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Combating Childhood Obesity in Indian Country

In his address on the State of the Union, President Obama announced that First Lady Michelle Obama would be taking the lead in the Administration's efforts "to tackle the epidemic of childhood obesity." Two weeks later, on February 9, the First Lady unveiled a nationwide campaign - Let's Move! - to fight the epidemic and improve the health of children. An integral part of the First Lady's campaign will be to work with American Indian and Alaska Native (AI/AN) communities, where childhood obesity rates are particularly high.

While nearly one third of children in the United States are overweight or obese - a rate that has tripled in adolescents and more than doubled in younger children since 1980 - the overweight/obesity rate is even higher among AI/AN children, approaching 50%. This figure is particularly alarming given studies showing that obese children have a very high risk of developing type 2 diabetes and other associated health problems such as hypertension and heart disease later in life. Although once non-existent in youth, type 2 diabetes is increasingly being diagnosed in children, and more than 75% of the young people that have it are obese. These recent findings make the fight against childhood obesity all the more urgent because individuals that acquire type 2 diabetes as children are more likely to develop serious diabetes-related complications as adults during the years that ordinarily would be the most productive of their lives.

In support of the First Lady's campaign against childhood obesity, on February 9, President Obama signed a Presidential Memorandum establishing an inter-agency task force "to solve the problem of childhood obesity within a generation through a comprehensive approach that builds on effective strategies, engages families and communities, and mobilizes both public and private sector resources." The Task Force will develop a national action plan that maximizes federal resources and sets concrete benchmarks toward the First Lady's national goal. In doing so, the Task Force will reach out to tribal authorities to ensure that childhood obesity solutions will be effective in AI/AN communities. This outreach is consistent with the Administration's commitment to tribal consultation and will further strengthen relationships developed at the recent White House Tribal Nations Conference and at agency listening sessions.

In addition to the First Lady's initiative and the creation of the Task Force, the President's FY 2011 Budget request for the Indian Health Service (IHS) includes $1.5 million for preventing and treating childhood obesity in AI/AN communities. $1.25 million of this would go to pilot test and evaluate an intervention by pediatricians and primary care teams in medical office and school-based health center settings to promote early identification and treatment of childhood obesity through a systematic overweight screening process, in-depth medical assessments, counseling, appropriate follow-ups and referrals, patient education, and staff training. Up to 25 sites would be selected for participation, and lessons learned would be disseminated to other IHS, tribal, and urban Indian health programs. The remaining $250,000 would be used to create the Indian Health System Healthy Weight for Life Workgroup to facilitate marketing, implementation and evaluation of the Healthy Weight for Life Strategy, a document that provides individuals, parents, schools, tribal organizations, Indian health care delivery system providers, and IHS leadership and staff with guidance for taking action to promote healthy weight among AI/AN people.

The President's Budget for 2011 also includes more than $400 million for the Healthy Food Financing Initiative to increase access to healthy foods in underserved rural and urban areas through financial and technical assistance to community development financial institutions and other nonprofits, public agencies, and businesses with sound strategies for addressing the healthy food needs of communities. The initiative is a partnership between the Departments of Treasury, Agriculture and Health and Human Services and will improve access to nutritious food while at the same time creating job and business development opportunities in low-income communities. Projects to address access to healthy food and job development in AI/AN communities will be eligible for funding under this initiative.

The Administration also recognizes that new partnerships and innovative solutions must be pursued, particularly in Indian Country, in the fight against childhood obesity. The Department of Interior's Bureau of Indian Education and the Myron L. Rolle Foundation developed a partnership to implement Our Way to Health, a program to reduce childhood obesity and prevent diabetes. Our Way to Health, designed by All-American Safety and Rhodes Scholar Myron Rolle, will help Indian middle school students manage their weight and diet through exercise, outdoor activity, and proper nutrition. Agencies have also partnered with Tribal Colleges to develop and disseminate the Diabetes Education in Tribal Schools curriculum for Native American students in grades K-12. The goal of the curriculum is to enhance understanding and awareness of diabetes by students, families, community members, and teachers, in order to prevent the disease. In addition to funding all of these new initiatives, the Administration is committed to supporting existing programs, like the Special Diabetes Program for Indians (SDPI) and Cherokee Choices, which have proven successful in the fight against childhood obesity and type-2 diabetes in children.

The President's FY 2011 budget proposes $150 million for SDPI which provides weight management programs for youth, public awareness campaigns, gestational diabetes programs to help reduce in utero exposure to elevated blood sugar levels, and other interventions that promote healthy behaviors among AI/AN youth. Cherokee Choices, a community-based intervention supported by Racial and Ethnic Approaches to Community Health grant funds provided by the Centers for Disease Control and Prevention, is an example of a more localized program that focuses on the prevention of type-2 diabetes, particularly in children. Cherokee Choices includes elementary school mentoring, worksite wellness for adults, and church-based health promotion. In designing the program, the Cherokee Choices team listened to and worked with tribal members, enabling the Program to confront and confound tribal members' resigned acceptance of diabetes as an inevitable part of Cherokee life that could not be prevented. To reverse this attitude, diabetes was brought to the forefront of the community's consciousness through television advertising, emotional and educational support mechanisms, and community coalitions with the singular goal of making tribal members healthier.

As part of our comprehensive campaign against childhood obesity, the Administration is committed to building on programs like SDPI and Cherokee Choices as well as the new programs and partnerships described above. For more information on these efforts please visit LetsMove.gov.