likely to develop into high blood pressure.

High blood pressure also known as raised blood pressure or hypertension, which increases the risk of heart attacks, strokes (cardiovascular diseases) and kidney diseases. Cardiovascular disease, also heart disease, is a class of diseases that involve the heart or blood vessels. Over time, high blood pressure can damage blood vessel walls and cause scarring that promotes the build-up of fatty plaque. This build-up can narrow and eventually block blood vessels. It also strains the heart and eventually weakens it. Very high blood pressure can cause blood vessels in the brain to burst resulting in a stroke. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more and leading kidney diseases eventually.

As the world’s population ages and grows, unhealthy behaviors, such as an unbalanced diet, a lack of physical activity, smoking, harmful use of alcohol together with stressful lifestyles, all increase the chances of developing high blood pressure. All regions of the world are affected. However, high blood pressure is both preventable and treatable. The risk of developing high blood pressure can be reduced by:

• Reducing salt intake
• Eating a balanced diet
• Avoiding harmful use of alcohol and tobacco
• Taking regular physical activity
• Maintaining a healthy body weight

In additional to the above, the key of hypertensive prevention is early detection, so getting your blood pressure checked regularly is very important. If necessary, take immediate steps to lower and control your risk of developing high blood pressure. Just visit NAOERO Public Health Centre and have your blood pressure measured.

Control Your Blood Pressure

Visit NAOERO Public Health Centre and have your blood pressure measured.

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March 2013 諾魯月報-第三十六版封面

The Nutrition Corner

Preventing Obesity and Diabetes in Nauru

I read an article on Bulletin of the World Health Organization (WHO) recently, which reported Pacific islanders pay heavy price for abandoning traditional diet. People in the Pacific Islands may know what constitutes healthy eating but still less than 20% of people surveyed reported eating the recommended five or more portions of fruits and vegetables a day. The often calorie-rich and nutrition-poor imported foods have a stronger appeal. Replacing traditional foods with energy dense and nutritionally poor imported products have contributed to high prevalence of obesity and related health problems in the Pacific islands. That’s the problem Nauruan are facing now. WHO defines overweight as having a body mass index (BMI) equal to or more than 25, and obesity as a BMI equal to or more than 30. In most Pacific countries, more than 50% (especially up to 90% in Nauru) of the population is overweight according to WHO surveys. More seriously, obesity prevalence ranges from more than 30% in Fiji to a staggering 70% in Nauru. It truly happens in this island. In the end of January, I joined the Independence Health screening team with Public Health Centre’s workers at Civic Centre. I checked people’s weight and height then calculate the BMI for them to see if their weights are healthy or not. To tell the truth, I seldom found someone’s BMI is less than 25. That means most of you are overweight.

Diabetes prevalence among adults in the Pacific region is among the highest in the world. The average age at which people develop diabetes is also getting lower. There is a link between diabetes and obesity. People diagnosed with type II diabetes, about 80 to 90 percent are also diagnosed as overweight or obese. Being overweight places extra stress on your body in a variety of ways, including your body’s ability to maintain proper blood sugar levels. In fact, being overweight can cause your body to become resistant to insulin; however, insulin is produced to regulate your blood sugar level and work hard to maintain it within a fairly narrow range. To reduce the chances that you will develop diabetes, you must maintain a healthy weight and increase your physical activity. If you are overweight, even a small weight loss (around 5 to 10 percent) can prevent diabetes or prolong the chance that you will develop the disease. And if you already have diabetes, this small weight loss can reduce the amount of medication you need, as well as help prevent common complications associated with diabetes, such as blindness, stroke and heart attacks. Avoid overeating, or eating foods high in carbohydrates, it can prevent sharp spikes in your blood sugar levels. Since your body already has difficulty producing the necessary insulin, maintaining a normal blood sugar level is easier when you don’t overload your body with too much food. Here are some dietary tips for people with diabetes.

• You can eat everything, but you should notice the portion size.
• You should eat regularly.
• To avoid too much starchy food and sugar.
• To avoid too much salt. Add ginger or lemon juice to flavor.
• Green leafy vegetables contain vitamins, minerals and fiber. You can eat freely.

Once that’s done, controlling diabetes is not as difficult as you think. Always be sure to monitor your blood sugar levels as recommended and immediately report any problems to your physician or dietitian. And if you can include some exercise in your daily routine, this will go even further toward controlling your diabetes. 

