The Pima Indians: A Study of Lifestyle and Obesity

By Sally J. Feltner, MS, Ph.D

The Pima Indians of Arizona have the highest rates of diabetes and obesity in North America. An estimated 50 percent of Pima adults are obese, and of those, 95% have diabetes type 2.

WHAT HAPPENED?

The story is not new – it more than likely began in the 1500’s when the Spanish explorers made contact with them in the New World. They and most Native tribes of that time were hunter-gatherers. They were lean, active and healthy people.

Pima Indians are believed to be descendants of people who crossed the Bering Strait from Asia to the Americas. Their traditional diet included meals made from the crops they cultivated including corn (maize), kidney beans, sunflower seeds, pumpkins and squash.  Small game such as rabbit, was a staple part of their diet together with meat from their livestock such as sheep and goats. Larger game was also available such as deer, elk and bear. As they were in close proximity to rivers, fish, duck and many different types of shellfish were major elements of their diet, which was also supplemented with herbs, acorns and roots. Sadly, as the years went on, the Arizona group met with some unavoidable circumstances that changed their way of life considerably – especially their traditional diets, economics, and well-being.

  • In 1859, the Arizona Pimas’ land along the Gila River was taken away by the U.S. government which left them to live on what land was left known as the Gila Reservation.
  • In 1866, new settlers began to populate the Pima region and diverted the water from the Gila River for their own use.
  • By 1869, the river had dried up and the Arizona Pimas were left with no water and less land to grow their food and crops resulting in an on – and – off – 40-year-old famine. As a result, the government exacerbated the problem again by providing subsidized foods to the tribe consisting of white flour, sugar, lard and canned goods, a far cry from their traditional diets of corn, beans and squash.

The timing of these significant changes in lifestyle and livelihood of the Arizona Pima population coincides with their development of diabetes type 2.  At the turn of the nineteenth century, studies recorded only one case on the Gila River Reservation. In 1937, a study documented twenty-one persons with diabetes. By the 1950’s, however, the prevalence had increased ten-fold and a study initiated in 1965 documented in the Arizona Pima Indians the highest prevalence of diabetes ever recorded.

THE PIMA INDIANS IN MEXICO

The Pima Indians who had settled in Mexico resided in the small town of Maycoba. For decades they had been isolated until 1991 when a paved access to the town was constructed.  Before that they grew a majority of their own food and still adhered primarily to their traditional diet that was similar to the Arizona tribe. Since they are genetically similar to the Arizona Pima, they present an opportunity to study and compare the two-lifestyle patterns of both tribes (diet and exercise) on their health statistics.

What Has Been Learned from Various Studies of these two Populations?

An Abstract from one study in 1994 that compared the two groups gives us the following details:

OBJECTIVE The Pima Indians of Arizona have the highest reported prevalence of obesity and diabetes type 2 In parallel with abrupt changes in lifestyle and the incidence in Arizona Pimas have increased to epidemic proportions during the past decades. To assess the possible impact of the environment on the prevalence of obesity and diabetes type 2, data were collected on members of a population of Pima ancestry living in a remote mountainous location in northwestern Mexico, with a lifestyle contrasting markedly with that in Arizona.

RESULTS  The Mexican Pimas were significantly lighter and shorter with a lower Body Mass Index. They also had a significantly lower plasma total cholesterol level than the Arizona Pimas. Even more startling was that diabetes type 2 was less prevalent with only 2 women (11%) and 1 man (6%) in the Mexican group compared with a prevalence of 37% and 54% in male and female Arizona Pima Indians respectively.

CONCLUSIONS This preliminary investigation shows that obesity, and perhaps type 2 diabetes is less prevalent among people of Pima heritage living a “traditional” lifestyle than among Pimas living in an “affluent” environment. These findings suggest that, despite a similar potential genetic predisposition to these conditions, a traditional lifestyle, characterized by a diet including less animal fat and more complex carbohydrates and by greater energy expenditure in physical labor, may protect against the development of cardiovascular disease risk factors, obesity, and diabetes type 2.

DISCUSSION:

These results indicate that a more traditional lifestyle of the Mexican Pimas protects the group against obesity, diabetes and kidney disease, even though they may have a genetic predisposition for such health problems.

What explains the results of experiences of the Arizona Pima?  One popular theory is one thing that drives obesity is a switch to a diet of highly refined carbohydrates that are so common in the Standard American Diet (SAD). When the Pima replaced traditional, unrefined carbohydrates with refined (sugar and flour), they became obese. It may not be the amount of food we eat but what kinds or quality we consume.

The lessons learned here support the theory that lifestyle factors appear to significantly influence the prevalence of obesity and diabetes type 2 in a population predisposed genetically to these conditions. Their story gives us all the opportunity to reassess our own current diets and lifestyle factors that may lead to healthier food environments and ultimately prevent our current situation of the diabesity dilemma.

SOURCES

Stephen Guyenet, Lessons From the Pima Indians. Whole Heath Source: Nutrition and Health Science.

Leslie O Schulz, PhD, Lisa S. Chaudhari, PhD. High-Risk Populations: The Pimas of Arizona and Mexico. Curr Obes Rep. 2015 March 1; 4(1): 92-98

Ravussin, et al. Effects of a Traditional Lifestyle on Obesity in Pima Indians, Diabetes Care 1994 September 17(9): 1067-1074

Obesity on the Rise – Some Solutions?

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The Obesity/Diabesity Pandemic

Obesity is a major risk factor for the development of  type 2 diabetes mellitus, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system.

Global Statistics,  Source: Lancet

  • Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
  • Diabetes is fast becoming a major problem in low and middle-income countries.
  • From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
  • Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.

So what are some solutions?  

The standard American diet is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking. .

Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half. In people over 60, the reduction was 70%.

Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why nutritious foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high schools levels by returning to a revamped and modernized home economics course in the curriculum. 

A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.

Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program..

There should be an increased access to professional treatments.  Physicians in reality do not have the time to directly counsel their patients on the myriad of diets designed for healthy weights. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or a new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced to keep out of pocket expenses reasonable for patients.

However, doctors can act as “cheerleaders” and in a  support role encourage their patients to practice lifestyle behaviors (diet included) that can overall prevent the onset of chronic diseases that make up the leading causes of death. This new paradigm of medical practice has abeen recently called “lifestyle medicine”.

We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.

Educate the public on food labeling including ingredient lists. Beware of food companies that promote products with a “health halo” meaning exaggerated claims are made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling so they include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.

Stop corporate-government partnerships and diminish lobbying.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by a myriad of food companies such as Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. A good example is the placing of a glass of milk on the MyPlate Logo.

Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another fee annually. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may still contain high levels of sodium. If the AHA were sincere in their efforts to help consumers choose healthier foods to rein in obesity/diabetes, they would realize that research has shown that a 1.8 oz. daily serving of processed meat raised the risk of diabetes by 19 percent and heart disease by 42 percent. Most current dietary recommendations emphasize a reduction in processed meats (my emphasis).

There is bad news on rising obesity rates – read about them HERE.

It will take a concerted effort from government, politics, industry, communities,consumers and the perpetrators of our obesigenic culture to begin to change this trend.