Obesity in American-Indian children: prevalence, consequences, and prevention

Sleep Time, Physical Activity, and Screen Time among Montana American Indian Youth

The purpose of this study is to describe sleep, PA, and screen time behaviors among rural American Indian (AI) youth, stratified by sex and grade, to better understand how to address these health behaviors in AI youth. Body composition, a screen time survey, and demographic information were collected from 65 AI youth. Accelerometers were worn for 7 days. Sixty percent were overweight or obese. Sleep did not differ by sex or grade, with an actigraphy-based total sleep time (aTST) of 7.8 h per night. Boys had significantly more light PA (p = 0.002) and vigorous PA (p = 0.01) compared to girls. Screen time did differ by sex but not by grade, with girls in the sixth and seventh grades reporting more screen time than boys, but boys in the eighth grade reporting more screen time than girls. Despite sex differences in screen time, high levels of screen time and obesity and low levels of PA and sleep are a concern in this population.

Native Americans' Responses to Obesity Attributions and Message Sources in an Obesity Prevention Campaign

This study investigated the effectiveness of Native American (NA) targeted obesity prevention messages. The researchers manipulated obesity attributions (internal vs. external) and message sources (NAs vs. non-NAs) in a 2 × 2 mixed experimental design to examine the way these message attributes influence NAs' emotional, attitudinal, cognitive, and behavioral responses. One-hundred and eighteen Cheyenne and Arapaho (C&A) tribal citizens read two paper-based obesity prevention PSAs and then answered questions that assessed their message responses. The key findings demonstrated that the match between participants' ethnicity and the message source's ethnicity had a significant effect, as it reduced anger and promoted positive message attitudes and favorable source evaluations. Implications, limitations, and suggestions for future research and NA targeted health campaigns are discussed.

Implementation of the Navajo fruit and vegetable prescription programme to improve access to healthy foods in a rural food desert

OBJECTIVE

To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.

DESIGN

A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.

SETTING

Navajo Nation, USA.

PARTICIPANTS

Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.

RESULTS

The Navajo Fruit and Vegetable Prescription (FVRx) Programme.

CONCLUSIONS

A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.

Usual Dietary Intake and Adherence to Dietary Recommendations among Southwest American-Indian Youths at Risk of Type 2 Diabetes

BACKGROUND

American Indians are disproportionately affected by obesity and diabetes, and American-Indian youths have the highest prevalence of obesity and diabetes among all ethnic groups in the USA.

OBJECTIVES

The purposes of this study were to assess the usual dietary intake in American-Indian youths who attended a wellness camp program; adherence to the Dietary Guidelines for Americans 2015-2020 (DGA) and to the Healthy People 2020 Objectives; and to compare pre- and postcamp reported diets.

METHODS

A total of six 24-h dietary recalls were conducted in person with American-Indian youths (aged 10-15 y; n = 26) from 3 different Southwest tribes. Three recalls were conducted before the wellness camp, and 3 were conducted after the camp. A series of 2-factor ANOVA were conducted, using a mixed model, to compare the nutrition differences before and after the health camp using a statistical program, R.

RESULTS

Adherence to federal dietary recommendations was low, with few of the youths meeting the DGA recommendations for fruits (15%, average serving 0.69 cup/d) and vegetables (35%, average serving 0.59 cup/d). All of the participants exceeded the DGA recommended limit on empty calories. Nutrient analysis of total fat intake showed a significant decrease in intake after the camp, F (1, 52) = 5.68, P = 0.02.

CONCLUSIONS

Diet is a modifiable risk factor for obesity and chronic diseases such as type 2 diabetes and needs to be an integral part of any healthy lifestyle intervention. The camp-based nutrition education had a positive effect on youths, as observed through the total fat intake decreasing after camp. To reinforce nutrition education, future nutrition education should involve parents, be delivered beyond the week at camp, and encompass social determinants of health and access to healthy foods.

Culturally Adapted Mobile Technology Improves Environmental Health Literacy in Laurentian, Great Lakes Native Americans (Anishinaabeg)

The presence of persistent bioaccumulative toxics (PBT) in aquatic food chains complicates decision processes of people with a strong culture of fish consumption. This environmental contamination is especially problematic for Native American populations in the Laurentian Great Lakes region (Anishinaabeg). Pursuing the growing discipline of environmental health literacy (EHL) may help reduce toxic exposures, support healthy decision-making, and combat health deficits. Our goals for this research were first to improve environmental health literacy using novel technologies and second to help define environmental health literacy metrics that can be tracked over time, especially regarding culturally-contextualized health interests. We recently reported that a mobile app (Gigiigoo'inaan App) presenting personalized, culturally-contextualized fish consumption advice may improve EHL for the Anishinaabeg. Gigiigoo'inaan App safely supports desired fish consumption rates by putting local data into the hands of the Anishinaabeg. We conducted a pre-test post-test evaluation with 103 Aninishinaabe adults. Participants estimated their current fish meal consumption over a hypothetical month before exposure to the software and then planned their future consumption of fish meals in a month after using the mobile app. Significantly more monthly traditional fish meals on average (Median: 4 vs 2, p=0.0005) were selected when using the app versus pre-exposure to the app. Significantly more traditional grams of fish were also selected during use of the app relative to the pretest (Median: 680.39g vs 453.59g, p=0.0007). These increases were accompanied by widespread (97%) adherence to conventional advice that minimizes PBT exposure health effects (ATSDR minimum risk levels).

Healthy Food Labels Tailored to a High-Risk, Minority Population More Effectively Promote Healthy Choices than Generic Labels

The decades-long increase in obesity in the US has led to a number of policies aimed at improving diets, which are thought to play a significant role in obesity. Many of these policies seek to influence individuals' behaviors. Front-of-package labels providing salient, easily interpretable information to consumers have exhibited promise in helping people identify and choose healthier foods. However, behavioral economics may offer an opportunity to enhance label effectiveness. Tailoring labels to high-risk communities, including minority and rural populations, which have higher rates of diet-related diseases than the overall population, may increase the label's effectiveness. We conducted a choice experiment with supermarket shoppers on a rural American Indian reservation to test labels tailored to the local population relative to a generic label, which had previously been identified as highly effective in the general population. Results show that while the generic label continues to be quite effective in encouraging healthier choices, the label that is tailored to the local community is more effective, resulting in a marked increase in the premium shoppers were willing to pay for a healthy item. Tailoring healthy food labeling systems using insights from behavioral economics may increase their effectiveness.

The Healthy Children, Strong Families 2 (HCSF2) Randomized Controlled Trial Improved Healthy Behaviors in American Indian Families with Young Children

BACKGROUND

American Indian (AI) families experience a disproportionate risk of obesity due to a number of complex reasons, including poverty, historic trauma, rural isolation or urban loss of community connections, lack of access to healthy foods and physical activity opportunities, and high stress. Home-based obesity prevention interventions are lacking for these families.

OBJECTIVE

Healthy Children, Strong Families 2 (HCSF2) was a randomized controlled trial of a healthy lifestyle promotion/obesity prevention intervention for AI families.

