Editor’s Note: This article is the first in a three-part series about health issues linked to nutritional problems in American Indian communities.
The battle with obesity has become one of the most urgent health issues in America today, as over one third of adults and 17 percent of children are now obese. But for Native Americans, this problem is even more dire.
American Indian (AI) and Alaska Native (AN) adults are 1.6 times more likely to be obese than Caucasians, according to the Department of Health and Human Services’ Office of Minority Health. Almost 33 percent of all American Indians and Alaskan Natives, including both children and adults, are obese, and over half of AI/AN women are overweight.
As a result, health consequences stemming from obesity, such as diabetes and heart disease, are also common among AI/AN people. Indeed, 16.1 percent of Native Americans and Alaskan Natives suffer from Type II diabetes, which has been closely linked to obesity. This is the highest age-adjusted prevalence of diabetes among all U.S. racial and ethnic groups, according to the American Diabetes Association.
And diabetes has been identified as a precursor to cardiovascular disease. Heart disease and stroke are the number 1 causes of death among people with Type II diabetes.
In some tribes, diabetes rates are much higher. For example, 50 percent of people in the Pima Indian tribe of Arizona are diabetic.
Now a recent government report has shown that this problem starts early for Native Americans. Obesity affects one half to one third to of AI/AN children, according to the Food and Nutrition Service (FNS), a branch of the U.S. Department of Agriculture. The report also notes that 20 percent of AI and ANs ages 2 to 4 who are enrolled in the Women, Infants and Children (WIC) supplemental nutrition program are obese.
By the time these children reach pre-teen and teen years, many are already developing Type II diabetes, traditionally called “Adult onset diabetes” because it develops over time, usually from high body fat. Now 1.74 in 1,000 American Indian children ages 10-19 have Type II diabetes, compared with a rate of .19 in 1,000 among White children, 1.05 among Black children, and .48 among Hispanic children.
What’s behind these alarming statistics? Why are Native Americans affected by obesity and its consequences at higher rates than the average U.S. population and than other ethnic minorities?
Poverty: A Leading Contributor
Access to nutritious foods is more difficult for anyone living in poverty, but this barrier to a healthy lifestyle is magnified among American Indian and Alaskan Native populations. In 2010, more than 24 percent of AI/AN households were below the federal poverty line, compared to 15 percent of the U.S. population as a whole.
Limited funds mean limited access to nutritious foods such as fresh fruits and vegetables or whole grain carbohydrates, which are often more expensive than commodity goods like flour or shortening.
“The bottom line is poverty,” confirms Kahti DeWilde, licensed nutritionist and director of the WIC program for the S’Klallam tribe in Port Gamble, WA. “It’s lacking the funds to be able to spend money on appropriate foods.”
Even getting to the grocery store can be a challenge for people without cars. A high percentage of Native American communities are located in “food deserts,” defined as a low-income area where the nearest supermarket is over a mile away, making obtaining fresh foods that much more difficult.
“When you live in poverty and you don’t have the money or the transportation, you just stay on the reservation and get what you get and that’s that,” DeWilde says, explaining the situation at Port Gamble.
Since the nearest grocery store here is over two miles away from most tribal members, many do their shopping at the local gas station’s convenience store, whose fresh produce offerings are next to nonexistent. When Food Safety News visited the store, fresh options there included a basket of lemons, some Dole processed fruit containers and a handful of sandwiches.
A tribal member says the establishment used to keep a supply of fresh fruits and vegetables, available upon request, but that those goods are no longer available consistently.
The source – who wished to remain anonymous – says that demand for fresh produce is still there and that people often go to the store looking for the occasional head of lettuce or potatoes to round out a potato salad.
And customers would pay for the fruits and vegetables if they were available, notes the source.
“People would buy it. It’s cheap. It’s the same price as you pay for those Dole containers in there.”
The store’s deli manager declined to comment.
A final factor in limiting Native Americans’ access to healthy foods is that AI/AN households are bigger than the average U.S. household, meaning that breadwinners have more mouths to feed.
“If you’re going to the store and you have no food, you’re not buying endive, you’re buying for your children the thing that’s going to feed as many children as possible and make them feel full,” says Suzan Harjo, a member of the Cheyenne and Muscogee tribes and President of the Morning Star Institute – a national Native American rights organization.
The Root of the Issue
But the problem of poor nutrition in Native American communities extends back far beyond the immediate obstacle of poverty.
The traditional Native American diet was one that modern-day nutritionists would consider a gold standard – full of lean meats, protein, fruits and vegetables and low in fat, refined sugars and sodium.
Native people hunted, fished and gathered their food from the land.
But then in 1830s and 1840s, under the Indian Removal Act, Native American tribes signed treaties with the U.S. government that relegated them to reservations. This relocation also removed Native people from their usual food sources and the active lifestyle that hunting and gathering required.
By 1890 the government decreed that Native Americans were not allowed to leave their lands to fish, hunt or gather in their usual territories. Instead, they were given government rations of commodities such as flour, lard and sugar.
“Those original commodities were not healthy for the people,” explains Fran Miller, Community Nutritionist for the Suquamish Tribe on Puget Sound in Washington State. “They moved to a lot of highly processed foods really quickly. At the same time, they lost that physically active lifestyle that was practiced because they had to be active to hunt and gather and fish. That’s why we’ve seen a rapid increas
e in obesity and diabetes within the last 150 years or so.”
These cheaper, nutritionally empty foods became the new “traditional” for American Indians as they developed a taste for the only foods available to them.
Harjo says she recalls her grandmother eating a lard sandwich.
“People now have a preference for processed foods, high sugar, white flour,” she notes. “All of those things that are terrible for you, terrible for all of us, are killing Indians.”
The nutritionally devoid “frybread” – made from a deep-fried mixture of flour and lard and eaten with butter, jam or meat and cheese – is the quintessential example of a food derived from government rations, now considered to be a “typical” American Indian food.
“We call frybread a cultural food because it’s not traditional,” explains Miller. “It was born out of necessity. People got these food packages and they were hungry and they had to figure out what to do with the rations they’d been given.”
Frybread is not something Harjo sees Native Americans giving up any time soon. It has become a comfort food.
In an American Indian family where the mother is alcoholic or addicted to drugs – conditions that occur at a higher rate among AI/ANs than among the average population – Harjo says sometimes making frybread is one simple thing she can do for her family. The food becomes associated with happiness.
“A mom who’s trying to do a good thing for the children will occasionally make a bunch of frybread and that’ll be a good memory,” says Harjo. “So a lot of people have a real emotional attachment to frybread because it represented good times.”
DeWilde says that instead of trying to get people to eliminate frybread from their diet, she suggests only eating it occasionally, spread out between healthier meals.
Agrees Miller, “People like frybread. It tastes good and it’s okay to eat for special occasions, but we make the distinction that it’s not something that’s part of the normal everyday diet.”
The second part of this series: “What’s Being Done,” will be featured by Food Safety News tomorrow, Tuesday March 6.
Graph courtesy of Centers for Disease Control and Prevention.
Photo #1 taken by Gretchen Goetz.