A Vision for Healthy Weight Across the Lifespan of 

American Indians and Alaska Natives

Actions for Communities, Individuals, and Families

Indian Health Service

2011

A Vision for Healthy Weight Across the Lifespan of 

American Indians and Alaska Natives

Actions for Communities, Individuals, and Families

Indian Health Service

2011

Top row: Suzanne Lewis and son, Gila River Indian Community

Second row, left to right: Tohono O’odham Nation Head Start Program, Hualapai 

Tribal Nation Youth Wellness Program, Northwest Tribes canoe journey

Third row, left to right: Carufel family bikers, Lac du Flambeau Ojibwe; Mille Lacs 

Band of Ojibwe harvesting wild rice; Zuni Pueblo walker, Choctaw Nation Healthy 

Heart Program walkers
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 Communities, Individuals, and Families.” 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.
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? 3

Energy Balance: The Key to Maintaining a Healthy Weight 3

Promoting Healthy Weight Across the Lifespan 3

We All Have a Role! 6

A Healthy Weight for Life Decision: Dione Harjo 9

Actions to Promote Regular and Lifelong Healthful Eating for Communities, Individuals, and Families 10

Communities 10

 Tribal Leaders and Governments 10

 Schools and Programs for Children and Youth 11

 Worksites and Businesses 11

 Community Organizations 12

Individuals and Families 12

Actions to Promote Regular and Lifelong Physical Activity for Communities, Individuals, and Families 14

Communities 14

 Tribal Leaders and Governments 14

 Schools and Programs for Children and Youth 15

 Worksites and Businesses 16

 Community Organizations 16

Individuals and Families 17

Resources for Healthy Weight Management 20

Food and Nutrition 20

Physical Activity 21

Infants and Toddlers 22

Children and Adolescents 23

Adults and Elders 24

Governments/Policymakers 25

Schools and Programs for Youth 26

Worksites 28

Communities 28

Health Care Teams and Leaders 29

Social Marketing/Awareness Campaigns 32

Acknowledgments 33

Index 35

List of Photos 38

TABLE OF CONTENTS

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

Actions for Communities, Individuals, and Families
ii Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives

Actions for Communities, Individuals, and Families
Foreword

FOREWORD

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

problem of overweight and 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.

The well-being of American Indians and Alaska Natives is affected by 

obesity. Increases in weight have been linked to increased rates of type 

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

cancer, asthma, and other diseases.

Tribal governments, communities, Tribal members, urban Indian health 

organizations, and the Indian Health Service have partnered to promote 

lifestyle choices for reaching a healthy weight through hundreds of 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.

» A healthy weight means starting early—even before pregnancy.

» A healthy weight is best achieved through lifestyle balance—balancing the energy (food and 

beverages) we take in with the energy we use (physical activity).

» 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 delay 

onset of diabetes and help control diabetes and heart disease.

Promoting healthy weight is a priority for the entire country. President Obama has created a 

Task Force on Childhood Obesity to develop a national action plan to solve the problem of 

obesity within a generation. First Lady Michelle Obama has launched “Let’s Move,” a nationwide 

awareness campaign. Surgeon General Regina Benjamin has released a Vision for a Healthy and Fit 

Nation that outlines actions to prevent obesity. 

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

Alaska Natives, Actions for Communities and Individuals and Families” is a guide for American 

Indians and Alaska Natives to take action. We all have a role to play. It is up to you to decide what 

actions you will take and how you will chart your journey. Select the actions best suited to your 

situation and draw on the resources on pages 20–32. Also, see the companion booklet, “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” 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

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

Actions for Communities, Individuals, and Families
iv Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives

Actions for Communities, Individuals, and Families
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.

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

Actions for Communities, Individuals, and Families
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 Communities

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.

Communities include Tribes and Tribal organizations, schools, worksites, and community 

organizations. By making changes in policies and environments, these organizations can help 

individuals make better choices about healthful eating and physical activity. Changes to zoning 

ordinances, improvements to parks, trails, walkways, and recreation facilities to promote 

walking and physical activity, creating ways to grow, gather, and hunt food, or distributing free or 

inexpensive fresh fruits and vegetables to promote healthful eating—these are some of the many 

ways community groups can work together to promote healthy weight.

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.

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 Communities, Individuals, and Families” provides guidance for taking 

action to stop the obesity epidemic. 

» As a Tribal leader, school administrator, employer, or other community leader, you can start 

by assessing your organization’s policies and needs and then identify what changes can help 

to promote healthy weight for the people you serve.