METHODS

Four hundred and fifty dyads consisting of an adult primary caregiver and a child ages 2 to 5 y from 5 AI communities were randomly assigned to a monthly mailed healthy lifestyle intervention toolkit (Wellness Journey) with social support or to a child safety control toolkit (Safety Journey) for 1 y. The Wellness Journey toolkit targeted increased fruit/vegetable (F/V) intake and physical activity, improved sleep, decreased added sugar intake and screen time, and improved stress management (adults only). Anthropometrics were collected, and health behaviors were assessed via survey at baseline and at the end of Year 1. Adults completed surveys for themselves and the participating child. Repeated measures analysis of variance was used to assess change over the intervention period.

RESULTS

Significant improvements to adult and child healthy diet patterns, adult F/V intake, adult moderate-to-vigorous physical activity, home nutrition environment, and adult self-efficacy for health behavior change were observed in Wellness Journey compared with Safety Journey families. No changes were observed in adult body mass index (BMI), child BMI z-score, adult stress measures, adult/child sleep and screen time, or child physical activity. Qualitative feedback suggests the intervention was extremely well-received by both the families and our community partners across the 5 participating sites.

CONCLUSIONS

This multi-site community-engaged intervention addressed key gaps regarding family home-based approaches for early obesity prevention in AI communities and showed several significant improvements in health behaviors. Multiple communities are working to sustain intervention efforts. This trial was registered at clinicaltrials.gov as NCT01776255.

Family Spirit Nurture (FSN) - a randomized controlled trial to prevent early childhood obesity in American Indian populations: trial rationale and study protocol

BACKGROUND

Childhood overweight and obesity is a persistent public health issue in the US. Risk for obesity and obesity-related morbidity throughout the life course begins in utero. Native Americans suffer the greatest disparities in the US in childhood overweight and obesity status of any racial or ethnic group. Existing early childhood home-visiting interventions provide an opportunity for addressing obesity during the first 1000 days. However, to date, no evidence-based model has been specifically designed to comprehensively target early childhood obesity prevention.

METHODS

This study is a randomized controlled trial to test the efficacy of home-visiting intervention, called Family Spirit Nurture, on reducing early childhood obesity in Native American children. Participants are expectant Native American mothers ages 14-24 and their child, enrolled from pregnancy to 24 months postpartum and randomized 1:1 to receive the Family Spirit Nurture intervention or a control condition. The intervention includes 36 lessons delivered one-on-one by locally-hired Native American Family Health Coaches to participating mothers from pregnancy until 18 months postpartum. A mixed methods assessment includes maternal self-reports, maternal and child observations, and physical and biological data collected at 11 time points from 32 weeks gestation to 2 years postpartum to measure the intervention's primary impact on maternal feeding behaviors; children's healthy diet and physical activity; children's weight status. Secondary measures include maternal psychosocial factors; household food and water security; infant sleep and temperament; and maternal and child metabolic status.

DISCUSSION

None of the 20 current federally-endorsed home-visiting models have demonstrated impacts on preventing early childhood obesity. The original Family Spirit program, upon which Family Spirit Nurture is based, demonstrated effect on maternal and child behavioral health, not including obesity related risk factors. This trial has potential to inform the effectiveness of home-visiting intervention to reduce obesity risk for tribal communities and other vulnerable populations and expand public health solutions for the world's obesity crisis.

TRIAL REGISTRATION

Clinicaltrials.gov (Identifier: NCT03334266 - Preventing Early Childhood Obesity, Part 2: Family Spirit Nurture, Prenatal - 18 Months; Retrospectively registered on 07 November 2017).

Growth achieved and correlation with blood pressure levels in schoolchildren

INTRODUCTION

The prevalence of systemic arterial hypertension in childhood has increased progressively.

OBJECTIVE

To analyze blood pressure and height reached by children in public schools in the South of Brazil.

METHODS

This is a sectional study of a randomized sample of 1,082 students of six to seven and nine to ten years old used to evaluate blood pressure and height. Blood pressure levels were classified by percentile for gender, age and stature according to the North American reference of National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents.

RESULTS

Schoolchildren presented adequate growth, which was, on average, higher than the WHO reference values. Blood pressure levels were altered in 13.8% of children, with a higher frequency in the nine and ten year olds (17.6%). The isolated analysis of systolic and diastolic Blood pressure revealed a similar trend, with blood pressure levels higher than the greater the value of the Z-score for stature.

CONCLUSION

The schoolchildren in the study evidenced adequate growth and an elevated prevalence of pre-hypertension and arterial hypertension, which tended to be higher in older children and/or those that achieved a greater stature growth.

Obesity, Overweightness, and Depressive Symptomology Among American Indian Youth

OBJECTIVES

Despite evidence that American Indian adolescents are at a heightened risk of obesity/overweightness and experiencing depression, relative to other groups, there exists a dearth of studies that have examined the association between objective and perceptual measures of obesity and overweightness and depression with this understudied group. Our study represents one of the first studies to examine this association among American Indian youth.

METHODS

Using a subsample of American Indian youth from waves I and II of the National Longitudinal Study of Adolescent Health (a survey of schools and students in the USA, with wave I collected in 1994 and wave II collected in 1995), we explore this association. We examine three measures of weight: obesity, body mass index, and weight perception. We also consider gender-specific models and a subsample of non-Hispanic whites, in order to assess race differences in the obesity and overweightness-depression relationship.

RESULTS

Our findings reveal that neither of our objective measures of weight, obesity, nor body mass index are significant predictors of depressive symptoms for either American Indian or white youth. However, we find evidence that the subjective measure of weight perception is a significant predictor of depressive symptoms for white females, but not for American Indian females.

CONCLUSIONS

Our results contribute to past findings that measures of obesity/overweightness weight may be more important to white female's mental health than females from other racial groups, although additional research is warranted.

Mercury, Polychlorinated Biphenyls, Selenium, and Fatty Acids in Tribal Fish Harvests of the Upper Great Lakes

The Chippewa Ottawa Resource Authority monitors fish contaminants in Anishinaabe (Great Lake Native American) tribal fisheries. This article updates previously reported trends in two persistent bioaccumulative toxic (PBT) substances that are the primary contributors to consumption advisory limits for these fish: methylmercury (MeHg) and polychlorinated biphenyls (PCBs). Also, we report, for the first time, an analysis of nutritional benefit bioindicators and metrics in these same Upper Great Lakes fish harvests: selenium (Se) and omega-3 fatty acids (PUFA-3s). A novel risk/benefit quantification originally presented by Ginsberg et al. is reported here to characterize the tradeoffs between fatty acid benefits and toxic MeHg health outcomes. We also report a Se benefit metric to characterize the possible protective value against MeHg neurotoxicity based on Ralston et al. Congruent with Anishinaabe cultural motivations to consume fish from their ancestral fisheries, nutritional content was high in locally caught fish and, in some respects, superior to farmed/store-bought fish. These Great Lakes fish still contained levels of PBTs that require careful education and guidance for consumers. However, the contaminant trends suggest that these fish need not be abandoned as important (both culturally and nutritionally) food sources for the Anishinaabe who harvested them.

Cardiovascular Disease Risk Factors and Health Outcomes Among American Indians in Oklahoma: the THRIVE Study

INTRODUCTION

Limited available data document higher prevalences of cardiovascular disease (CVD) risk factors and health outcomes among American Indians (AIs) compared to other racial/ethnic groups.

