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Studying Obesity in American Indian Kids

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Dr. Alex Adams, UW Health Pediatric Fitness ClinicMADISON – Diabetes and heart disease are serious problems in American Indian tribes. The Centers for Disease Control (CDC) estimates that American Indians are 2.6 times more likely to be afflicted with diabetes than non-Hispanic whites.
Heart disease claims more American Indian lives than any other malady. Charles W. Grim, director of the CDC’s Indian Health Services, says, “Heart disease has become the leading cause of death among American Indians … The incidence of coronary heart disease among American Indians occurs at rates almost double that of non–Indian communities.”
Obesity and overweight are two of the primary contributors to diabetes and heart disease, and eating healthier foods and getting more exercise are the best ways to avoid putting on extra pounds. But do we know how to best address the problem? And when is the most effective time to intervene?
Alex Adams, MD, PhD, a family medicine physician and nutrition expert at UW Health’s Pediatric Fitness Clinic, is trying to answer those questions.
Dr. Adams (pictured) and her research team are in the midst of a study called Healthy Children, Strong Families (HCSF), the goal of which is to reduce obesity and the concomitant increased risk for diabetes and heart disease in three American Indian tribes in Wisconsin – Menominee, Lac du Flambeau and Bad River.
“The purpose of my work is to understand how we can prevent diabetes and cardiovascular disease,” Dr. Adams says. “When I started looking at who really is most effected by these diseases, it was the minorities in the state and primarily the American Indian populations.”
HCSF evolved out of the Wisconsin Nutrition and Growth Study (WINGS), a collaborative project involving the three aforementioned tribes, The Great Lakes Inter-Tribal Council and researchers at the University of Wisconsin, including Dr. Adams. WINGS research demonstrated the prevalence of overweight in Wisconsin American Indian children aged 5 to 8 years was 27 percent and that an additional 19 percent were at risk for being overweight.
Those alarming numbers made Dr. Adams wonder if sedentary habits and poor nutrition set in at an even earlier age.
“When we looked at the data we were astonished to see that these kids are overweight before they even hit kindergarten,” Dr. Adams says. “So we went back to the tribes and said, ‘What would you like to do now?’”
With HCSF, Dr. Adams believes they have created a program that works with tribal families with young children to help them make healthy choices in a way that respects the strong heritage of the American Indian community.
“When I work with the tribes, I don’t have a set agenda,” Dr. Adams says. “I say, ‘I’m interested in helping you prevent diabetes and heart disease. How can we do that together?’ We have been working together for the past seven years and have developed this intervention as a result of that partnership.”
The HCSF intervention involved developing a curriculum emphasizing diet and physical activity and having “community mentors” – tribal mothers, grandmothers, aunts – deliver the message to participating families during 12 home visits. The interventions emphasize goal-setting and incentives as a means of changing behavior and were approved by tribal councils and health directors as well as the University of Wisconsin-Madison Human Subjects Review Board.
SuAnne Vannatter, RN, BSN, Great Lakes Inter-Tribal Council’s HCSF coordinator, stresses the importance of integrating members of the tribes into the educational sessions.
“Having a community mentor has been important, because the mentors have already been in the community,” she says. “They develop ties and connections with the families that go beyond the program. Our program has the potential to effect other important issues within the family as well as reducing the risk for diabetes and heart disease.”
Community mentors are effective, Vannatter says, because they share a history and legacy with HCSF participant families and are able to present the lessons as a way of recapturing the active and productive lives their ancestors lived.
“(The interventions) have a cultural piece,” Vannatter says. “We’re trying to stress that we’re not bringing a new thing into our Native communities. The Native community once knew and practiced a healthy way of life but through time societal changes decreased the practice of hunting and gathering while introducing non-traditional foods into our diets. Through knowledgeable mentors and fun and education lessons we’re trying to bring back that state of health and existence we once knew while living in the world we now live in.”
HCSF interventions continue. After the 12 lessons have been delivered by the community mentors, Dr. Adams’ group will begin a period of evaluation, comparing data such as waistline circumference and body mass index to baseline statistics recorded at the study’s inception.
No firm conclusions can be drawn yet, but Vannater says the interventions have been well-received, particularly by the children.
“The kids are really excited, so they have a tendency to remind the parents” that they should be eating fruits and vegetables rather than fast food or taking a walk rather than watching television, Vannatter says.
“These kids are very high-risk,” adds Dr. Adams. “We’re trying work with them really early, so we can prevent diseases associated with obesity."

Date Published: 01/29/2008

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