1. Ryan D. Brown, MD Assistant Clinical Professor Department of Pediatrics University of Oklahoma College of Medicine

3. Health Disparities About 1 of every 4 American Indians and Alaska Natives lived below the poverty level, compared with about 1 of every 10 non-Hispanic Whites The median income of American Indian and Alaska Native households in the 12 months prior to being surveyed was about $31,600. This was about $17,000 less than the median income of non-Hispanic White households (about $48,800) No usual source of healthcare, 18 years and under: 5.1% compared to 5.8%, lowest of any group. Health, United States, 2009.

4. info.ihs.gov/files/disparitiesfacts-Jan2006.pdf American Indians and Alaska Natives born today have a life expectancy that is 2.4 years less than the U.S. all races population (74.5 years to 76.9 years, respectively; 1999- 2001 rates) American Indian and Alaska Native infants die at a rate of 8.5 per every 1,000 live births, as compared to 6.8 per 1,000 for the U.S. all races population (2000-2002 rates). Safe and adequate water supply and waste disposal facilities are lacking in approximately 12% of American Indian and Alaska Native homes, compared to 1% of the homes for the U.S. general population. Health Disparities

5. AI Healthcare Resource Disparities Bureau of Prisons

6. Obesity: What is the BIG deal?

7. Trends in prevalence of obesity among children aged 2-5 years

8. Contributing Factors Relative abundance of high-fat, low-fiber foods Rapid transition from an active, traditional subsistence lifestyle to a wage economy and sedentary lifestyle In utero exposure to diabetes Energy expenditure or metabolic rate is NOT significantly different between American Indian and white children References: Int J Obes Relat Meta Disord 1993;71(8):445-52; Pediatrics 1998;95:89-95.

9. Barriers to Health Park and/or rec center in neighborhood Has neither : 37.0% Has either or both: 30.9% Neighborhood housing conditions No poorly kept/rundown housing: 30.9 % Has poorly kept/rundown housing: 36.3% Neighborhood safety and supportiveness Neighborhood not rated usually or always safe and/or supportive: 38.6 % Neighborhood rated both safe and supportive: 29.6% TV watching and TV in bedroom No TV in bedroom, does not watch more than 2 hours per day: 23.9 % Has TV in bedroom or watches more than 2 hours a day, or both: 36.5% Participation in activities outside school None or minimal: 40.3 % Does participate: 29.9% Thompson J. Patterns of physical activity among American Indian children: an assessment of barriers and support. Journal of Community Health, Vol. 26, No. 6, December 2001

10. Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Larson, NI, Neighborhood environments: disparities in access to healthy foods in the U.S.Am J Prev Med. 2009 Jan;36(1):74-81. Epub 2008 Nov 1.

11. Barriers to Engaging in Physical Activity Not having a ride to the community fitness center (21%) Not feeling safe on the bike path because there are no leash laws (18%) Not having activities to do (14%) Being too tired (10%) Not liking my body (3%) Jollie-Trottier T. Correlates of Overweight and Obesity in American Indian Children, Journal of Pediatric Psychology 34(3) pp. 245–253, 2009

12. Barriers to Physical Activity Lack of physical facilities, equipment, and trained physical-education teachers in the school setting Weather conditions Safety concerns Time for homework Chores during and after school hours Thompson, J. L., Davis, S. M., Gittelsohn, J., Going, S., Becenti, A., Metcalfe, L., et al. (2001). Patterns of physical activity among American Indian children: An assessment of barriers and support. Journal of Com- munity Health, 26(6), 423-445.

13. The Original Fast Food

14. Fast Food Today

15. Food Choices Food sources of dietary constituents were dominated by less healthful foods than seen among national samples Sweetened beverages contributed substantially more to energy and carbohydrate intake in rural sample than among 2- to 5-year-olds nationally Stroehla B. Dietary Sources of Nutrients among Rural Native American and White Children, Journal of the American Dietetic Association 105:12, December 2005.

16. Food intake 31-37% of caloric intake from Fat (<30% recommended) 11-13% of fat was saturated fat (<10% recommended) School Food services in Native Schools Breakfast: 33% and 13% of calories from Fat and saturated fat, respectively Lunch: 29% and 12% of calories from fat and saturated fat, respectively Story et al., 2002 Story, M., Snyder, P., Anliker, J., Cunningham-Sabo, L., Weber, J. L., Ring, K., et al. (2002). Nutrient content of school meals in elementary schools on American Indian reservations. Journal of the American Dietetic Association, 102(2), 253-256. Sweetened beverages are a leading source of energy intake among AI people Wharton, C. M., & Hampl, J. L. (2004). Beverage consumption and risk of obesity among Native Americans in Arizona. Nutrition Reviews, 62(4), 153-159.

17. Solutions

18. Sample R X

19. New Web page www.aap.org/obesity

20. ryan-brown@ouhsc.edu