Diabetes and Obesity Associated with Poor Food Environments in American Indian Communities: the Tribal Health and Resilience in Vulnerable Environments (THRIVE) Study

Abstract

Background American Indians (AIs) have significantly higher rates of diet-related chronic diseases than other racial/ethnic groups, and many live in environments with limited access to healthy food. Objective As part of the Tribal Resilience in Vulnerable Environments (THRIVE) study, we examined the relations between the perceived food environment, utilization of food retailers, fruit and vegetable intake, and chronic diseases, including obesity, hypertension, and type 2 diabetes among AI adults. Methods Through a community-based participatory research partnership, we surveyed a cross-sectional sample of 513 AIs living within the Chickasaw Nation and the Choctaw Nation of Oklahoma. Results Only 57% of participants reported that it was easy to purchase fruits and vegetables in their town, and fewer (35%) reported that available fruits and vegetables were of high quality. Additionally, over half (56%) reported traveling ≥20 miles round trip to shop for food. Few participants met the recommended daily intake for fruit (44%) or vegetables (25%). Obesity (55%), hypertension (49%), and diabetes (25%) were commonly reported. Obesity was significantly higher among participants who reported that the price of fruits and vegetables were cost-prohibitive (prevalence proportion ratio (PPR): 1.24; 95% CI: 1.02, 1.50) and those who shopped frequently for food at nontraditional food retailers, such as Dollar Stores (PPR: 1.35; 95% CI: 1.08, 1.69) and small markets (PPR: 1.38; 95% CI: 1.02, 1.86). Diabetes was significantly higher among participants who frequently shopped at convenience stores/gas stations (PPR: 2.26; 95% CI: 1.22, 4.19). Conclusions Our study found that the use of nontraditional food retailers, including convenience stores, gas stations, and Dollar Stores, as a regular source of food was associated with obesity and diabetes. These results underscore the importance of interventions to improve rural Tribal food environments. Healthy retail interventions in nontraditional retail settings, such as those implemented through the THRIVE study, may contribute to reducing AI health disparities.

Usual Dietary Intake and Adherence to Dietary Recommendations among Southwest American-Indian Youths at Risk of Type 2 Diabetes

“…Our findings that over half of our youths are obese and 40% meet the criteria for type 2 diabetes underscores the need for interventions. The suboptimal diet reported by youths in this study are like other reports (16–18) and underscore the need to address the broader and larger issues (19) such as food insecurity, limited access to healthy foods, reliance on commodity foods, family finances, transportation, employment, and housing, for example. Limited access to fruits and vegetables and easier access to foods high in empty calories most likely contributed to the dietary patterns reported by the youths.…”

Latent Class Analysis Offers Insight into the Complex Food Environments of Native American Communities: Findings from the Randomly Selected OPREVENT2 Trial Baseline Sample

“…This analysis also adds to the growing research on Native American food environments and relationship to adiposity. More recently, Love et al found that frequent shopping at convenience stores, gas stations, or dollar stores as regular food sources was associated with an increased prevalence of obesity and diabetes [15]. Previous studies describing Native American food environments [12,13] did not examine the relationship between the food environment and BMI, although Jernigan et al described an association between food insecurity of Native American participants and higher prevalence of obesity, diabetes, and hypertension [42].…”

“…Previous research has demonstrated that convenience stores are the most common food outlet on reservations and that healthy foods are less available [12,13] and more expensive on-reservation compared to off-reservation [12]. Greater reliance on convenience stores and gas stations as primary food sources limits healthy food and beverage options [14] and has been associated with a greater prevalence of both obesity and diabetes [15].…”

Susceptibility of Southwestern American Indian Tribes to Coronavirus Disease 2019 (COVID‐19)

“…In addition to genetic links and immunological naivety, potential reasons for the American Indian susceptibility to communicable infections are the social determinants of health (ie, nonmedical factors that impact health), 15 and high prevalence of concomitant physical comorbidities. 14,16 Relevant social determinants of health include poverty, low educational status, crowded living conditions, household air pollution, lack of running water that makes washing hands challenging, 7 inadequate access to health care due to chronic underfunding of the healthcare system and inadequate transport, and inadequate access to healthy foods. During a pandemic, a community's preventive behaviors (such as hand hygiene) and avoidance behaviors (such as avoiding hospitals if not severely sick) are influenced by social determinants, mediated by its members' ability to seek and process information.…”