METHODS

As part of a randomized control trial to improve tribal food and physical activity environments, our tribal-academic partnership surveyed a cross-sectional sample of American Indian adults (n = 513) to assess the prevalence of type 2 diabetes, obesity, hypertension, tobacco use, physical activity, and vegetable and fruit intake. Surveys were collected from April through May 2015. We used logistic regression to examine the association between CVD-related risk factors and health outcomes.

RESULTS

The prevalence of CVD-related outcomes was high, ranging from 25% for diabetes to 75% for low vegetable intake. The prevalence of diabetes, obesity, and hypertension tended to be higher among participants with any tobacco use compared to no tobacco use, but findings were not statistically significant. The prevalence of diabetes (prevalence ratio 2.1, 95% CI 1.4-3.2) and obesity (prevalence ratio 1.5, 95% CI 1.2-1.8) was higher among participants with low physical activity levels compared to recommended physical activity levels.

CONCLUSIONS

CVD risk factors and health outcomes persist among American Indians even as some risks (e.g., smoking) appear to be stabilizing or even declining in the general US population. Efforts to include American Indians in national health surveys, implement broad reaching environmental and policy interventions, and address the social determinants of health are critical to the elimination of these disparities.

Obesity and Overweight in American Indian and Alaska Native Children, 2006-2015

OBJECTIVES

To estimate obesity and overweight prevalence in American Indian and Alaska Native (AI/AN) children across genders, ages, and geographic regions in the Indian Health Service active clinical population.

METHODS

We obtained data from the Indian Health Service National Data Warehouse. At least 184 000 AI/AN children aged 2 to 19 years had body mass index data for each year studied, 2006 to 2015. We calculated body mass index percentiles with the 2000 Centers for Disease Control and Prevention growth charts.

RESULTS

In 2015, the prevalence of overweight and obesity in AI/AN children aged 2 to 19 years was 18.5% and 29.7%, respectively. Boys had higher obesity prevalence than girls (31.5% vs 27.9%). 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 US children overall in the National Health and Nutrition Examination Survey. Results for 2006 through 2014 were similar.

CONCLUSIONS

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.

Breastfeeding in Infancy Is Associated with Body Mass Index in Adolescence: A Retrospective Cohort Study Comparing American Indians/Alaska Natives and Non-Hispanic Whites

BACKGROUND

American Indians and Alaska Natives have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI; calculated as kg/m2) is not well understood. Previous studies have investigated the association between breastfeeding in infancy and offspring BMI, but rarely included American Indians and Alaska Natives.

OBJECTIVE

This study investigated the association between breastfeeding in infancy and BMI in American Indians and Alaska Native and non-Hispanic white adolescents and young adults.

DESIGN

Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994 to 2008).

PARTICIPANTS

Adolescent respondents who self-identified as American Indians and Alaska Native or non-Hispanic white, and whose parents completed the parental questionnaire, reported their height and weight. The final sample included 655 American Indians and Alaska Native and 10,305 non-Hispanic white respondents.

STATISTICAL ANALYSES PERFORMED

Generalized estimating equations were used to measure the mean differences, 95% CIs, and P values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables.

RESULTS

The length of breastfeeding was inversely associated with BMI in both populations. American Indians and Alaska Natives that were breastfed for 6 to 12 months or for more than 12 months had a mean BMI of 2.69 (95% CI -3.46 to -1.92; P<0.01) and 1.54 (95% CI -2.75 to -0.33; P<0.05) units lower than those that were never breastfed. Non-Hispanic whites that were breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI of 0.71 (95% CI -0.93 to -0.50; P<0.01), 0.68 (95% CI -0.87 to -0.50; P<0.01), and 0.85 (95% CI -1.09 to -0.62; P<0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (P<0.01).

CONCLUSIONS

Breastfeeding in infancy is associated with lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in American Indians and Alaska Natives can prevent increasing BMI.

Step Counts on Weekdays, Weekends, and During Physical Education of Navajo High School Students

BACKGROUND

Understanding the physical activity patterns of youth is important for the implementation and evaluation of programming and interventions designed to change behavior. To date, little is known about the objectively measured physical activity patterns of Native American youth. Therefore, the purpose of the study was to examine the step counts of Navajo youth during weekdays, weekend days, and physical education classes.

METHODS

Participants included 63 high school students (mean age = 15.14 ± 1.37 years). Youth wore a pedometer (Walk-4-Life 2505) for seven consecutive days. Means and standard deviations were calculated for weekdays, weekend days, and physical education.

RESULTS

Boys averaged 11,078 ± 4400 steps/weekday compared to 6493 ± 5651 on weekend days. Girls averaged 7567 ± 5614 on weekdays compared to 7589 ± 7712 on weekend days. Both boys (20 %) and girls (26 %) accumulated a large percentage of their weekday step counts from physical education classes.

CONCLUSIONS

Findings highlight the importance of additional physical activity opportunities in the community. Youth are falling well short of recommended levels of physical activity with physical education being an important source of physical activity.

Beliefs about diabetes and medication adherence among Lumbee Indians living in rural southeastern North Carolina

This study assessed personal beliefs about the causes and meaning of having diabetes among the members of the Lumbee Indian tribe living in rural southeastern North Carolina. The sample included 20 males (50%) and 20 females (50%); the mean duration of having diabetes was 9.82 years. The average body mass index (BMI) for females was 34.76 (range, 24.21-55.44), whereas the average BMI for males was 35.10 (range, 22.71-59.71). Ninety percent reported a family history of diabetes. The majority of participants held beliefs that diabetes was a serious and chronic condition and that the disease was amenable to personal control. Participants perceived that diabetic medications were an essential and effective part of their treatment regimen, and they reported greater comfort in adhering to prescribed medication regimens than making long-term lifestyle changes. This study highlights the high prevalence of diabetes among Lumbee Indians and also the need for future studies in this area.

'We usually just start dancing our Indian dances': urban American Indian (AI) female youths' negotiation of identity, health and the body

In this article, we utilise qualitative research techniques to explore how 14 urban American Indian (AI) females (aged 11-17) living in the state of Maryland discursively construct and experience health and the body, as well as how/if traditional culture shapes their understandings. In doing so, we address a significant gap in the knowledge base concerning the health beliefs of urban AI youth, and build upon research utilising a decolonising approach. Using a two-step process of thematic analysis and poststructuralist discourse analysis, we arrived at three key findings: (1) while youths are taught (and learn) mainstream lessons about health and bodily norms (mostly at school), they negotiate these lessons in complex and at times contradictory ways; (2) they do not view their AI status as conferring more or less risk upon them or their community; and (3) AI identity appears to be fluid in nature, becoming more salient, even a resource, in certain situations. We conclude with a discussion of the importance of spaces within the urban context in shaping youths' embodied subjectivities, and in particular, contrast the space of the school with that of the urban AI community centre.

Parental misperceptions of children's underweight status: a meta-analysis

BACKGROUND

Accurate parental perceptions of their children's underweight status are needed to prevent overlooking potential disordered eating patterns or health conditions affecting growth.

PURPOSE

The aim of this study is to determine overall proportion of parents who misperceive children's underweight status and correlates of such misperceptions.

METHODS

Original studies published to January 2013 were chosen through a literature search in established databases. Studies included assessed parental perceptions of their children's underweight and then compared perceptions to recognized standards for defining underweight based on anthropometric measures. Random- and mixed-effects models were used.

