Student Scene
 Ellen Rothman Photo by Graham Ramsay |
Doctor Sees Culture of Overweight Among the Navajo
Kayleen giggled as she sat on the examining table. She nervously twirled her finger in her rich black waist-length hair as I talked to her mother. Only four years old, Kayleen was already seriously overweight. At that visit, she weighed in at 60 pounds, the average weight of a 9-year-old. Her T-shirt strained across her belly, and the waistband of her skirt carved a deep canyon in her skin. I tried to gently approach the subject of Kayleen's girth with her mother."You think I don't know that she's too fat?" her mother said angrily. Kayleen's mother herself was significantly overweight. "Look, everyone tells me that she's too fat. We've tried everything. I don't want to talk about this anymore."
Diabetes Risk
The Navajo, like other Native American groups, have experienced an obesity epidemic that mirrors the current national trend. However, with a current 30 percent rate of adult-onset diabetes by the age of 60 among Navajos, there likely will be even more dramatic health consequences on the "Rez" than in the general population.
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Our kids aren't teased for being fat because most of their peers are overweight as well. --Ellen Rothman |
Our public health nurses have undertaken an ambitious screening program to determine the prevalence of obesity among children in our area. This year, they screened two thirds of all sixth-, seventh-, and eighth-graders in our town for body mass index, a more accurate measurement of overweight. The results were staggering--51 percent of the students were above the 85th percentile for body mass index. Of that number, 26 percent were above the 95th percentile, which is in the obese range. Our kids aren't teased for being fat because most of their peers are overweight as well.
"We're all big-boned," one mother said to me recently. Most locals take it as a given that they and their families are bound to be big. It may well be that the average Navajo is going to be larger and heavier than the average Anglo. Researchers have long speculated about a "thrifty gene" that forces Native Americans, long deprived of ample and abundant calories during their hunter-gatherer past, to inappropriately store extra calories in this modern time of plenty. Nonetheless, this trend is alarming since the number of dangerously overweight kids is increasing. I care for a 122-pound five-year-old, a 170-pound nine-year-old, a 250-pound 12-year-old, and a 330-pound 16-year-old.
Bigger Is Better
There is even a reverse stigma against children who are normal weight or thin in the Navajo Nation. "They're trying to stuff the normal ones so they can be fat, too" exclaimed a frustrated pediatrician. Recently, a mother brought in her active four-year-old, all knobby knees and scrapes, scarcely able to sit still to finish a bag of chips, and said, "I can't get him to eat anything." A willowy teenager in teen clinic asked to go on the progesterone birth control shot. When I asked why, she hastily corrected me. "Oh, I don't have sex," she said. "My friend said it makes you gain weight."In a disturbing modern world where Snapple has paid $166 million to become the official drink of New York City, soda has an even more outsized reputation on the Rez. With nearly 50 percent of our families living without running water, prepackaged cans of soda can offer convenience over a glass of water. Whereas in Boston most people recognized that soda was not healthy, on the Rez people are often dramatically misinformed. One mother recently told me, "We drink soda, but not the dark ones. Only Sprite and 7-Up." In the clinic, we display the number of sugar cubes in various types of soda, and families are routinely shocked. At the 4th of July Rodeo, a 10-month-old in the bleacher row just below me was drinking Pepsi from a bottle.
I saw Kayleen back for her 5-year physical this summer. Her mother had a fixedly resigned frown, arms crossed as Kayleen stepped on the scale. The brief delay until the red digital numbers popped up on the screen was uncomfortable. Kayleen hopped off and skipped into the examining room, eager to play with the brightly colored blocks. Her mother exchanged a grim look with me as we registered the number: 71 pounds.
--Ellen Rothman, HMS '98, now practicing in northern Arizona on the Navajo Reservation
All patient names in this column are pseudonyms. The opinions expressed are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.