Improving Kūpuna Health Through ʻAi Pono

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By Dr. Landon Opunui, ND & Miki Wong, RD

There are multiple social and health disparities facing Native Hawaiian kūpuna, such as high rates of life-threatening diseases, financial hardship, disability, shorter life expectancies and underutilization of services. As a result, it should be no surprise that the data suggests the health care needs of Native Hawaiian kūpuna far exceeds that of their non-Hawaiian counterparts. This leads to health equity problems.

Hawaiian culture emphasizes care for kūpuna. However, many adult caregivers are less available to care for their aging loved ones because of competing work and ʻohana responsibilities.

On Molokaʻi, kōkua for caregivers is available via Nā Puʻuwai’s flagship Kūpuna Program, the only adult day care offered on the island. The program provides kūpuna with a safe and structured environment to enjoy daily activities with other kūpuna and staff while ʻohana caregivers are at work. The program supports kūpuna to help them remain active and healthy so they can remain at home as long as possible.

Several studies have reported on the health benefits associated with a return to a pre-contact Hawaiian diet. Although this may be an ideal dietary approach, for many Hawaiians food access and cost limitations may not always allow for this as a practical option, especially for some of our kūpuna who rely on meal assistance. In addition, the high concentration of complex carbohydrates found in native starches, along with the sugar in tropical fruits, may still be problematic for kūpuna challenged with diseases such as diabetes.

So on July 1st, we launched our kūpuna nutrition program, which redesigns meals with the goal of providing high-quality nutrition using flavorful, locally-inspired recipes prepared with locally-sourced ingredients. The program was launched under the direction of cook Neil Gonzalez, registered dietitian/nutritionist Miki Wong, and volunteer chef coach consultant, Ikaika Molina.

The menus were designed to support the health and wellbeing of our kūpuna, many of whom have chronic health conditions. Gonzalez was inspired to change the menu after making improvements to his own diet. In addition, he developed daily themes to add creativity and fun to meal planning. For example, “Mostly Molokaʻi Mondays” showcases island-sourced ingredients—and the kūpuna are enjoying their meals! Many of them were already avoiding rice, citing health concerns. Since introducing cauliflower “rice,” kūpuna are finishing their plates with their compliments to the cook. Recipes include egg white frittatas, almond-flour waffles, venison stir-fry and beef short ribs with cauliflower mash. Providing delicious and familiar meals also provides comfort to kūpuna who have been isolated.

The program has helped Nā Puʻuwai forge partnerships with local organizations committed to ensuring the health of the community, such as Sustainable Molokaʻi which provides reduced pricing on produce.

We hope to inspire other organizations who have the resources and opportunities to feed our kūpuna to consider consulting with nutrition experts to curate ʻai pono meals that can be used to combat many of the chronic health challenges our kūpuna face today.


Dr. Landon Opunui, ND is the newly appointed Medical Director of Nā Puʻuwai Native Hawaiian Health Care Center who offers a shared vision of broadly and comprehensively nourishing mauli ola through integrative health services.

Miki Wong, RD is Nā Puʻuwai’s Registered Dietitian/Nutritionist with a focus on using food as medicine to support patients with metabolic disease.