For American Indians, Food Insecurity and Chronic Disease May Be Linked

Rates of food insecurity remain high in American Indian communities, and a recent study indicates that inadequate food quality and quantity may put these populations at higher risk of diabetes, obesity, and hypertension.

Numerous prior studies have found that food insecurity tends to be more prevalent in American Indian households, including one that found rates of almost 30% compared with 16% of non-American Indian households. Previous surveys of the general population have also found that food-insecure respondents were more likely to have diabetes and twice as likely to be obese as food-secure participants. The authors of this study set out to investigate the association between food insecurity and the prevalence of obesity, diabetes, and hypertension among American Indians in particular.

The research published in the American Journal of Public Health surveyed 513 American Indian adults in rural Oklahoma. The participants were members of the Chickasaw Nation and the Choctaw Nation, which have poverty rates of 15.3% and 20.7%, respectively, compared to the national poverty rate of 13.8%. Respondents answered questions about their health history of diabetes and hypertension and their body mass index was calculated using self-reported height and weight.

Researchers asked how often participants felt that “the food that [they] bought just didn’t last, and [they] didn’t have money to get more” as an indicator of inadequate food quantity, and how often they “couldn’t afford to eat healthy meals” to assess inadequate food quality. They also collected information on demographic characteristics like age, education, household income, employment status, household size, and participation in nutritional assistance programs.

Of the participants, 56% agreed that the statement assessing inadequate food quantity was sometimes or often true, while 62% agreed that the inadequate food quality measure was sometimes or often true. The prevalence of diabetes, obesity, and hypertension was higher among participants with inadequate food quantity compared to those with adequate quantity, but the associations were not statistically significant after adjusting for demographic characteristics.

The prevalence of diabetes, obesity, and hypertension was higher among respondents reporting inadequate food quality. After adjustment for sociodemographic qualities, the associations between inadequate food quality and increased prevalence of these 3 conditions remained statistically significant.

This finding that inadequate food quality, rather than quantity, is more robustly associated with chronic disease “adds to the literature that suggests perceptions and behaviors related to food insecurity vary from 1 culture to the next,” the authors wrote.

To reduce disparities in chronic disease prevalence among American Indians, the authors called for “more precise and culturally tailored measures of food insecurity that capture the unique relationship to tribal food programs, traditional food practices, and household food sharing” in these communities. They also recommended testing strategies to eliminate “the structural and environmental barriers to healthy food access in tribal food environments.”