A Vision for Healthy Weight Across the Lifespan of 

American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

Indian Health Service 

2011 

 

 

 

A Vision for Healthy Weight Across the Lifespan of 

American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

Indian Health Service 

2011 

Top row: Prenatal care, IHS facility 

Second row, from left: IHS health care team; Postpartum care, IHS facility 

Third row, from left: Patient exam, Santa Fe IHS Hospital; Health care team, 

Wewoka Service Unit; Community nutrition lesson, Ohkay Owingeh Pueblo 
 

 

 

Indian Health Service 

Office of Clinical and Preventive Services
 


Division of Diabetes Treatment and Prevention
 


Division of Clinical and Community Services
 


Copyright Information 

All material contained in this report is in the public domain and may be used and reprinted without special 

permission; citation to source, however, is appreciated. 

Suggested Citation 

Indian Health Service.“Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians 

and Alaska Natives, Actions for Health Care Teams and Leaders.” Rockville, MD: U.S. Department of Health and 

Human Services, Indian Health Service, 2011. 

Sources of Copies 

To download a copy from the Web or to obtain hard copies, please visit http://www.ihs.gov/healthyweight. 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives i 

Actions for Health Care Teams and Leaders 

TABLE OF CONTENTS 

Table of Contents 

Foreword iii 

Executive Summary v 

Introduction: Laying Out the Vision 1 

Trends and Impact of Obesity and Overweight 1 

What Is a Healthy Weight? 2 

Energy Balance: The Key to Maintaining a Healthy Weight 3 

Promoting Healthy Weight Across the Lifespan 3 

We All Have a Role! 6 

Health Care System Actions to Promote Healthy Weight for Life 9 

Conduct Universal Body Mass Index Screening and Assessment 10 

Provide Pre-conception and Prenatal Counseling and Care 10 

Provide Breastfeeding and Infant Feeding Education and Support (Post Partum) 11 

Implement Comprehensive, Agency-Wide Food Standards Policies for Promoting Healthy Weight 11 

Implement Universal Nutrition and Physical Activity Education 12 

Deliver Quality Health Care 12 

Match the Size and Capability of the Workforce to the Disease Burden 13 

Identify Ways to Increase Reimbursement for Healthy Weight Management 14 

Agency Actions to Promote Healthy Weight for Life 15 

Create a Standing Body in the Indian Health System—the Healthy Weight for Life Workgroup—
 

to Help Implement the Vision
 15 

Promote and Support Lifestyle Change Strategies for Healthy Weight Across the Lifespan 

Throughout the Indian Health System 15 

Increase Quality Improvement, Program Evaluation, and Research on Healthy Weight Management 16 

Foster Collaboration and Innovation Across the Indian Health System and With External Partners 16 

Design and Launch a Web Site to Promote Healthy Weight Management Strategies 17 

Plan and Implement a Social Marketing Campaign to Promote Healthy Weight 17 

Resources for Healthy Weight Management 18 

Food and Nutrition 18 

Physical Activity 19 

Infants and Toddlers 20 

Children and Adolescents 21 

Adults and Elders 22 

Governments/Policymakers 23 

Schools and Programs for Youth 24 

Worksites 26 

Communities 26 

Health Care Teams and Leaders 27 

Social Marketing/Awareness Campaigns 30 

Acknowledgments 31 

Index 33 

List of Photos 36 
ii Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives iii 

 

 

 

 

 

 

 

 

 

 

Actions for Health Care Teams and Leaders 

FOREWORD 

Foreword
 

Now is the time to put our minds and resources together to beat the 

epidemic of obesity. With “Healthy Weight for Life: A Vision for Healthy 

Weight Across the Lifespan of American Indians and Alaska Natives” as 

a guide, we can make a difference. 

American Indians and Alaska Natives nationwide are concerned that 

the obesity epidemic is affecting the well-being of our communities. 

Increases in weight have been associated with increased rates of type 

2 diabetes, high blood pressure, high cholesterol, heart disease, stroke, 

cancer, asthma, and other pulmonary diseases, as well as orthopedic and 

psychological issues. 

Tribal governments, communities, Tribal members, urban Indian organizations, and the Indian 

Health Service already have partnered together to promote lifestyle choices for reaching a healthy 

weight through hundreds of innovative and creative programs and activities. What do all these 

programs have in common? They are all based on research that shows: 

» A healthy weight means healthier American Indians and Alaska Natives across the lifespan. 

» Ensuring a healthy weight means intervening early—even before conception. 

» A healthy weight is best achieved through lifestyle balance—in other words, balancing the 

energy (food and beverages) we take in with the energy we expend (physical activity). 

» Research shows that adults who are overweight only need to lose 5 percent to 10 percent of 

their body weight by eating less and moving more—that’s 10 to 20 pounds in a 200-pound 

person—to reduce the risk of developing diabetes. Weight loss also helps control diabetes 

and cardiovascular disease. 

Promoting healthy weight is not just a priority for the Indian health system. President Obama has 

established a Task Force on Childhood Obesity to develop a national interagency action plan to solve 

the problem of obesity within a generation. First Lady Michelle Obama has launched Let’s Move!, 

a national awareness campaign. Surgeon General Dr. Regina Benjamin has released a “Vision for a 

Healthy and Fit Nation” that outlines interventions to prevent obesity at every level of society. 

“Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and 

Alaska Natives, Actions for Health Care Team Members and Leaders” provides Native Americans 

with guidance for taking action. Health care teams and leaders have a role to play. Select the 

actions best suited to your program and draw on the Resources on pages 18–30. Also, refer to the 

companion booklet,“Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of 

American Indians and Alaska Natives, Actions for Communities, Individuals, and Families,” for 

additional information. 

Working together, we can make a difference in ensuring the health and well-being of American 

Indians and Alaska Natives—now and for future generations. 

Yvette Roubideaux, M.D., M.P.H. 

Director, Indian Health Service 
iv Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives v 

 

 

Actions for Health Care Teams and Leaders 

EXECUTIVE SUMMARY 

Executive Summary
 

Promoting a healthy weight across the lifespan is critical to improving the health status and wellbeing of American Indians and Alaska Natives (AI/AN), to reducing health disparities, and to 

maximizing the limited resources of the Indian health system. Taking action now has the potential 

to help achieve the Indian Health Service’s mission of raising the physical, mental, social, and 

spiritual health of AI/AN to the highest level. 

Across the country, hundreds of thousands of AI/AN participate in innovative nutrition, physical 

activity, and weight loss programs. Communities have conducted assessments and designed 

culturally sensitive programs to meet their particular needs. While progress has been made on 

certain measures, disparities still remain. Overweight and obesity continue to drive the high rates of 

type 2 diabetes, heart disease, stroke, pulmonary disease, many cancers, as well as orthopedic, oral 

health, and psychological problems. 

Trends and Impact of Obesity and Overweight 

The prevalence of obesity in AI/AN and the U.S. population at large has increased dramatically 

over the past 30 years. According to the IHS Clinical Reporting System, over 80 percent of AI/AN 

adults ages 20 to 74 are overweight or obese; among children and youth, between 45 percent and 

51 percent are not at a healthy weight. 

The most recent estimate puts the cost of obesity-related medical spending alone in the United 

States at $147 billion per year in 2008, compared with $78.5 billion in 1998. This accounts for 

almost 10 percent of all medical spending. 

What Is a Healthy Weight? 

For adults, a normal or healthy weight is defined as an appropriate weight in relation to height. This 

ratio of weight to height is known as the body mass index (BMI). BMIs for youth 2–20 years old 

are determined by comparing their weight and height against growth charts that take their age and 

gender into account. 

Maintaining a healthy weight requires keeping an energy (or calorie) balance. Energy balance 

means balancing the calories people get from foods and beverages (ENERGY IN) with the calories 

people use to keep their bodies going and for being physically active (ENERGY OUT). 

Promoting Healthy Weight Across the Lifespan 

The best approach to promoting healthy weight is a strategy that begins with conception and 

includes interventions throughout the lifespan to promote lifelong healthful eating and regular 

physical activity. This means protecting the fetus and newborn, infants and toddlers, children and 

adolescents, and adults and elders. 
vi Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

 

EXECUTIVE SUMMARY 

We All Have a Role to Play 

Given the multitude of factors that contribute to obesity and overweight, there is no one single 

approach that will work to turn the problem around. That is why individuals, families, schools, 

worksites, communities, the health care system, Tribal leaders and Tribal organizations, and society 

all have a role to play. 

Actions for Society 

Society is made up of communities, organizations, families, and individuals—all working together 

for change. Healthful nutrition and physical activity legislation, statewide school policies, media 

campaigns, promoting healthy weight as a cultural, societal norm, and partnerships with Tribes are 

just some of the ways a comprehensive strategy to promote healthy weight across the lifespan takes 

shape on a large scale. 

Actions for Communities 

Community organizations include the health care system, Tribes and Tribal organizations, schools, 

and worksites. By making changes in organizational policies and environments, these organizations 

can help individuals make better choices about healthful eating and physical activity. 

Actions for Health Care Teams and Leaders 

Treating obesity and overweight is essential for preventing and treating diabetes, cardiovascular 

disease, and many other chronic conditions that take a major toll on the lives of AI/AN. The 

Indian health care system has the potential to play a major role in helping patients achieve and 

maintain a healthy weight across the lifespan by: adopting universal BMI screening, assessment, 

and intervention; adopting physical activity screening and encouraging patients to participate in 

physical activity; developing and fostering a breastfeeding-friendly culture policy; implementing 

comprehensive food standards policies for promoting healthy weight; and delivering quality health 

care. Health care team members can take action to influence patients’ dietary choices and physical 

activity behaviors by implementing universal nutrition and physical activity education. They also 

can collaborate with schools, community groups, and worksites to help educate and reinforce 

healthy lifestyle behaviors and advocate for health care policy changes. 

Actions for Individuals and Families 

Close interpersonal groups, such as families and friends, play an important role in encouraging 

more healthful behaviors and giving individuals the knowledge and support they need to make 

healthful eating and physical activity choices. Family mentoring can help pass on healthy habits 

to children. Intergenerational activities can help connect individuals and family members, and 

empowering elders can help facilitate change. Strengthening the individual culturally, spiritually, 

physically, and emotionally helps him or her live Life in Balance and to adopt healthful eating and 

physical activity behaviors. 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives vii 

 

 

 

Actions for Health Care Teams and Leaders 

EXECUTIVE SUMMARY 

Choose the Action Steps Best Suited for You 

“Healthy Weight for Life: A Comprehensive Strategy Across the Lifespan of American Indians and Alaska 

Natives, Actions for Health Care Teams and Leaders” provides guidance for taking action to stop the 

obesity epidemic. It is up to you to choose the role you want to play. Use the actions laid out in 

this booklet to chart your journey, and draw on the resources on pages 18–30 to help. Also, see the 

companion booklet,“Healthy Weight for Life: A Comprehensive Strategy Across the Lifespan of American 

Indians and Alaska Natives, Actions for Communities, Individuals, and Families.” 

» As a health care team member, you can begin by assessing every patient’s BMI; if the BMI 

is out of range, you can intervene based on current clinical guidelines and best practices to 

help your patient achieve a healthy weight. 

