Valerie is 48 years old, married, and the mother of four daughters. For most of her life she has lived with morbid obesity as did her mother, two sisters, and brother. Like her mother, Valerie loves to cook for her family making large recipes of meat entrees, potatoes, and desserts. She keeps the refrigerator full of soda for her family as well as quick snacks of cookies, potato chips, and lunch meat to make sandwiches with their favorite white bread.

Although Valerie has tried several approaches to losing weight, none have been successful as she dislikes dieting – she finds it is just too difficult when she prepares all meals at home and is the cook for her family. She accepts her responsibility to keep her family content with their meals, and they love her cooking.

Valerie worked at a factory in town for many years, but because of hip and knee problems, she could no longer stand for the long hours required and had to stop working. She became certified as disabled and now watches TV at home, plays video games, and makes traditional Native American beadwork that she sells on eBay.

Valerie smokes a pack of cigarettes a day as does her husband and eldest daughter. Her youngest daughter passed away when she was an infant due to sudden infant death syndrome (SIDS).  Valerie’s loss of her daughter started her long history with depression which causes her to eat and smoke to cope with her grief. After the loss of her infant daughter to SIDS, her doctor started her on antidepressant medication therapy. 

Valerie knows she is obese, but she tells her family that being large is what makes her strong. She was not born on the reservation, or lived there during her life, but is connected to many friends and relatives through Facebook and tries to visit during the powwow season. Even though she has lived in a rural area for her life, she considers her reservation her home.

You are the public health nurse who will be visiting Valerie at home as requested by her doctor to follow her hypertension and assess her response to her antidepressant medication.  You are preparing for the visit.

Answer the following questions:

1. Learn about the Strong Heart Study and summarize what it reveals about obesity in Native Americans and the relationship of obesity to health outcomes.
2. Can traditional Native American culture positively impact the high rates of obesity in Native Americans? Give specific examples.
3. What are the priority concerns for Deborah that you would like to discuss during your visit and what are her strengths? What are some ways that you can prepare to talk to her about achieving optimal health for herself and her family?

Policy Considerations

1. Embed health equity in disease control and health prevention efforts
   • The Centers for Disease Control and Prevention (CDC) is working to remove environmental and systemic barriers to health. The CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) leads the nation’s public health efforts to promote good nutrition, regular physical activity, and a healthy weight for all. The CDC works with partners and state, tribal, local, and territorial health agencies to bring greater health equity. Health equity is embedded in several CDC initiatives such as:
     • the national initiative, “Active People, Healthy Nation”
     • the REACH (Racial and Ethnic Approaches to Community Health) program where recipients work to reduce health disparities among populations with a high burden of chronic disease through culturally tailored interventions to address preventable health risks.
     • The High Obesity Program (HOP) works to increase access to healthier foods and accessible places for physical activity in communities where more than 40% of adults have obesity.
2. Reduce racial misclassification in AI/AN mortality data and cancer incidence
   • There is a strong need to continuously improve data collection and analysis for American Indian/Alaska Native populations, reducing misclassification on death certificates is one example. Efforts to reduce racial misclassification in AI/AN mortality data and cancer incidence can enhance understanding of AI/AN health disparities and highlight differences by region. Overall, the AI/AN death rate for SIDS among infants is more than twice that for the non-Hispanic White population. This disparity cannot be attributed to economic status, maternal age, birth weight, or prenatal care. However, educational campaigns have been effective in decreasing SIDS through improving infant sleep practices.

Calls to Action

• Recognize the important of spiritual support when clinical depression is present. Traditional healers and spiritual leaders can be a resource towards greater health.
• Add Indigenous foods into the diet and empower Indigenous agricultural economies.
• Increased opportunities for tribal communities to teach at a systems level.

References

Centers for Disease Control and Prevention. (2021). Division of nutrition, physical activity, and obesity – Health equity. https://www.cdc.gov/nccdphp/dnpao/health-equity/index.html

Solomon, T. et al. (2017). What’s killing our children? Child and infant mortality among American Indians and Alaska Natives. https://nam.edu/wp-content/uploads/2017/03/Whats-Killing-Our-Children-Child-and-Infant-Mortality-among-American-Indians-and-Alaska-Natives.pdf National Academy of Medicine, Washington DC