According to this broad literature review, the most effective and sustainable interventions to reduce obesity within the American Indian and Alaska Native populations are programs that combine the strengths of (1) tribal-run, culturally-adapted efforts that provide services to a wide range of the population; with (2) an evaluative component to measure impact on both individual and community norms. Evaluation is usually part of the program structure created by a non-tribal academic research organization.

Chronic disease associated with lack of physical activity, such as diabetes, has been identified as a leading cause of premature death among indigenous populations in North America, leading to the development of many programs to spur American Indians (AI) and Alaska Natives (AN) to exercise. This review looked at literature from 1986 to 2006, related to 64 different interventions in the U.S. and Canada, in order to provide guidance for future effective programs. The strength of this review is its inclusion of data from peer-reviewed journals, as well as “gray literature,” (e.g., conference proceedings, annual reports of funding agencies, Web sites, dissertation abstracts) where information about tribal health programs is more likely to be disseminated.

Key Findings:

• Most interventions were conducted in the Southwest U.S. (35.4%); in reservation communities (72%); and were aimed at children under age 18 (57.8%).
• However, in recent years, obesity has grown steadily in AI/AN populations in Alaska and the Southeast U.S.; and although 61 percent of AI/ANs live in cities, only 8 percent of the programs specifically targeted urban populations.
• Twenty-seven of the interventions included some way to evaluate the impact of the program; and 41 percent of those reported significant changes in health, behavior or knowledge.
• Just over half of the interventions were administered by a tribal or AI/AN organization of some sort; 81 percent of those had been implemented for more than five years at the time of the review, demonstrating their longevity.
• By contrast, none of the projects initiated by non-tribal organizations were continued by the hosting tribal community beyond the initial funding period.

The authors note there is a need for interventions to better serve city dwellers, as well as indigenous populations who do not live in reservation communities in the Southwest. The authors also note that programs designed and run by tribal organizations or practitioners are usually culturally adaptive; more broadly targeted at the community and health goals; and better promoted to, and utilized by, their target populations. However, these community-run programs often do not include any mechanism for evaluation. Showing measurable impact is often necessary for a program to receive continued stable funding. Therefore, the authors suggest the most effective and sustainable programs would be community-based but also incorporate best research practices so the program’s effectiveness could be judged and its funding stabilized.