Kaiser studies youth obesity in N.W. tribes

Authors: Community intervention can help in weight battle

By Tom Vogt, Columbian science, military & history reporter

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The community can play a role in helping American Indian families fight early childhood obesity, according to a new Kaiser Permanente study.

The study also showed that adding in-home visits by community health workers can reduce a child’s obesity level.

The Kaiser Permanente Center for Health Research in Portland worked with the Northwest Portland Area Indian Health Board on the study, which was published online in the Journal of Community Health.

While the study was conducted among Northwest tribal communities, the authors said many of the strategies could work with all children.

About a third of children in the United States are overweight, according to Kaiser. But the problem is even more pronounced among American Indian families, where nearly half the children are overweight.

Their rapid weight gain starts at birth, said Kaiser investigator Njeri Karanja, lead author of the study.

The study included 205 families from three American Indian tribes in Oregon and Washington. One tribe received only community interventions; the two other tribes received the community interventions along with in-home visits and telephone calls from tribal community health workers.

The intervention boosted breast-feeding rates, reduced consumption of sugar-sweetened beverages and helped slow excess weight gain. One tribe started a breast-feeding room at its tribal health clinic; another passed a resolution to stop buying sugar-sweetened beverages for tribally sponsored events.

“Community health workers also customized home visits to the needs of the family,” said Tam Lutz, study co-author and junior investigator with the Indian Health Board. “Mothers who needed more breast-feeding support received additional home visits.”

Breast-feeding falls

Sixty percent of American Indian mothers start out breast-feeding their babies, according to the U.S. Centers for Disease Control and Prevention, but six months after birth the rate falls to 23 percent.

For families involved in the study, 74 percent of mothers who received community intervention and in-home visits started out breast-feeding; 38 percent still were breast-feeding after six months.

Body mass index — a measure of weight in relation to height — did increase for all of the children in the study. But the increase was significantly less in the tribes with community intervention and in-home visits.

BMI scores increased by 30 percent in the tribe that received community intervention alone, and by 8 percent in the two tribes that received both interventions.

This study was just the beginning, Karanja said.

“In terms of implementation, we’re three or four steps away,” she said.

Researchers now are working on a larger study involving different Northwest tribes. Strategies include delaying the introduction of solid foods: “Not at two, three or four months,” Karanja said, “but at six months.”

They’re also looking at the role of food.

“A lot of parents use food as comfort or as a reward. We all do it,” Karanja said.

Parents play another part in this, as role models: “Children watch you and do what you do.”

Other issues involve encouraging activity by keeping youngsters out of playpens — “Let them roam around the house, and they stay more active” — and not automatically setting them in front of a television.

“We encourage parents not to introduce TV until the age of 2,” Karanja said. “They’re very common-sense things, but we don’t do those things any more.”

Tribal communities aren’t a reflection of overall society, so study results might not necessarily transfer immediately to the wider world, Lutz said.

“Each tribe is its own government and sets its own laws,” Lutz said. “They can do things more quickly than we can do in our own communities.”