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.

 

Nutrition Timeline: How the U.S. Diet Evolved

Nutrition Timeline:

Obviously, a lot has happened in nutrition since the first Thanksgiving in America. Many scientific discoveries have given us a better idea how foods can contribute to health and disease. At first, little was known about nutrition science and there is still a lot to know. Knowing our progression helps us to know how we got from there to here.  The bottom Line: After all the science, we often still ponder on “what’s for dinner?”and “how do we lose weight”?

Note: Those events in Bold type tell the story of how our current food patterns evolved and have affected our present health status.

1621 First Thanksgiving Feast at Plymouth Colony

1702 First coffeehouse in America opens in Philadelphia

1734 Scurvy recognized

1744 First record of ice cream in America

Lind publishes “Treatise on Scurvy”and citrus is identified as cure.

Sandwich invented by the Earl of Sandwich

Potato heralded as famine food

Americans drink more coffee in protest over Britain’s tea tax

1775 Lavoisier (“the father of nutrition science) discovers the energy property of food (calories)

1816 Protein and amino acids identified followed by carbohydrates and fats

1833 Beaumont’s experiment on a wounded man’s stomach greatly expand knowledge about digestion

1862 U.S. Department of Agriculture founded by authorization of President Lincoln

1871 Proteins, carbohydrates, and fats determined to be insufficient alone to support life, there are other “essential” compounds in foods

First milk station providing children with un-contaminated milk opens in New York City

Pure Food and Drug Act passed by President Theodore Roosevelt to protect consumers against contaminated foods

Pasteurized milk introduced

Funk suggests scurvy, beriberi, and pellagra caused by deficiency of “vitamines” in the diet

1913 First vitamin discovered (vitamin A)

1914 Goldberger identifies the cause of pellagra (niacin deficiency) in poor children to be a missing component of the diet rather than a germ as others believed

1916 First dietary guidance material produced for the public released: Title is Food for Young Children

1917 First food groups published for the Five Food Groups: Milk and Meat, Vegetables and Fruits, Cereals, Fats and Fat Foods, Sugars and Sugary Foods. (Imagine: Sugar is a food group).

1921 First fortified food produced: iodized salt needed to prevent widespread iodine deficiency goiter in many parts of the U.S.

1929 Essential fatty acids identified

1930’s Vitamin C identified in 1932, followed by pantothenic acid and riboflavin in 1933 and vitamin K in 1934

1937 Pellagra found to be due to the deficiency of niacin.

1938 Health Canada issues nutrient intake standards

1941 First refined grain enrichment standards developed (Niacin, riboflavin,  and iron added)

First Recommended Dietary Allowances (RDAs) announced by President Franklin Roosevelt on the radio

1946 National School Lunch Act passed

1947 Vitamin B12 identified

1953 Double helix structure of DNA discovered

1956 Basic Four Food Groups released by the U.S. Department of Agriculture

1958 The Seven Countries Study was conceived by Ancel Keys, a Minnesota physiologist, who brought together researchers from all over the world. It became a collective effort to study questions about heart and vascular diseases among countries having varied traditional eating patterns and lifestyles. This alone changed the U.S. food supply dramatically to emphasize low fat diets high carbohydrate foods that continued to dominate until around 1983.

1965 Food Stamp Act passed. Food Stamp program established

1966 Child Nutrition Act adds school breakfast to the National School Lunch Program

1968 First National nutrition survey in U.S. launched. (The Ten State Nutrition Survey)

1970 First Canadian national nutrition survey launched (Nutrition Canada National Survey)

1972 The “Atkins Diet” by Dr. Robert Atkins started as a fad, but quickly became a counter-conventional movement that reset people’s thinking of nutrition and weight loss, and its link to health. It promoted a low carbohydrate, high fat diet to replace and challenge  the current conventional thinking that a low fat, high carbohydrate diet promoted by Keys was heart healthy.

1977 Dietary Goals for the U.S. issued  

1978 First Health Objectives for the Nation released

1989 First national scientific consensus report on diet and chronic disease published

1992 The Food Guide Pyramid is released by the USDA that contained a food group recommending 6-11 servings a day from the Bread, Cereal, Rice, Pasta Group (High carbohydrate foods).

1994 The nutritional food label was put into effect by the Nutrition Labeling and Education Act.

1997 RDAs expanded to Dietary Reference Intakes (DRI’s)

1998 Folic acid fortification of refined grain products begins

2003 Sequencing of DNA in the human genome completed; marks beginning of new era of research in nutrient-gene interactions

2015 – 2020 The current  U.S.Dietary Guidelines include the following:

  • Follow a healthy eating pattern across the lifespan. Eating patterns are the combination of foods and drinks that a person eats over time.
  • Focus on variety, nutrient-dense foods, and amount.
  • Limit calories from added sugars and saturated fats, and reduce sodium intake.
  • Shift to healthier food and beverage choices.
  • Support healthy eating patterns for all.

2020  Obesity and diabetes have become global epidemics/pandemics with the highest rates in the U.S. The custom is for them to be revised every five years.  The latest U.S. Dietary Guidelines are due to be published sometime in 2020 or early 2021.

 

 

 

 

The Rising Rate of Obesity and Its Consequences

“The headlines this week broadcast the following research:  Doctors at NYU Langone Health center conducted the largest study so far of US hospital admissions for COVID-19, focused on New York City. They found obesity, along with age, was the biggest deciding factor in hospital admissions, which may suggest the role of hyper-inflammatory reactions that can happen in those with the disease.”

Just what are the latest facts and implications about our obesity epidemic in the U.S.?