RESULTS

Thirty-seven articles (representing 39 studies; N = 4,039) were included. Pooled effect sizes indicated that 46.58 % (95 % CI 40.90-52.35 %) of parents misperceive their children's underweight status, though the extent of misperceptions depended on a number of moderators.

CONCLUSIONS

Nearly half of parents perceive their underweight children as weighing more than they actually do. Health care professionals are well positioned to take steps to remedy misperceptions and encourage healthy behaviors.

Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children

PURPOSE

Obesity is one of the most serious health problems among American Indian/Alaska Native (AI/AN) children. We investigated Indian Health Service (IHS) primary care providers' implicit and explicit attitudes about weight and race and their association with treatment approaches to overweight in children.

METHODS

We conducted an online survey of long-term primary care clinicians in two western regions of the IHS. We used the existing Weight Attitude Implicit Association Test (IAT) and developed a new Native American Attitude IAT to measure implicit attitudes. Explicit attitudes about weight and race were assessed through self-report. We assessed self-rated treatment approaches to childhood overweight. We used linear regression models to evaluate the association of attitudes about weight and race with treatment approaches.

RESULTS

Our sample included 75 clinicians (56% response rate) who, on average, saw 74 patients per week. Fifty-five percent of clinicians reported that 30-60% of their child and adolescent patients were overweight or obese, and 25% of clinicians reported that 60-100% of their patients were overweight or obese. We found strong implicit bias favoring thin people (Cohen's d=1.44) and weak implicit bias favoring whites (Cohen's d=0.35). We found no association between implicit or explicit bias scores and self-reported treatment of childhood overweight. Continuing education on obesity was associated with self-rated success and competence in weight management.

CONCLUSIONS

Weight and race bias exists among long-term IHS clinicians, but may not influence treatment approaches for overweight AI/AN children. Further research should assess the effect of clinicians' attitudes on real-world weight management.

Partnering with Indigenous student co-researchers: improving research processes and outcomes

Objective

To examine the contribution of student co-researchers to a community-based participatory Photovoice investigation of Indigenous children's food-related lived experience. We examine co-researchers’ contributions to the research process, their role in knowledge co-generation and dissemination, and factors that fostered research partnership with the teenage co-researchers.

Methods

High school students attending a First Nation community school in Canada were trained as research partners. They contributed to aspects of research design, conducted interviews with grades 3 and 4 Photovoice participants, and participated in data analysis and the development of a culturally relevant photobook. The study was initiated by the community's research committee. It is informed by critical consciousness theory and the positive youth development framework.

Results

Student co-researchers incorporated culturally appropriate strategies as they interviewed participants. Co-researchers adopted conversational approaches, built rapport by articulating personal and cultural connections, and engaged in mentoring and health promotion as they interviewed participants. They made critical contributions to dissemination by developing photobook content that promoted the importance of traditional foods and the vital role of family and community in healthy eating practices. Relationships and “dialogic” space were important to building partnership with and promoting capacity development among youth co-researchers.

Conclusions

Partnership between university researchers and Indigenous student co-researchers holds great promise for health promotion in communities. Co-researchers developed research and leadership skills, gained understanding of health challenges facing their community, and initiated health and cultural promotion through the project's Photobook. This investigation supports the powerful potential of student co-researchers to meaningfully contribute to research processes and to build knowledge that is relevant and credible both within and outside of their communities. Findings have implications for youth, communities and researchers.

Through the lens of our cameras: children's lived experience with food security in a Canadian Indigenous community

BACKGROUND

The related issues of food security and obesity among North American Indigenous children are serious public health concerns. This community-based participatory study sought to gain deeper understanding of young First Nation children's lived experience with food and to learn, from their perspective, about food security issues in their community.

METHODS

In this Photovoice investigation 26 young children attending a rural reserve school in Canada were asked to take photographs of the food they ate. Nine high school students from the same school were trained as co-researchers: they interviewed the younger students, helped identify emerging themes and contributed to knowledge translation. Data analysis incorporated conventional content analysis, grounded theory's constant-comparative method, and examination of photos and texts.

RESULTS

Five primary findings emerged from photographs and interviews: (1) children had a dualistic understanding of healthy vs. unhealthy foods; (2) packaged, quick-preparation foods played a dominant role in children's everyday food experiences; (3) families were critical to children's food-related experiences; (4) although traditional foods are viewed as central to Aboriginal health, few were depicted in the photographs; and (5) photos do not tell the whole story - despite the smaller numbers of fruits and vegetables in photos, children like to eat these foods when they are available at home.

CONCLUSIONS

The study improved understanding of children's everyday food-related experiences, provided insight into community food security, and demonstrated the contribution of children and youth as experts on their lives and matters affecting them. A photobook representing findings provided a rich, visual tool for communicating the food-related experiences of children and messages about healthy eating within the school and to community members and leaders. Intervention efforts can build on participants' understanding of healthy versus unhealthy foods and on the critical role of family for healthy eating.

Using a participatory research approach in a school-based physical activity intervention to prevent diabetes in the Hualapai Indian community, Arizona, 2002-2006

Introduction

In the United States, type 2 diabetes has reached epidemic proportions among indigenous people. Community-based participatory research offers American Indian communities and university partners an opportunity to integrate skills in community action and systematic inquiry to develop locally acceptable primary prevention interventions to combat diabetes risk factors. The Hualapai Tribe and the University of Arizona designed, implemented, and assessed a school-based physical activity intervention to reduce diabetes risk factors among youth.

Methods

During a 2-year period, trained community members led in-school physical activity classes 2 times per week among students in grades 3 through 8. Body mass index (BMI), fitness measures, and fasting blood glucose level were measured on 6 occasions. Descriptive statistics and t tests were used to assess change in outcome measures.

Results

Of the more than 100 youth who took part in the physical activity classes for 2 years, 71 youth (38 male, 33 female) participated in 3 or more data collection sessions. Over time, the percentage of youth with a high fasting blood glucose level of more than 125 mg/dL decreased concurrently with significant improvements in fitness measures. However, BMI increased in both male and female participants. The high number of youth who missed more than 3 data collection sessions was attributed to poor school attendance and tardiness.

Conclusion

Classes led by lay physical activity leaders can affect diabetes risk factors in youth. Incongruous health and fitness outcomes suggest that one indicator does not adequately define the risk profile; BMI alone may not be sufficient as a measure of diabetes risk in youth.

Correlation analysis of genetic admixture and social identification with body mass index in a Native American community

OBJECTIVES

Body mass index (BMI) is a well-known measure of obesity with a multitude of genetic and non-genetic determinants. Identifying the underlying factors associated with BMI is difficult because of its multifactorial etiology that varies as a function of geoethnic background and socioeconomic setting. Thus, we pursued a study exploring the influence of the degree of Native American admixture on BMI (as well as weight and height individually) in a community sample of Native Americans (n = 846) while accommodating a variety of socioeconomic and cultural factors.

METHODS

Participants' degree of Native American (NA) ancestry was estimated using a genome-wide panel of markers. The participants also completed an extensive survey of cultural and social identity measures: the Indian Culture Scale (ICS) and the Orthogonal Cultural Identification Scale (OCIS). Multiple linear regression was used to examine the relation between these measures and BMI.