» As an individual, parent, elder, or family member, you can start by using lifestyle change 

strategies to achieve your own goals for a healthy weight and help your loved ones.

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

Actions for Communities, Individuals, and Families
EXECUTIVE SUMMARY

It is up to you to choose the role you want to play. Use the actions explained in this booklet to chart 

your journey. Draw on the resources on pages 20–32 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 Health Care Team Members and Leaders.”

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.

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

Actions for Communities, Individuals, and Families
viii Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives

Actions for Communities, Individuals, and Families
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. 

INTRODUCTION: LAYING OUT THE VISION

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

Actions for Communities, Individuals, and Families
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, 2009, Vol. 28 (5), pp. w822–w831). 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)

INTRODUCTION: LAYING OUT THE VISION

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

Actions for Communities, Individuals, and Families
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

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.

INTRODUCTION: LAYING OUT THE VISION

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

Actions for Communities, Individuals, and Families
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

Supporting 

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 

Limiting 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 

INTRODUCTION: LAYING OUT THE VISION

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

Actions for Communities, Individuals, and Families
INTRODUCTION: LAYING OUT THE VISION

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

Actions for Communities, Individuals, and Families

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.
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

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

Actions for Communities, Individuals, and Families

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.
INTRODUCTION: LAYING OUT THE VISION

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 7

Actions for Communities, Individuals, and Families

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

SOCIETY

Tribal

Regulations

Tribal & Federal

Government

Tribal & Federal

Laws

Policy

Media

Food

Industry

COMMUNITY

Built

Environment

Grocery Stores

and Markets

Child Care

Neighborhood

ORGANIZATIONAL

Clinics

Community

Organizations

Quality 

Health Care

Hospitals Schools

Worksites

Tribal

Organizations

INTERPERSONAL

Language Traditional 

Values

Family Culture 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—
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

INTRODUCTION: LAYING OUT THE VISION

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

Actions for Communities, Individuals, and Families
A HEALTHY WEIGHT FOR LIFE DECISION: DIONE HARJO

A Healthy Weight for Life Decision: Dione Harjo

Growing up, food didn’t command my thoughts. 

But in my late 20s, I couldn’t finish one meal before I 

began to think about the next one. At age 42, I found 

myself with an obese BMI (31), high cholesterol 

(255), tight and uncomfortable jeans (size 14–16), 

and my highest weight ever (188 pounds).

As a U.S. Public Health Service officer working 

for a community health representative program, 

I knew I wasn’t living a life that reflected my title 

or the program I served. I felt like a Public Health 

Hypocrite! Harjo Family, Chickasaw/Creek/Seminole

In February 2008, I saw a picture of myself and was disgusted at how I looked. I knew losing weight 

was hard, but so was being overweight. In addition to being obese, I have severe knee problems. 

One ligament is torn on my left side, and another is torn on my right side; both will need surgeries 

in the future. I knew a lighter me could possibly give me healthier knees.

I have struggled with losing weight since 1998. I consider myself a diet expert. I feel like I have tried 

every diet out there, but I have not failed. I just have found 240 ways that did not work—until I 

found Weight Watchers. I had lost some weight on all the diets I tried, but I could never sustain the 

rigid guidelines of eliminating certain foods. A friend at church was having success with Weight 

Watchers, so I researched it online. I knew my work and travel schedule would not allow me to 

attend meetings on a regular basis, but, when I learned I could do it all online, I was thrilled and 

joined on July 1, 2008.

After only 7 months, my BMI was normal (24). I lowered my cholesterol to 212, I wore size 8–10 

jeans, and I weighed 142 pounds. I officially joined the ranks of the asterisk holders that state 

“results not typical.”

I truthfully can say being overweight was hard, but this has been the easiest “diet” I have ever tried. 

Now, it is a way of life for me. When I was growing up, I didn’t even know food products had 

labels. Because of Weight Watchers, my children are learning about reading labels, and they often 

ask, “How many points is that?” We all are eating healthier as a result of my changes and mostly 

without grumbling (birds of a feather eat together). My kids now look forward to eating out; they 

don’t expect it. Now, we only eat out once a month. They have seen the change in their mom, not 

just the physical change but also activity-wise. They love all the energy I have now to do things with 

them.

Through my success, my husband and parents have started the program. My husband started about 

3 months ago and has lost 25 pounds. My mom, dad, co-worker, and friend are just starting. My 

new motto is: “Nothing tastes as good as thin feels.” I feel energy. I feel alive. I feel hope.

