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AI/ANs: Obesity, Food Systems, and the Pursuit of Health Equity
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November is National American Indian and Alaska Native Heritage Month. American Indian/Alaska Natives (AI/ANs) make up 1.7% of the total U.S. population. In 2019, an estimated 5.7 million people identified as AI/AN alone or in combination with one or more other races.

AI/ANs experience one of the highest rates of obesity across all racial and ethnic groups in the United States. In 2018, 48.1% of AI/AN adults aged >18 years old had obesity. AI/AN adults are approximately 60% more likely to have obesity than non-Hispanic White adults. AI/ANs also experience disparities in mortality rates. AI/AN individuals born in 2019 have a life expectancy that is 5.5 years less than the U.S. average for all races (73.0 years versus 78.5 years). AI/AN populations experience higher mortality rates due to obesity-related conditions, such as heart disease, diabetes, stroke, and chronic liver disease and cirrhosis compared to all U.S. races.
Children who identify as AI/AN have consistently experienced higher rates of both overweight and obesity compared to White children. In 2015, 29.7% of AI/AN children aged 2 to 19 years had obesity, whereas in 2015-2016, 14.1% of non-Hispanic White children aged 2 to 19 years had obesity. Among children ages 2 through 4 enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in 2016, AI/AN children experienced a much higher prevalence of overweight and obesity compared to Non-Hispanic White children, as demonstrated in the figure.


Source: Graph adapted from Pan et al., 2019

Various upstream factors have contributed to the disproportionately high rates of obesity in AI/AN communities. Historically, the forced relocation of AI/AN peoples away from their ancestral lands and onto reservations severely restricted their access to traditional, regionally-specific food systems such as hunting, gathering, fishing, and farming. Many tribes were agriculturalists and originated the concept of regenerative agriculture. One example is seen in the Iroquois’ cultivation of the “Three Sisters” (corn, beans, and squash). This disruption of indigenous food systems by colonizers has resulted in dependence on federal government programs which include unhealthy foods. While AI/AN communities have adapted to these systemic changes by inventing new “traditional” foods such as fry bread, inconsistent funding for food assistance programs and other social services continue to contribute to food insecurity. Today, AI/AN tribal area populations are mostly rural and experience high rates of poverty, restricting geographic and economic access to food.

AI/ANs also face barriers in accessing and navigating health care services, including the geographical isolation of rural areas, costs of travel, and/or lack of access to transportation. This population also experiences higher rates of unemployment and poverty and lower rates of insurance coverage compared to other races. In addition to these disparities, inadequate funding of the Indian Health Service (IHS) contributes to staff shortages and prolonged wait times in IHS clinics.

To increase health equity for AI/AN communities, stakeholders must recognize and address the lasting impact of historical trauma and systemic racism, while honoring the strength and resiliency of AI/AN communities. Specific actions to improve the health and reduce obesity of AI/AN communities include the implementation of community-based participatory research and culturally relevant programs to promote local food production and increase food security. These steps include promotion of food sovereignty, embracing indigenous diets, improving access to traditional foods, promotion of early childhood nutrition through culturally tailored programs, taxation of unhealthy foods and subsidization of healthier options, increasing funding for the IHS, and increasing tribal control of health programs and services. In addition to these actions, public health efforts can also include the restoration of cultural traditions of physical activity, such as running long distances, to help prevent and control the prevalence of obesity and other chronic diseases.

The pursuit of health equity for AI/ANs is a complex effort that requires a multipronged approach. For more information on AI/AN health disparities and proposed solutions, you may view our new fact sheet here.


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Upcoming Events
Dec 8: COPE Culinary Nutrition Series Module 2
Dec 15: COPE Webinar on Bariatric Surgery
Jan 20-22: ASMBS re-UNITED Meeting
Apr 27-May 1: Obesity Medicine 2022 Conference
May 18-21: Obesity Medicine 2022 DX 
STOP's AI/AN Fact Sheet
TFAH Webinar Recording Now Available
New OPEN Podcast Series
OAC Unveils New Resource Library
STOP Fact Sheet on Obesity and AI/AN Populations
American Indian/Alaska Natives face one of the highest rates of obesity and increased obesity-related mortality compared to other races. Colonialism and the displacement of AI/AN tribes led to the disruption of food systems, but there are current efforts to embrace indigenous foods. Efforts to diminish obesity rates should prioritize systemic, community-led, culturally relevant change for the most effective and lasting results.

View the fact sheet here.
TFAH Webinar Recording Now Available: State of Obesity 2021 
Trust for America's Health (TFAH) would like to thank those who joined on November 10th for our virtual congressional briefing based on The State of Obesity 2021: Better Policies for a Healthier America report.

The panel covered the latest national obesity rates and trends; highlighted promising approaches states and localities have undertaken to ensure healthy communities; and offered policy recommendations that incorporate innovative approaches that help all Americans lead healthier lives. 

To view the webinar recording, slides, and resources, click here.
OPEN Launches New Podcast Series: An OPEN Conversation
OPEN is extremely pleased to announce the new OPEN podcast series titled An OPEN Conversation is now live on all major streaming platforms, including Spotify and Apple podcasts. The first two episodes have been published so far, and two additional episodes will be released before the end of this year. Be sure to check out the episode "Informing Obesity Policy" as it features STOP's very own Dr. William Dietz and Cristine Gallagher as guests!

Listen to the podcast here.
OAC Unveils New Resource Library
The OAC has a new educational resource tool to help you with your journey with weight and health: the OAC Resource Library. The library features a wealth of information on topics such as, nutrition strategies, the science of obesity, bariatric surgery, weight bias, exercise and more. From resource articles to videos to guides, the OAC Resource Library is a true testament to the unparalleled science-based education that the OAC is known and respected for.

Explore OAC's Resource Library here.
COPE's Online Culinary Nutrition Series Continues

December 8, 5:30-7pm ET
There is still time to register for COPE's upcoming Culinary Nutrition sessions! Join the upcoming module for a deep dive into the history of African heritage food traditions, and watch Chef Jason Johnson prepare recipes that highlight the key concepts of this cultural foodway. Learn how to apply practical knowledge with clients to help them adjust their diets to allow them to continue to cook and consume their favorite foods while meeting their personal health needs. Continuing Education credit awarded for participation.

Learn more and register here.

December 15, 12-1pm ET
Caroline M. Apovian, MD, FACP, FTOS, DABOM is Co-Director of the Center for Weight Management and Wellness (CWMW) in the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women’s Hospital and a member of the faculty at Harvard Medical School and has held a position at the forefront of the obesity and nutrition fields for over thirty years. Dr. Apovian will present a practical approach for the early recognition of weight regain in post-bariatric surgery patients, which can lead to more effective and timely treatment.

Learn more and register here.
Register for ASMBS re-UNITED Meeting
Join ASMBS January 20th-22nd, in Las Vegas, Nevada, for a weekend of high quality continuing education for bariatric surgeons and integrated health professionals. Programming will cover subjects such as robotics, SADI/DS, revisions, hot topics in integrated health, and more, including the NEW Focus Practice Designation Review Course. 19.5 CME/13 CEs available!

Spots are limited. Learn more and register here.
Registration Now Open for Obesity Medicine 2022 Conference
Registration for Obesity Medicine 2022 Conference is officially open! This leading medical obesity conference provides clinical obesity treatment education for physicians, NPs, PAs, nurses, dietitians and nutritionists, pharmacists, medical students, and more. Join us in Atlanta, April 27-May 1, or through the virtual Digital Experience (DX), May 18-21.

Learn more and register here.
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