Editor’s Note: This is the final article is a three-part series on health issues linked to nutritional problems in American Indian communities.
Even the best nutrition education is likely to fall flat without the opportunity to put it into practice.
“You can teach people, but unless you change the environment it’s very difficult for people to actually use what you’ve taught them,” explains Fran Miller, community nutritionist for the Suquamish Tribe of Port Madison, WA.
This means making nutritious foods more available and eliminating opportunities to choose fatty, nutritionally empty options.
Some tribes have started by cutting out sugary beverages at community events.
The S’Klallam tribe of Jamestown, WA took a drastic step toward building a healthy environment in 2008 when it requested that the new, large convenience store at its 7 Cedars Casino not have a deep fryer in-store.
“They didn’t want to have the fried foods,” explains Randy Lemon, the Longhouse Market and Deli’s General Manager. “They wanted something healthier and they were very receptive to having the produce.”
Instead of fried deli offerings, “A lot of our food is oven-baked,” he says. “It’s a specific kind of oven that gives food a crunchy texture like what you’d get out of a grease fryer but they are not cooked that way.”
Lemon says that coming up with non-fried alternatives was easy after the request was made. One item his store introduced was panini sandwiches. This option is an example of how changing what’s offered can change people’s preferences.
“[The paninis] were not very popular at first,” he says, but “that’s probably one of our biggest sellers now.”
In addition to cutting fried foods from its menu, the store offers a variety of fresh fruits and vegetables, including apples, bananas, lettuce, tomatoes and other staple produce.
The Port Gamble S’Klallam tribe recently finished a waterfront walkway that DeWilde hopes will serve as a path to combatting obesity.
“I tell them just start walking,” she says. “Just walk from here to the [convenience store] and then back. “They’re starting,” she notes, adding that she thinks more people will take to the path as the weather gets warmer.
Diabetes: Not a Death Sentence
With 30 percent of the AI/AN population now suffering from pre-diabetes and over 16 percent diagnosed with the disease, diabetes can seem like an inevitability for many in the population, especially as it is affecting people at a younger and younger age. Between 1994 and 2004, diabetes spiked by 68 percent among Native American youths ages 15-19.
“When you have both parents and grandparents with diabetes, it’s a matter of when not if,” says Harjo, who herself has diabetes. “It’s a Damocles sword. You can’t escape it,” she says, describing the feeling among some Native Americans that diabetes is a fate rather than a possibility.
But today this attitude is slowly changing. Extraordinarily high diabetes rates among some tribes has called attention to the problem and the need for change, she says.
One key to convincing people that change is possible is helping them understand that diabetes doesn’t have to be a death sentence, says DeWilde. It’s important to remind Native Americans that they can delay the negative effects of the disease after diagnosis, or even avoid its onset altogether, if they adopt a healthy lifestyle, she says.
“When people come to my office because they were just diagnosed, they’re anxious,” she says. “They’re like, ‘What do I eat? Can I eat anything? Do I need to change my diet completely?’
I tell them they can decide that if they want to live a healthy life, there are steps they can take to make sure they don’t have complications,” she says.
DeWilde describes a young patient who was recently diagnosed with diabetes and came to her, nervous about what this meant. “Before she left she was at ease because she had confidence that with diet and exercise she could control her blood sugar,” DeWilde explains.
And for those who don’t yet have diabetes but are at risk for it, DeWilde says it’s important to realize that you can put the disease off, and by doing so extend your life.
“Obviously we can’t help it if we have the genes,” she says. “But if we’re destined to have it, it’s better to have it at age 60 instead of age 45. So if we can delay the onset as long as possible, then we have succeeded.”
Miller agrees, noting that at-risk Native Americans shouldn’t just take for granted the fact that they’ll get diabetes.
“We’re really trying to educate people that it’s not inevitable. You can do something about it.”
Slowly but surely, nutritionists like DeWilde and Miller, along with tribal leaders, are working to get this message across.
Poor dietary habits have become deeply engrained since the move to reservations, and transitioning back to healthier foods is a slow process.
Says Harjo, “It’s a lot of bad history to overcome.”
But it’s a change many are dedicated to seeing through.
“I still think we have quite a bit of work to do,” says DeWilde. “We’re at the infancy of this whole battle with diabetes and obesity, but it’s a smaller community and word spreads rather quickly, so it’s my hope that we could just step it up a notch, especially with the children.”
Photo courtesy of Longhouse Market and Deli.