» As an IHS executive staff member at a local facility, you can incorporate healthy weight 

actions into your local services, programs, and activities. 

» As IHS senior leadership, you can set direction, establish policies, and promote 

accountability in your healthy weight programs and activities. 

Remember that everyone has a role to play no matter how large or small. Working together, we can 

make a difference in achieving a healthy weight across the lifespan of American Indians and Alaska 

Natives—now and for future generations. 
viii Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 
 

 

Actions for Health Care Teams and Leaders 

INTRODUCTION: LAYING OUT THE VISION 

Introduction: Laying Out the Vision
 

Promoting a healthy weight across the lifespan is critical to improving the health status and wellbeing of American Indians and Alaska Natives (AI/AN), to reducing health disparities, and to 

maximizing the limited resources of the Indian health system. Taking action now has the potential 

to play a major role in achieving the Indian Health Service’s mission of raising the physical, mental, 

social, and spiritual health of AI/AN to the highest level. 

Across the country, hundreds of thousands of AI/AN participate in innovative nutrition, physical 

activity, and weight loss programs. Communities have conducted assessments and designed 

culturally sensitive programs to meet their particular needs. While progress has been made on 

certain measures, disparities still remain. Overweight and obesity continue to drive the high rates of 

type 2 diabetes, heart disease, stroke, pulmonary disease, and many cancers, as well as orthopedic, 

oral health, and psychological problems. 

Trends and Impact of Obesity and Overweight 

The prevalence of obesity in AI/AN and the U.S. population at large has increased dramatically 

over the past 30 years. According to the IHS Clinical Reporting System, over 80 percent of AI/AN 

adults ages 20 to 74 are overweight or obese; among children and youth, between 45 percent and 

51 percent are not at a healthy weight. See Table 1. 

Table 1. Prevalence of Overweight and Obesity in IHS Active Clinical Patients 

Adults (ages 20–74): 

81 percent are overweight or obese 

54 percent are obese 

85 percent of adults ages 45–54 are overweight or obese (highest percentage of adult patients) 

Children and Youth (ages 2–19): 

45 percent of children ages 2–5 are overweight or obese 

25 percent of children ages 2–5 are obese 

49 percent of children ages 6–11 are overweight or obese 

31 percent of children ages 6–11 are obese 

51 percent of youth ages 12–19 are overweight or obese 

31 percent of youth ages 12–19 are obese 

Source: Unpublished fiscal year 2008 data from the IHS Clinical Reporting System (CRS) (2009 update coming) 

In FY 2008, the Government Performance and Results Act (GPRA) user population was 1,256,963. The active clinical 

population ages 2–74 was 837,545; this included 520,986 adults ages 20–74 and 316,559 youth ages 2–19. In FY 

2008, 618,310 active clinical patients were screened for body mass index; this included 429,809 adults ages 20–74 

and 188,501 youth ages 2–19. See the definition of overweight and obesity in adults and children and youth on the 

following page. 

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 1 
2 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

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INTRODUCTION: LAYING OUT THE VISION
 

Six Nations Territory Unity Run 

A recent analysis of CDC data on low-income, preschool-age children participating in federally 

funded health and nutrition programs showed that from 2003 through 2008 the rate of obesity 

remained stable among all groups except American Indian and Alaska Native children. In 2008, 

prevalence of obesity was highest among AI/AN (21.2 percent) and Hispanic (18.5 percent) 

children. Prevalence was lowest among non-Hispanic black (11.8 percent), Asian American and 

Pacific Islander (12.3 percent) and non-Hispanic white (12.6 percent) children. (Morbidity and 

Mortality Weekly Report, July 24, 2009, Vol. 58 (28), pp. 769–773) 

The financial and societal impact of obesity is enormous. In 2000, the Centers for Disease Control 

and Prevention (CDC) estimated the total annual cost of obesity in the United States was $117 

billion for medical spending and the value of wages lost by employees unable to work because of 

illness, disability, or premature death. (This estimate is for the United States; a comparable figure for 

the Indian health system is not available.) 

The most recent estimate puts the cost of obesity-related medical spending alone at $147 billion 

per year in 2008, compared with $78.5 billion in 1998, and accounts for almost 10 percent of all 

medical spending in the United States (Health Affairs, September/October 2009, Vol. 28 (5), pp. 

822–831). Given the rapidly increasing rates of overweight, obesity, and diabetes in the general 

population and in AI/AN, the future costs of weight-related health care could be staggering. 

In addressing the many complex factors that have contributed to the obesity epidemic, it is essential 

to recognize the principle of “behavioral justice.”While individuals are responsible for engaging 

in health-promoting behaviors such as healthful eating and getting regular physical activity, 

they should be held accountable only when they have adequate resources to do so. It is society’s 

responsibility to provide health-promoting environments that enable individuals to control and 

be accountable for their behaviors. As noted by Adler and Stewart in a recent issue of the Milbank 

Quarterly, we need to “[reframe] the discussion as one of justice rather than blame.” (Milbank 

Quarterly, March 2009,Vol. 87 (1), pp. 49–70) 
What Is a Healthy Weight? 

For adults, a normal or healthy weight is defined as an appropriate weight in relation to height. This 

ratio of weight to height is known as the body mass index (BMI). People who are overweight have 

too much body weight for their height; people who are obese have a large amount of extra body fat 

in relation to their height. BMI for adults falls into the following categories: 

Weight Status BMI 

Underweight <18.5 

Normal, or healthy weight 18.5–24.9 

Overweight 25.0–29.9 

Obese 30.0 and above 

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 3

Actions for Health Care Teams and Leaders 

INTRODUCTION: LAYING OUT THE VISION 

For children and teens, overweight is defined differently than it is for adults. BMIs for youth 2–20 

years old are determined by comparing their weight and height against growth charts that take 

their age and gender into account, because children are still growing, and boys and girls develop 

at different rates. A child’s “BMI-for-age,” as it is called, shows how his or her BMI compares with 

other girls or boys of the same age. A child or teen between the 85th and 95th percentile on the 

growth chart is considered overweight. A child or teen at the 95th percentile or above is considered 

obese. 

Energy Balance: The Key to Maintaining a Healthy Weight 

A person’s weight is the result of many factors working together: height, genes, metabolism, 

behavior, life stresses, and environment. Maintaining a healthy weight requires keeping an energy 

(or calorie) balance. Energy balance means balancing the calories people get from foods and 

beverages (ENERGY IN) with the calories people use to keep their bodies going and for being 

physically active (ENERGY OUT). 

» The same amount of ENERGY IN and ENERGY OUT over time = weight stays the same 

» More ENERGY IN than OUT over time = weight gain 

» More ENERGY OUT than IN over time = weight loss 

ENERGY IN and OUT do not have to balance exactly every day. It is the balance over time that 

helps to maintain a healthy weight in the long run. For many people, the key to energy balance is 

eating fewer calories and increasing their physical activity. 

Promoting Healthy Weight Across the Lifespan 

The best approach to promoting healthy weight is to develop a strategy that begins with conception 

of the fetus and includes interventions throughout the lifespan to promote lifelong healthful eating 

and regular physical activity. See Table 2. 
 

Actions for Health Care Teams and Leaders 

INTRODUCTION: LAYING OUT THE VISION 

Table 2. Promoting Healthy Weight Across the Lifespan 

Fetuses & Newborns Infants & Toddlers Children & 

Adolescents Adults & Elders 

Promoting healthy 

weight at conception 

and during pregnancy 

Promoting diabetes 

(blood glucose) 

control before and 

during pregnancy 

Preventing low birth 

weight 

Preventing high birth 

weight 

Promoting 

breastfeeding 

Promoting 

breastfeeding 

Promoting timely 

introduction of 

healthy solid foods 

Decreasing sweetened 

beverage consumption 

Limiting fast food, 

takeout food, and 

eating out 

Encouraging 30 to 60 

minutes of structured 

play and physical 

activity daily 

Decreasing TV 

viewing and other 

screen time 

Promoting healthful 

eating habits 

Limiting fast food, 

takeout food, and 

eating out 

Promoting regular 

physical activity 

Decreasing sweetened 

beverage consumption 

Decreasing TV viewing 

and other screen time 

Promoting healthful 

eating by modeling 

behaviors 

Decreasing portion 

size 

Limiting fast food, 

takeout food, and 

eating out 

Increasing physical 

activity 

Decreasing TV 

viewing and other 

screen time 

Promoting healthy 

weight maintenance 

Adapted from: The Permanente Journal, Summer 2003, Vol. 7 (3): 9–10. 

Protecting Fetuses (Unborn) and Newborns 

Indian health 

facility newborn 

Since the risk for obesity begins as early as the perinatal period, taking action 

while the baby is in utero (in the womb) is essential. This means women must 

plan their pregnancies and prepare for them by starting off at a healthy weight. 

Women with diabetes must be in good glycemic (blood glucose) control before 

they conceive and throughout their pregnancy. The possibility of the pregnant 

mother’s food insecurity must be addressed to ensure healthy weight gain. These 

strategies, plus smoking cessation, can help to prevent low birth weight and high 

birth weight, key risk factors for obesity later on. 

Protecting Infants and Toddlers 

Sisseton-Wahpeton 

Oyate infant 

Numerous studies appear to show a positive association between breastfeeding 

and lower rates of overweight among children. The protective effect appears to 

persist into older childhood. Research also indicates that the longer children have 

been breastfed, the less likely they are to become overweight. It is recommended 

that women breastfeed exclusively during the first 6 months and continue 

4 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 5 

Actions for Health Care Teams and Leaders 

INTRODUCTION: LAYING OUT THE VISION 

breastfeeding for at least 12 months. Breastfeeding needs to be followed by timely introduction 

of healthy solid foods in appropriate quantities. Infants and toddlers should get at least 30 to 60 

minutes of physical activity to help develop motor skills and coordination. 

Protecting Children and Adolescents 

Sechelt (British 

Columbia) 

adolescents 

Three behavioral factors commonly associated with overweight among children 

are: long hours of television viewing and other screen time, consuming sweetened 

drinks (such as sodas), and consuming fast food. The role of parents and 

caregivers is particularly important in helping children establish a lifestyle that 

includes healthful eating habits and regular physical activity. Parents need to 

encourage children to follow the “5-2-1-0” model to ensure a healthy weight: 

» 5: Eat 5 or more servings of fruits and vegetables 

each day. 

» 2: Limit TV and other screen time to no more 

than 2 hours a day. 

» 1: Engage in 1 hour of physical activity per day. 

» 0: Limit sugar-sweetened beverages each day— 

none is best. 

Weight bias may marginalize children and youth who are considered to be obese by other youth 

and teachers and may place them at risk for teasing and bullying. Efforts need to address this bias 

and the impact of teasing and bullying on the mental health of children and youth. Weight-related 

stigma and obesity have been found to co-occur with depression, low self-esteem, and suicidal 

thought. 

White Mountain 

Apache elder 

Protecting Adults and Elders 

Research shows it is much easier to maintain a healthy weight than it is to lose 

weight later on. To maintain body weight in a healthy range, adults must continue 

to balance calories from foods and beverages with calories expended. Adults need 

to decrease food and beverage calories and increase physical activity to prevent 

gradual weight gain over time. For elders, it is important to maintain weight by 

balancing nutrition and physical activity to avoid excessive weight loss. Most 

importantly, research continues to show that modest weight loss—even in older 

adults—can help to prevent the onset of type 2 diabetes and help to manage 

chronic diseases, such as diabetes, high blood pressure, and abnormal cholesterol. 
6 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

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INTRODUCTION: LAYING OUT THE VISION
 

“Two key strategies for promoting healthy weight and reducing risk of chronic diseases later in 

life are to ensure high-quality nutrition for women and children and reduce psychosocial stress. 

Whether people are ‘over-caloried’ or over-stressed, the effect is the same.” 

—Ann Bullock, M.D., IHS Chief Clinical Consultant for Family Practice and Medical Advisor, 

IHS Division of Diabetes Treatment and Prevention 

We All Have a Role! 

The Indian Health Service, in collaboration with its partners, is determined to make a substantial and 

sustained effort to promote healthy weight across the lifespan in American Indian and Alaska Native 

communities. Given the multitude of factors that contribute to obesity and overweight, there is no one 

single approach that will work to turn the problem around. That is why individuals, families, schools, 

worksites, communities, the health care system, Tribal leaders and Tribal organizations, and society as 

a whole all have a role to play in achieving our vision for healthy weight across the lifespan. 

“For years, we have encouraged Americans to eat better, exercise regularly, and 

maintain healthier lifestyles. But for these things to happen, Americans need 

to live and work in environments that support their efforts. There is a growing 

consensus that we, as a nation, need to create communities and environments 

where the healthy choices are the easy and the affordable choices.” 

—U.S. Surgeon General Regina M. Benjamin, M.D., M.B.A. 

The Social-Ecological Model, currently used by the public health community, provides a framework 

for addressing and influencing a person’s physical, social, and cultural surroundings to support 

long-term, healthy lifestyle choices for maintaining a healthy weight. As shown in Figure 1, 

the model, which encompasses all of the key sectors of society, is consistent with the value of 

connectedness of self, community, and place, intrinsic in American Indians and Alaska Natives as 

they strive for harmony and balance in life. 
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Actions for Health Care Teams and Leaders 

INTRODUCTION: LAYING OUT THE VISION 

Figure 1. Harmony and Balance in Life: Applying the Social-Ecological Model in AI/AN Communities 

Tribal & Federal SOCIETY

Government 

Tribal & Federal 

Laws 

Tribal 

Regulations 

Policy COMMUNITY

Grocery Stores 

and Markets 

Neighborhood 

Child Care 

Community 

Organizations 

Built 

Environment 

ORGANIZATIONAL Quality 

Health Care 

Clinics 

Hospitals 

Worksites 

Schools 

Media 

Food 

Industry 

Tribal 

Organizations 

INTERPERSONAL

Language 

Family Culture 

Traditional 

Values 

INDIVIDUAL

Adapted from: Diabetes Care, November 2008, Vol. 31 (11), page 2217. 

Society 

This all-encompassing category involves communities, organizations, families, and individuals—all 

working together for change. Healthful nutrition and physical activity legislation, statewide school 

policies, media campaigns, and partnerships with Tribes are just some of the ways a comprehensive 

strategy to promote healthy weight across the lifespan takes shape on a large scale. 

For American Indians and Alaska Natives, this means: 

» All levels of society working together. 

» Promoting healthy weight across the lifespan as a cultural, societal norm. 

Communities 

Community organizations include schools, worksites, the health care system, and Tribal 

organizations. These organizations can help individuals make better choices about healthful eating 

and physical activity by making changes in organizational policies and environments and by 

providing health information. 

A community is like a large organization, able to make changes in policy and the environment 

to give its residents the best possible access to healthful foods and ways to be physically active. 

Changing zoning ordinances, improving parks, trails, walkways, and recreation facilities, creating 

ways to grow, gather, and hunt food, or distributing free or inexpensive fresh fruits and vegetables— 
8 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

INTRODUCTION: LAYING OUT THE VISION
 

these are some of the many ways individuals, groups, and organizations can work together to 

promote healthy weight. 

For American Indians and Alaska Natives, this means: 

» Promoting community ownership and engagement. 

» Increasing community self-empowerment. 

» Engaging in community needs assessments. 

» Providing communities with tools to help them change. 

» Inviting full participation of Tribal leaders. 

» Using the public health or population-based approach. 

Individuals and Families 

Close interpersonal groups, such as families and friends, are an important way to encourage more 

healthful behaviors and to give individuals the knowledge and support they need to make healthful 

eating and physical activity choices. 

For American Indians and Alaska Natives, this means: 

» Promoting self-empowerment and wellness. 

» Strengthening the individual culturally, spiritually, physically, and emotionally (Life in 

Balance). 

» Connecting individuals to intergenerational activities. 

» Empowering elders to help facilitate change. 

» Family mentoring to pass on healthy habits to children. 

“The physical and emotional health of an entire generation and the 

economic health and security of our nation is at stake. This isn’t the kind of 

problem that can be solved overnight, but with everyone working together, 

it can be solved. So, let’s move!” 

—First Lady Michelle Obama 
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Actions for Health Care Teams and Leaders 

HEALTH CARE SYSTEM ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

Health Care System Actions to Promote 

Healthy Weight for Life 

Treatment of obesity and overweight is essential for 

preventing and treating diabetes, cardiovascular disease, 

and many other chronic conditions. These chronic 

diseases take a major toll on the lives of American Indians 

and Alaska Natives and divert essential funds from 

prevention and early intervention. Weight loss improves 

control of blood glucose, blood pressure, abnormal 

cholesterol and lipids; it reduces risk of morbidity and 

mortality, and it lowers medical costs. Health care system 

changes and reimbursement for services are needed to achieve comprehensive and effective primary 

health care services for healthy weight management. 

IHS health care team 

The Indian health care system, including IHS, Tribal, and urban Indian health programs, has the 

potential to play a major role in helping patients achieve and maintain a healthy weight across 

the lifespan. Health care providers, nurses, dietitians, pharmacists, public health nutritionists and 

nurses, community health representatives, and others can influence patients’ dietary choices and 

physical activity behaviors. In addition, as shown in the Social-Ecological Model, health care team 

members can collaborate with schools, community groups, and worksites to help educate and 

reinforce healthful eating and regular physical activity, and they can advocate for health care policy 

changes to help effect change. 

“So what does obesity have to do with the type of care you as health care professionals provide 

on a daily basis? I say to you that obesity is everyone’s problem. Each of us needs to work together 

as part of the health care team to help prevent obesity and mitigate some of the early problems 

associated with it. Obesity is already taxing our Indian health system to the breaking point. Unless 

we begin to work together more proactively to fight this growing problem, I’m afraid that we’ll see 

this problem get worse in the coming years.” 

—RADM Richie Grinnell, R.S., M.P.H., IHS Nashville Area Director 
10 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

HEALTH CARE SYSTEM ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

Conduct Universal Body Mass Index (BMI) Screening and Assessment 

» Develop a policy on bundling of screening measures (so-called “advanced vital signs”), 

including BMI and physical activity. Bundle age-specific measures for children’s BMI 

documentation with physical activity, nutrition, screen time, healthy beverages, and others. 

» Gather and provide accurate and timely clinical data, following clinical guidelines, on BMI 

for all patients across the lifespan. Measure height and weight and calculate BMI. Put data 

in patient charts, and track BMI trends. 

» Work collaboratively with the IHS workgroup that addresses accountability measures 

regarding specific obesity measures as informed by Government Performance and Results 

Act (GPRA) and Clinical Reporting System (CRS) Part 1. 

» Ensure that appropriate anthropometric measurement devices are available at all IHSfunded sites. 

» Educate all health care personnel on accurate measurement of height and weight and on the 

use of BMI-for-age as a tool for assessing growth and development. 

» Heighten the role of agency coordinator(s) for data collection and reporting of trends in 

weight for people at all ages to build a comprehensive database and surveillance system. 

» Promote and implement universal, age-appropriate physical activity screening across the 

lifespan. 

Provide Pre-conception and Prenatal Counseling and Care 

Prenatal care 

» Offer nutrition education and weight management counseling 


to all women planning pregnancy and to pregnant women.
 

» Screen all pregnant women for gestational diabetes at the first 


prenatal visit and at 24–28 weeks of gestation. 

»	 Assess weight gain pattern at each prenatal visit. 

»	 Coordinate prenatal nutrition education and ensure access to 

optimum healthful foods through the Special Supplemental 

Nutrition Program for Women, Infants, and Children program 

(WIC). 

»	 Offer intensive medical nutrition therapy to women of child-bearing age who have diabetes 

to ensure healthy weight and excellent blood glucose control at the time of conception and 

throughout the perinatal period. 

» Provide education to mothers and mothers-to-be (especially to those with gestational 

diabetes) on the role of modeling and practicing healthful eating and physical activity. 

» Provide education to pregnant women, families, community, and health care staff about the 

weight management and diabetes prevention benefits of breastfeeding. 

» Intensify public health efforts to prevent maternal smoking before and during pregnancy 

because of the evidence linking maternal smoking to childhood obesity and diabetes control. 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 11 

 

Provide Breastfeeding and Infant Feeding Education and Support (Post Partum) 

Actions for Health Care Teams and Leaders 

HEALTH CARE SYSTEM ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

Post partum care 

» Develop a breastfeeding-friendly culture policy based on 

the World Health Organization’s Ten Steps to Successful 

Breastfeeding. Establish hospital policies to promote 

breastfeeding; encourage IHS direct hospitals to work toward 

Baby-Friendly Hospital designations. 

» Offer breastfeeding support tools, education, and resources to 

community and health care personnel. 

» Use the infant feeding tool in Electronic Health Records (EHR), Resource and Patient 

Management System (RPMS), and CRS to monitor trends and follow up with patients. 

» Use the infant feeding tool to measure breastfeeding rates for 2-, 6-, 9-, and 12-month-old 

infants. 

» Provide post partum followup support for breastfeeding families. 

» Provide mothers and families with resources for breastfeeding support, including contact 

numbers for national, state, and Tribal breastfeeding coalitions and IHS breastfeeding 

hotlines. 

» Assist nursing mothers with practical and realistic strategies to continue breastfeeding even 

when they are separated from their infants by work, school, or other circumstances. 

» Encourage accommodations for breastfeeding mothers at the worksite. 

» Encourage access for breastfeeding employees to resources, such as hospital-grade electric 

breast pumps and WIC electric breast pumps. 

» If mothers or families choose to bottle feed, provide appropriate education on feeding 

in response to hunger cues, weaning, timely introduction of solids, and avoidance of 

overfeeding. 

» Offer nutrition education and weight management counseling to all women post partum. 

» Screen women with gestational diabetes for diabetes 6–12 weeks post partum and follow up 

with subsequent screening for the development of diabetes or pre-diabetes. 

Implement Comprehensive,Agency-Wide Food Standards Policies for Promoting Healthy Weight 

Healthy Heart worksite 

nutrition class 

»	 Implement food standards for hospitals and clinics addressing 

patient meal service. 

»	 Implement food standards for worksites addressing employee 

cafeterias, vending machines, and food vendors that come on 

campuses, as well as foods served at IHS meetings and events. 

»	 Implement procurement policies for food and formula. 

»	 Implement human resources policy changes consistent with the 

food standards policies. 
12 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

Implement Universal Nutrition and Physical Activity Education 

HEALTH CARE SYSTEM ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

Medical nutrition therapy, IHS 

Turtle Mountain Comprehensive 

Healthcare Center 

» Implement universal health education and awareness campaigns 

for individuals and families regarding healthful eating behaviors 

and increased physical activity to promote healthy weight across 

the lifespan. 

» Encourage parents to support and model healthful eating and 

engage in regular physical activity with their children. 

» Provide quality information about healthy weight management 

to patients, health care personnel, and communities through 

improved information systems and multimedia communications. 

» Offer lifestyle intervention programs for individuals who are overweight. (E.g., provide 

the Lifestyle Balance program developed by the Special Diabetes Program for Indians to 

individuals and families through classes and support groups.) 

» Connect people with services that support healthy behaviors, including consulting 

techniques in cognitive restructuring, motivational interviewing, and group support. 

» Mobilize local health advocates—community health representatives, health promotion/ 

disease prevention area coordinators, health educators, and public health nurses—to 

promote healthful eating and physical activity in the community. 

» Incorporate traditional and contemporary Native healing and wellness, such as prayer, 

affirmations, sweats, dances, local medicinals and plants, acupuncture, yoga, and 

meditation. 

» Promote and advocate for healthful eating and physical activity policies in schools, 

worksites, Tribal organizations, etc. (See suggested policies in “Healthy Weight for Life: A 

Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives, 

Actions for Communities, Individuals, and Families.”) 

» Partner with local businesses and organizations to increase access to healthy food and 

opportunities for physical activity. 

Deliver Quality Health Care 

Patient exam, Santa Fe 

IHS Hospital 

»	 Identify and disseminate evidence-based best practices regarding healthy 

weight management; promote consistent messages based on proven 

science and methods to improve effectiveness. 

»	 Define the scope of services for healthy weight management and 

provide guidance to health care personnel by disseminating clinical care 

guidelines and standards of care. 

»	 Assess individuals already overweight or obese for complications and 

co-morbidities. Provide counseling and/or medical nutrition therapy. 

Identify and refer patients to resources that promote personalized weight 

reduction, weight management, nutrition, and physical activity. 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 13 

 

 

 

Actions for Health Care Teams and Leaders 

HEALTH CARE SYSTEM ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

» Use the Care Model developed by the IHS Improving Patient Care program (on the Web 

at http://www.ihs.gov/ipc/index.cfm?module=dsp_ipc_improvprog_models) to align 

all resources of the care team to improve quality of care for individuals, families, and 

communities. 

» Assess and address the behavioral and emotional components that affect an individual’s 

weight and health. 

» Integrate behavioral health into the primary care health care team. In collaboration with the 

patient, address physical, emotional, cognitive, and financial barriers and develop coping 

strategies. 

» Understand the unique role behavioral therapy plays in referrals for more complex issues, 

such as disordered eating and depression. 

» Conduct audits and assessments to monitor the quality of care provided to overweight and 

obese individuals. 

» Incorporate a quality improvement effort focusing on healthy weight across IHS initiatives 

and programs (e.g., the Improving Patient Care program, the Special Diabetes Program for 

Indians, and the Maternal and Child Health initiative). 

Match the Size and Capability of the Workforce to the Disease Burden 

Northern Navajo Native Lifestyle 

Balance staff 

»	 Increase the number of registered dietitians who plan, 

facilitate, deliver, and evaluate services to support healthy 

weight management to meet standardized staffing ratios. 

»	 Increase the number of other personnel who plan, facilitate, 

deliver, and evaluate services to support healthy weight 

management. 

»	 Strengthen workforce skills and role modeling behaviors 

related to nutrition and physical activity by implementing staff 

wellness policies and programs. 

»	 Emphasize training of health care personnel in behavioral modification and motivational 

interviewing skills in clinical and community settings. 

»	 Train health care personnel to be culturally and empathically skilled in working with 

overweight and obese individuals and to present culturally sensitive, standardized 

information and curricula/materials. (The IHS Division of Diabetes Treatment and 

Prevention has best practices for nutrition and physical activity.) Increase awareness, 

training, and utilization of toolkits for health care personnel on documentation of nutrition 

and physical activity in the EHR and RPMS. 

»	 Increase awareness, training, and utilization of evidence-based best practices regarding 

healthy weight management. 
14 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

HEALTH CARE SYSTEM ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

Identify Ways to Increase Reimbursement for Healthy Weight Management 

Medical nutrition therapy 

reimbursement team, IHS Turtle 

Mountain Comprehensive 

Healthcare Center 

»	 Determine how to quantify the impact of obesity and overweight 

on agency resources. 

»	 Establish a dialogue within the Indian health system and with 

payers to consider classifying obesity as a disease category for 

reimbursement coding. 

»	 Make the case for the cost-effectiveness of prevention and 

treatment services to promote healthy weight across the lifespan. 

»	 Develop a business plan for reimbursement of weight 

management (e.g., medical nutrition therapy, early periodic 

screening, diagnosis, and treatment). 

»	 Use the lessons learned from the IHS “Step-by-Step Guide to Medicare Medical Nutrition 

Therapy Reimbursement” to guide efforts to seek reimbursement for healthy weight 

management. 

»	 Promote third-party reimbursement for medical nutrition therapy and other services. 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 15 

 

 

 

 

 

 

 

 

 

Actions for Health Care Teams and Leaders 

AGENCY ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

Agency Actions to Promote Healthy Weight for Life 

Create a Standing Body in the Indian Health System—the Healthy Weight for Life Workgroup—to 

Help Implement the Vision 

Indian Health Service staff 

»	 Identify the members of a new core workgroup, currently 

envisioned as a small and responsive team. 

»	 Convene subcommittees to design and implement IHS’ top 

three priorities. 

»	 Develop an implementation and evaluation plan for 

achieving healthy weight goals. 

»	 Establish working relationships with Tribal leaders who 

are advising on various IHS initiatives, such as the Special 

Diabetes Program for Indians. 

»	 Establish working relationships with leaders in relevant IHS offices, divisions, and 


programs.
 

»	 Keep healthy weight an agency priority through deliberate, ongoing communications and 


program marketing (such as a Web site, e-bulletins, listserv messages, articles in IHS Primary 


Care Provider, etc.).
 

» Enlist stakeholders to deliver presentations at key national and regional Indian health 


meetings.
 

» Offer periodic webinars and trainings at national and regional meetings to promote healthy 


weight management throughout the Indian health system.
 

»	 Develop companion “how to” toolkits for key audiences to implement healthy weight 


management strategies (such as the IHS Physical Activity Kit developed by the Health 


Promotion/Disease Prevention program).
 

»	 Routinely revisit progress on the Healthy Weight for Life initiative during the annual 


meeting of the Medical Nutrition Therapy Collaborative at the IHS Combined Councils 


meeting.
 

»	 Oversee, plan, and implement a social marketing campaign (see below). 

Promote and Support Lifestyle Change Strategies for Healthy Weight Across the Lifespan 

Throughout the Indian Health System 

Diabetes regional meeting 

»	 Implement a comprehensive food standards policy that 

includes patient meal service, employee cafeterias, vending 

machines, formula and food procurement, as well as foods 

and beverages served at IHS functions (including meetings). 

»	 Coordinate breastfeeding education activities with the 

IHS national Head Start and Maternal and Child Health 

programs and with Women, Infants, and Children (WIC) 

programs. 
16 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

AGENCY ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE
 

» Monitor and track breastfeeding education services and activities in IHS and Tribal 

facilities. 

» Continue to promote the IHS best practices throughout the Indian health system. 

» Increase the number and types of trained personnel who plan, facilitate, deliver, and 

evaluate community programs to promote healthful eating and physical activity. 

» Ensure that all chronic disease, behavioral health, and health promotion and disease 

prevention programs and initiatives throughout IHS incorporate healthful eating and 

physical activity programs into their work plans. 

» Monitor and track programs and activities designed to promote regular, lifelong healthful 

eating and physical activity. 

» Assess and update IHS workplace wellness policies related to healthful eating and physical 

activity. 

» Promote a healthy weight norm in the IHS workforce by implementing organized wellness 

programs and events, including: healthful eating education programs; healthy foods in 

vending machines and cafeterias; healthy weight loss programs (rather than rapid weight 

loss competitions); and physical activity programs, such as the Physical Activity Kit, the Just 

Move It campaign, and the use of pedometers to increase the number of steps per day. 

» Promote and implement universal, age-appropriate physical activity screening across the 

lifespan. 

Increase Quality Improvement, Program Evaluation, and Research on Healthy Weight Management 

» Work collaboratively with the American Indian and Alaska Native Health Research 

Advisory Council (http://www.omhrc.gov/hrac/). 

» Partner with Envision New Mexico, a project of the Department of Pediatrics at the 

University of New Mexico Health Sciences Center (http://www.envisionnm.org). 

»	 Partner with: the Committee on Native American Child Health of the American Academy 

of Pediatrics (AAP) (http://www.aap.org/NACH/); the American Association of Indian 

Physicians (http://www.aaip.org/); First Nations Behavioral Health Association (http:// 

www.fnbha.org/); the Society of Indian Psychologists (http://aiansip.org/); the Indian 

Country section of the American Psychological Association Psychologists in Public Service; 

and others. 

»	 Partner with the National Institutes of Health (NIH), the Centers for Disease Control and 

Prevention (CDC), and the Agency for Healthcare Research and Quality to support healthy 

weight management research and evaluation among AI/AN. 

»	 Partner with Native American Research Centers for Health (http://www.ihs.gov/ 

medicalprograms/research/narch.cfm). 

Foster Collaboration and Innovation Across the Indian Health System and With External Partners 

»	 Strengthen and expand partnerships with Tribal leaders and Tribal organizations. 

»	 Develop and maintain partnerships within IHS and with other Federal agencies to ensure 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 17 

AI/AN have access to services and funding opportunities related to healthy weight management,
 

including: 


- The Department of Health and Human Services, including the Centers for Medicare and 


Medicaid Services, the Health Resources and Services Administration, the CDC, and the 

Administration for Children and Families. 

- The Department of Agriculture, including cooperative extension programs, Food Distribution 

Program on Indian Reservations, WIC, school nutrition programs, and senior meals on wheels 

programs. 

- The Department of the Interior, including the Bureau of Indian Affairs.
 

 

 

 

 

Actions for Health Care Teams and Leaders 

AGENCY ACTIONS TO PROMOTE HEALTHY WEIGHT FOR LIFE 

- The Department of Housing and Urban Development.
 

- The Department of Justice.
 

»	 Strengthen and enhance partnerships with non-Federal agencies, managed care systems, 

universities, and private foundations. 

Design and Launch a Web Site to Promote Healthy Weight Management Strategies 

» Create a Web site to provide healthy weight management resources, such as the “Surgeon General’s 

Vision for a Healthy and Fit Nation 2010,” clinical guidelines, evidence-based best and promising 

practices, success stories, toolkits, PowerPoint slides, and awareness campaign messages. 

» Coordinate with the Health Promotion/Disease Prevention program and the Special Diabetes 

Program for Indians regarding resources already compiled. 

» Create a SharePoint site for the Healthy Weight for Life Workgroup to exchange information. 

» Create a database or data mart; link to CRS page with BMI. 

Plan and Implement a Social Marketing Campaign to Promote Healthy Weight 

»	 Compile examples of existing healthy weight campaign messages 

that could be adopted or tailored for use in AI/ AN communities 

(e.g., the 5-2-1-0, Small Step (HHS), and Just Move It 

campaigns). 

»	 Pre-test the healthy weight campaign messages in focus groups with AI/AN audiences. 

»	 Identify messages that are most appealing to AI/AN audiences. 

»	 Prepare a communications plan for a healthy weight awareness campaign. 

»	 Produce campaign messages and materials as outlined in the plan. 

»	 Disseminate the campaign to AI/AN communities throughout the Indian health system, via regional 

and national meetings, the media, the Internet, and local community channels. 
18 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Resources for Healthy Weight Management 

Food and Nutrition 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes Best 

Practice Nutrition for Diabetes Prevention and Care.” Albuquerque, NM, 2009. The revised 2009 

Indian Health Diabetes Best Practices are consensus-based approaches, developed by Indian health 

system professionals, for use in clinical and community settings to implement or improve diabetes 

treatment and prevention. These best practices describe nutrition recommendations that target 

people who are at risk of developing diabetes or currently living with diabetes. 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_Nutrition.pdf 

Indian Health Service Nutrition Program.“Strengthen the Family Circle.” The American Indian 

adaptation of the Dietary Guidelines for Americans features emotion-based messages and materials, 

including tips for healthy eating by AI/AN. 

http://www.ihs.gov/MedicalPrograms/Nutrition/documents/IHS6-handouts.pdf 

U.S. Department of Health and Human Services and U.S. Department of Agriculture.“Dietary 

Guidelines for Americans, 2010.” 7th Edition, Washington, DC: U.S. Government Printing Office, 

December 2011. The Dietary Guidelines for Americans are the cornerstone of Federal nutrition policy 

and nutrition education activities. The Dietary Guidelines are jointly issued and updated every 5 

years by the Departments of Agriculture and Health and Human Services (HHS). They provide 

authoritative advice for people 2 years and older about how dietary habits can promote health and 

reduce risk for major chronic diseases.

http://www.dietaryguidelines.gov 

WIN. The Weight-control Information Network is a service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), the Federal 

Government’s lead agency responsible for biomedical research on nutrition and obesity. WIN 

provides the general public, health professionals, the media, and Congress with up-to-date, sciencebased information on weight control, obesity, physical activity, and related nutritional issues. 

http://www.win.niddk.nih.gov
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 19 

 

 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Physical Activity 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes Best 

Practice Physical Activity for Diabetes Prevention and Care.”Albuquerque, NM, 2009. The revised 

2009 Indian Health Diabetes Best Practices are consensus-based approaches, developed by Indian 

health system professionals, for use in clinical and community settings to implement or improve 

diabetes treatment and prevention. This best practice describes physical activity recommendations 

for any person at risk for developing diabetes or living with diabetes. 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_Physical_ 

Activity.pdf 

Indian Health Service Health Promotion/Disease Prevention and University of New Mexico 

Prevention Research Center.“Physical Activity Kit (PAK): Staying on the Active Path in Native 

Communities ... a Lifespan Approach!” Albuquerque, NM, 2009. The goal of the comprehensive 

kit is to promote age- and culture-appropriate physical activities across the lifespan in Native 

American communities to increase each person’s time spent in moderate-to-vigorous physical 

activity. The kit has been successfully received in field testing in Tribal communities. 

http://www.ihs.gov/hpdp/index.cfm?module=dsp_hpdp_resources_physicalactivitykit 

U.S. Department of Health and Human Services. “2008 Physical Activity Guidelines for Americans.” 

Washington, D.C. 2008. The Physical Activity Guidelines for Americans are the most comprehensive 

of their kind. Adults gain substantial health benefits from 21⁄2 hours a week of moderate aerobic 

physical activity, and children benefit from an hour or more of physical activity a day, according to 

these guidelines. The guidelines are designed so people can fit physical activity into their daily plans 

and incorporate activities they enjoy. 

http://www.health.gov/paguidelines/ 

U.S. National Physical Activity Plan is a private-public sector collaborative, engaging hundreds of 

organizations dedicated to changing our communities in ways that will enable every American to 

be sufficiently physically active. The National Plan aims to create a culture that supports physically 

active lifestyles for the ultimate purposes of improving health, preventing disease and disability, and 

enhancing quality of life. 

http://physicalactivityplan.org/ 
20 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

 

 

 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Infants and Toddlers 

Administration for Children and Families, Office of Head Start. Early Childhood Learning and 

Knowledge Center. The Center offers relevant, timely information, knowledge, and learning 

to Head Start programs and the early childhood community in an easy-to-use format. It is a 

comprehensive resource for anyone involved with, or interested in, early childhood education, 

health, and wellness. 

http://eclkc.ohs.acf.hhs.gov/hslc 

Head Start Performance Standards and other subjects can be found at: 

http://eclkc.ohs.acf.hhs.gov/hslc/Program Design and Management/Head Start Requirements/Head 

Start Requirements 

Indian Health Service Web Site on Breastfeeding. IHS Breastfeeding Web page, part of the 

Maternal and Child Health Web site, provides moms, dads, parents, communities, and health 

care team members evidence-based information on human milk, lactation, and milk expression. 

Visitors to the site can join a listserv, scan frequently asked questions, and find links to other 

breastfeeding sites, making this the “go to” IHS reference site. 

http://www.ihs.gov/MedicalPrograms/MCH/M/bf.cfm 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes Best 

Practice Breastfeeding Support.”Albuquerque, NM, 2009. The revised 2009 Indian Health Diabetes 

Best Practices are consensus-based approaches, developed by Indian health system professionals, 

for use in clinical and community settings to implement or improve diabetes treatment and 

prevention. This best practice provides clinical tools and technical resources to effectively support 

breastfeeding. 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_ 

Breastfeeding.pdf 

U.S. Department of Agriculture, WIC Program.“Infant Nutrition and Feeding.” This handbook 

provides an overview of topics related to infant nutrition and feeding and answers some common 

questions on feeding infants. Chapter topics include: the nutritional needs of infants; the 

development of feeding skills; breastfeeding; formula feeding; the introduction of complementary 

foods; oral health; obesity; and physical activity and motor skill development. It is available as a 

PDF. 

http://www.nal.usda.gov/wicworks/Topics/Infant_Feeding_Guide.html#guide 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 21 

 

 

 

 

 

 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

U.S. Department of Health and Human Services, Office on Women’s Health. “An Easy Guide to 

Breastfeeding for American Indian and Alaska Native Families.” This 28-page online booklet is for 

all American Indian and Alaska Native women and their families who choose to breastfeed. The 

booklet covers healthcare benefits, planning, workplace accommodations, and the father’s role in an 

easy-to-read text, designed to answer women’s and families’ questions. 

http://www.womenshealth.gov/pub/BF.AIAN.pdf 

Children and Adolescents 

American Academy of Pediatrics. “5-2-1-0 Pediatric Obesity Clinical Decision Support Chart.” 

This flipchart, a BMI calculator, and other clinical tools provide health care team members with 

practical support and guidance to help improve care and outcomes for overweight children. 

http://www.aap.org/obesity/clinical_resources.html 

Indian Health Service Division of Diabetes Treatment and Prevention and Division of Information 

Resource Management.“Promoting a Healthy Weight in Children and Youth: Clinical Strategies, 

Recommendations, and Best Practices.” Albuquerque, NM, 2008. This IHS report outlines clinical 

strategies on five childhood obesity prevention and treatment recommendations for health care 

professionals in Indian Health Service, Tribal, and urban Indian health clinical settings. The report’s 

five recommendations are based on the best available clinical evidence regarding the prevention and 

treatment of childhood overweight. 

http://www.diabetes.ihs.gov/HomeDocs/Tools/ClinicalGuidelines/Promoting_Healthy_ 

Weight_1208.pdf 

National Initiative for Children’s Healthcare Quality (NICHQ). NICHQ is an independent, 

action-oriented organization dedicated to achieving a world in which all children receive the highquality health care they need. NICHQ’s current initiatives include the prevention and treatment of 

childhood obesity and improving perinatal care. 

http://www.nichq.org 

Indian Health Service Head Start Program.“My Amazing Body.” My Amazing Body is a 

comprehensive curriculum that meets the Head Start Performance Standards. The curriculum is 

specifically designed for American Indian and Alaska Native Head Start children, with the intent to 

include exercise and nutrition. My Amazing Body is divided into 10 lesson plans that incorporate a 

weekly nutritional experience, physical activity, and teacher and parent resources. The lesson plans 

are divided into “Learning Circle” and “Hands-on Learning Activities.”To assist the teacher, each 

activity is divided into domains, with measurable objectives, materials needed, and step-by-step 

instructions. For additional information contact: IHSHeadStart@ihs.gov. 
22 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT
 

U.S. Department of Health and Human Services, Office on Women’s Health.“BodyWorks Program 

and Toolkit.” BodyWorks is designed to help women and girls improve family eating and activity 

habits. The toolkit includes games, a recipe book, food and fitness journals for teens, and a “how 

to” video. Ten American Indian sites field tested the Native American version, and the American 

Indian and Alaska Native version will be available. See general population version at: 

http://www.womenshealth.gov/bodyworks/ 

Adults and Elders 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes 

Best Practice Adult Weight Management and Diabetes.” Albuquerque, NM, 2009. The revised 2009 

Indian Health Diabetes Best Practices are consensus-based approaches, developed by Indian health 

system professionals, for use in clinical and community settings to implement or improve diabetes 

treatment and prevention. This best practice provides recommendations to achieve and maintain a 

healthy weight for adults with diabetes regardless of duration of diabetes. 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_Adult_ 

Wt_Management.pdf 

NIH SeniorHealth. Easy-to-use Web site features basic health and wellness information for older 

adults on a variety of nutrition topics. Numerous videos, pamphlets, and online guides are available 

on healthful eating, shopping, and cooking for adults over 50. Hear the text read aloud or view the 

videos online. The “Eating Well as You Get Older” section is available at: 

http://nihseniorhealth.gov/eatingwellasyougetolder/toc.html 

The “Exercise and Physical Activity for Older Adults” section is available at: 

http://nihseniorhealth.gov/exerciseforolderadults/toc.html 

National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Prevention Program 

Lifestyle Balance Program Materials. Participant handouts and lifestyle coach materials are 

available in PDF and RTF formats. 

http://www.bsc.gwu.edu/dpp/lifestyle/dpp_part.html 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 23 

 

 

