Obesity in Indian Country Is Mostly the Same; Why That’s Incremental Progress

Mark Trahant

A fundamental question about government.

TRAHANT REPORTS— The most fundamental question about government is this: Does it work? When does government — tribal, state or federal — actually make a difference in our lives?

There are two ways to answer that question, data and story. Data tells what happens over time, a reference point that ought to provide the proof of self-government. But story is what we tell ourselves about what works, and more often, what does not work. Ideally data and story lead us to the same conclusion.

One problem with data is that it measures incremental progress. That should be a good thing. But when telling a story it’s awfully difficult to report that things are kinda, sorta getting better. We humans want clarity, a success story, right? Or even an outright failure.

Yet progress is often measured slowly.

We all know there is an epidemic of diabetes in Native American communities. Yet it’s also true that adult diabetes rates for American Indian and Alaska Natives have not increased in recent years, and there has been a significant drop in both vision-related diseases and kidney failures. Incremental progress.

Now a new study, one that is built on a massive amount of data, reports that obesity among Native American youth is mostly the same.

“The prevalence of overweight and obesity among AI/AN children in this population may have stabilized, while remaining higher than prevalence for US children overall,” according to a study published last month by the American Journal of Public Health. The study concluded that American Indian and Alaska Native youth still have higher rates of obesity than the total population, but those rates have remained constant for a decade. In other words: The problem is not getting worse. (At least, mostly.) This report is remarkable because it reflects a huge amount of data – reports from at least 184,000 active patients in the Indian health system – from across geographic regions and age groups. Most scientific studies rely on a small sample group, making it difficult to compare regions or even break down the data by gender or age. (So Native Americans who are treated outside of the Indian health system would not be included in this data.)

​The results: “In 2015, the prevalence of overweight and obesity in AI/AN children aged 2 to 19 years was 18.5 percent and 29.7 percent, respectively. Boys had higher obesity prevalence than girls (31.5 percent v. 27.9 percent). Children aged 12 to 19 years had a higher prevalence of overweight and obesity than younger children. The AI/AN children in our study had a higher prevalence of obesity than U.S. children overall in the National Health and Nutrition Examination Survey. Results for 2006 through 2014 were similar.”

The findings show that the problem is not getting worse. And that is incremental progress.

To put this report into a policy context, think about the hundreds of programs that are designed to get Native American youth more active. Or the education campaigns to improve diet and to encourage exercise that occur every day across Indian country.

This is timely data because Congress must soon reauthorize the Special Diabetes Program for Indians. And this report is evidence that $150 million program works and it’s also worth a continued investment by taxpayers. (Remember: Chronic diseases, such as diabetes, are by far the most expensive part of health care. Every dollar spent on prevention saves many, many more down the road.)

The goal of course must be a decline in overweight and obesity statistics, not just stability. (And one warning sign in the report is that there was a slight increase in severe obesity even while the general trend is stable.)

The report, by Ann Bullock, MD, Karen Sheff, MS, Kelly Moore, MD, and Spero Manson, PhD, said there are many reasons for a higher obesity prevalence in American Indian and Alaska Native children but also said this was a “relatively new phenomenon seen only in the past few generations. The explanations range from the rapid transition from a physically active subsistence lifestyle to the wage economy and sedentary lifestyle. Add to that the risk factors of poverty, stress and trauma.

“Indeed, many AI/AN people live in social and physical environments that place them at higher risk than many other U.S. persons for exposure to traumatic events,” the study found. “Among children in a National Institute of Child Health and Human Development study, the experience of numerous negative life events in childhood increased risk for overweight by age 15 years. Another contributing factor to obesity in children living in lower-income households is food insecurity, which is the lack of dependable access to sufficient quantities of high-quality foods. Even before birth, stress and inadequate nutrition during pregnancy alter metabolic programming, increasing the risk for later obesity in the offspring.”

Because obesity is a relatively new phenomenon seen only in the past few generations, there is much that can be done to reverse the trend. And that starts with making sure the problem is not getting worse. Then we can get healthier. Kinda, sorta, at least.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports.