Salt River Pima-Maricopa Indian Community’s fitness center and programs helped Alex Alejandre, right, lose 75 pounds in a year by incorporating such workouts as Brazilian jiu-jitsu. (Photo by Daniel Gatalica/Cronkite News)

PHOENIX – Alex Alejandre lost 75 pounds in a year. His wife, Mary, lost 40.

They want to set a good example for their 17-year-old son, Nathan, and take a personal stand against obesity, which can lead to diabetes and other serious health problems, especially in Native Americans.

“The health of my child is everything to me. I want him to grow up to be healthy,” said Alex, a member of the Salt River Pima-Maricopa Indian Community. With the help of a community program, his family is getting healthy.

Native American adults are 50% more likely to be affected by obesity than non-Hispanic whites, according to a report by the federal Centers for Disease Control and Prevention. Native Americans also are twice as likely as non-Hispanic whites to have diabetes, the CDC says.

Diabetes and obesity are linked; more than 90% of people with Type 2 diabetes are affected by some degree of obesity, according to the Obesity Action Coalition. Excess weight can make the cells of muscle and other tissue more resistant to self-produced insulin.

Historical discrimination and modern disparities have left Native Americans with less access to good farmland and grocery stories. But several communities, from the Navajo Nation to the Pima-Maricopa tribe, are instituting programs to educate and help members battle for better health.

Junk food and historical disparities

The Navajo Nation Reservation, the largest in the U.S., sprawls across 27,413 square miles but has only 13 grocery stores, according to the American Nutrition Association.

“We have fast food restaurants and more that are just all across the Navajo Nation,” said Lucinda Charleston, program director of the Navajo Special Diabetes Project by the Navajo Department of Health. “A lot of individuals are tired from work and are looking for a quick meal, leading them to eat junk food.”

Obesity can start at a young age, when access to physical activity is limited.

“P.E. (physical education) teachers are often cut out from schools in the nation where funding is no longer available,” said Dr. Jill Jim, executive director for the Navajo Department of Health.

Editors: A previous version of this story inverted Dr. Jill Jim’s name in the 10th graf and subsequently used the wrong pronoun for her in the 11th graf. The story here has been corrected, but clients who used earlier versions of this story are asked to run the correction that can be found here.

For students in the most remote areas of the reservation, she said, school bus rides often are an hour or more, which is more time spent sedentary.

Obesity and diabetes also are rooted in the historical discrimination against Indigenous people, according to Shervin Aazami, deputy director of congressional relations at the National Indian Health Board.

“Acts of physical and cultural genocide, forced relocation from ancestral lands, involuntary assimilation into Western culture and persecution and outlawing of traditional ways of life, religion and language, have resulted in disproportionately higher rates of health problems among the Native community,” he said.

Mary Alejandre, the Pima-Maricopa woman who shed 40 pounds, agrees.

“I think the cause of the issue is that they isolated us in these little areas with unfarmable land,” she said. “There was a damper on our water resources, and in order to keep us alive they gave us these boxes of unhealthy canned foods – flour, lard, canned vegetables, powdered milk, et cetera.”

Aazami said the federal government doesn’t put enough funds into the Native American health system, contributing to diabetes and obesity. Funding for the Indian Health Service, a division of the U.S. Department of Health and Human Services, was roughly $5.8 billion in fiscal year 2019, he said.

“However, the IHS Tribal Budget Formulation Workgroup, which is a nationally representative body of tribal leaders, budget experts, and tribal policy experts, estimate that IHS needs to be funded at over $37 billion to meet current health needs,” Aazami said. “Chronic underfunding of the Indian health system forces a greater allocation of resources to the most dire health conditions, and contributes to less investment in public health prevention.”

Getting healthy

Federal officials and tribal leaders are implementing programs and services to fight the toll of obesity and diabetes.

The Indian Health Service has a Special Diabetes Program for Indians, which focuses on prevention and treatment. Aazami said the program has reduced end-stage kidney failure by 54% and diabetic eye disease by 50% in the Native population.

The CDC has funded the Good Health and Wellness in Indian Country program to revitalize Native foods, improve reconnections to culture and inform communities about traditional tools and ways for staying healthy.

In 2014, the Navajo Nation Council approved a 2% junk food tax on sweetened beverages and foods high in fat, salt and sugar, including candy, chips, pastries and fried foods bought on the reservation.

Research into the effectiveness of the law, conducted by Navajo officials in collaboration with Northern Arizona University’s department of health services, said obesity, diabetes and related diseases are multifaceted health problems that can’t be curbed based solely on diet, but that the junk food tax “may ultimately address the critical public health concern by promoting communities to improve their health through physical activity, health education, and traditional knowledge, as well as improving access to these healthy resources.”

Charleston said education is a key part of the Navajo diabetes program.

“Our primary focus is implementing three areas for diabetes prevention: increasing diabetes education, increasing nutrition education and increasing more physical activity events across the Navajo Nation,” she said.

“We have put all the numbers aside and our goal to educate our Navajos about what prediabetes and obesity looks like, because we know that prediabetes and the early stages of weight gain are reversible.”

The program also has implemented wellness activities and wellness centers where school-aged children can be more physically active.

The Salt River Pima-Maricopa Indian Community also has a fitness center, the two-story Way of Life Facility.

The Alejandre family credits the center and its programs with guiding their journey to good health.

Mary has a private session with a personal trainer every week at the facility, which offers a large workout area with weights, cardio equipment and a pool and slide.

The Alejandres, who also run marathons and 5Ks, attribute the much of their weight loss to Brazilian jiu-jitsu, which they say makes working out fun.

“There’s something about someone beating you up,” Mary said.

She, her husband and their teenage son are members of Kiko France Brazilian Jiu-Jitsu, where they train multiple times a week.

After two years of training, Alex has earned a blue belt. Nathan and Mary are close to achieving their blue belts.

Besides working on their physical fitness, they watch their diet. Mary avoids junk food, feeding her family traditional foods instead.

“Our Pima tribe is very fortunate to have an agricultural and environmental awareness department where they cultivate traditional foods and they grow it,” she said. “They have a garden on the Salt River where you can plant these foods and you can harvest it when available.”

Alex said he ate the wrong foods when he was growing up.

“As a kid, I would indulge in unhealthy junk food,” he said. “Nowadays, I avoid that. I make sure no soda, and the staple of my diet is rice and chicken.”

And Alex and Mary Alejandre have achieved one more goal. Their son believes his parents are a good example.

“I keep on the right path, to stay healthy both mentally and physically,” Nathan said.