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The Federated States of Micronesia (FSM) and other countries throughout the Pacific are facing an epidemic of non-communicable disease health problems. These are directly related to the increased consumption of unhealthy imported processed foods, the neglect of traditional food systems, and lifestyle changes, including decreased physical activity. The FSM faces the double burden of malnutrition with both non-communicable diseases and micronutrient deficiencies, including vitamin A deficiency and anemia. To help increase the use of traditional island foods and improve health, the Island Food Community of Pohnpei has initiated a program in the FSM to support and promote local food policies, along with its Go Local awareness campaign. Such local food policies are defined broadly and include individual and family commitments, community group local food policies and policies established by government, including presidential proclamations and increased taxation on soft drinks. The aim of this paper is to describe this work. An inter-agency, community- and research-based, participatory and media approach was used. Partners are both non-governmental and governmental. The use of continuing awareness work along with local food policy establishment and the acknowledgement of the individuals and groups involved are essential. The work is still in the preliminary stage but ad hoc examples show that this approach has had success in increased awareness on health issues and improving dietary intake on both an individual and group basis. This indicates that further use of local food policies could have an instrumental impact in FSM as well as other Pacific Island countries in promoting local foods and improving dietary intake and health, including the control of non-communicable diseases and other dietary-related health problems.

The people of Kapinga Village are suffering from chronic diseases as a result of their lifestyles and eating habits, similar to many Pohnpeians. Kapinga Village is an urban area on the island of Pohnpei, Federated States of Micronesia, settled by people from Kapingamarangi, a remote atoll. The villagers have limited access to traditional staple foods, including breadfruit, banana, and taro, fruits, vegetables, and other healthy foods. The Island Food Community of Pohnpei (IFCP) carried out several nutrition interventions in Kapinga Village to prevent disease, including promotion of physical activity through growing local food, a nutritious diet of local foods, cooking classes, container gardening, and charcoal oven workshops. This study evaluated the effect of those interventions on dietary intake. A 7-day Food Frequency Questionnaire (FFQ) was administered in June-July, 2010 to participants from 68 households and data were compared to 2009 baseline data. Qualitative data were collected and analyzed to identify salient themes that were associated with changes in dietary intake. The FFQ data indicated that there was an increase in consumption of local fruits and vegetables compared with the baseline. Qualitative data revealed that participants viewed the interventions positively. The data also revealed that some of the new foods and drinks consumed were those already available in the village, but for which their uses had not previously been known (such as banana flower and hibiscus tea). Such improvements are likely to be sustainable. Recommendations are for more education, in the Kapingan language if possible, and future research to determine what culturally appropriate interventions are still needed to improve nutrition in Kapinga Village.

Federated States of Micronesia (FSM) faces increasing rates of non-communicable diseases related to the neglect of the traditional food system and the shift to consumption of imported food and adoption of sedentary lifestyles. To reverse this trend, a two-year, food-based intervention in one Pohnpeian community in FSM promoted local food production and consumption using a variety of approaches including education, training, agriculture and social marketing following a "Go Local" message. Foods promoted were banana, giant swamp taro, breadfruit and pandanus varieties, green leafy vegetables and fruits for their provitamin A and total carotenoids, vitamins, minerals and fiber content. An evaluation was conducted in a random sample of households (n=47) to examine the extent of dietary changes following the intervention. Results indicated increased (110%) provitamin A carotenoid intake; increased frequency of consumption of local banana (53%), giant swamp taro (475%), and local vegetables (130%); and increased dietary diversity from local food. Exposure to intervention activities was high and there were positive changes in attitudes towards local food. The intervention approaches appear to have been successful in this short period. It is likely that similar approaches in additional communities in Pohnpei and other parts of the Pacific would also be successful in promoting local food. Evidence gathering should continue to document the long-term health outcomes of increased reliance on local food.

