TOWARD COMPREHENSIVE OBESITY PREVENTION PROGRAMS IN NATIVE-AMERICAN COMMUNITIES

Obesity is a particularly important challenge to the health status of Native Americans. This challenge is manifest in the increasing rates o f non-insulin-dependent diabetes mellitus among Native Americans. Most studies of Native American infants, preschool children, schoolchildre n, and adults have confirmed a high prevalence of overweight. Historic al studies suggest that for many Native American communities the high rates of obesity are a relatively recent phenomenon. The specific reas ons for the increase in obesity among Native Americans have not been d etermined, although it has been hypothesized that Native Americans hav e a genetic predisposition to overweight in a ''westernized'' environm ent of abundant food and decreased energy expenditure. Few detailed st udies of diet or of physical activity levels of contemporary Native Am ericans have been published. Community-based interventions to modify d iet and activity levels to prevent obesity in Native American communit ies are needed. Preliminary evidence from two formative school-based p rograms in the Southwest suggest that Native American communities are receptive to school-based interventions, and that such programs may be able to slow the rate of excess weight gain and to improve fitness in schoolchildren. Because of the cultural diversity among Native Americ ans, future studies should focus on collecting community- and region-s pecific data, and should emphasize the need for obesity prevention thr ough culturally appropriate community- and school-based behavioral int erventions.