This data is from the U.S. Centers of Disease Control and Prevention in February 2020 and presented in Life Extension Magazine, May 2020.

  • A startling result is that 42.4% of adults are obese. Additionally, 31.8% were overweight.
  • This situation is expected to not improve statistically. A study in the New England Journal of Medicine estimates that by 2030, the percentage of obese American adults will rise to 48.9%. These percentages reflect a total of $446 billion dollars of medical costs annually.
  • Women, African Americans, and those with a low socioeconomic status are affected at a significantly higher rate.

What are the medical implications?

  • Excess body weight increases the risk of developing and dying from a broad spectrum of cardiovascular diseases, cognitive disorders (e.g. Alzheimer’s) and at least 13 different types of cancers.
  • Obesity has been determined to be the underlying cause of approximately 20% of deaths in the United States.
  • An analysis of 57 studies encompassing 900,000 individuals published in Lancet found that for every 5 point increment in Body Mass Index was associated with a 30% increased mortality risk.
  • Additional negative effects of excess weight include fatty liver disease, sleep apnea, chronic pain syndromes like low back pain, IBS, osteoarthtis, depression, negative pregnancy outcomes, and chronic inflammation.

Foods that Kill

There are many factors that contribute to the rise in obesity rates; however, diet and lifestyle have recently been identified and collectively referred to as components of the Standard American Diet (SAD). One of these is processed food.

  • Processed foods tend to be high in added sugar, salt, oil and unhealthy fats are often mentioned as well as ultra-processed foods that are so altered that they hardly resemble their original whole-food state.
  • The food industry refers to them as an “industrial product” loaded with additives that attempt to enhance the food’s characteristics such as food stability, shelf life, textures, colors, and flavors. They are often referred to as emulsifiers, humectants, and sequestrants or others that have barely recognizable names.  Ultra-processed foods are often ready-to-eat, require minimal preparation and are highly marketed. Ultra-processed foods account for more than 60% of dietary energy in the U.S.
  • Populations that have the lowest intake of processed foods exist and have been recently studied and known as the Blue Zones. These are groups of individuals that live an average of 10 years longer than those in cultures who consume the SAD, otherwise known as the Western diet. These areas are found around the globe in Sardinia, Italy, Ikaria, Greece, Okinawa, Loma Linda, California, and Nicoya, Costa Rica.
  • An observational study of Spanish university graduates followed participants for a median of 10.4 years. Consumption of an average of 5.3 servings of ultra-processed food per day, compared to an average of less than 1.5 servings per day, was associated with a 62% increase for all-cause mortality. For each additional serving, this risk increased by 18%.

What Is the Optimal Diet?

There are numerable reports on the health benefits of vegan, vegetarian, or plant-based diets. However, there is one diet that has been studied extensively for its healthy effects called the Mediterranean Diet. There is no one Mediterranean diet; however, it is usually associated with the intake of vegetables, fruits, whole grains, beans, nuts and seeds, extra-virgin olive oil, fish, seafood, moderate amounts of poultry, eggs, and dairy products. Red meat and sweets are limited as well as a low intake of processed foods.  A moderate intake of wine is acceptable. (moderate = 1-2 glasses).

Conclusions:
A possible molecular explanation for why overweight is harmful has been discovered by researchers. They suggest that overeating increases the immune response. This response causes the body to generate excessive inflammation  during the COVID-19 infection and that inflammation is at the core of many other chronic diseases.
University of Oslo. “Being overweight causes hazardous inflammations.” ScienceDaily, 25, August 2014.
If current trends continue and we find that 50% of our population is in the obese weight category, there will be alarming rates of catastrophic health consequences. Our health care costs will become unsustainable. It is a common belief that as long as you are not obese, you can be overweight and still be healthy. This is not always true. Many studies have found that a higher weight was associated with a higher risk of dying; however, this has remained  a major debate issue among obesity experts.

Who Lives Longer? Why?

A flag concept of a dinner plate with the flag of France on it.

More lessons are to be learned from the French culture. They just keep giving and we (the U.S) just keep ignoring their clues reflected by their lower disease rates (some of the lowest on the globe).

For example, the cardiovascular disease rate: 86.89 deaths in U.S per 100,000 population; 43.25 in France. The obesity rates are much higher in the U.S. than in France. However the lower rates are climbing in France due to less adherence to their traditional diets and their higher intake of Westernized fast and processed foods.

The dietary lessons are relatively simple suggestions(in my opinion). The  French generally do not diet or snack. They enjoy food and eat sensibly when it comes to portions. There may be others that are more complex. Please check out the table and graph in the article.

CLICK HERE.

What Does “Fattening” Mean?

Spaghetti, Noodles, Tomatoes, Pasta

A term used for decades to describe foods that would make one gain weight was the expression of  “fattening”.

Moderate avoidance (though not totally responsible) of these foods became the conventional wisdom to help avoid weight gain and became a dieter’s mantra.  In fact, food history indicates that body-weight was relatively stable until about the late 1990’s in the United States. At that time, dietary advice had shifted to low-fat diets with the added disadvantage of food companies at the time replacing fat in their food products with more carbohydrate-containing foods.

Keep in mind- basic biochemistry tells us that all carbohydrates (except for dietary fiber) are eventually converted to glucose in the body to be used for energy.  We are further reminded that some carbs are referred to as “starchy” (bad) and others as “non starchy” (good ).

The following article further elucidates the term of what are now commonly referred to as “white foods” and refers to their state of processing – refined or unrefined and how they may participate in our current obesity epidemic.

CLICK HERE.