RESULTS

Our results suggest that BMI is correlated positively with the proportion of NA ancestry. Age was also significantly associated with BMI, while gender and socioeconomic measures (education and income) were not. For the two cultural identity measures, the ICS showed a positive correlation with BMI, while OCIS was not associated with BMI.

CONCLUSIONS

Taken together, these results suggest that genetic and cultural environmental factors, rather than socioeconomic factors, account for a substantial proportion of variation in BMI in this population. Further, significant correlations between degree of NA ancestry and BMI suggest that admixture mapping may be appropriate to identify loci associated with BMI in this population.

A review of childhood and adolescent craniopharyngiomas with particular attention to hypothalamic obesity

BACKGROUND

Although craniopharyngiomas are considered "benign" neoplasms by the World Health Organization classification, these tumors may create significant morbidity and mortality in patients. Hypothalamic obesity is a frequent complication of craniopharyngiomas and is refractory to current management options.

PATIENTS/METHODS

We reviewed 24 cases of craniopharyngiomas treated from 1992 to 2010 in patients <18 years of age regarding clinical presentation, neuroimaging, recurrence, morbidity, and mortality, with particular attention to hypothalamic obesity.

RESULTS

Our cohort conformed to published data in regard to neuroimaging characteristics, and clinical findings in the areas of endocrine, visual, neurological, neurobehavioral, and hypothalamic domains. At last follow-up, 53% of our patients were overweight (8%) or obese (46%). Only 25% of our patients had a healthy body mass index. Contrasting these data with body mass indices at diagnosis, where 21% of patients were overweight and 17% were obese, we found that there was a significant trend towards obesity over time. A significant portion of our mortality appears to be related to complications of obesity. The Native American population in Arizona appears to have a statistically greater incidence of obesity in childhood. Despite our small sample size, 75% of our Native Americans were obese at last follow-up and accounted for 50% of the mortality.

CONCLUSION

Hypothalamic obesity is a significant complication of craniopharyngiomas associated with increased mortality. The development of hypothalamic obesity is influenced by premorbid obesity, genetics, and therapy received, specifically radiation. Because of the intractability of hypothalamic obesity, improved understanding of neuroendocrine mechanisms, genomics, and newer antiobesity medications will be necessary to curb this significant complication.

Obesity in american Indian and mexican american men and women: associations with blood pressure and cardiovascular autonomic control

Obesity is a serious public health problem, especially in some minority communities, and it has been associated with an increased risk of cardiovascular diseases. While obesity is a serious health concern in both American Indian and Mexican American populations, the relationship between obesity and cardiac autonomic control in these two populations is not well understood. The present study in a selected sample of American Indians and Mexican Americans assessed associations between obesity, blood pressure (BP), and cardiovascular autonomic control. Cardiovascular autonomic control, systolic and diastolic mean BP, and body mass index were obtained from one hundred thirty-two American Indian and Mexican American men and women who are literate in English and are residing legally in San Diego County. Men had a significant greater systolic and diastolic BP and were more likely to develop systolic prehypertension and hypertension than women. Obese participants showed greater mean heart rate (HR) and systolic and diastolic BP than nonobese participants. Obese men also exhibited greater cardiac sympathetic activity and lower cardiovagal control than obese women. These results suggest that obesity and gender differences in cardiovascular autonomic control may contribute to risk for cardiovascular disorders in this sample of American Indians and Mexican Americans.

Youth-onset type 2 diabetes among american indians and alaska natives

Youth-onset type 2 diabetes has emerged as a significant public health concern for American Indians and Alaska Natives. Data from the National Institutes of Health longitudinal epidemiological study among the Pima Indians of southern Arizona and the Indian Health Service continue to document a rising incidence and prevalence of type 2 diabetes among American Indian and Alaska Native youth. Although national trends related to lack of physical activity and to unhealthy nutrition behaviors have contributed to the epidemic, the adverse conditions created by poverty, social injustice, trauma, and cultural disruption are also important in understanding the underlying causes for this public health crisis. This adverse environment is likely to provide little support for healthy nutrition and physical activity behaviors as well as other diabetes self-care behaviors. Known risk factors from the Pima Indian studies, such as intrauterine exposure to diabetes, bottle-feeding, and obesity, provide a basis for worthwhile intervention strategies. In this article, the author will review the current literature on the epidemiology of youth-onset type 2 diabetes among American Indians and Alaska Natives, discuss causes for the diabetes epidemic among American Indians and Alaska Natives, review risk factors for youth-onset type 2 diabetes in this population, and share promising youth physical activity promotion programs created and implemented specifically for American Indian and Alaska Native youth. However, more research on interventions to address the Native communities' psychosocial issues and concerns around youth-onset type 2 diabetes is urgently needed.

Race/Ethnicity, Obesity, and Related Cardio-Metabolic Risk Factors: A Life-Course Perspective

The adoption of health behaviors characterized by minimal energy expenditure and overconsumption of energy has led to cardiometabolic risk factors in pregnancy, childhood, and youth, all of which increase the prevalence of cardiovascular disease in adulthood. The propensity to develop abdominal obesity and cardiometabolic risk factors appears to disproportionally affect non-white ethnic groups. While the majority of observational research has been conducted in populations of European origin, studies in non-white ethnic groups across the life-course are underway and there is evidence that unique ethnic-specific differences exist. This review will focus on the life-course determinants of obesity and its related cardio-metabolic risk factors among diverse ethnic groups including people of Afro-Caribbean origin, South Asian, East Asian, and indigenous ancestry.

Trends of overweight and obesity among white and American Indian school children in South Dakota, 1998-2010

OBJECTIVE

To investigate the prevalence of overweight and obesity among white and American Indian children in a predominantly rural state.

DESIGN AND METHODS

Using a repeated, cross-sectional design of school children's height and weight, the study sample included 361,352 measures of children who were 5.0-19.9 years, attending school across 13 academic calendar years. Trained staff measured height, weight, and recorded gender, age, and race. Data were voluntarily reported to the State Department of Health.

RESULTS

American Indian children consistently had higher rates of overweight and obesity compared to white children. Across the years, 16.3% of white students were overweight, whereas 19.3% of American Indian students were overweight. In addition, 14.5% of white children were obese and 25.9% of American Indian children were obese. Examining by rural versus urban schools, prevalence of overweight had been increasing among white male and female students and American Indian female students living in rural areas. Obesity is also increasing among rural white females and male and female American Indian children.

CONCLUSIONS

The findings here suggest that although American Indian children are at higher risk, in general, compared to white children, rural populations in general are experiencing increases in childhood overweight and obesity. Targeted rural interventions beginning at an early age are necessary to improve the health of rural children, especially in American Indian communities.

Correlates of overweight and obesity among American Indian/Alaska Native and Non-Hispanic White children and adolescents: National Survey of Children's Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children's Health, behavioral (child's sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child's bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child's age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10-17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5-2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1-3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3-5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.

Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender

Overweight patients report weight discrimination in health care settings and subsequent avoidance of routine preventive health care. The purpose of this study was to examine implicit and explicit attitudes about weight among a large group of medical doctors (MDs) to determine the pervasiveness of negative attitudes about weight among MDs. Test-takers voluntarily accessed a public Web site, known as Project Implicit®, and opted to complete the Weight Implicit Association Test (IAT) (N = 359,261). A sub-sample identified their highest level of education as MD (N = 2,284). Among the MDs, 55% were female, 78% reported their race as white, and 62% had a normal range BMI. This large sample of test-takers showed strong implicit anti-fat bias (Cohen's d = 1.0). MDs, on average, also showed strong implicit anti-fat bias (Cohen's d = 0.93). All test-takers and the MD sub-sample reported a strong preference for thin people rather than fat people or a strong explicit anti-fat bias. We conclude that strong implicit and explicit anti-fat bias is as pervasive among MDs as it is among the general public. An important area for future research is to investigate the association between providers' implicit and explicit attitudes about weight, patient reports of weight discrimination in health care, and quality of care delivered to overweight patients.

Intakes of milk and alternatives among on-reserve First Nations youth in northern and southern Ontario, Canada

OBJECTIVE

To assess the adequacy of milk and alternatives, Ca and vitamin D intakes in First Nations (FN) youth in Ontario, Canada. Intakes were compared with the general population and dietary standards. Variation in intakes by community (proxy for remoteness) and BMI was examined.

DESIGN

Data were collected by 24 h recall between November 2003 and June 2010. Intakes were analysed descriptively. Variation in intakes, by community and BMI category, was assessed using ANOVA.

SETTING

Five remote FN communities of the Mushkegowuk Territory (northern Ontario, Canada) and two less-remote southern Ontario FN communities.

SUBJECTS

Schoolchildren (n 457) in grades 6 to 12.

RESULTS

Compared with Canada's Food Guide recommendations, 72.6 to 84.7% had an inadequate intake of milk and alternatives depending on age and sex group; 86.2% of individuals fell below the RDA for Ca; 96.4% fell below the RDA for vitamin D. Community variation in intakes was detected, although in all cases Fort Albany had higher intakes, even when it was the more northern (remote) community. A BMI × sex interaction was found for intake of milk and alternatives (P = 0.041): an inverse relationship between intake and BMI was seen in females; in males, those who were overweight had the highest intake, followed by normal-weight and obese youth.

CONCLUSIONS

The nutritional inadequacies parallel the results of other Canadian studies of Aboriginal populations. Population health interventions to improve intakes are warranted. Moreover, community variation in intakes exists among FN youth in the present study (Fort Albany pairs only), but results were not as expected.

Overweight and obesity among North American Indian infants, children, and youth

The frequency of overweight and obesity among North American Indian children and youth exceeds that of other ethnic groups in the United States. This observation is based on studies using body mass index as the primary measure of overweight and obesity. In the mid-20th century, there were regional differences among North American Indian groups in sub-adults' size and shape and only a few Southwestern groups were characterized by high rates of overweight and obesity. In most populations, the high prevalence of overweight and obesity developed in the last decades of the 20th century. Childhood obesity may begin early in life as many studies report higher birth weights and greater weight-for-height in the preschool years. Contributing factors include higher maternal weights, a nutritional transition from locally caught or raised foods to store bought items, psychosocial stress associated with threats to cultural identity and national sovereignty, and exposure to obesogenic pollutants, all associated to some degree with poverty. Obesity is part of the profile of poor health among Native Americans in the US and Canada, and contributes to woefully high rates of diabetes, cardiovascular disease, and early mortality. Interventions that are culturally appropriate are needed to reduce weights at all points in the lifespan.

Vegetable and fruit intakes of on-reserve first nations schoolchildren compared to Canadian averages and current recommendations

This study investigated, in on-reserve First Nations (FN) youth in Ontario, Canada, the following: (a) the intakes of vegetable and fruit, "other" foods and relevant nutrients as compared to current recommendations and national averages, (b) current prevalence rates of overweight and obesity and (c) the relationship between latitude and dietary intakes. Twenty-four-hour diet recalls were collected via the Waterloo Web-Based Eating Behaviour Questionnaire (WEB-Q) (n = 443). Heights and weights of participants were self reported using measured values and Body Mass Index was categorized using the International Obesity Task Force cutoffs. Food group and nutrient intakes were compared to current standards, Southern Ontario Food Behaviour data and the Canadian Community Health Survey, Cycle 2.2, using descriptive statistics. Mean vegetable and fruit, fibre and folate intakes were less than current recommendations. Girls aged 14-18 years had mean intakes of vitamin A below current recommendations for this sub-group; for all sub-groups, mean intakes of vegetables and fruit were below Canadian averages. All sub-groups also had intakes of all nutrients and food groups investigated that were less than those observed in non-FN youth from Southern Ontario, with the exception of "other" foods in boys 12-18 years. Prevalence rates of overweight and obesity were 31.8% and 19.6%, respectively, exceeding rates in the general population. Dietary intakes did not vary consistently by latitude (n = 248), as revealed by ANOVA. This study provided a unique investigation of the dietary intakes of on-reserve FN youth in Ontario and revealed poor intakes of vegetables and fruit and related nutrients and high intakes of "other" foods. Prevalence rates of overweight and obesity exceed those of the general population.

Inadequate Nutrient Intakes in Youth of a Remote First Nation Community: Challenges and the Need for Sustainable Changes in Program and Policy

Background. The current study established baseline nutrient intakes of youth and examined the potential for sustainability of a pilot school snack program in the remote First Nation of Kashechewan, Ontario, Canada. Methods. Twenty-four-hour dietary recalls established baseline intakes in grade 6–8 students (n=43). Subsequently, a pilot healthy school snack program was initiated. Dietary recalls were completed one week (n=43) and one year after the program (n=67). Paired Wilcoxon signed-ranks tests were used to detect changes in intakes. Impressions of the teachers (n=16), principal, and students were collected qualitatively. Results. Most youth had dietary intakes below current standards. Although vitamin C (P=0.024) and fibre (P=0.015) intakes improved significantly after one week, these improvements were not sustained over the following year. Program impressions were positive. Conclusion. The need for a nutrition program is clear. While benefits were realized in the short term, improvements could not be maintained. Policy changes are needed to address barriers to sustainability.

Associations of home food availability, dietary intake, screen time and physical activity with BMI in young American-Indian children

OBJECTIVE

To evaluate associations between home environmental factors and BMI of young American-Indian children.

DESIGN

Cross-sectional and prospective study.

SETTING

School-based obesity prevention trial (Bright Start) on a Northern Plains Indian reservation in South Dakota. Mixed model multivariable analysis was used to examine associations between child BMI categories (normal, overweight and obese) and home food availability, children's dietary intake and physical activity. Analyses were adjusted for age, gender, socio-economic status, parent BMI and school; prospective analyses also adjusted for study condition and baseline predictor and outcome variables.

SUBJECTS

Kindergarten children (n = 424, 51 % male; mean age = 5.8 years, 30 % overweight/obese) and parents/caregivers (89 % female; 86 % overweight/obese) had their height and weight measured and parents/caregivers completed surveys on home environmental factors (baseline and 2 years later).

RESULTS

Higher fast-food intake and parent-perceived barriers to physical activity were marginally associated with higher probabilities of a child being overweight and obese. Vegetable availability was marginally associated with lower probabilities of being overweight and obese. The associations between home environmental factors and child weight status at follow-up were not significant.

CONCLUSIONS

Findings indicate that selected aspects of the home environment are associated with weight status of American-Indian children. Obesity interventions with this population should consider helping parents to engage and model healthful behaviours and to increase availability of healthful foods at home.

