The Trust for America’s Health has issued its 2015 report on obesity in the U.S., and there’s no good news for the American Indian/Alaska Native community.
Fifty-four percent of AI/AN adults are obese and 81 percent are overweight or obese, compared with 32.6 percent and 67.2 percent respectively for whites and just 10.8 percent and 38.6 percent for Asian Americans.
Even more disturbing is the finding that since 2003 obesity rates for children ages 2 to 4 are the same or lower for all racial and ethnic groups except AI/AN, whose rates are up from 16.3 percent in 1998 to 18.9 percent in 2003 to 21.1 percent in 2011. The report gives these stats for AI/AN children: 25 percent of 2- to 5-year olds are obese, and 45 percent are overweight or obese; 31 percent of 6- to 11-year olds are obese, and 49 percent are overweight or obese; and 31 percent of 12- to 19-year olds are obese, and 51 percent are overweight or obese.
“The most important consequence of childhood obesity is the increased risk for the development of Type 2 diabetes. It’s one thing getting diabetes in your fifth or sixth decade of life, but getting it in your first or second decade is extremely serious because we know that the longer one has diabetes, the more likely one is to develop complications,” explains Dr. Kelly Moore, Muskogee Creek Nation of Oklahoma, an associate professor at the Colorado School of Public Health’s Center for American Indian and Alaska Native Health.
“To think of American Indian youth having problems with the dire complications of Type 2 diabetes, such as needing dialysis, having cardiovascular disease, requiring amputations and developing blindness, as they enter the most productive years of their lives is really quite devastating for an AI/AN community,” she says.
In children, obesity is correlated with lowered academic achievement, an effect that shows up as early as first grade. And teens with metabolic syndrome, which is closely linked with being obese or overweight and a lack of physical activity, test lower on intelligence, math and spelling and have less mental flexibility and shorter attention spans, according to Trust’s 2015 report.
Other complications of childhood obesity include “all the psychosocial problems of stigma, low self-esteem, depression, and how people with obesity are often labeled. It’s a public health crisis because we know that childhood obesity tends to perpetuate into adulthood,” says Moore.
Obesity, says Moore, is “notoriously difficult to treat,” for many reasons, such as problems with getting appropriate testing done, high turnover in health care personnel and a lack of dieticians, nutritionists and behavioral health counselors on rural reservations.
The lack of “access to healthy fruits and vegetables, the problem of food marketing and the problem of the availability of a lot of fast food and energy-dense foods that are really low in nutritional value and the micronutriets together create a serious problem in terms of being able to change behaviors related to the attainment of a healthy weight and healthy lifestyle,” she says.
Dr. Jeffrey Powell, a pediatrician at the IHS Northern Navajo Medical Center in Shiprock, New Mexico, says obesity is exceptionally challenging to treat because it is not a single medical condition with a single cause. “Obesity is highly multi-factorial. We diagnose it as a medical condition once a child’s body reaches a certain threshold of gaining extra weight. It’s more an overall outcome in any given child rather than an illness.”
The most exciting prevention/intervention programs, he says, “are the ones that get at all the various causes throughout the lifespan of children, and then adults, particularly young adults with reproductive health needs.” Prevention “starts with early intervention, from the very start during pregnancy, which is very important in giving the baby the best possible chance.”
One initiative that is being employed on the Navajo Nation with good results is baby-friendly hospitals, the most significant aspect of which is encouraging breast feeding, he says. “Promoting breast feeding is one of the key elements early on to get things going in the right direction.”
Collaborating with community organizations and members is essential, says Powell. For example, one Navajo task force worked on promoting the concept of a junk food tax and decreasing the tax on healthy foods.
“Schools are a critical community partner because of their influence over kids’ nutritional environment.” In 2002, while working with kids in a middle school clinic and focusing much of his time on obesity prevention and intervention, Powell noticed that just outside the clinic door was the school concession stand, which was open during school hours selling soda and candy bars. That’s changed now, as schools around the country have become more aware of the importance of nutrition.
Coaches also play a major role, says Powell, in “realigning the social norms so it’s not so great to be drinking sodas every day and you don’t actually have to have energy drinks or power drinks or sports drinks. That’s powerful because the kids really look up to their coaches.”
Other groups on Navajo, says Powell, are working on food availability and on promoting innovative ways to incentivize families to buy and stores to carry healthier food options.
Powell says he has seen strong enthusiasm for programs that promote the concept that families want their children to be healthy and strong rather than focusing on a medical condition that needs to be cured or dealt with. The programs that work best are those that employ community health coaches as teachers and guides. Powell also stresses the importance of relying more on indigenous knowledge. “There are models, very core teachings that relate directly to lifelong health. The Navajo wellness model is a very comprehensive model for health and wellbeing.”