This paper presents a summary of Pohnpei, Federated States Micronesia's involvement in a global health study focused on documenting traditional food systems in different parts of the world and providing evidence that local resources are critical for food security, nutrition and health. The Pohnpei study was based in Mand Community, Madolenihmw. The study found that there was a great diversity of foods locally available (381 food items documented), but these were underused. Overweight, obesity, diabetes, and vitamin A deficiency were identified as serious problems. Interventions included community meetings, school activities, and agriculture workshops, cooking classes, charcoal oven development, weight loss and planting competitions, poster campaigns and other relevant mass media. Significant dietary improvements were achieved following the intervention efforts, as well as positive changes in attitude towards local food including: decrease in average daily rice consumption from 846 g/person in 2005 to 544 g/person in 2007 (p = 0.0002); increase in provitamin A carotenoid intake from 227 microg/person in 2005 to 475 microg/person in 2007 (p = 0.02); increased frequency of consumption of local banana (53%), giant swamp taro (476%), local vegetables (130%); and increased dietary diversity (4.8 local food groups consumed in 2005 to 5.5 in 2007). Another positive outcome in Pohnpei was the popularization of the slogan "Let's Go Local."

Dietary- and lifestyle-related diseases are problems of epidemic proportion in the Federated States of Micronesia (FSM). Public health resources to help prevent nutrition-related problems are limited. There is also concern about biodiversity, neglect of traditional staple foods, and threatened loss of traditional knowledge. A "Go Local" campaign was initiated to increase production and consumption of locally grown foods, for their Culture, Health, Environment, Economics, and Food security ("CHEEF") benefits. To provide updates and discuss local island food topics, the Island Food Community of Pohnpei launched an interagency email network in 2003. Interested members' email addresses were recorded in distribution lists, weekly/bi-weekly emails were sent and from these messages, a database was organized to record email topic details. An analysis of all emails up to July 2009 showed that membership had expanded to over 600 listed people from all FSM states, other Pacific Island countries and beyond. Information was shared on topics ranging from scientific findings of carotenoid content in local island food cultivars, to discussions on how daily habits related to island food use can be improved. Over 200 men and women, aged 22 to 80 years, contributed items, some indicating that they had shared emails to a further network at their workplace or community. In conclusion, this email network is a simple, cost-effective method to share information, create awareness, and mobilize island food promotion efforts with potential for providing health, biodiversity and other benefits of island foods to populations in the FSM and other countries.

Non-communicable diseases are escalating rapidly within the Pacific region, including Pohnpei, Federated States of Micronesia. A shift in dietary patterns from indigenous, high fiber, healthy local food to energy-dense, imported food with low nutritional value, and increased sedentary lifestyles are expediting this process. Essential to counteract this trend is an understanding of how people make food decisions. This participatory assessment utilized a quantitative and qualitative approach to capture diet patterns and knowledge, attitudes, beliefs and practices of food consumption. A structured 7-day food frequency questionnaire (FFQ) was used to quantify the diets of 293 adult Pohnpeian women attending an island-wide education/disability screening program. An ethnographic approach, including in-depth interviews, informal focus groups and observations documented food behavior practices and contributed to the design of the FFQ. Of those responding to the FFQ, 96% reported eating rice frequently (3-7 days/week) whereas 75% reported eating locally grown carbohydrate foods frequently. Factors associated with culture change, including availability, affordability, convenience, and status of food items were found to determine food decisions. Food-based, culturally sensitive and innovative strategies that utilize existing resources are required to promote local food production and consumption. Prevention programs with an information, education and communication (IEC) approach are needed to provide accurate and available health and nutrition knowledge and to increase the demand for local foods. Behavior modification requires the continued collaboration of the national, state, and community organizations that partnered on this research to strategize programs in order to target individual food choices and to transform the environment to support these decisions.

A programme of weight loss competitions and associated activities in Tonga, intended to combat obesity and the noncommunicable diseases linked to it, has popular support and the potential to effect significant improvements in health.