 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Governments/Policymakers 

Indian Health Service.“Indian Health Service Strategic Plan 2006–2011.” Rockville, MD, 2006. The 

IHS Strategic Planning Workgroup, a diverse group of Indian health stakeholders, developed the 

plan to leverage the HHS Strategic Plan and the President’s Management Agenda. 

http://www.ihs.gov/PlanningEvaluation/documents/IHSStrategicPlan20062011.pdf 

Institute of Medicine and the National Research Council of the National Academies.“Local 

Government Actions to Prevent Childhood Obesity.” Washington, DC: National Academies Press, 

2009. The Institute of Medicine’s Committee on Childhood Obesity Prevention Actions for Local 

Governments was convened to identify promising actions that local governments can take to curb 

obesity among children. The report offers a list of actions that hold the greatest potential to curb 

obesity rates among children. Many of these steps focus on increasing access to healthy foods and 

opportunities for active play and exercise. 

http://www.iom.edu/Reports/2009/ChildhoodObesityPreventionLocalGovernments.aspx 

Pitt Barnes, S, Robin, L, Dawkins, N, Leviton, L, and Kettel-Khan, L (2009).“Early Assessment of 

Programs and Policies to Prevent Childhood Obesity Evaluability Assessment Synthesis Report: 

Local Wellness Policy.”Atlanta: U.S. Department of Health and Human Services, Centers for 

Disease Control and Prevention. The report identifies and assesses local-level programs and policies 

that have been implemented with apparent success to prevent obesity by improving the eating 

habits and physical activity levels of youth ages 3–17 years. 

http://www.cdc.gov/obesity/downloads/LWP_Synthesis_Report.pdf 

U.S. Department of Health and Human Services.“The Surgeon General’s Vision for a Healthy and 

Fit Nation” Rockville, MD: Office of the Surgeon General, January 2010. The recommendations 

identify opportunities for improving our communities, encouraging healthy choices and healthy 

home environments, creating healthy child care settings, creating healthy schools, creating healthy 

work sites and mobilizing medical communities. 

http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf 

U.S. Department of Health and Human Services.“The Surgeon General’s Call to Action to Prevent 

and Decrease Overweight and Obesity: Overweight in Children and Adolescents.” Washington, DC. 

This online fact sheet describes the causes of overweight in youth, assessment of growth, and tips 

for families on physical activity and healthful eating. 

http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm 
24 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT
 

U.S. Department of Health and Human Services.“The Surgeon General’s Call to Action to Prevent 

and Decrease Overweight and Obesity, 2001.” Washington, DC. 2001.The Call to Action Report 

outlines strategies that communities can use in helping to address the problems. These options 

include requiring physical education at all school grades, providing more healthy food options on 

school campuses, and providing safe and accessible recreational facilities for residents of all ages. 

http://www.surgeongeneral.gov/topics/obesity/ 

Schools and Programs for Youth 

Centers for Disease Control and Prevention.“Children’s BMI Tool for Schools.” The Children’s 

BMI Tool for Schools is an Excel spreadsheet intended for use by school, child care, and other 

professionals who want to compute BMI-for-age for a group of up to 2,000 children (e.g., a school 

classroom or grade). This calculator computes BMI and BMI percentiles for individual children 

in a group using height and weight measurements, sex, date of birth, and date of measurement 

information. It provides a group summary of children’s BMI-for-age categories and graphs for 

prevalence of overweight and obesity and for prevalence of overweight and obesity by sex. 

http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.html 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes 

Best Practice School Health: Promoting Healthy Habits and Preventing Disease.”Albuquerque, 

NM, 2009. The revised 2009 Indian Health Diabetes Best Practices are consensus-based 

approaches, developed by Indian health system professionals, for use in clinical and community 

settings to implement or improve diabetes treatment and prevention. This best practice presents 

recommendations for comprehensive school health programs that serve youth of all ages. 

http://www.diabetes.ihs.gov/HomeDocs/Tools/BestPractices/2009_BP_School_Health.pdf 

Indian Health Service Head Start Program.“My Amazing Body.” My Amazing Body is a 

comprehensive curriculum that meets the Head Start Performance Standards. The curriculum is 

specifically designed for American Indian and Alaska Native Head Start children with the intent to 

include exercise and nutrition. My Amazing Body is divided into 10 lesson plans that incorporate a 

weekly nutritional experience, physical activity, and teacher and parent resources. The lesson plans 

are divided into “Learning Circle” and “Hands-on Learning Activities.”To assist the teacher, each 

activity is divided into domains with measurable objectives, materials needed, and step-by-step 

instructions. For additional information contact: IHSHeadStart@ihs.gov. 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 25 

 

 

 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Comprehensive School Physical Activity Programs Package is an online resource of the National 

Association for Sport and Physical Education. The program advocates physical activity 

programming before, during, and after the school day and includes quality physical education, 

school-based physical activity opportunities, school employee wellness and involvement, and family 

and community involvement. 

http://www.aahperd.org/naspe/publications/teachingTools/cspa.cfm 

Move It! And Reduce Your Risk for Diabetes School Kit, developed by the American Indian/Alaska 

Native Workgroup of the National Diabetes Education Program, helps schools develop programs 

that promote physical activity among American Indian and Alaska Native youth. The Move It! kit 

includes customizable posters of youth engaging in fun physical activities, a fact sheet that can be 

used as a teaching aid, and sample newsletter text for school and community publications. 

http://ndep.nih.gov/media/moveit_school_kit.pdf 

The Diabetes Education in Tribal Schools (DETS) Curriculum for grades K-12 integrates science 

and Native American traditions to educate students about diabetes and its risk factors and about 

the importance of nutrition and physical activity in maintaining health and balance in life. The 

curriculum was developed by the National Institute of Diabetes and Digestive and Kidney Diseases 

and the IHS Division of Diabetes Treatment and Prevention. Teachers can order a printed copy of 

the curriculum and related materials from the IHS Division of Diabetes Treatment and Prevention 

online catalog at: 

http://www.diabetes.ihs.gov/RESOURCES/Catalog/rde/index.cfm?module=catalog&opt=2 

An electronic version is available at Keweenaw Bay Ojibwa Community College Web site: 

http://www.kbocc.org/dets.htm 
26 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

 

 

 

 

 

 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Worksites 

The Centers for Disease Control and Prevention’s LEAN Works! is a Web-based resource that offers 

interactive tools and evidence-based resources to design effective worksite obesity prevention and 

control programs, including an obesity cost calculator to estimate how much obesity is costing your 

company and how much savings your company could reap with different workplace interventions. 

http://www.cdc.gov/leanworks/ 

Indian Health Service Circular No. 2006–05. “Lactation Support Program.” This IHS Lactation 

Support in the Workplace Policy, a benefit for IHS employees, their families, and the workplace, is 

provided online with downloadable toolkit. July 7, 2006. 

http://www.ihs.gov/PublicInfo/Publications/IHSmanual/Circulars/Circ06/Circ06_05/circ06_05/ 

circ06_05.htm 

Communities 

Indian Health Service, Health Promotion/Disease Prevention and University of New 


MexicoPrevention Research Center.“Physical Activity Kit (PAK): Staying on the Active Path 


in Native Communities ... a Lifespan Approach!” Albuquerque, NM, 2009. The goal of the 


comprehensive kit is to promote age- and culture-appropriate physical activities across the lifespan 


in Native American communities to increase each person’s time spent in moderate-to-vigorous 


physical activity. The kit has been successfully received in field testing in Tribal communities.
 

http://www.ihs.gov/hpdp/index.cfm?module=dsp_hpdp_resources_physicalactivitykit
 

Indian Health Service.“Healthy Beverages Community Action Kit, 2006.”This kit is designed 


to help take action to increase access to healthy beverages in Tribal communities. It includes 


assessment forms, fact sheets, sample letters to Tribal officials, Tribal resolutions, a presentation,
 

and over 25 Web resources. To download the kit, visit the IHS Web site at the link below and click 


on “Healthy Beverages Kit”: 


http://www.ihs.gov/MedicalPrograms/Nutrition/
 

Khan L, Sobush K, Keener D, Goodman K, Lowry A, Kakietek J, Zaro S.“Recommended Community 


Strategies and Measurements to Prevent Obesity in the United States.” Morbidity and Mortality 


Weekly Report. July 24, 2009. Vol. 58 (RR–7). The 24 recommended community strategies represent 


a first step that communities can use to assess local policies and environments that support healthy 


eating and active living.
 

http://www.cdc.gov/mmwr/PDF/rr/rr5807.pdf
 

A companion manual,“Implementation and Measurement Guide,” shows how local governments 


can use community strategies and measures of environmental and policy change.
 

http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf
 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 27 

 

 

 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

A walkable environment naturally supports children as they play, exercise, and go to school. But, 

pedestrian death and injury rates on Tribal roads are very high. The Tribal School Zone Safety 

toolkit from the Office of Federal Lands Highway (U.S. Department of Transportation) has videos 

and publications to educate children and adults on safe walking on sidewalks, along roads and 

streets, at bus stops, and through parking lots.“Safety Doesn’t Happen by Accident,” an 8-minute 

video, primarily targets AI/AN children 9 to 12 years old in classroom or community settings. 

“Pedestrian Safety: A New Tradition,” a 9.5-minute video produced by Tribal leaders, is geared to 

Tribal and community elders, parents and guardians of school-age children, school board members, 

policy makers, and older teens. 

http://flh.fhwa.dot.gov/programs/irr/safety/school-zones.htm 

Health Care Teams and Leaders 

American Academy of Pediatrics.“5-2-1-0 Pediatric Obesity Clinical Decision Support Chart.” This 


flipchart, a BMI calculator, and other clinical tools provide health care team members with practical 


support and guidance to help improve care and outcomes for overweight children.
 

http://www.aap.org/obesity/clinical_resources.html
 

The CDC’s Body Mass Index Web site has easy-to-use BMI calculators for adults and for children 


and teens.
 

http://www.cdc.gov/healthyweight/assessing/bmi/
 

The CDC has a Growth Charts Web site to help pediatricians, nurses, and parents track the growth 


of children and teens according to CDC and World Health Organization standards.
 

http://www.cdc.gov/growthcharts/
 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes 


Best Practice Adult Weight Management and Diabetes.”Albuquerque, NM, 2009. The revised 2009 


Indian Health Diabetes Best Practices are consensus-based approaches, developed by Indian health 


system professionals, for use in clinical and community settings to implement or improve diabetes 


treatment and prevention. This best practice provides recommendations to achieve and maintain a 


healthy weight for adults with diabetes regardless of duration of diabetes.
 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_Adult_
 

Wt_Management.pdf
 
28 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT
 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes Best 


Practice Breastfeeding Support.”Albuquerque, NM, 2009. The revised 2009 Indian Health Diabetes 


Best Practices are consensus-based approaches, developed by Indian health system professionals,
 

for use in clinical and community settings to implement or improve diabetes treatment and 


prevention. This best practice provides clinical tools and technical resources to effectively support 


breastfeeding.
 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_
 

Breastfeeding.pdf
 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes Best 


Practice Nutrition for Diabetes Prevention and Care.”Albuquerque, NM, 2009. The revised 2009 


Indian Health Diabetes Best Practices are consensus-based approaches, developed by Indian health 


system professionals, for use in clinical and community settings to implement or improve diabetes 


treatment and prevention. These best practices describe nutrition recommendations that target 


people who are at risk of developing diabetes or currently living with diabetes.
 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_
 

Nutrition.pdf
 

Indian Health Service Division of Diabetes Treatment and Prevention.“Indian Health Diabetes Best 


Practice Physical Activity for Diabetes Prevention and Care.”Albuquerque, NM, 2009. The revised 


2009 Indian Health Diabetes Best Practices are consensus-based approaches, developed by Indian 


health system professionals, for use in clinical and community settings to implement or improve 


diabetes treatment and prevention. This best practice describes physical activity recommendations 


for any person at risk for developing diabetes or living with diabetes.
 

