Native Americans represent approximately 1 percent of the U.S. population, but account for some of the worst health outcomes related to preventable chronic diseases (diabetes, heart disease, cancer, alcoholism) than any other racial or ethnic group. In considering the risk factors for these diseases, Native American people have among the highest rates of obesity, with many children experiencing obesity rates two to three times greater than other racial/ethnic populations. But this was not always the case. Only in the last half of the 20th century have the documented cases of diabetes rates in Native communities increased so drastically. 
From a public health perspective, the policies, systems, and environment have had a significant impact on rates of obesity. For example, the environment in many Native communities drastically changed over the past 200 years, shifting from traditional hunting and gathering or farming subsistence cultures to forced relocation and reservations, leading to sedentary lifestyles and dependence on federal government food programs. These drastic generational changes to the environment, culture, and language, and the connection to land and food, have had a direct impact on the health of Native American people.
Native American communities disproportionately lack access to safe places to exercise and for children to play. Families and communities face a variety of barriers to being physically active, such as limited access to parks and recreation facilities, dirt roads with little to no walkable areas, stray dogs, and gang violence. Physical activity has always been an integral part of Native American life and history from running for endurance and speed valued for hunting, to running as a spiritual connection.
Native peoples are well aware of the research that links social determinants of health to the health of a community (level of educational attainment, poverty, access to health services, etc.). For example, poverty leads to dependence on federal government food programs such as the Food Distribution Program on Indian Reservations or “commodity foods”). In addition, due to the remote nature of many Native communities, access to healthy food choices is a challenge due to the cost of transporting fresh fruits and vegetables and other perishable foods. As a result, food access is typically limited to preserved and packaged foods that can be transported and stored inexpensively. These foods are typically not the healthiest choices, and are not consistent with traditional healthy diets.
Using this lens, we can approach solutions and strategies to address the root causes of obesity. Understanding these social and environmental changes impacting Native people requires an understanding of their history and treatment in this country as well as how this history over hundreds of years has impacted and drastically changed Native communities, their environment, and their health. Understanding this context will help inform strategies and solutions that will shed light on the foundational inequities facing Native people and build on their resiliency and inherent strength.
Despite these significant challenges, there are numerous positive and promising Native-led strategies to increase physical activity in Native communities. For example, some tribes in the Northeast are working to bring back leg wrestling, which in previous times would help create strong, agile men. Also in the Northeast, traditional games like lacrosse are being promoted as part of children’s daily physical activity. In the Midwest, canoeing was not only a way to get around a land full of streams and lakes, but it also provided a means for fishing and collecting wild rice, a staple of many Midwestern tribes’ diets. In the Southwest, several Pueblo and Navajo chapters are returning to their roots as long-distance runners. Runners played a critical role for the Pueblos, not only for entertainment and keeping their people strong and healthy, but also as an intricate piece of the 1680 Pueblo revolt. Long-distance runners were tasked with sharing communication throughout the Pueblo villages for when and how the revolt would take place.  In addition, many Native communities are embracing the concept of food sovereignty and regaining traditional food systems. These efforts need to be evaluated, highlighted, and shared with other Native communities to expand the evidence base of promising practices in obesity prevention and to promote health in Native communities.
- Will, J. C., et al. 1997. Diabetes mellitus among Navajo Indians: Findings from the Navajo Health and Nutrition Survey. Journal of Nutrition 127:10.
- Nobokov, P. 1987. Indian running: Native American history and tradition. Santa Fe, New Mexico: Ancient City Press.