Zeroing In On Health – The Blog!


Obesity Among the Poor Part 1
Obesity research literature dates back further than the current epidemic. Any hypothesis that purports to explain the cause of obesity must explain obesity emergence in all populations at any time. The Pima Indians of southwestern Arizona are now infamous for having the highest rates of obesity and diabetes in the United States. Today, the standard explanation for obesity among the Pima is that they have succumbed to prosperity and the toxic environment of American life. The Pima supposedly experienced a nutrition transition. Farmers and hunters became relatively sedentary wage earners while their diet changed from one very low in fat and high in fiber-rich carbohydrates and vegetables to a modern high-fat, high-sugar American diet. This is in keeping with the story we’ve all heard about eating too much and moving too little. However, this theory tells us nothing about the cause of overeating and moving too little, and the obesity researchers seem to be okay with this glaring omission.

There was a National Institutes of Health (NIH) reported entitled The Pima Indians: Pathfinders for Health which said,

“As the typical American diet became more available on the reservation after the Second World War, people became more overweight. If the Pima Indians could return to some of their traditions including a high degree of physical activity and a diet with less fat and more starch, we might be able to reduce the rate and surely the severity of unhealthy weight in most of the population.”

The problem with this Pima history is that obesity and overweight was evident over a century ago when the relevant nutrition transition was from relative abundance to extreme poverty. From November 1901 to June 1902, the Harvard anthropologist Frank Russell lived on the Pima reservation in the south of Phoenix studying the tribe and its culture. He wrote,

“Many of the older Pima exhibit a degree of obesity that is in striking contrast with the ‘tall and sinewy’ Indian conventionalized in popular thought.”

Anthropologist and physician Alex Hrdlicka visited the Pima reservation in 1902 and 1905. He reported that,

“Especially well-nourished individuals, females and also males, occur in every tribe and at all ages but real obesity is found almost exclusively among the Indians on reservations.”

For perhaps two millennia, the Pima had lived as both hunter-gatherers and agriculturalists. Game was abundant in the region as were fish and clams in the Gila River. When the Jesuit missionary Eusebio Kino arrived among the Pima in 1787, the tribe was already raising corn and beans on fields irrigated with Gila River water. In the decades that followed, they took to raising cattle, poultry, wheat, melons, and figs. They also ate mesquite beans, the fruit of the saguaro cactus, and a mush of what Russell later called “unidentified worms.” In 1846, when a U.S. Army battalion passed through Pima lands, the battalion’s surgeon John Griffin described the Pima as “sprightly” and in fine health.” He also noted that the Pima had “the greatest abundance of food, and take care of it well, as we saw many of the storehouses full of pumpkins, melons, and corn.”

Life began to change dramatically when a wagon route was opened to California “by way of Tucson and the Pima villages.” This became the southernmost overland route for the California gold rush that began in 1849; tens of thousands of travelers passed through the Pima villages on the way west over the next decade. They relied on the Pima for food and supplies. With the arrival of Anglo-American and Mexican settlers in the late 1860s, the prosperity of the Pima came to an end, replaced by what the tribe referred to as “the years of famine.” Over the next quarter-century, these newcomers hunted the local game almost to extinction, and the Gila River water, on which the Pima depended for fishing and irrigating their own fields was “entirely absorbed by the Anglo settlements upstream.” By the mid-1890s, the Pima were relying on government rations to avoid starvation and this was still the situation when Hrdlicka and Russell arrived in the early 1900s.

Alex Hrdlicka

Both Hrdlicka and Russel struggled with the dilemma of poverty coincident with obesity. Russel knew that the life of these Indians was arduous. Sedentary behavior could not be a cause of obesity in the Pima. Instead he proposed that a dietary factor was responsible. “Certain articles of their diet appear to be markedly flesh producing.” Hrdlicka suggested that the “role played by food in the production of obesity among the Indians is apparently indirect.” He suggested that the relatively sedentary life on the reservation could play a role, when he wrote, “the change from their past active life to the present state of not a little indolence.” However, he did not appear particularly confident about that statement. After all, obesity was quite rare among the Pueblo “who have been of sedentary habits since ancient times.” And obesity among the Pima was found “largely but not exclusively” in the women and the women of the tribe worked considerably harder than the men, spending their days harvesting the crops, grinding corn, wheat, and mesquite beans and carrying whatever burdens were not carried by pack animals.