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2009_BP_Physical_
 

Activity.pdf
 

Indian Health Service Division of Diabetes Treatment and Prevention.“Step-by-Step Guide to 


Medicare Medical Nutrition Therapy Reimbursement.”Albuquerque, NM, 2010 (in press).
 

Updated from July 2006 edition, this guide shows how teamwork among health care providers,
 

executives, and data entry and billing personnel makes a difference—not only to the health of 


patients by increasing access to nutrition services, but also to a clinic’s financial bottom line.
 

Coming soon to: 


http://www.ihs.gov/medicalprograms/diabetes/
 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 29 

 

 

 

 

 

 

 

 

Actions for Health Care Teams and Leaders 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Indian Health Service Division of Diabetes Treatment and Prevention and Division of Information 

Resource Management.“Promoting a Healthy Weight in Children and Youth: Clinical Strategies, 

Recommendations, and Best Practices.” Albuquerque, NM, 2008. This IHS report outlines clinical 

strategies on five childhood obesity prevention and treatment recommendations for health care 

professionals in Indian Health Service, Tribal, and urban Indian health clinical settings. The report’s 

five recommendations are based on the best available clinical evidence regarding the prevention and 

treatment of childhood overweight. 

http://www.diabetes.ihs.gov/HomeDocs/Tools/ClinicalGuidelines/Promoting_Healthy_ 

Weight_1208.pdf 

Indian Health Service and Inter Tribal Council of Arizona, Inc. “American Indian and Alaska 

Native Pediatric Height and Weight Study Web Site: Training Guide.” The guide illustrates correct 

procedures for weighing or measuring an infant or child. 

http://www.ihs.gov/MedicalPrograms/Anthropometrics/index.cfm?module=train&option=guide&new 

query=1 

National Heart, Lung, and Blood Institute and North American Association of the Study of Obesity. 

“The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in 

Adults.” Bethesda, MD, 2000. The guide describes how health care practitioners can provide their 

patients with the direction and support needed to effectively lose weight and keep it off. It provides 

the basic tools needed to appropriately assess and manage overweight and obesity. The guide 

includes practical information on dietary therapy, physical activity, and behavior therapy, while also 

providing guidance on the appropriate use of pharmacotherapy and surgery as treatment options. 

http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf 

National Initiative for Children’s Healthcare Quality (NICHQ). NICHQ’s current initiatives 

focus on ensuring that every child receives care in a high-performing medical home, including the 

prevention and treatment of childhood obesity and improving perinatal care. 

http://www.nichq.org 

U.S. Preventive Services Task Force.“Screening for Obesity in Children and Adolescents: U.S. 

Preventive Services Task Force Recommendation Statement.” Pediatrics. February 2010. Vol. 125 

(2), pp. 361–367. The task force recommends that clinicians screen children ages 6 years and older 

for obesity and offer them, or refer them to, intensive counseling and behavioral interventions to 

promote improvements in weight status. 

http://pediatrics.aappublications.org/cgi/content/full/125/2/361 
30 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

RESOURCES FOR HEALTHY WEIGHT MANAGEMENT 

Social Marketing/Awareness Campaigns 

The CDC’s Social Marketing for Nutrition and Physical Activity online course teaches public 


health professionals how to use social marketing to plan nutrition, physical activity, and obesity 


prevention programs.
 

http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/
 

Just Move It is a national campaign to promote physical activity for American Indians and Alaska 


Natives. Use the Web site below to learn how to start an activity in your own community, share 


information about ongoing programs, contribute stories, find resources, and enter information in 


Just Move It’s calendar.
 

http://justmoveit.org/jmi/home.htm
 

The Let’s Move! campaign has an ambitious, but important, goal: to solve the epidemic of 


childhood obesity within a generation. Join First Lady Michelle Obama, community leaders,
 

teachers, doctors, nurses, moms, and dads in a nationwide campaign to tackle the challenge of 


childhood obesity.
 

http://www.letsmove.gov/
 

McCormack Brown, K., Alfonso, M.L., and Bryant, C.A. “Obesity Prevention Coordinators’ Social 


Marketing Guidebook.”Tampa, FL, 2004. Developed by the Florida Prevention Research Center at 


the University of South Florida, the guidebook, provides instruction on how to coordinate a social 


marketing intervention for nutrition, physical activity, or obesity prevention. It includes worksheets,
 

tools, and information to help in the management and coordination of a social marketing program.
 

The guidebook supplements the CDCynergy Social Marketing Edition, an interactive training and 


decision-support tool, and adds practical tips and information specific to nutrition, physical activity,
 

and obesity.
 

http://health.usf.edu/NR/rdonlyres/1F6E6B64-967D-45D1-8BC1-357EC9B3BC30/24125/
 

ObesityPreventionCoordinatorsSocialMarketingG.pdf
 

National Diabetes Education Program (NDEP). We Have the Power to Prevent Diabetes.
 

Radio and print public service ads and tip sheets, tailored for American Indians and Alaska Natives 


at risk for type 2 diabetes, promote moving more and eating less to lower their risk for diabetes.
 

Copyright-free ads and tip sheets can be downloaded from the NDEP Web site.
 

Print ads: http://www.ndep.nih.gov/media/Power_ads_ai.pdf
 

Radio ads: http://www.ndep.nih.gov/resources/ResourceDetail.aspx?ResId=78
 

Tip Sheets: http://www.ndep.nih.gov/media/Power_tips.pdf
 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 31 

 

Actions for Health Care Teams and Leaders 

ACKNOWLEDGMENTS 

Acknowledgments 

The Core Workgroup Leaders wish to acknowledge all the individuals whose hard work, expertise, 

and ideas contributed to crafting “Healthy Weight for Life: A Vision for Healthy Weight Across the 

Lifespan of American Indians and Alaska Natives.” 

Kelly Acton, Director, IHS Division of Diabetes Treatment and Prevention 


Amina Bashir, Health Service Officer, IHS Division of Behavioral Health 


Alberta Becenti, Health Promotion/Disease Prevention Consultant, IHS Office of Clinical and 


Preventive Services* 


Norma Benally, Public Health Nurse, Dzilth-NA-O-Dith-Hle Health Center 


Silvia Benincaso, Supervisory Clinical Dietitian, Phoenix Indian Medical Center 


Bob Bialas, Early Childhood Health and Safety Specialist, IHS Head Start Program 


Nancy Bill, Principal Injury Prevention Consultant, IHS Office of Environmental Health and 


Engineering
 

Melissa Boney, Budget Analyst, IHS Office of Finance and Accounting
 

Jill Breyen, IHS Bemidji Area Nutrition Contact, Red Lake Hospital and Healthcare Facility 


Brenda Broussard, Consultant/Meeting Facilitator 


Tammy Brown, Nutrition Consultant, IHS Division of Diabetes Treatment and Prevention* 


Ann Bullock, IHS Chief Clinical Consultant for Family Practice and Medical Advisor, IHS 


Division of Diabetes Treatment and Prevention 


Cecelia Butler, Clinical Dietitian/Diabetes Program Coordinator, Santa Fe Indian Hospital 


Joshua Cabrera, Child Psychiatrist, IHS Navajo Area 


Mark Carroll, Program Director, IHS Telehealth Program 


Jean Charles-Azure, IHS Principal Nutrition Consultant 


Edith Clark, Director, Nutrition Services and Director, IHS Southwestern Dietetic internship 


Consortium, Phoenix Indian Medical Center, and USPHS, Chief Professional Officer—Dietetics
 

Honorable Norman Cooeyate, Governor, Zuni Pueblo and Co-Chair, National Tribal Advisory 


Committee on Behavioral Health
 

Candice Donald, Program Management Specialist, IHS Improving Patient Care Program
 

Shelley Frazier, HPDP Program Specialist, Northern Navajo Medical Center 


Scott Gee, Pediatrician, Kaiser Permanente Medical Group
 

Tim Gilbert, Sr., Director, Division of Community Health Services, Alaska Native Tribal Health 


Consortium 


Rachel Greenberg, Writer/Health Communications Consultant 


Dione Harjo, Deputy Director, IHS Community Health Representative Program 


Steve Holve, IHS Chief Clinical Consultant for Pediatrics, Tuba City Regional Health Care 


Corporation 


Brian Hunter, Dietitian, IHS Navajo Area Chinle Service Unit, IHS Health Promotion/Disease 


Prevention Policy Advisory Council (PAC) 

32 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

ACKNOWLEDGMENTS
 

Dwayne Jarman, former Prevention Specialist, IHS Health Promotion/Disease Prevention 

Wendy Johnson-Askew, Public Health Nutrition and Health Policy Advisor, National Institute of 

Diabetes and Digestive and Kidney Diseases 

Candace Jones, National Program Liaison Officer, IHS National Programs* 

Susan Karol, Chief Medical Officer, IHS 

Chris Lamer, Information Technology Specialist, IHS Office of Information Technology 

Donnie Lee, IHS Portland Area Diabetes Consultant 

Jodi Lutjens, Maternal and Child Health Nurse, Sisseton Wahpeton Oyate Health Care Center 

Robert McSwain, IHS Deputy Director for Management Operations 

Suzan Murphy, Breastfeeding Promotion Specialist, Phoenix Indian Medical Center 

Susannah Olnes, Recruiter, IHS Office of Public Health Support 

Richard Olson, Director, IHS Division of Clinical and Community Services 

Tom Pack, former HHS Emerging Leader 

Judy Goforth Parker, Chickasaw Nation Health System Administrator 

Amy Patterson, Public Health Analyst, IHS California Area Office 

Chris Percy, Director, Community Health Services, Northern Navajo Medical Center 

Emily Proctor, Tribal Extension Educator, Michigan State University-Emmet County 

Terry Raymer, IHS Alaska Area Diabetes Consultant 

C. Ty Reidhead, IHS Chief Clinical Consultant in Internal Medicine and Chief Medical Officer, 

IHS Phoenix Area
 

Michelle Ruslavage, Health Informaticist and Data Coordinator, United South and Eastern Tribes,
 

Inc.
 

