The rates of obese and overweight American Indian and Alaska Native children were relatively stable between 2006 and 2015, suggesting that we may be turning the corner in dealing with this serious health threat, according to a study published in the American Journal of Public Health July 20.
“We’ve been afraid in Indian country that things were bad and just going to get worse when it comes to diabetes and obesity and all kinds of problems that have plagued our communities now for several decades, but 10 years’ worth of data shows that rates of obesity and overweight in AI/AN children are stable,” said Ann Bullock, director of the Indian Health Service Division of Diabetes Treatment and Prevention and co-author of the study, in a call with reporters.
Childhood obesity is associated with an increased risk of type 2 diabetes and other chronic diseases including hypertension, coronary heart disease, and some forms of cancer later in life. Obese and overweight children often suffer from emotional and social problems as well.
“Obesity and Overweight in American Indian and Alaska Native Children, 2006-2015,” is the largest ever study of childhood obesity and overweight AI/AN children and includes kids of all ages and from all regions, with at least 184,000 children included in each year’s data.
The leveling off is consistent with findings for the nation as a whole, but the prevalence of obesity and overweight among AI/AN children for all age groups and all categories remains higher than the prevalence for other kids.
For example, in 2014, severe obesity (defined as having a body mass index in the 95th or higher percentile) among American Indian and Alaska Native children ages 2 to 19 was nearly double the most recent estimate of that condition in the population as a whole—11.7 percent for AI/AN children compared with 6.2 percent for all U.S. children.
The authors note that these weight disparities are not historic but have occurred only over the past few generations. Explanations may include the rapid transition from a physically active lifestyle to a wage economy and in utero exposure to material diabetes. Recent studies suggest that in utero and early childhood stress and inadequate nutrition may play a role, according to the study.
Bullock, a member of the Minnesota Chippewa Tribe, said factors that have been suggested as causes “most likely have their roots in poverty, food insecurity, chronic stress, adverse childhood experiences and many of the things that contribute in general to health inequities and inequality for Native people versus the U.S. overall.”
The study looked only at children who had visited an IHS, tribal or urban Indian health facility in the year under consideration; therefore, the results cannot be generalized to all AI/AN children because a “substantial but unknown number” of those children do not receive care at those facilities.
Spero Manson, Centers for American Indian and Alaska Native Health at Colorado School of Public Health, also a co-author of the study, sounded another cautionary note: the most severe type of obesity is actually getting worse. “Despite the overall stabilization of obesity and overweight rates among our children we’re actually seeing an increase in this higher band of severe obesity and it’s a significant increase over time. That is also mirrored in the general population,” he said.
“We need to continue to keep our efforts focused on engaging youth in healthy eating habits and physical activity.” Those at the severe end of the obesity scale are most vulnerable to chronic health problems, Manson, of the Pembina Chippewa, said.
The question of why rates have stabilized remains open. Bullock said, “We really don’t know the answer, just as it’s not clear in the U.S. trends overall, but a couple of things that we hope and think have contributed [include] an emphasis on this issue across Indian country, the Special Diabetes Program for Indians certainly being one of those, with many of our SIPI grantees focusing on child obesity, prevention or treatment. Also, health care in general in our IHS, tribal and urban facilities has taken this on as an important issue, and of course, our parents of our kids have become much more aware just as U.S. parents in general have about this issue.”
For the future? “While we hope to see decreases in overweight and obesity in the future, before you go from rising to falling rates, you end up with that point in the middle where things plateau and that’s where we are… we are no longer seeing things getting worse. We are seeing a stabilization of something that we had feared would just continue to get worse,” Bullock said.