Hrdlicka also noted that by 1905, the Pima diet already included “everything obtainable that enters into the dietary of the white man,” which raises the possibility that this might have been responsible for the obesity. At the half dozen trading posts that opened on the Pima reservation after 1950, the Indians took to buying “sugar, coffee and canned goods to replace traditional foodstuffs lost ever since whites had settled in their territories.”

Neither Hrdlicka nor Russell suggested that the US government rations might be the cause of obesity. But if the Pima diet on government rations was anything like that of tribes reduced to similar situations at the time on which data exist – including the Sioux on the Standing Rock Reservation in the Dakotas – then almost 50 percent of their calories came from sugar and flour.

Obesity in association with widespread poverty was documented again on the Pima reservation in the early 1950s by Bertram Kraus, a University of Arizona anthropologist working with the Bureau of Indian Affairs. According to Kraus, more than 50 percent of the children on the Pima reservation could legitimately be described as obese by their eleventh birthday. The local Anglos, Krause wrote, got leaner as they got older (at the time, at least) and this was not the case with the Pima. Kraus lamented the absence of dietary data to assess the nutritional state of the tribe, but this situation was remedied a few years later by Frank Hesse, a physician at the Public Health Service Indian Hospital on the Gila River Reservation. Hesse noted that he Pima diet of the mid-1950s was remarkably consistent from family to family and consisted of

“mainly beans, tortillas, chili peppers and coffee, while oatmeal and eggs are occasionally eaten for breakfast. Meat and vegetables are only eaten once or twice a week.”

Hesse neglected to assess sugar consumption, but he did note that a “large amount of soft drinks of all types is consumed between meals.” Hesse then concluded that 24 percent of the calories consumed by the Pima (the soft drinks excluded) were from fat, which is certainly low by modern standards.

Over the next twenty years, the prevalence of obesity and diabetes among the Pima continued to rise, now coincident with a change in the foods distributed by government agencies and sold on the reservation trading posts. By the late 1950s, according to the Indian Health Service in Tucson, “large quantities of refined flour, sugar, and canned fruits high in sugar were being distributed widely on the reservations, courtesy of a surplus commodity food program run by the US Department of Agriculture. When mechanization of the local agriculture industry brought a cash economy to the Pima, the local stores and trading posts “started to carry high caloric pre-packed sweets, such as carbonated beverages, candy, potato chips, and cakes”. “Soda pop is used in immense amounts” as a 1962 study described.

In April 1973, when the evils of dietary fat were still widely considered hypothetical, the NIH epidemiologist Peter Bennett appeared before George McGovern’s Senate Select Committee on Nutrition and Human Needs to discuss diabetes and obesity on the Pima reservation. The simplest explanation for why half of all adult Pima were diabetic, said Bennett, was the amount of sugar consumed which represented 20 percent of the calories in the Pima diet.

“The only question that I would have is whether we can implicate sugar specifically or whether the important factor is not calories in general, which in fact turns out to be really excessive amounts of carbohydrates.”

Bennett’s opion was consistent with that of Henry Dobyns of the D’Arcy McNickle Center for the History of the American Indian. He is considered the foremost authority on Pima history. In 1989, Dobyns described obesity and diabetes in the tribe as being “to some extent a result of inadequate nutrition” and added that

“This inadequate nutrition comes about because “many of the poorer individuals subsist on a diet of potatoes, bread, and other starchy foods. Their traditional diet is beyond their reach, for they cannot catch fish in a dry riverbed and they cannot afford to buy much meat or many fresh fruits and vegetables.”