Clayton Chong, M.D. / More than a fifth of Hawaii’s people–21.8 percent–are obese. Among native Hawaiians/Pacific Islanders, the rate is 31.7 percent. Dr. Clayton Chong, a physician-oncologist at Queen’s Medical Center and a researcher and associate professor at the University of Hawaii Cancer Center, discusses obesity’s links to poverty, as well as to cancer, diabetes, heart disease and other health problems. In terms of solutions, Chong, who is native Hawaiian and also has a degree from the Harvard School of Public Health, prioritizes education, which, he says, changed his life and is the best hope for the survival of his people.
Is it true that obesity, and even being overweight, have been shown to have a contributing role in causing cancer?
Yes. Absolutely. In today’s world we’re finding more and more reasons for that and more techniques for treating cancer via obesity.
How are the two diseases connected?
When a person is obese, metabolic problems in the body can induce cancer growth.
Obesity raises levels of insulin, a hormone produced by the pancreas that makes cells, including some cancer cells, grow and grow longer. A current trend in research today focuses on monitoring and manipulating insulin and other hormone levels to help treat cancer.
Obesity may, one: be stimulating cancer to grow. Two: obesity’s side effects–heart and kidney disease, raised blood sugar–make the body weaker over years and years. It’s not just getting fat overnight.
Some of my cancer patients, from Molokai for example, I can’t give them the best treatment because obesity has caused heart and kidney disease, and their bodies can’t withstand [the chemotherapy].
Is that why you are an outspoken critic of L&L Drive-Inn and other fast food restaurants, and have pushed for healthier food choices and compostables in the Queen’s Medical Center cafeteria?
Go to L&L and see who’s there. They’re making a killing off giving people unhealthy food and using petroleum products to serve food. We should be using only recyclable and compostable products. I worry about plastic chemicals getting into food, because they’re carcinogenic.
Has the study of cancer made you an environmentalist?
When we look at everything–cancer-causing polycyclic aromatic hydrocarbons (PAHs) from combustion engines, release of toxins from plastics and any kind of oil-based products–it’s not disposable, they never go away.
The environment? I think it’s everything. I think it’s being aware.
What is your reply to opponents of soda taxes and other junk food regulation, who say it’s up to individuals, not society?
Obesity is not only a habit, but may be economically driven. Some people cannot afford to eat well. Spam musubi and hot dogs may be the best they can afford.
Eating three meals a day, you can burn calories in between, but there’s a tendency among [some] to eat just one large meal at home.
A recent report in the Journal of the American Medical Association found that people at the lowest level of obesity were no more likely to die than those of normal weight. Do you worry that such findings undermine people’s will to slim down?
To me, that’s an incentive to Hawaiians to do better. It’s a continuum. Basically, yes, it’s better to be mildly obese than greatly obese, and better if you’re just overweight than obese.
[Again], it has to do with hormone levels. People with metabolic syndrome, such as diabetics or pre-diabetics, and central obesity–that really large belly–are at greater risk of developing cancer and heart disease.
What about the news from the Robert Wood Johnson Foundation that Hawaii has the second lowest adult obesity rate in the U.S.?
This is too general. We have a very large Asian population, and they change it, overall. They’re not looking at subpopulations of risk such as native Hawaiians and other Polynesians and Micronesians.
The U.S. Centers for Disease Control said that native Hawaiians/Pacific Islanders were almost three times more likely to be obese than the overall Asian American population in 2010; is that more accurate?
In the past, native Hawaiians were lumped with Pacific Asian Islanders, so we were underrepresented. Now, they lump us with Pacific Islanders, which better reflects reality. But the statistics may [still] be skewed; [the groups] need to be separated.
Along with colleagues such as Dr.s Kekuni Blaisdell and Emmett Aluli, you advocated for the Native Hawaiian Health Care Act. Have you seen improvements since it’s been implemented?
[Compared with] five to 10 years ago, health has improved and awareness has, too, definitely within the last five years. There are more mammograms being done. When I have a patient come in now, they want to know what’s wrong, they ask bright questions, they want to have the best treatment done. In the past, they didn’t want to know about it, just wanted to be told what would be done.
In the past, they used to have classes for doctors regarding how to speak to different ethnicities. [I was asked, but] I refused to lecture other doctors regarding how to speak to Hawaiians. I speak to everybody the same way.
You were born and raised in Hilo and came to Kamehameha Schools (KS) as a boarder. Why did you want to become a doctor?
Because I liked school. It wasn’t hard, compared to working. My grandfather, who had his own construction company, Robert Yamada & Sons, told me to stay in school. He believed that education would take me farther than money.
It was the era of Vietnam; when I was 18 I was 1A and had a low draft number. But I didn’t graduate college [at UH]. I went to [UH] medical school at 20 because my scores and GPA were good. [I hope my example can] help other Hawaiian kids to stay in school and not give up.
I believe KS has done the best thing, [educating] generations. Each generation improves upon the one before. To improve, to increase the Hawaiian race, we need to keep ourselves healthy. Get education. Get a job.
Hawaiian people won’t have sovereignty until they’re independent in their own minds.
What do you tell young people?
Always keep your mind open. The more you’re exposed to, the more you become aware and can help others. You can always do more, the more you know.
But use [knowledge] wisely. A smart person knows that a tomato is a fruit. A wise person knows not to put a tomato in fruit salad.