Obesity, diabetes plague Native Americans

SAN FRANCISCO, Aug. 12 (UPI) -- Back in the 1950s, before urban sprawl, gridlocked traffic and Disneyland arrived, Molin Malicay's extended family of Pomo Indians moved freely between California's seafood-rich Pacific coast and their warm, fertile settlements in Sonoma County. Subsisting on seaweed, fish and grains, Malicay, enjoyed a healthy lifestyle of constant exercise and nutritious food.

Over the years, as American culture encroached and Malicay was integrated into the public school system, the Pomo traditions gave way to a sedentary routine. His meals often consisted of Wonder Bread, sodas and fast food, he told United Press International.

A dramatic shift in diet and lifestyle has wreaked havoc on the health of Native Americans across the country. Now 59, Malicay has developed adult-onset diabetes and his condition is alarmingly common -- almost one-third of Native Americans over age 55 now have diabetes.

A quiet epidemic of chronic diseases has swept across Indian country over the last 30 years and new data from the Centers for Disease Control and Prevention in Atlanta testify to the resulting explosion in health care costs.

"The signs were there but we didn't realize it -- it just crept up on us," said Malicay, who directs the Sonoma County Indian Health Project in Santa Rosa.

Obesity is driving this skyrocketing surge in diabetes, said Dr. W. Craig Vanderwagen, chief medical officer of the Indian Health Service.

"In some Indian communities we have twice the rate of obesity as in the general population," he told UPI.

Diabetes began emerging among tribes of the Southwest in the 1980s but the more isolated communities of the Great Plains and Alaska remained virtually diabetes-free, Vanderwagen said.

Northern tribes viewed the disease as a problem peculiar to the Southwest and therefore did not heed the warnings signs of diabetes' spread.

Yet as Alaskan tribes gradually gave up their subsistence lifestyles and converted to a carbohydrate- and sugar-rich diet, diabetes moved north and now has invaded communities from Arizona to the Arctic.

"Today our eating habits tend toward those kinds of products that are high in carbohydrates and sugars and of course our diets weren't used to those kind of foods," Malicay said. Our bodies genetically can't deal with that."

Changing the now-ingrained eating habits of Indian communities has not been easy, Vanderwagen conceded. "It's difficult to tell people to change their diets when they have very few options to begin with," he said.

Indeed, highly isolated, impoverished communities seem to be the hardest hit by the chronic disease epidemic. In such places as the remote Sioux reservations in South Dakota and the Chippewa of Minnesota, the residents are most dependant on "commodities" foods from the U.S. Department of Agriculture. These are surplus goods that are donated to reservations on a regular basis.

Historically the commodities program flooded communities with nutritionally-poor, high-fat groceries that are now the staple of many families' diets.

"They send out lard, refried beans and products that are really bad for you, health-wise," Malicay said. "Most people don't buy Crisco anymore but Indians use it because it's there."

According to the CDC, heart disease, respiratory infections and some cancers also are disproportionately high in Native American communities. Given these downward spiraling health trends, some Indian tribes are taking innovate steps to halt the spread of the diseases of modern society.

Northern California tribes formed an innovative health consortium in 2000 and will launch the nation's first Indian-run Health Maintenance Organization, called the Turtle Health Plan, this fall.

The Turtle plan will be tailor-made to better meet the evolving health needs of Native Americans and will expand its members' access to specialty care. Turtle's organizers believe the initiative will improve health outcomes by eliminating barriers to care such as fear of racial discrimination, cultural insensitivity and geographic isolation to health care facilities.

"These cultural barriers to care can be so great that people simply don't go (to a doctor)," Malicay said. "Our providers know how to deal with Native people. Simple things like you can't rush and you can't look people in the eye. Our patients are very receptive to our providers."

In 1995 Congress mandated an initiative to combat diabetes on reservations that also boosted prevention efforts and improved outcomes.

"Before that initiative we had a high rate of diabetes-related amputations and now we've seen our rates drop way down. With tribes involved we've seen a market improvement in blood sugar control," said Dr. Kathy Annette, a member of the White Earth Chippewa nation and director of the Bemidji Indian Health Service in Minnesota.

Another strategy to prevent future cases of obesity and diabetes has involved overhauling the grocery items available through the commodities program, Vanderwagen noted.

"In the 1990s we really started putting more juice in diabetes prevention but we were behind the curve -- most of the people who are diabetic now had poor eating habits before the intervention," he said.

Although the figures might seem depressing at times, Annette said it is important to remember great strides have been made in slowing the spread of chronic disease and solutions are within reach if appropriate resources and energy are invested in addressing the problem.

"We have to take a step back as Indian people and realize that all these chronic diseases are emerging which sometimes seems overwhelming," Annette said. "But there is light at the end of the tunnel. If we improve access to health care, jobs, fitness centers and better food, we can prevent these diseases."