Commander Dione Harjo, M.P.H., is assistant director of the National Community Health Representative 

Program, Indian Health Service.

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 9

Actions for Communities, Individuals, and Families
ACTIONS TO PROMOTE REGULAR AND LIFELONG HEALTHFUL EATING

Actions to Promote Regular and Lifelong Healthful Eating 

for Communities, Individuals, and Families

Communities

American Indians and Alaska Natives need to live, work, and play in healthy communities that 

support and foster healthy lifestyle behaviors. Tribal leaders and governments, schools, worksites, 

and other community organizations need to work together to pool their resources and to ensure 

that AI/AN have access to healthful foods and safe places to make physical activity a part of their 

daily routine. Ideally, every neighborhood and community will become actively involved and 

community members will work closely with community leaders to make the changes needed to 

support healthy lifestyles.

Sisseton-Wahpeton workplace 

community garden

Tribal Leaders and Governments 

» Assess Tribal or community needs and access to nutritious 

 foods and safe drinking water. 

» Assess Tribal, workplace, school, restaurant, and other 

 community policies related to access to healthful food choices 

 and food security. 

» Ensure that all community members have enough healthful 

 food by filling in the gaps in case of shortages.

» Promote efforts to provide fruits and vegetables in a variety 

of settings such as farmers markets, farm stands, mobile markets, community gardens, and 

youth-focused gardens.

» Encourage farmers markets to accept vouchers and coupons from the Women, Infants, and 

Children (WIC) program.

» Increase participation in Federal, State, and local government nutrition assistance programs to 

maximize AI/AN access to healthful foods. 

» Increase access to free, safe drinking water in public places to encourage water consumption 

instead of sugar-sweetened beverages.

» Increase availability of healthful, affordable food and beverage choices in Tribal facilities.

» Increase community access to healthful foods through grocery stores and convenience stores 

by creating incentive programs for carrying healthier, affordable food items (e.g.: grants or 

loans to purchase refrigeration equipment to store fruits, vegetables, and fat-free or low-fat 

dairy; free publicity; or sponsoring an awards program).

» Improve the availability and identification of healthful foods in restaurants by requiring 

calorie information on chain restaurant menus and by offering incentives to restaurants that 

offer healthier food options.

» Create and support policies that promote exclusive breastfeeding for infants and baby-friendly 

hospital policies using the World Health Organization’s 10 steps for successful breasfeeding.

» Raise awareness about the importance of healthful eating behaviors to prevent overweight 

and obesity across the lifespan. 

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

Actions for Communities, Individuals, and Families
ACTIONS TO PROMOTE REGULAR AND LIFELONG HEALTHFUL EATING 

Schools and Programs for Children and Youth

Round Valley Indian Tribes afterschool cooking workshop

» Create a task force to promote a healthy school environment 

 where students easily can make healthy lifestyle choices. 

» Provide healthful food choices and beverages at Early Head 

 Start and Head Start programs, child care centers, schools, 

 and school-sponsored events, and youth regional treatment 

 centers by: 

- Enforcing existing Head Start Program Performance 

Standards and U.S. Department of Agriculture regulations 

that prohibit serving foods of minimal value.

- Adopting wellness policies specifying that all foods and beverages available at school, 

including afterschool programs, contribute toward eating patterns that are consistent 

Dietary Guidelines for Americans.

- Providing more food options in lunch rooms, vending machines, and school stores that are 

low in saturated fat, calories, and added sugars (e.g., fruits, vegetables, whole grain foods, 

low-fat or nonfat dairy foods, meat, poultry, and fish). 

» Offer training to teachers and school administrators about healthful eating habits for 

themselves and their students. 

» Require school food service managers to be well trained in food preparation techniques to 

provide school meals that are lower in saturated fat, sodium, and sugar. 

» Advocate for and create “food-free zones” within walking distance of schools. 

» Require a closed campus during lunch in schools. 

» Prohibit schools from displaying advertisements promoting junk foods on vending machines 

or in other places. 

» Teach media literacy to help students and parents become informed consumers. 

» Require the classroom, the school dining room, and other school activities to provide clear 

and consistent messages that explain and reinforce healthful eating habits. 

» Encourage parent-teacher associations or organizations, student groups, and clubs to choose 

activities and fundraisers that offer or recommend healthy choices when food is provided. 

» Provide culturally appropriate health education about healthful eating in school wellness 

programs. E.g., adopt the Diabetes Education in Tribal Schools (DETS) curriculum designed 

for the grade levels of the students in your school. 

