This paper provides a literature review that examines the prevalence of
diabetes among American Indian children, and compares it to the incidence
found at the Fort Peck Indian Reservation in Montana. It describes the activities
of the Healthy Schools Summit, an effort designed to educate Indian children
about the role that nutrition and exercise can take in controlling diabetes,
and concludes with recommendations from the Healthy Schools Summit.
American Indians are experiencing a surge in the prevalence of obesity and
diabetes. Diabetes, especially adult-onset, or type 2, diabetes, is a growing
health problem throughout the region and the country, but indications are
that it is more serious on the Fort Peck Indian Reservation and on other
Montana Indian Reservations. Risk factors for type 2, or adult-onset,
diabetes, include older age, obesity, physical inactivity, and race/ethnicity.
However, diabetes is beginning early among American Indians, between the
ages of 2 and 5. Approximately 13 percent of American Indian preschool
children are overweight, with up to 40 percent of American Indian and
Alaskan Native children reportedly overweight. An especially worrisome
trend in childhood obesity is the sharp rise in type 2 diabetes, normally
found only in adults.
Montana’s American Indians experience a higher prevalence of diabetes,
smoking, and obesity compared to whites, according to a report of the
Montana State Advisory Council on Food and Nutrition issued in 2001.
Diabetes ranks seventh among the leading causes of death for Montanans,
but fourth for American Indians.
During spring 2003, health officials from seven reservations in Montana
formed the Healthy Schools Summit to address childhood diabetes. The
Summit developed strategies to reduce the rate of diabetes and its complications,
including early screening and treatment, utilization of Tribal College
Wellness Centers for exercise and physical fitness, Indian Health Service
clinic visits, and clinical trials to prevent the onset of type 2 diabetes among
individuals at most risk for developing the disease.
Dietary habits contribute to development of obesity, with the diet of many
American Indians characterized by frequent intake of nonindigenous protein,
combined with a high proportion of low-nutrient-density carbohydrates and
fats. The Summit worked with three Fort Peck Reservation schools to
promote a healthier school food environment. In cooperation with the Indian
Health Service, the Summit is developing a software program to track and
analyze health-screening data from reservation schools. The Summit also
actively collaborated with reservation schools to educate Indian communities
about healthier school environments, including educating parents to
foster family eating practices that can reduce the incidence of obesity.
Key recommendations resulting from the project include:
- Prevention of diabetes on the Fort Peck Indian Reservation should
begin in the classrooms and in the home using targeted information
appropriate for the intended audience.
- All agencies whose mission includes diabetes prevention should
build strong coalitions to maximize resources and share information
that can be used to educate at-risk populations.
- Special efforts should be made to involve all children in physical
- Health services need to be designed to engage entire families in
- Diabetes prevention outreach should target sedentary and at-risk
individuals and their families to provide nutrition education and
involve them in physical activity.