Childhood Obesity in American Indians

Trends in height, weight, BMI, skinfolds, and measures of overweight and obesity from 1979 through 1999 among American Indian Youth: The Akwesasne Mohawk

BACKGROUND/OBJECTIVES

Information on recent changes in overweight, obesity, and adiposity among American Indians is scarce. To assess changes in size and adiposity among American Indian youth, data from two samples of Akwesasne Mohawk youth, were compared.

SUBJECTS/METHODS

Both project 1, conducted in 1979 (n = 75) and Project 2, conducted between 1996 and 1999 (n = 206), sampled youth 10-14 years of age from the Akwesasne Mohawk Reservation (aka St. Regis) that borders New York state, and Ontario and Quebec provinces. Heights, weights, and skinfold thicknesses were converted to z-scores using CDC reference values. BMI status was calculated in terms of WHO age-specific cutoffs and CDC cutoffs.

RESULTS

z-Scores for heights differed little between projects. The between-project difference in weight z-score is twice the between-project z-score difference for height. Differences among males are larger and more often significant. Triceps and subscapular skinfold thickness are significantly greater in Project 2. The rate of overweight and obesity combined, increased 3.3-fold. In multiple regression analyses with sex, height, and age in the model, project is a significant predictor of weight and skinfolds.

CONCLUSIONS

Weight and adiposity have increased substantially from 1979 to 1996-99. Overweight and obesity became significantly more common. Given the increase in adiposity, these youth may be facing significant health risks as adults in terms of cardiovascular disease, cancer, and type II diabetes unless weight and adiposity is reduced.

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.

Targeting risk factors for type 2 diabetes in American Indian youth: the Tribal Turning Point pilot study

BACKGROUND

American Indian (AI) youth are at high risk for type 2 diabetes.

OBJECTIVES

To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study.

METHODS

We enrolled 62 overweight/obese AI children (7-10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes.

RESULTS

Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m^-2 , p < 0.001) but not intervention participants (+0.3 kg m^-2 , p = 0.13); BMI z-score decreased in intervention (-0.17, p = 0.004) but not control participants (0.01, p = 0.82). There were no treatment effects for cardiometabolic or behavioural outcomes.

CONCLUSIONS

We demonstrated that a behavioural intervention is feasible to deliver and improved obesity measures in AI youth. Future work should evaluate TTP for effectiveness, sustainability and long-term impact in expanded tribal settings.

Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies

Diabetes mellitus (DM) is the seventh leading cause of death in the United States and the leading cause of death in the U.S. American Indian/Alaskan Natives (AI/ANs), who comprise only 2% of the total population. The AI/AN population has a high prevalence of DM in adults aged 20 years or older and is developing DM at a younger age than the general U.S.

POPULATION

DM is a major risk factor for cardiovascular disease (CVD), and mortality from CVD is higher in AI/ANs than the general population, as is the prevalence of stroke and 1-year poststroke mortality for both genders when compared to non-Hispanic whites. A genome-wide scan found a number of chromosome linkages in the AI/AN population that suggest that genetic factors may contribute to their high risk of DM and CVD. Importantly, studies also suggest that in addition to race/ethnicity, cultural norms and historic conditions play important roles in the prevalence of DM and CVD in this population. Therefore, multiple factors should be taken into consideration when establishing prevention programs to decrease the prevalence of obesity, diabetes, and CVD incidence among adults and children in the AI/AN population. Prevention programs should focus on behavioral risk factors and lifestyle changes like encouraging smoking cessation, healthy diet, and increased physical activity while taking into consideration cultural, economic, and geographic factors.

Cardiometabolic risk profile based on body mass index in American Indian children and adolescents

BACKGROUND

Childhood obesity is associated with increased cardiometabolic risk.

OBJECTIVE

To study the relationship between body mass index (BMI) and cardiometabolic risk factors in American Indian children and adolescents.

METHODS

Differences in metabolic variables by age and sex-specific BMI percentiles (2000 Centers for Disease Control and Prevention Growth Charts) were examined in a cross-sectional analysis of 2977 individuals across three age categories. Children with an exam in two consecutive age categories were included in a longitudinal analysis. Spearman's correlations were used to test the association of BMI percentile with anthropometric and biochemical variables.

