This report describes the process of developing cultural adaptations to a nutrition curriculum. Curriculum modifications were initiated by the investigators and then extended by 22 teachers and the school nurse of an elementary school on Guam during a 15-hour in-service session. Investigators modified the curriculum for historical and technological issues while teachers focused on appropriate food substitutions, cultural foodways, and methods of presenting the curriculum. Teachers taught the lessons and provided written and oral evaluations. Effective components of the modified curriculum were the attention to local food and history, emphasis on group learning activities, and cultural sensitivity.