Predictors of wellness and American Indians

Wellness is an important American Indian (AI) concept, understood as being in balance with one's body, mind, and environment. Wellness predictors are reported in this paper within the context of health. A cross-sectional randomized household survey of 457 AI adults at 13 rural health care sites in California was conducted. Measures included wellness perceptions, barriers, health status/health conditions, spirituality, cultural connectivity, high-risk behaviors and abuse history. Statistical analysis obtained the best predictive model for wellness. Predictors of wellness were general health status perception, participation in AI cultural practices and suicide ideation. Significant differences in wellness status were observed depending on experience of adverse events in childhood and adulthood (neglect, physical abuse, and sexual abuse). Cultural connectivity (speaking tribal language, participating in AI practices, and feeling connected to community) was also associated with perceptions of wellness. Recommendations are for culturally-appropriate education and interventions emphasizing community and cultural connectivity for improving wellness status.

The co-occurrence of obesity, elevated blood pressure, and acanthosis nigricans among American Indian school children: identifying individual heritage and environment-level correlates

OBJECTIVE

To estimate the prevalence and explore the social and cultural etiologic roots of weight status, blood pressure, and acanthosis nigricans among American Indian children on a reservation in South Dakota.

METHODS

This observational study was conducted in 26 schools from 1998 to 2002 and included 5,422 observations representing 3,841 children, ages 3 to 19. Trained staff measured height, weight, blood pressure, and assessed the presence of acanthosis nigricans (AN). Percent Indian heritage (PIH) was abstracted from tribal records. Sociodemographic environment (SDE) was calculated using the 2000 Census at the city/town level. Descriptive analyses were conducted using one measurement time point, including tests for trend and co-occurrence of risk factors using the [kappa] statistic. Hierarchical, multivariate logistic regression estimated associations with overweight/obesity status, accounting for multiple measures on individuals and SDE.

RESULTS

The overall prevalence of overweight/obesity was 46%, of hypertension 9%, and of AN 14%. The co-occurrence of risk factors was moderate to high. PIH and AN were positively associated in unadjusted analysis. Controlling for sex, age, and SDE, higher PIH was a significant correlate of overweight/obesity, although when hypertension (OR = 5.92, CI = 3.27-10.72), prehypertension (OR = 3.80, CI = 1.99-7.26), and AN (OR = 16.20, CI = 8.08-32.48) were included in the model PIH was no longer significant. SDE was not significantly associated with overweight/obesity.

CONCLUSION

PIH appeared to be an important correlate of overweight and obesity, except when adjusted for the co-occurrence of high blood pressure and AN. Overall, the prevalence and co-occurrence of various risk factors in this population was high. Obesity prevention initiatives targeting families and communities are needed, as well as access to screening and treatment services.

Linking farmers to community stores to increase consumption of local produce: a case study of the Navajo Nation

OBJECTIVE

To understand the barriers to farmer participation in Farm-to-Table (F2T) programmes and to identify possible solutions to these obstacles.

DESIGN

Cross-sectional analysis of farmer perspectives on F2T programmes.

SETTING

Three service units on the Navajo Nation (Chinle, Tuba City and Fort Defiance).

SUBJECTS

Forty-four Navajo farmers.

RESULTS

Most participants reported that farming on the Navajo Nation is getting harder (61 %) but that it is very important to maintain Navajo farming traditions (98 %). A modest number of farmers (43 %) expressed interest in participating in an F2T programme. All farmers reported that childhood obesity was a very serious or serious problem in the Navajo Nation. The farmers expressed support for an F2T programme if key barriers to farming, including water access and pest control, could be addressed. Key barriers to participation identified included lack of fruits and vegetables to sell, sale price of crops and lack of certification of produce by the US Food and Drug Administration.

CONCLUSIONS

Navajo farmers are aware of the burden of childhood obesity on the Navajo Nation and feel that an F2T programme could be beneficial. To successfully implement a Farm-to-Table programme, the barriers to participation identified will need to be addressed.

Body image, body dissatisfaction and weight status in South Asian children: a cross-sectional study

Background

Childhood obesity is a continuing problem in the UK and South Asian children represent a group that are particularly vulnerable to its health consequences. The relationship between body dissatisfaction and obesity is well documented in older children and adults, but is less clear in young children, particularly South Asians. A better understanding of this relationship in young South Asian children will inform the design and delivery of obesity intervention programmes. The aim of this study is to describe body image size perception and dissatisfaction, and their relationship to weight status in primary school aged UK South Asian children.

Methods

Objective measures of height and weight were undertaken on 574 predominantly South Asian children aged 5-7 (296 boys and 278 girls). BMI z-scores, and weight status (underweight, healthy weight, overweight or obese) were calculated based on the UK 1990 BMI reference charts. Figure rating scales were used to assess perceived body image size (asking children to identify their perceived body size) and dissatisfaction (difference between perceived current and ideal body size). The relationship between these and weight status were examined using multivariate analyses.

Results

Perceived body image size was positively associated with weight status (partial regression coefficient for overweight/obese vs. non-overweight/obese was 0.63 (95% CI 0.26-0.99) and for BMI z-score was 0.21 (95% CI 0.10-0.31), adjusted for sex, age and ethnicity). Body dissatisfaction was also associated with weight status, with overweight and obese children more likely to select thinner ideal body size than healthy weight children (adjusted partial regression coefficient for overweight/obese vs. non-overweight/obese was 1.47 (95% CI 0.99-1.96) and for BMI z-score was 0.54 (95% CI 0.40-0.67)).

Conclusions

Awareness of body image size and increasing body dissatisfaction with higher weight status is established at a young age in this population. This needs to be considered when designing interventions to reduce obesity in young children, in terms of both benefits and harms.

Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods

PURPOSE

The purpose of this study was to use a community-based participatory research (CBPR) approach to translate the original Diabetes Prevention Program (DPP) to be age and culturally specific for American Indian (AI) youth.

METHODS

Tribally enrolled members on 2 Montana Indian reservations conducted focus groups and interviews to discuss community members' perspectives of factors that encouraged or were barriers to healthy diet and exercise behaviors in AI youth. In total, 31 community members, aged 10 to 68 years old, participated in 4 focus groups and 14 individual interviews. Participants were self-identified as elder, cultural expert, tribal health worker, educator, parent/guardian, youth, or school food service worker. Researchers analyzed transcripts based on inductive methods of grounded theory.

RESULTS

Data analysis revealed translating the DPP to youth was contingent on the lessons incorporating cultural strategies for healthy behaviors in youth such as berry picking, gardening, horseback riding, and dancing; improving knowledge and access to healthy foods and physical activity for youth and their parents; having interactive, hands-on learning activities for healthy lifestyles in the DPP lessons; using a group format and tribal members to deliver the DPP lessons; and having tribal elders talk to youth about the importance of adopting healthy behaviors when they are young.

CONCLUSIONS

A CBPR approach engaged community members to identify strategies inherent in their culture, tradition, and environment that could effectively translate the DPP to Montana Indian youth living in rural reservation communities.

Correlates of physical activity in young American Indian children: lessons learned from the Wisconsin Nutrition and Growth Study

BACKGROUND

Obesity is a serious and growing health problem in American Indian (AI) children. Our study, the Wisconsin Nutrition and Growth Study, aimed to understand the prevalence and contributing factors to pediatric obesity in Wisconsin tribes and provide the foundation for intervention design.