» Offer access at schools to extended education programs, including parenting classes and 

cooking classes.

Worksites and Businesses

» Establish workplace policies to promote breastfeeding and to disseminate to the community 

as model policies. 

» Assess and create worksite policies and programs that promote access to healthful food 

choices (e.g., vending machines, lunch rooms, and refreshments served at meetings). 

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 11

Actions for Communities, Individuals, and Families
ACTIONS TO PROMOTE REGULAR AND LIFELONG HEALTHFUL EATING

Healthy Heart worksite nutrition 

class

» Offer nutrition education programs to employees on 

 healthful eating. 

» Offer healthful foods and beverages at business meetings and 

 conferences. 

» Promote and offer healthy weight support groups for 

 employees.

Community Organizations

» Provide support to breastfeeding mothers through policies that promote breastfeeding in 

public places. 

» Encourage environmental changes for increasing access to healthful foods, including 

neighborhood gardens, farmers markets, and healthful food and beverage choices in grocery 

stores. 

» Promote adoption of healthful traditional foods and food preparation practices that 

encourage a resurgence of cultural pride. 

» Offer parenting and caregiver education that encourages, supports, and models healthful 

eating habits for families and children. 

» Offer families food budgeting, healthful food shopping, and cooking classes that combine 

nutrition education with hands-on meal planning and cooking techniques. 

Individuals and Families

Weight management requires a lifelong commitment to healthful eating 

practices. A wide variety of studies shows that healthful eating habits 

contribute to healthy lives and healthy weight. The Dietary Guidelines 

for Americans provide science-based advice to adopt a healthful, 

lifelong eating plan that focuses on generous amounts of healthful 

foods containing a small number of calories in a large volume of food, 

especially: fruits and vegetables; whole grain foods; lean sources of 

protein such as fish, poultry, beef, game, and legumes; non-fat dairy 

products; and heart-healthy fats. These guidelines are incorporated 

into actions promoting regular and lifelong healthful eating for individuals and families.

Suzanne Lewis and son, Gila 

River Indian Community

» Ask health care team members about the benefits of breastfeeding, common breastfeeding 

problems, and strategies for overcoming them. 

» Breastfeed exclusively for 6 months before introducing solid foods and continue to 

breastfeed for 12 months and thereafter for as long as desired. 

» Introduce solid foods no sooner than 4 months. 

» Practice parenting and caregiver skills that encourage, support, and model healthful eating 

habits: 

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

Actions for Communities, Individuals, and Families
ACTIONS TO PROMOTE REGULAR AND LIFELONG HEALTHFUL EATING 

- Provide plenty of vegetables, fruits, and whole-grain products. 

- Include low-fat or non-fat dairy products. 

- Choose lean meats, poultry, fish, lentils, and beans for protein. 

- Serve reasonably-sized portions. 

- Encourage your family to drink lots of water. 

- Limit sugar-sweetened beverages. 

- Limit consumption of sugar and saturated fat in meals and snacks. 

- Eat a healthy breakfast every day. 

- Make eating together as a family a priority. 

Dinner time at the Cawstons’ home

» Follow the “5–2–1–0 model” for children every day: 

- 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 each day. 

- 0: Limit sugar-sweetened beverages. None is best. 

» Protect children’s oral health by limiting sugar-sweetened 

beverages and by practicing regular tooth brushing and 

flossing. 

» Advocate to local leaders and at public meetings (Tribal, school board, state, chapter, and 

district) the need for adequate and affordable healthful foods.

Successful Approaches to Adopting a Healthful Eating Lifestyle for Individuals and Families

» Make a commitment to healthful eating.

» Learn about local healthy weight and healthful eating resources available to you.

» Set realistic goals for the number of calories you will take in based on realistic weight 

loss goals (1–2 pounds a week).

» Eat moderate portions of a wide variety of healthful foods that you enjoy; drink more 

water and fewer or no sugar-sweetened beverages.

» Keep track of what you eat, and evaluate your progress.

» Practice mindful eating by being aware of your surroundings and of your mind, body, 

and spirit.

» Listen to your body, and eat only until you have had enough.

» Avoid eating to cope with stress; get physically active instead.

» Get emotional support, and plan for setbacks.

» Celebrate your successes with small rewards for the healthful eating lifestyle changes 

you make.