Estimated Prevalence of overweight and obesity among Pacific islands and other countries

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February 2013 諾魯月報-第三十五版封面

The Nutrition Corner

You Are What You drink


As we know, up to 60% of human body weight comes from water. Every system in your body depends on water. For instance, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues. We cannot live without water. Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water. By the time you feel thirsty, you have probably already lost two or more cups of your total body water composition. How much water should you drink a day? It depends on several factors, including your health condition, how active you are and where you live. The average of water an adult should drink a day is around 2 liter. What kind of fluid will you usually choose to drink when you feel thirsty? Water is the best fluid to keep you hydrated for sure. However, we are likely to choose soft drinks or sugar-sweetened beverages as our way to beat dehydration. Too bad! That’s not an appropriate way for your own health. The following are the syndromes and diseases, which would happen after you consume so much caffeinated and sugar-sweetened drink. 

Osteoporosis and related fractures
Osteoporosis, which means "porous bone," is a disease in which the bones gradually become weak and brittle. The condition often results in broken bones, or fractures, especially of the hip, wrist, and spine from simple activities like lifting a chair or bending over. According to researches, soft drinks contain caffeine and phosphoric acid (H3PO4), which may adversely affect bone mineral density (BMD), especially in women. Low BMD is the reason why you are prone to suffer osteoporosis and related fractures, which would be a quite considerable medical burden.

Obesity

Obesity means having too much body fat. Taking in more calories than you burn can lead to obesity because the body stores unused calories as fat. According to the information from World Health Organization (WHO), the prevalence of obesity is 71.1% in Nauru. It means seven out of every ten adults are obese. Obesity can be caused by some reasons like eating more food than your body can use, drinking too much alcohol and not getting enough exercise. However; Fructose, a component of both sucrose (common sugar) and high fructose corn syrup (HFCS), is usually used as a sweetener in sugar-added beverages. Epidemiological studies show growing evidences that consumption of sweetened beverages (containing either sucrose or a mixture of glucose and fructose) is associated with increased body weight and the occurrence of metabolic or cardiovascular disorders.

Diabetes Mellitus

Diabetes is a chronic (long-term) condition marked by abnormally high levels of sugar (glucose) in the blood. Diabetes prevalence among adults in Pacific region is highest in the world, especially in Nauru. People with diabetes either do not produce enough insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life or cannot use the insulin that their bodies produce. A study in the American Journal of Clinical Nutrition revealed one serving of a caffeinated, sugar-sweetened drink was associated with a 13% increased risk of type 2 diabetes in one patient group, while a serving of a decaffeinated sugary beverage or a decaffeinated artificially sweetened drink was tied to 11% and 6% increased risk, respectively. It might have had great influences on our health no matter which kind of sweetened beverage you drink.

After introducing some syndromes and diseases associated with sugar-sweetened beverages, you should know sugar-sweetened beverages are nothing but high calorie. Why not decrease the amount of sugar-sweetened beverages you drink step by step and replace it with water now. As the proverb goes, “Where there is a will there is a way.”

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January 2013 諾魯月報-第三十四版封面

The Nutrition Corner

Talking About Eating Vegetables

Vegetables are an important part of your everyday diet. In general, vegetables contain water, vitamins, electrolytes, dietary fiber and antioxidants. Eating vegetables not only maintains our physical functions but also makes our body much healthier. There are some common vegetables provided by some supermarkets or Taiwan Technical Mission (TTM) in Nauru. These include cabbage, lettuce, cucumber, eggplant, carrot and radish. Of course, there are also pumpkin, sweet potato and potato. Whilst pumpkin, sweet potato and potato belong to vegetable group these crops contain more starch than leafy vegetables, so they are categorized as staple food, like rice and noodle. If we take too much staple food, the excessive starch will be digested and then converted into extra energy we don’t need. In the end, the extra energy will be stored as triglyceride (fat) in human body. Therefore, we  should check the portion size of staple foods before we eat.

What can we get from eating vegetables? The following is a list of good things found in Vegetables:

Vitamins-these are the ingredients to maintain our lives by regulating the metabolism of carbohydrate, protein and fat. We cannot produce vitamins by ourselves, so we must consume and uptake from foods. Extremely important ones are Vitamin C, Vitamin E, and Vitamin K.

Electrolytes-these mainly regulate the balance of osmotic pressure, muscular contraction, signal transduction in nervous system, and body pH value maintenance. Although the amounts we need are just microgram (μg) or minigram (mg), they are still necessary for the body. Some of the most important ones are Sodium, Potassium, and Calcium.