OBJECTIVE

This article focuses on associations among age, gender, and 3 measures of weight status with proxy-reported physical activity and TV/screen time in 3 to 8 year-old AI children.

DESIGN/METHODS

In a cross-sectional design, 581 AI children (49.1% female, aged 3-8 years) participated in health screenings that included height, weight, waist circumference, percent body fat, and a caregiver survey on demographics and health, with questions on physical activity and TV/screen time.

RESULTS

Forty-five percent of children were overweight or obese. Boys were significantly more obese and had higher levels of body fat than girls. There were no differences in weight category across age groups. Boys participated in significantly more weekly sports than girls and sports participation was somewhat higher in younger children. Body mass index and waist circumference were not significantly correlated with TV/screen time or with the 3 activity measures (sports participation, outdoor play time, or physical education classes). Hours of outdoor play significantly predicted child body fat percentage controlling for maternal body mass index and child age and gender.

CONCLUSIONS

Young AI children in Wisconsin have high rates of overweight/obesity starting at a very early age, and outdoor play may play a significant role in mediating body fat. There is a need to develop obesity-prevention interventions at early ages.

Disparities in peaks, plateaus, and declines in prevalence of high BMI among adolescents

OBJECTIVES

The objective of this study was to investigate trends in prevalence of high BMI from 2001 to 2008 and examine racial/ethnic disparities.

METHODS

Records for a total of 8 283 718 fifth-, seventh-, and ninth-grade students who underwent California's school-based BMI screening between 2001 and 2008 were included. Logistic regression identified trends in prevalence of high BMI (>or=85th, >or=95th, >or=97th, and >or=99th percentiles).

RESULTS

For 3 of 4 BMI cut points, prevalence continued to increase for black and American Indian girls through 2008, Hispanic girls plateaued after 2005, non-Hispanic white girls declined to 2001 prevalence levels after peaking in 2005, and Asian girls showed no increases. Non-Hispanic white boys peaked in 2005, then declined to 2001 prevalence levels for all BMI cut points; Hispanic and Asian boys declined after 2005 (for 3 lowest BMI cut points only) but remained above 2001 levels; and American Indian boys peaked later (2007) and declined only for BMI>or=95th. No girls and few boys showed a decline after peaking in prevalence of BMI>or=99th percentile. In 2008, disparities in prevalence were greatest for BMI>or=99th percentile, with prevalence of 4.9% for American Indian girls and 4.6% for black girls versus 1.3% for non-Hispanic white girls.

CONCLUSIONS

On the basis of statewide California data, prevalence of high BMI is declining for some groups but has not declined for American Indian and black girls. These trends portend greater disparities over time, particularly in severe obesity. Interventions and policies that are tailored to the highest risk groups should be pursued.

Changing patterns in health behaviors and risk factors related to cardiovascular disease among American Indians and Alaska Natives

OBJECTIVES

We assessed changes in cardiovascular disease-related health outcomes and risk factors among American Indians and Alaska Natives by age and gender.

METHODS

We used cross-sectional data from the 1995 to 1996 and the 2005 to 2006 Behavioral Risk Factor Surveillance System. The respondents were 2548 American Indian and Alaska Native women and men aged 18 years or older in 1995-1996 and 11 104 women and men in 2005-2006. We analyzed the prevalence of type 2 diabetes, obesity, hypertension, cigarette smoking, sedentary behavior, and low vegetable or fruit intake.

RESULTS

From 1995-1996 to 2005-2006, the adjusted prevalence of diabetes among American Indians and Alaska Natives increased by 26.9%, from 6.7% to 8.5%, and obesity increased by 25.3%, from 24.9% to 31.2%. Hypertension increased by 5%, from 28.1% to 29.5%. Multiple logistic models showed no meaningful changes in smoking, sedentary behavior, or intake of fruits or vegetables. In 2005-2006, 79% of the population had 1 or more of the 6 risk factors, and 46% had 2 or more.

CONCLUSIONS

Diabetes, obesity, and hypertension and their associated risk factors should be studied further among urban, rural, and reservation American Indian and Alaska Native populations, and effective primary and secondary prevention efforts are critical.

Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions

Part I of this two-part introduction to this Special Issue on the practice of physical therapy in the 21st century outlines the epidemiological basis and rationale for evidence-informed physical therapy practice for addressing contemporary health priorities. This evidence emanates from the definition of health by the World Health Organization (WHO) and the International Classification of Functioning (ICF), and WHO and other international databases on the prevalence of lifestyle conditions. Lifestyle conditions include ischemic heart disease, smoking-related conditions, hypertension and stroke, obesity, diabetes, and cancer. Epidemiological data combined with evidence supporting the effectiveness of noninvasive interventions related to physical therapy to address these priorities (e.g., health education and exercise) are highly consistent with the promotion of health and wellness and the ICF. Given their commitment to exploiting effective noninvasive interventions, physical therapists are in a preeminent position to focus on prevention of these disabling and lethal conditions in every client or patient, their cure in some cases, as well as their management. Thus, a compelling argument can be made that clinical competencies in 21st century physical therapy need to include assessment of smoking and smoking cessation (or at least its initiation), basic nutritional assessment and counseling, recommendations for physical activity and exercise, stress assessment and basic stress reduction recommendations, and sleep assessment and basic sleep hygiene recommendations. The physical therapist can then make an informed clinical judgment regarding whether a client or patient needs to be referred to another professional related to one or more of these specialty areas. The prominence of physical therapy as an established health care profession and its unique pattern of practice (prolonged visits over prolonged periods of time) attest further to the fact that physical therapists are uniquely qualified to lead in the assault on lifestyle conditions. Evidence-based physical therapy practiced within the context of epidemiological indicators (i.e., evidence-informed practice) maximally empowers clinicians to promote lifelong health in every person and in turn, the health of communities. This vision of physical therapy's leading role in health promotion and health care in the 21st century holds the promise of reducing the need for invasive health interventions (drugs and surgery). Part II of this introduction describes evidence-based physical therapy practice within this context of evidence-informed practice.

Undernutrition and obesity in indigenous children: epidemiology, prevention, and treatment

Over the past 50 years there has been a shift in nutritional problems amongst Indigenous children in developed countries from under-nutrition and growth faltering to overweight and obesity; the major exception is small numbers of Indigenous children predominately living in remote areas of Northern Australia. Nutritional problems reflect social disadvantage and occur with disproportionately high incidence in all disadvantaged subgroups. There is limited evidence of benefit from any strategies to prevent or treat undernutrition and obesity; there are a limited number of individual studies with generalizable high grade evidence of benefit. Potential solutions require a whole of society approach.

Cultural issues in eating pathology and body image among children and adolescents

Eating pathology and body image issues are now recognized as affecting all racial and ethnic groups. This article reviews eating pathology and body image concerns in four diverse groups in the U.S. (African Americans, Latino/as, Asians, and Native Americans). The major conclusion based on this review is that eating disturbances and body dissatisfaction occur to some degree in children and adolescents from all four major ethnic groups in the U.S; however, there is substantial variability across studies. Future directions include the need for studies of prevalence, prevention and treatment research, and investigations of neurobiological and genetic variables.