Small changes for big differences #obesity crisis #Native peoples @minorityhealth @un4indigenous @WHO

By Bill Graves / Native Health News Alliance

Small social changes in diet and activity could have a big influence on halting weight gain among Native Americans, but it often takes transformational personal changes to drive people to lose weight and keep it off, experts say.

The daunting challenge of motivating Americans to move more and eat less was a dominant theme in the four-day obesity program for 14 health reporters in early June sponsored by the National Press Foundation at the University of Colorado’s Anschutz Medical Campus in Aurora, a suburb of Denver.

In presentations in the university’s Anschutz Health and Wellness Center, researchers, physicians, fitness and nutrition experts, journalists, and food company executives described the biological and social forces that give rise to obesity and strategies for pushing back against those forces.

The challenges may be even bigger for Native Americans because they are disproportionately disadvantaged, with more living both on reservations and in low income city neighborhoods where good food is scarce and options for work and an active lifestyle more limited. The obesity epidemic has rendered 30 percent of Native Americans overweight and another 40 percent obese. The rates for all Americans are not much better, with a third overweight and another third obese.

Dr. Holly Wyatt, a University of Colorado professor of medicine, said to lose weight and sustain the loss people need to have bigger, deeper reasons than fitting into a summer bikini or avoiding diabetes down the road. They need to tap deeper desires to change, to transform, to move from a victim mindset to a sense of empowerment, Wyatt said.

The obesity epidemic over the past three decades is the fruit of our success in building an environment full of calorie-rich, fat- and sugar-laden, low-cost food and machines that allow us to move less both in work and play, said James O. Hill, executive director of the Anschutz Health and Wellness Center and co-author with Wyatt of the diet book, “State of Slim.” We have more food energy at our fingertips than ever while our more sedentary lives demand less energy, creating an imbalance that makes us fat.

“Our biology is not broken; it is what gets us obese in the current environment,” he says. “Our physiology says eat, eat, eat. Our biology is set up for that”

At the same time, Americans are moving less, with more working service jobs and fewer in manufacturing and only a fraction in farming, said John Peters, professor of Medicine at the University of Colorado. American males at work on average burn about 100 fewer calories today than they did in 1960. Amish men, who still live agrarian lives common in the 1800’s, take 18,000 steps a day compared to an average 6,000 steps for other American men.

Genetics can make people, including some Native Americans, more prone to weight gain, said Dr. Daniel Bessesen, also a professor of medicine at the University of Colorado. Ninety percent of the Pima Indians in Arizona, for example, are obese. Genetically related Pima people in northern Mexico are lean, probably because they are more active in their agrarian lifestyle, Bessesen said.

An individual’s level of impulsivity and emotional attachment to food also can affect weight gain. So can his or her friends. A study of 12,000 people in the Framingham Heart Study between 1971 and 2003 showed that a person’s chance of becoming obese increased by 57 percent if they had a friend who became obese.

While losing weight can be difficult, keeping it off is even more so because the body resists staying lean, Bessesen said. The body metabolism changes and uses less energy, yet the appetite increases. And as the body ages, it burns less energy so if you don’t eat less, you will gain weight. Health experts at the workshop stressed that regular exercise is necessary to successfully keep weight off permanently.

Several speakers also noted that small changes could make big differences in the obesity crisis. Americans eat on average only 15 calories more a day than they burn, enough to add a pound or two a year. Small changes like walking 15 minutes a day or eating a few less bites at each meal could prevent weight gain in most of the population, Hill said. The fast food industry could go a long ways toward equalizing the energy balance by reducing portion sizes for say a hamburger by 5 percent, he said.

One study, which has important implications for Indian Country, found that people can cut the amount of sugar their body absorbs in half by taking a 15 minute walk after each meal, said Dr. James A. Levine, professor of medicine at the Mayo Clinic. Brian Wansink, professor of marketing at Cornell University, said schools can double or triple the number of public school students taking fruit for lunch by simply putting fruit in a nice bowl in a well-lit area.

Still, as simple as it might seem to cut 100 calories out of your daily diet, said Wyatt, sustaining that requires a big change in mindset and lifestyle.

© Native Health News Alliance

The Native Health News Alliance (NHNA), a partnership of the Native American Journalists Association (NAJA), creates and promotes shared health news content for American Indian communities at no cost.