Healthy Eating vs. Food Insecurity

American Indians have higher rates of obesity than the general U.S. population. Indian children in particular are twice as likely to be obese as children in the majority culture. Obesity, in turn, is directly linked to diabetes, which is three times as common in American Indians as in the general population.


The epidemic of obesity and diabetes in Native people is a very recent development. Before European colonization, depending on geography and culture, Native tribes ate traditional diets based on wild game, fish, roots, nuts, berries, greens, and organically grown corn. Even after tribal people were driven off their traditional lands, they still lived active lives, and obesity remained almost unknown. In the last few generations, however, sedentary lifestyles and processed foods have tipped the scales. Almost half of all American Indian children are now overweight, and one in four is obese.



Much research has revealed close links between poverty and obesity in the modern world. A major pathway between the two is food insecurity. This is defined as limited or irregular access to “healthy” (nutritionally adequate) food. In American Indian communities, “limited access” typically means the following: people are too poor to buy nutritious food, or they lack transportation to places where nutritious food is sold, or both. Families who have to stretch their food dollars are more likely to buy cheap foods with plenty of fat and sugar instead of more healthy options. They are also more likely to eat fast food, and to overeat whenever food becomes abundant.


Nationwide, one in six Americans fits the definition of food insecurity used by the U.S. Department of Agriculture. The rate among Native Americans is probably higher, but no national study has ever been done. Poverty and food insecurity provide the real-world context for Native American obesity.


Food Insecurity on the Reservation


A recent study led by Dr. Britta Mullany investigated food insecurity in four reservation communities in Arizona and New Mexico. Their goal was to find ways to combat food insecurity and obesity by looking at eating patterns in families with young children.


The researchers approached adult tribal members as they visited the delivery sites of an emergency food program, Menu for Life. Adults who were the heads of households with at least one child aged five or younger were invited to take a survey. Food insecurity was measured by 13 questions, including these:


“In the last 12 months, did your child ever not eat for a whole day because there wasn’t enough money for food?”


“In the last 30 days, did you skip a meal because your family didn’t have enough money for food?”


Rates of food insecurity were very high among the Native people who responded to the survey: 29% of young children and 45% of adults were food insecure. Such high rates would be expected among people using an emergency food program, so these numbers probably don’t apply to the full population of American Indians. However, all four communities experienced food insecurity in similar ways, even though they represented different tribes. Therefore, many of the patterns observed by the researchers are likely to be repeated in Native communities across the country.


Which Households Experience Food Insecurity?


There was a strong connection between the age of the head of household and the likelihood of food insecurity. Adults aged 45 and older were more likely to be food insecure than younger adults. Children in households headed by people aged 45 and older were also more likely to be food insecure.


The number of children in the household was another factor. Households with four or more children were more likely than others to be food insecure.


Although all four reservations in the study were rural, places that were more remote also had higher rates of food insecurity.


In addition, food insecurity was associated with two other key characteristics: food-insecure households were less likely than others to have healthy foods in the home, and less likely to sit down together for a daily meal.


Survey participants were asked to name the major barriers they experienced in providing healthy meals for their households. Two-thirds reported that it took too much time to prepare food; about half reported that food was too expensive; and more than one-fourth reported that transportation was a barrier.


Statistical analysis of survey results painted a slightly different picture. Adults who said preparation time was a barrier were no more likely than others to be food insecure. Nor were their children more likely than others to miss meals. Adults who said transportation was a barrier were indeed more likely to be food insecure than other adults, but their children were no more likely than others to share this outcome. Instead, the most significant barrier was cost. Heads of households who said high prices were a barrier were the most likely to be food insecure, and so were their children.


In short: poverty is the biggest barrier to good nutrition.


What Can Be Done?


Dr. Mullany and her colleagues offered several recommendations for interventions in Native communities: fund more food delivery programs, establish farmers’ markets within the communities, and develop mobile grocery stores that feature healthy foods, including fresh fruits and vegetables.


Obviously, all these options cost money. Yet in today’s America, very little money seems to be available to help poor families eat better. In September of 2013, the U.S. House of Representatives voted to cut $39 billion from the Supplemental Nutrition Assistance Program (SNAP).Many poor households, both Native and non-Native, rely on SNAP to make ends meet – and even without funding cuts, SNAP hardly results in a cornucopia of healthy food.


Another of Dr. Mullany’s recommendations seems more affordable for rural communities: plant gardens to grow vegetables and fruit in each community, perhaps at schools or other accessible locations. As her group noted, community gardens add to the supply of healthy food and help to ensure food security. They also provide an opportunity for Native people to restore traditional agricultural practices, as long as they have tribal land suitable for farming.



Mullany B, Neault N, Tsingine D, Powers J, Lovato V, Clitso L, Massey S, Talgo A, Speakman K, Barlow A. (2013) Food insecurity and household eating patterns among vulnerable American Indian families: associations with caregiver and food consumption characteristics. Public Health Nutrition 16(4) 752-760. Abstract at

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