RESULTS

Body mass index percentile correlated with systolic (r = 0.24 to 0.38) and diastolic (r = 0.13 to 0.22) blood pressure, fasting plasma glucose (r = 0.20 to 0.33), 2-h plasma glucose (r = 0.30 to 0.46), total cholesterol (r = 0.12 to 0.23), serum triglycerides (r = 0.40 to 0.51) and HDL cholesterol (r = -0.36 to -0.43) in each age group (5-9, 10-13 and 14-17 years). Among participants examined in multiple age categories, BMI percentile increased over time. Change in BMI percentile from one age category to the next was associated with an increase in fasting glucose, 2-h glucose and triglycerides and a decrease in HDL cholesterol.

CONCLUSION

Higher BMI was associated with blood pressure elevation, hyperglycaemia and dyslipidaemia in American Indian children and adolescents.

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.

Building Capacity to Increase Health Promotion Funding to American Indian Communities

Foundations and government agencies have historically played a critical role in supporting community-based health promotion programs. Increased access to health promotion funding may help address significant health issues existing within American Indian (AI) communities, such as childhood obesity, type 2 diabetes, and cardiovascular disease. Understanding the capacity of AI communities to successfully apply for and receive funding may serve to increase resources for health promotion efforts within AI communities in Montana. This exploratory qualitative study completed 17 semistructured interviews across three AI reservations in the state of Montana. Dimensions of community capacity within the context of the funding application process and partnership with funding agencies were identified, including resources, leadership, community need, networks, and relationship with the funding agency. Dimensions of AI community capacity were then used to suggest capacity-building strategies for improved partnership between AI communities in Montana and the funding agencies.

Increased arterial stiffness in South Dakota American Indian children

Arterial stiffness has been observed in white American obese children, yet there are no data in American Indian youth, who are affected disproportionately by the cardiovascular consequences of childhood obesity and its accompanying risk factors. The purpose of this study was to determine the association of childhood overweight-obesity and cardiometabolic risk factors with arterial stiffness in South Dakota white American and American Indian children. Thirty-six (28 white American and 8 American Indian) children (age, 13 ± 1 years; grades 6-8) from a rural South Dakota elementary and middle school were studied: 18 had a healthy weight (body mass index (BMI), 19.5 ± 1.9 kg/m(2)) and 18 were overweight-obese (BMI, 26.8 ± 3.5 kg/m(2)). Arterial stiffness was assessed using applanation tonometry via pulse wave analysis to determine carotid-radial pulse wave velocity (crPWV) and aortic augmentation index (AIx). There were no differences (P = 0.94) in crPWV between healthy weight (7.1 ± 1.4 m/s) and overweight-obese (7.3 ± 1.0 m/s) children, even after controlling for risk factors. However, crPWV was markedly elevated (P = 0.002) in overweight-obese American Indian children (7.7 ± 1.1 m/s) compared with white American children (6.8 ± 0.5 m/s), and these differences remained after controlling for blood pressure and more severe obesity in the American Indians. An obesity-matched subgroup analysis indicated that crPWV (7.7 ± 1.1 vs 6.8 ± 0.4 m/s) remained significantly greater in the American Indians (P = 0.03). There were no between-group differences in aortic AIx. These findings indicate an adverse influence of American Indian ethnicity on arterial stiffening in children with elevated adiposity. Arterial stiffness in American Indian children may accelerate early adulthood vascular disease.

Racial/ethnic differences in obesity trends among young low-income children

INTRODUCTION

Racial/ethnic differences in recent obesity trends have not been reported among young low-income children. The purpose of this study is to examine trends in obesity prevalence from 1998 through 2011 by race/ethnicity among low-income children aged 2-4 years.

METHODS

The study was based on measured weight and height records of 29,040,851 participants of federally funded health and nutrition programs from 30 states and the District of Columbia, which provided data each year from 1998 through 2011. More than 80% of data were collected through the Special Supplemental Nutrition Program for Women, Infants, and Children, and about 50% of eligible children were included. In 2014, joinpoint regression was used to identify the inflection years when significant changes in obesity trends occurred and piecewise logistic regression was used to examine annual changes in obesity prevalence before and after the inflection years controlling for age, sex, and race/ethnicity.