Marlene Saraficio, School Health Education Technician, IHS Tucson Area 


Renita Selmon, Diabetes Education Consultant, IHS Oklahoma City Area 


Audrey D. Solimon, Senior Advisor, Public Health Programs, National Indian Health Board 


Denean Standing-Ojo, Assistant Web Service Manager, IHS Office of Information Technology
 

Rodney Stapp, Chief Executive Officer, Urban Inter-Tribal Center of Texas 


Peter Stuart, National Psychiatry Program Consultant, IHS Division of Behavioral Health 


Cathy Stueckemann, Public Health Advisor/National Director, IHS Community Health 


Representative Program 


Kelly Taylor, Director, IHS Division of Environmental Health Services
 

Judith Thierry, Coordinator, IHS Maternal and Child Health* 


Leonard Thomas, Chief Medical Officer, IHS Albuquerque Area 


Carol Treat, IHS Alaska Area Diabetes Nutrition Consultant 


Mary Wachacha, Health Education Consultant, IHS Division of Clinical and Community Services
 

Rose Weahkee, Director, IHS Division of Behavioral Health 


Lorraine Whitehair, Public Health Nutritionist, Division of Nutrition, Physical Activity, and 


Obesity, CDC 


Cheryl Wilson, Team Leader, IHS Head Start Program* 


* Healthy Weight Core Workgroup Leader 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 33 

 

 

 

 

 

Index 

5-2-1-0 model 5, 17, 21, 27
 

- A ­

Access 7, 10, 11, 12, 17, 23, 26, 28
 

Activity (see physical activity)
 

Adolescents v, 4–5, 21, 23, 27, 29
 

Adults iii, v, 1–5, 19, 22, 27, 29
 

Awareness campaign iii, 12, 17, 30 


- B ­

Behavioral health 13, 16, 31, 32
 

Behavioral justice 2
 

Best practices vii, 12–13, 16, 18–22, 24, 27–29 

Beverages iii, v, 3–5, 10, 15, 26
 

Birth weight 4
 

Body fat 3
 

Body mass index (BMI) v–vii, 1, 3, 10, 17, 21,
 

24, 27
 

Breastfeeding vi, 4–5, 10–11, 16, 20–21, 26,
 

28, 32
 

Built environment 7
 

Businesses 12
 

- C ­

Calories v, 3, 5, 6
 

Children and youth iii, v–vi, 1–8, 10, 12–13,
 

15–16, 19–21, 23–25, 27, 29–32, 36
 

Clinic/clinical care v, vii, 1, 6–7, 10–13, 17–22,
 

24, 27–29, 31–32
 

Collaboration 6, 13, 16
 

Community iii, v–vii, 1, 6–13, 16–20, 22–28,
 

30–32, 36
 

Community health representatives (CHRs) 

9, 12, 31–32 

Cost of obesity v, 2, 26
 

- D ­

Data 1–2, 10, 17, 28, 32
 

Diabetes iii, v–vi, 1–2, 4–7, 9–13, 15, 17,
 

18–22, 24–25, 27–32, 36
 

Diabetes Education in Tribal Schools (DETS) 


Curriculum 25
 

Diet/dietary vi, 9, 18, 29
 

Dietitian 9, 13, 31
 

- E ­

Eating 


behavior 12
 

healthful v–vi, 2–10, 13, 16, 18, 22–23, 26
 

healthful foods 4–5, 7, 10, 16
 

portion size iii, 4, 30
 

Actions for Health Care Teams and Leaders 

INDEX 

Elders/elderly v–vi, 4–5, 8, 22, 27, 36
 

Energy balance iii, v, 3
 

Evaluation 13, 15–16, 23, 29
 

- F ­

Families iii, vi–vii, 6–8, 10–13, 18, 20–23, 

25–26 ,31 

Fetuses v, 3– 4
 

Fitness 16, 22
 

Five-two-one-zero model 5, 17, 21, 27
 
34 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

Actions for Health Care Teams and Leaders 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX 

Food
 

fast food 4–5
 

healthful 4–5, 7, 10, 16
 

insecurity/hunger 4, 11
 

portion sizes iii, 4, 30
 

Fruits and vegetables 5, 7
 

- G ­

Goal 15, 19, 26, 30
 

Guidelines vii, 10, 12, 17–19, 21, 29
 

- H ­

Head Start 15, 20–21, 24, 31–32 

Health/healthy
 

body weight 4–5
 

promotion 12, 15–17, 19, 26, 31
 

toolkits 13, 15, 17
 

Health care providers
 

counseling by 10–12, 29
 

education 10–12, 15–16, 18, 20, 24–25
 

training 13, 15
 

treatment of obesity 9
 

Health care system vi, 6–7, 9–14 

Healthy weight
 

defined v, 2–3
 

maintaining a v–vi, 3, 5–6, 925, 16, 22, 27
 

management 9–30
 

Hunger 11
 

- I ­

IHS Strategic Plan 23
 

Individuals iii, vi–vii, 2, 6–8, 12–13
 

Infants v, 4–5, 10–11, 15, 20–21, 36
 

Intergenerational vi, 8
 

- J/K/L ­

Leaders/leadership iii, vi–vii, 6, 8, 15–16
 

Let’s Move! iii, 8, 30
 

Lifespan iii, v–vii, 1, 3–4, 6–7, 9–10, 12, 14–16,
 

19 , 26, 31
 

Lifestyle change strategies 15–16
 

Low birth weight 4
 

- M ­

Media vi, 7, 17–18, 30
 

Medical Nutrition Therapy 10, 12, 14–15, 28,
 

36
 

Messages 12, 15, 17–18
 

Mothers 4, 10–11
 

- N ­

Newborns 4
 

Nutrition v–vi, 1–2, 5–7, 9–14, 17–18, 20–22,
 

24–26, 28, 30–32, 36
 

- O ­

Obese/Obesity
 

behavioral factors 5
 

defined 2–3
 

financial impact of 2
 

prevalence and scope 12
 

programs v, 1, 12–13, 16, 24–26, 30
 

Oral health v, 1, 20
 

Overweight
 

behavioral contributions 5
 

defined 3
 

financial impact of 2
 

prevalence and scope 12
 
Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 35 

 

 

 

 

 

 

 

 

Actions for Health Care Teams and Leaders 

INDEX 

- P ­

Parents/parenting 5, 12, 20–21, 24, 27
 

Partnership/partners iii, vi, 6–7, 12, 16–17
 

Physical activity
 

guidelines 19
 

Physical Activity Kit 15–16, 19, 26
 

physical education 24–25
 

recommendations 18–19, 21–24, 27–29
 

Play 4, 23, 27
 

Policy, policies vi–vii, 7, 9–13, 15–16, 18, 23,
 

26–27, 31–32
 

Pre-conception and prenatal care 10
 

Pregnant, post partum women 10–11
 

Preschool 2
 

Prevention iii, vi, 4–5, 9–10, 12, 14–32
 

Primary health care 9
 

Public health 6, 8–10, 12, 30–32
 

- Q/R ­

Quality vi, 6, 12–13, 16, 19, 21, 25, 29
 

Recommendations 18–19, 21–24, 27–29
 

Reimbursement 9, 14, 28
 

Research and evaluation 16
 

Resources iii, v, vii, 1–2, 11–14, 17–30
 

- S ­

School
 

health and wellness 21–22
 

lunch 12
 

physical activity 25
 

policies vi, 7
 

Screen time (after school) 4–5
 

Self-esteem 5
 

Social-Ecological Model 6–7, 9
 

Stress (psychosocial) 3, 6
 

Surgeon General’s Vision for a Healthy and Fit 


Nation iii, 6, 17, 23
 

- T ­

Toddlers v, 4–5, 20–21
 

Toolkits 13, 15, 17, 22, 26–27
 

Traditions/traditional
 

healing 12
 

Trails 7
 

Treatment 9, 14, 18–22, 24–25, 27–29
 

Tribes/Tribal
 

leaders vi, 6, 8, 15–16, 26–27
 

resolutions 26
 

TV/television viewing 4–5
 

- U/V ­

Vegetables 5, 7
 

Vending machines 11, 15–16
 

Vision iii, 1–8, 12, 15, 17, 23
 

- W ­

Walking/walkways 7, 27
 

Weight iii, v–vii, 1–18, 21–22
 

bias/stigma 5
 

Wellness 8, 12–13, 16, 20, 22–23, 25
 

WIC Program 10–11, 15, 17, 20
 

Women/women’s 4–6, 10–11, 15, 20–21
 

Workforce 13, 16
 

Worksite/workplace vi, 6–7, 9, 11–12, 16, 21,
 

26, 36
 

- X/Y ­

Youth v, 1, 5, 21 23–25, 29, 36
 

- Z ­

Zoning ordinances 7
 
36 Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Actions for Health Care Teams and Leaders 

LIST OF PHOTOS 

List of Photos 

IHS wishes to thank everyone who contributed photos or are seen in the photos in this publication. 

Cover: 

Top row: Prenatal care, IHS facility (Source: “IHS Strategic Plan 2006–2011”)
 

Second row, from left: IHS health care team (Source: “IHS Strategic Plan 2006–2011”); 


Postpartum care, IHS facility (Source: “IHS Strategic Plan 2006–2011”)
 

Third row, from left: Patient exam, Santa Fe Indian Hospital (Source: Diane Phillips); center,
 

Health care team, Wewoka Service Unit (Source: Kelli Wilson); Community nutrition lesson,
 

Ohkay Owingeh Pueblo (Source: Diane Phillips)
 

P. iii. Yvette Roubideaux, MD, MPH, Director, Indian Health Service (Source: IHS Director’s Blog) 

P. 2. Youth of the Six Nations Territory Unity Run (Source: “IHS Health for Native Life”) 

P. 4. Indian health facility newborn (Source: “Indian Health Service Strategic Plan 2006–2011”) 

P. 4. Sisseton-Wahpeton Oyate infant (Source: Angela Erdrich) 

P. 5. Sechelt (British Columbia) adolescents (Source: Cecilia Kayano) 

P. 5. White Mountain Apache elder (Source: “IHS Health for Native Life”) 

P. 6. U. S. Surgeon General Regina M. Benjamin, MD, MBA (Source: Office of the Surgeon General) 

P. 8. First Lady Michelle Obama (Source: The White House) 

P. 9. IHS health care team (Source: “IHS Strategic Plan 2006–2011”) 

P. 10. Prenatal care, IHS facility (Source: “IHS Strategic Plan 2006–2011”) 

P. 11. Postpartum care, IHS facility (Source: “IHS Strategic Plan 2006–2011”) 

P. 11. Healthy Heart worksite nutrition class (Source: IHS Healthy Heart Demonstration Project) 

P. 12. Medical nutrition therapy, IHS Turtle Mountain Comprehensive Healthcare Center (Source: 

Sandra Poitra) 

P. 12. Patient exam, Santa Fe IHS Hospital (Source: Diane Phillips) 

P. 13. Northern Navajo Native Lifestyle Balance staff (Source: “IHS Special Diabetes Program for 

Indians 2007 Report to Congress”) 

P. 14. Medical nutrition therapy reimbursement team, IHS Turtle Mountain Comprehensive 

Healthcare Center (Source: Jody Rosendahl) 

P. 15. Indian Health Service staff (Source: “IHS Strategic Plan 2006–2011”) 

P. 15. Diabetes regional meeting (Source: “IHS Special Diabetes Program for Indians 2007 Report 

to Congress”) 
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