American Indians fight against Type II diabetes

Youth participate in physical activity at the American Indian Youth Wellness Camp. Photo Courtesy: Native American Research and Training Center
Youth participate in physical activity at the American Indian Youth Wellness Camp. Photo Courtesy: Native American Research and Training Center

More than 50 percent of Tohono O’odham Indian Reservation adults have Type II diabetes, the highest rates in the world since 1990.

Several studies indicate that the primary cause of diabetes in American Indians is due to the rapid change from the traditional farming and harvesting of food to a more mainstream diet that includes high-processed food, according to the Tohono O’odham Community Action, a non-profit organization dedicated to creating sustainable community development on the Tohono O’odham Nation.

Ranking at 15.9 percent, American Indians and Alaskan Natives have the highest diabetes rates among all U.S. racial and ethnic group.

“Because of westernization we’ve become much less active, not just Native American people but all people,” said Francine Gachupin, director of the Native American Resource Center and family and community medicine professor at the University of Arizona. “People are relying on fast food more often.”

Hunting and gathering allowed American Indians to be more physically active and healthier.

Stress, depression, anxiety, domestic violence, alcohol and drug use all contribute to high obesity rates that impact diabetes, Gachupin said. These factors are present in some native households.

The Fight Against Diabetes

In 1999, Christine Woolfok, was diagnosed with Type II diabetes.

“I was a drinker, I weighted over 230 pounds, had high blood pressure, high cholesterol and just ate whatever I wanted,” said Woolfok, diabetes outreach specialist at Pascua Yaqui Tribe Diabetes Prevention and Treatment program and a member of the tribe. “This is my personal history that does not reflect on the community members here.”

After waking up and feeling really sick, Woolfok said she decided to make a change in her life after seeing her sugar level go above 300. Woolfok was on medication until she started attending a group lifestyle balance class that focused on cutting down carbs, eating healthier and exercising often.

“I am off all my medication now because I chose to do it,” Woolfok said. “My lifestyle changed and a lot of the tribal members don’t want to do the lifestyle change.”

In Pascua Yaqui Tribe changes are imminent. Tribal members are participating in physical activities because “people now want to get fit,” Woolfok said. Last year, 30 overweight diabetic tribal members participated in El Tour de Tucson, road bicycling race.

“I was one of them finishing 42 miles in 3 hours and 1/2,” Woolfok said. “That is what we have committed ourselves to.”

This year 77 tribe members will participate in the race.

“Everyday is a struggle,” Woolfok said. “I’ll be diabetic until the day I die. As long as I watch what I eat, how much I eat and I keep exercising I will be a diet controlled diabetic.”

The American Indian culture has played a role in obesity.

“Whatever they put in front of you, out of respect you eat it and if you tell people I am sorry I can’t eat that anymore they get offended,” Woolfok.

Woolfok has been a huge advocate for reducing diabetes rates and educating the community on the importance of modifying their eating and exercising habits.

“A lot of people are trusting me now when I share with them my story,” Woolfok said. “They see me out in the community walking and riding my bike to keep myself where I am at. There has been a lot more physical active people here on the reservation.”

Woolfok now weights 174 pounds and maintains a healthy nutritious diet against her fight with diabetes.

Early Recognition in American Indians

Peter Bennett began conducting research with the Arizona Pima American Indians in 1963, when scientists discovered increases in obesity and Type II diabetes on the reservations. Pimas are groups of Indigenous American living in what is now known as southern Arizona.

Bennett, a retired chief of the Phoenix Epidemiology and Clinical Research Branch of the National Institute of Diabetes and Digestive and Kidney Diseases, has been working on identifying the risk factors for Type II diabetes in Arizona’s Pima Indian community over the past five decades.

Bennett conducted a glucose tolerance tests for 30 years on most of the Pima Indian starting at the age of 5. Bennett’s results showed the Arizona Pimas have the highest rates of Type II diabetes of any group in the world, according to the National Institutes of Health records.

What is Diabetes?

Type 2 diabetes is a disease where the body fails to properly process sugar. There is a genetic connection with Type II diabetes, as well as lifestyle and obesity play a factor.

Typically the body turns food into sugar, or insulin, and the pancreas is supposed to release the insulin, which serves to open the cells and use the sugar as a source of energy, according to the CDC. When this process does not work a person is diagnosed with diabetes either because the body is producing some insulin but not enough (Type II) or because the body did not adequately responds to it (Type 1).

Scientists are still trying to figure out why the body behaves like this, said Merri Pendergrass, director of the Diabetes Program within the U.A. College of Medicine.

The National Diabetes Statistics report released by the Centers for Disease Control and Prevention reported 29.1 million people have diabetes but only 21 million are diagnosed. Adults ages 45-64 have the highest rates of diabetes, with 13.4 million across the globe.

Type 1 diabetes is an autoimmune destruction of the pancreas, and researchers are trying to figure out how that happens, Pendergrass said. With Type II diabetes the body is making a lot of insulin to begin with but the body is not responding well.

Diabetes is associated with an increased risk of high kidney disease, heart attacks and strokes.

“The longer a person has diabetes the higher the risks are of having complications,” Pendergrass said. “Diabetes is clearly common in certain groups. If you take a non-Hispanic white person versus someone who is Native American and they both have the same body weight, the Native American will have a higher risk of diabetes.”

One of the many first steps that diabetes patients should take is changing their eating and exercising habits, Pendergrass said.

“That is a big problem that medicine does not have a solution to, figuring out how to change the behavior to get people to eat less and be active,” Pendergrass said. “Calories in this country are cheap. Lack of access to healthy food, safe and inviting environment for exercise all contribute to the problem of diabetes.”

Diabetes in Young Children

Youth learn about nutrition food labels at the American Indian Youth Wellness Camp. Photo Courtesy: Native American Research and Training Center
Youth learn about nutrition food labels at the American Indian Youth Wellness Camp. Photo Courtesy: Native American Research and Training Center

In order to address the issue of youth with diabetes, University of Arizona Professor Emerita Jennie Joe founded The Youth Wellness Camp in 1991 after recognizing the increase of Type II diabetes in the younger generation.

The camp was established to bring youth with a high risk of getting diabetes or those who are already diagnosed to a week-long camp to introduce them to physically-active routines, said Gachupin, who now oversees the camp.

The camp is held once every year and accepts around 40 American Indians between the ages of 10 and 15. The non-profit organization operates on donations through the UA Foundation. The camp is a program through the Native American & Research Training Center.

An education component of the camp is providing participants with instruction on healthy eating, how to read nutrition labels, portion sizes and different exercises routines.

The meal menus are prepared so that all the different food groups are represented. This past summer, participants left the camp with Polar Loop Activity Trackers, or wrist accelerometers, to track the amount of time spent in physical activity, daily steps, calories burned and hours slept.

“It’s motivating for them because technology is such a big thing now,” Gachupin said. “The kids appreciate that we are using technology to monitor the behavior as well.”

“We are hoping if we can educate these kids how to exercise and offer them a healthier home environment,” Gachupin added, “we will make changes that will really support healthier lifestyles.”

Yara Askar is a reporter for Arizona Sonora News, a service from the School of Journalism at the University of Arizona. Reach her at

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