RESULTS

The overall obesity prevalence increased from 13.05% in 1998 to 15.21% in 2003, and decreased slightly to 14.74% in 2011. The increasing trends among non-Hispanic white, non-Hispanic black, and Hispanic children began decreasing in 2003. Asian/Pacific Islander was the only racial/ethnic group with a continual decreasing trend in obesity prevalence from 1998 (14.34%) through 2011 (11.66%). Among American Indian/Alaska Native children, obesity prevalence consistently increased from 16.32% in 1998 to 21.11% in 2011, although the annual increases slowed since 2001.

CONCLUSIONS

The study findings indicate modest recent declines in obesity prevalence for most racial/ethnic groups of low-income children aged 2-4 years. However, obesity prevalence remains high.

Health-related fitness of American Indian youth

A physically fit lifestyle is important for American Indian (AI) youth who are at risk for hypokinetic diseases, particularly type 2 diabetes. Some evidence exists on the physical activity patterns of AI youth, but there is little information on their health-related fitness.

PURPOSE

The purpose of this study was to describe the health-related fitness levels of youth living in an AI community.

METHOD

Participants included youth from 5th to 9th grade (N = 85) in a Southwestern U.S. AI community. Youth were of AI descent and were 12.36 +/- 1.68 years of age. Participants completed 5 parts of the FITNESSGRAM fitness test during physical education. The tests included the Progressive Aerobic Cardiorespiratory Endurance Run fitness test (cardiovascular fitness), curl-up (muscular endurance), pushup (muscular strength), sit-and-reach (flexibility), and body mass index (estimated body composition).

RESULTS

Results were similar to other youth studies with some of the students reaching the healthy fitness zone for muscular strength (28%), body composition (30%), flexibility (60%), aerobic fitness (63%), and muscular endurance (74%).

CONCLUSIONS

Findings highlight the capacity for improvement for students across all of the components of health-related fitness.

Incidence of obesity among young U.S. children living in low-income families, 2008-2011

OBJECTIVE

To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups.

METHODS

We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile.

RESULTS

The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups.

CONCLUSIONS

The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs.

High food insecurity and its correlates among families living on a rural American Indian Reservation

OBJECTIVES

We sought to better understand the prevalence and consequences of food insecurity among American Indian families with young children.

METHODS

Parents or caregivers of kindergarten-age children enrolled in the Bright Start study (dyad n=432) living on the Pine Ridge Reservation in South Dakota completed a questionnaire on their child's dietary intake, the home food environment, and food security. We assessed food security with a standard 6-item scale and examined associations of food insecurity with family sociodemographic characteristics, parents' and children's weight, children's dietary patterns, and the home food environment.

RESULTS

Almost 40% of families reported experiencing food insecurity. Children from food-insecure households were more likely to eat some less healthful types of foods, including items purchased at convenience stores (P= .002), and food-insecure parents reported experiencing many barriers to accessing healthful food. Food security status was not associated with differences in home food availability or children's or parents' weight status.

CONCLUSIONS

Food insecurity is prevalent among families living on the Pine Ridge Reservation. Increasing reservation access to food that is high quality, reasonably priced, and healthful should be a public health goal.

Diet, physical activity, and obesity in school-aged indigenous youths in northern australia

Purpose. To examine the relationship between diet, physical activity, and obesity in Indigenous youths from northern Australia. Methods. In a cross-sectional study, physical activity and dietary intake ("short nutrition questionnaire") were assessed among all youths during a face-to-face interview. For 92 high school youths, additional dietary information was assessed using a food-frequency questionnaire. Height and weight were measured and BMI was calculated. Multiple logistic regression was used to assess associations. Results. Of the 277 youths included, 52% had ≤2 servings of fruit and 84% had <4 servings of vegetables per day; 65% ate fish and 27%, take-away food ("fast food") at least twice a week. One in four ate local traditional sea food including turtle and dugong (a local sea mammal) at least twice a week. Overweight/obese youths engaged in fewer days of physical activity in the previous week than normal weight youths (OR = 2.52, 95% CI 1.43-4.40), though patterns of physical activity differed by sex and age (P < 0.001). Overweight/obese youths were 1.89 times (95% CI 1.07-3.35) more likely to eat dugong regularly than nonobese youths. Analysis of food-frequency data showed no difference by weight assessment among high-school students. Conclusions. Low fruit and vegetable intake were identified in these Indigenous youths. Regular consumption of fried dugong and low frequency of physical activity were associated with overweight/obesity reinforcing the need to devise culturally appropriate health promotion strategies and interventions for Indigenous youths aimed at improving their diet and increasing their physical activity.