Dietary fiber-Vegetables are rich in this. Dietary fiber keeps the bowels working and moving digested food more quickly through human body. It also increases the stool volume to prevent constipation. Most important of all, the scientific evidence shows that appropriate dietary fiber intake with meals is helpful to control postprandial blood sugar, so it is especially good for diabetic patients.

On 18^th of November, 2012, Taiwan Technical Mission (TTM) held a cooking demonstration and workshop for community at Location. Before demonstration, I spoke to locals about The Benefits of Eating Vegetables. I asked them some questions about the benefits of eating vegetables and how much and how many kinds do they eat a day? I found they knew eating vegetables is good for their health, but in many cases, they are so expensive that they cannot afford them. In addition, school feeding program provided lunch boxes to all infant school students that had vegetables as part of the meal. The problem is that children didn’t like to eat vegetables and in some cases even threw them away. I wondered if there is any solution to these problems. There must be a way to get students to start eating vegetables and get used to the taste. The first thing that came to my mind is that if you are interesting in eating vegetables but you cannot afford them, why not start planting vegetables yourselves. Don’t worry! Anyone who truly wants to plant vegetables can look for assistance from TTM. We are glad to help and see that you put worthwhile effort into planting, growing and eating vegetables. We can also educate people on the importance of eating vegetables. A further six cooking demonstration lectures will be held in communities in the coming year. Through education, you will not only find out the benefits of eating vegetables, but also understand how to make delicious vegetable dishes for you and your family to enjoy. Adding vegetables into daily meals gives more flavors to the food and is definitely good for your health. I hope that people in communities can join in the cooking demonstration lectures with us and acquire knowledge from it to improve the health of the whole island.

A group of the Taiwan Technical Mission and community who  participated in the cooking demonstration

The Taiwan Technical Mission (TTM) held a cooking demonstration and workshop for the community at Location

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December 2012 諾魯月報-第三十三版封面

The Nutrition Corner

The Stages of Change Model

Recently, I do an assistant job at NAOERO Public Health Centre, and there is a competition called Ijababa ken wam kg’s Weight Loss Challenge. All the participants return every two weeks to recheck their weights, and a new target weight was then issued for the following fortnight. The target for every two weeks is 2% loss of their body weight. It’s quite reasonable and approachable. Nowadays, the Stage of Change Model has been widely applied to behaviors, including quitting smoking, overcoming alcohol, losing weight, and drug problem.

The Stages of Change Model was originally developed in the late 1970's and early 1980's by James Prochaska and Carlo DiClemente at the University of Rhode Island when they were studying how smokers were able to give up their habits or addiction. Here are the five stages below:

•  Precontemplation - a person is not even thinking about making a change
• Contemplation - a person has started considering that making a change might be a good idea and is perhaps starting to make plans about how to implement those changes
• Preparation - a person has made a commitment to make a change
• Action - a person believes he/she has the ability to change his/her behavior and are actively engaged in taking steps to change their bad behavior by using a variety of different techniques
• Maintenance - a person sustains the change in the behavior over time through continued effort

As a proverb goes, “Rome was not built in one day”. The concept behind the model is that behavior changes do not happen in one step. Instead, people tend to progress through different stages on their way to successful change.

There are plenty people attending this challenge, and all the participants were aware of the effects of overweight and obesity prior to joining this program. Some who have got involved in contemplation stage have started thinking about making some differences and are willing to come to check their weight, but they still find it hard to carry out such changes. Some who have got themselves involved in preparation stage have started to make small changes towards their weight goals; however weight results were not too obvious. The others who have got involved in the action stage are aggressive and intended to lose their weight by doing exercises and going on a diet control. Furthermore, if those whom are in the action stage continue for about 6 months to a year, they could progress further into maintenance stage. Maintenance means you are able to successfully avoid any temptations to return to your previous unhealthy habits. However, people sometimes will suffer relapses or fail to maintain the new changes of behavior for several times, and also accompany feelings of discouragement and failure. It’s quite normal that people run into these situations. Never give up so early! Try to figure out what the problem is, and then find practical solutions for it. It will make your mind stronger when you face next relapse. Gladly speaking, until now the overall outcome of this challenge is positive to those who truly want to lose weight. I am here to encourage people to start making some changes to have your lives better. Never too late to make up your mind!

The stages of Change Model

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