Monday, June 7, 2010

Simple Interventions Slow Trends in Native American Childhood Obesity

Childhood obesity is an epidemic in Indian Country, with almost 50 percent of its kids overweight, but tribal communities are not powerless in the fight against it. In fact, as a recent feasibility study concludes, there are simple ways that they can intervene and help stop the trend.

The study, conducted by Kaiser Permanente and the Northwest Portland Area Indian Health Board (NPAIHB) from 2001 to 2006, is the first to target obesity prevention among Native American children starting at birth. It included 205 families from three tribes in Oregon and Washington.

The research focused on interventions, community-wide and in-home, all designed by tribal community health workers. The goals were to increase breastfeeding initiation and duration, limit the introduction of sugar-sweetened beverages to infants and toddlers and promote the consumption of water for thirst among toddlers.

The community-wide interventions, designed in six-month cycles, had five strategies: raising awareness, providing health education, facilitating individual behavior change, augmenting public health practices and modifying environments and/or policies related to breastfeeding, sugar-sweetened beverages and water consumption.

Most community-wide interventions were media-based, like brochures, videos, newspaper articles and flyers. Yet the tribes also made environmental, public health practice and policy changes. One created a breast-feeding room at its clinic; another passed a resolution to stop buying sugar-sweetened beverages for tribally sponsored events; and one negotiated with the hospital to which it contracted out pregnancy care to not give out formula packs to new mothers.

The in-home interventions were customized to the needs of the family, such as a new mother having difficulty breastfeeding, and were tested with just two of the three tribes.

The results were positive. Although Body Mass Index (BMI), a measure of weight in relation to height, increased for all of the children in the study, the rise was far less in the tribes that received the community intervention and in-home visits. BMI scores increased by 30 percent in the tribe that received community intervention alone, but they rose by only 8 percent in the tribes that received both interventions.

Just as positive were the signs that Native American people are ready to make behavior changes. In a survey given at the end of the intervention, the families were asked about their confidence level in drinking more water and fewer sugar-sweetened beverages: 90 percent said they were confident they could help their family drink more water and 82 percent said they would limit sugar-sweetened beverages.

Njeri Karanja, lead author and investigator with the Kaiser Permanente Center for Health Research, also sees the participant retention numbers as indication that they are ready. “Eighty-percent of the parents came back and brought their children to be measured,” she said.

While the three tribes that participated seemed ready to take the leap, what about the nation’s other 561 tribes? Are they ready to create and commit to similar intervention plans, ones that may include changes in practices and policies?

“I think a lot of tribes, given the recent increase in diabetes and seeing it occurring at younger and younger ages, are ready for that. They want to see their children have a good quality of life. They know their health system, [which is] critically under-funded, is going to be affected by increasing numbers of people with diabetes,” said Tam Lutz, study co-author and junior investigator with the NPAIHB.

The study, funded by the Indian Health Service and National Institutes of Health through the Native American Research Center for Health, has been published online in the Journal of Community Health.

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