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 13

Actions for Communities, Individuals, and Families
Actions to Promote Regular and Lifelong Physical Activity 

for Communities, Individuals, and Families

Snoqualmie youth snowshoeing 

expedition

A wide range of studies provides the scientific evidence that states 

physically active people have (a) higher levels of health-related 

fitness, (b) a lower risk profile for developing a number of disabling 

medical conditions, and (c) lower rates of various chronic diseases 

than do people who are inactive. According to the “2008 Physical 

Activity Guidelines for Americans” issued by the U.S. Department of 

Health and Human Services, some activity is better than none for all 

individuals. 

Communities

Tribal Leaders and Governments

Seminole community walk

ACTIONS TO PROMOTE REGULAR AND LIFELONG PHYSICAL ACTIVITY

» Assess and create Tribal, workplace, school, and other 

community policies that promote access to physical activity 

and build physical activity into daily routines. 

» Transform policy into action by encouraging changes in 

the built environment to increase opportunities for physical 

activity, such as safe walkways, safe streets, traffic laws, more 

playgrounds, and the repair of dilapidated gyms. 

» Promote successful Tribal community planning and land use 

decisions to develop and maintain safe, attractive parks and 

playgrounds near residential areas. 

» Promote and implement programs that support walking, 

bicycling, and other activities, such as the “Physical Activity 

Kit (PAK): Staying on the Active Path in Native Communities 

... A Lifespan Approach” at all levels.

» Raise awareness about the importance of regular, lifelong 

physical activity.

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

Actions for Communities, Individuals, and Families

“Chickasaw Nation passed a resolution for a walking program in 1996. This Tribally funded 

program now has hundreds, if not, thousands of walkers. It is so important to have the leadership 

of our Tribes supporting these efforts and legislation can be such an important message.”

– Judy Goforth Parker, Ph.D., R.N., Chickasaw Nation Health System Administrator
ACTIONS TO PROMOTE REGULAR AND LIFELONG PHYSICAL ACTIVITY

Schools and Programs for Children and Youth

Up the climbing wall, King 

Island Native Community

» Assess and establish school policies related to time, space, and 

facilities for daily physical activity—including physical education 

classes from Head Start through high school—to help students 

participate in at least 60 minutes of moderate-intensity physical 

activity each day.

» Ensure daily, quality physical education in all school grades. Hire 

certified physical education specialists to provide this teaching.

» Increase the percentage of students who walk or ride a bike to 

school. Encourage the creation of biking lanes on reservation 

roads, and make bike racks available on school campuses.

» Improve signage, and provide safe routes and safe road crossings 

to school. See The Tribal School Zone Safety Video and Toolkit 

in the Resources section of this booklet on page 29.

» Provide culturally appropriate health education to students about regular physical activity.

» Adopt the Diabetes Education in Tribal Schools (DETS) curriculum designed for the grade 

levels of students in your school.

» Get students and staff to use the “Physical Activity Kit (PAK), Staying on the Active Path in 

Native Communities ... A Lifespan Approach.” 

» Adopt and implement the Move It! And Reduce Your Risk for Diabetes School Kit for 

American Indian and Alaska Native youth.

» Provide access to intramural and interscholastic sports programs and other physical activity 

clubs, programs, and lessons—during school and after school. 

» Allow afterschool and summer use of school facilities and community centers for physical 

fitness and sports activities for individuals and families. 

» Work with the local parent-teacher association or organization to coordinate school year 

kick-off and year-round physical activity events that include parents, teachers, and students. 

» Explore relationships with sporting goods companies or one of their trade associations to 

provide sports equipment at a discount for schools to increase the amount and range of 

physical activity for students.

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 15

Actions for Communities, Individuals, and Families
Native Fitness Training Event, Northwest 

Porland Area Indian Health Board and Nike, Inc.

Worksites and Businesses 

» Create more opportunities for structured physical 

activity either at worksites or off site at nearby 

recreational facilities.

» Create incentives for employees to engage in physical 

activity during lunch, before work, and after work 

(e.g., walking clubs, extra half hour during lunch for 

physical activity, or recognition of exercisers).

» Facilitate employees’ physical activity by supplying 

showers and promoting active transportation to 

work by providing secure bicycle storage.

Community Organizations

» Make community facilities accessible for physical activity for all people, including the 

elderly.

» Promote the availability of maps and information regarding 

community physical activity resources that offer physically active 

alternatives to driving, such as walking and cycling.

» Encourage buildings to provide safe, accessible stairways with 

visible signs that tout the benefits of climbing stairs.

» Create and promote indoor “walking trails” with half mile 

markers.

» Assess community perceptions of regular physical activity and 

produce a social marketing campaign to promote physical 

activity across the lifespan.

Carufel family bikers, Lac 

du Flambeau, Ojibwe

» Promote and implement the PAK in youth and elder centers.

» Offer culturally appropriate community education and activity programs to promote 

regular physical activity, such as hiking, swimming, canoeing, and horseback riding. 

Physical activity is safe for almost everyone, and the health benefits of physical activity far outweigh 

the risks. People who are healthy do not need to consult with a health care provider about physical 

activity. People with diagnosed chronic conditions (such as diabetes, heart disease, or osteoarthritis) 

and disease symptoms (e.g., chest pain or pressure, dizziness, or joint pain) should consult with a 

health care provider before starting a physical activity program. (U.S. Department of Health and 

Human Services. “Physical Activity Guidelines Advisory Committee Report,” 2008)

ACTIONS TO PROMOTE REGULAR AND LIFELONG PHYSICAL ACTIVITY 

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

Actions for Communities, Individuals, and Families
How to Overcome Some Barriers to Physical Activity* 

Common Problems Solutions

I feel self-conscious working out in a 

gym or swimming in a pool.

Join an exercise class with people who are in the same 

shape as you are. Or, try exercising at home; research shows 

it’s just as good, or better, than working out in a gym. 

Exercise wears me out, and it hurts. Set realistic goals, and, again, try exercising with other 

people in the same shape as you. 

I’m too busy to exercise. Turn everyday activities into exercise. Instead of driving 

everywhere, walk or bike to work, to the store, or to a 

friend’s house. Take the stairs instead of the elevator. Walk 

the dog; it’ll help both of you.

Also, try exercising in shorter time frames. Research shows 

that several short bursts of activity (say, 15 minutes at a 

time) are just as beneficial as one whole hour of exercise.

Exercise is boring. Mix it up. Do some fun activities, like group dancing.

*Journal of Obesity, 2011, Volume 2011, Article ID 348293.

ACTIONS TO PROMOTE REGULAR AND LIFELONG PHYSICAL ACTIVITY

Individuals and Families

» Follow the recommended guidelines for physical activity presented in Tables 3 and 4 on 

pages 18 and 19, respectively. 

» Parents and caregivers should follow the “5–2–1–0 model” for their children every day: 

- 5: Eat 5 or more servings of fruits and vegetables each day. 

- 2: Limit television and other screen time to no more than 2 hours a day. 

- 1: Engage in 1 hour of physical activity each day. 

- 0: Limit sugar-sweetened beverages. None is best. 

» Advocate for adequate, safe play areas and walking 

trails in your community to friends, family, local 

leaders, and at public meetings (Tribal, school board, 

planning board, and elsewhere). 

» Advocate for policies to increase daily physical 

activity (including physical education classes) from 

Early Head Start and Head Start to child care centers 

and from elementary school through high school.

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 17

Actions for Communities, Individuals, and Families

Croff and Whiteman Family, Blackfeet 

horse relay racing
ACTIONS TO PROMOTE REGULAR AND LIFELONG PHYSICAL ACTIVITY 

Table 3. Physical Activity Guidelines Across the Lifespan: Infants–Adolescents

Infants1, 2

(birth to 1 year)

Toddlers1, 2

(1 to 3 years)

Preschoolers1, 2

(3 to 5 years)

Children & Adolescents1, 3 

(6 to 17 years)

Infants should be 

naturally active, 

stretching and kicking 

when on their backs.

An infant needs tummy 

time to raise his head and 

chest.

Infants should enjoy 

playing with parents and 

caregivers and should 

grasp and shake toys.

Infants should progress 

from rolling to sitting, 

then to creeping, 

standing, cruising, and, 

finally, walking.

Infants need supervision 

to safely explore the 

natural world.

Infants have no 

developmental need to 

view a screen or TV.

Toddlers should be 

naturally active, learning 

to run, pull toys, tiptoe, 

and kick a ball.

Toddlers should enjoy 

playing with their parents 

and caregivers.

Toddlers need supervision 

and a safe environment 

for play.

Toddlers need at least 30 

minutes of structured play 

daily.

Toddlers need at least 60 

minutes of unstructured, 

active play daily.

Parents should limit 

toddlers’ sedentary 

activity, like sitting still, to 

no more than 60 minutes.

Parents should allow 

toddlers to walk; parents 

should use a stroller 

judiciously.

Screen time is not 

necessary for the 

development of toddlers. 

Parents should limit 

toddlers’ screen time to 

no more than 60 minutes 

daily.

Parents should limit 

toddlers’ TV viewing 

to age-appropriate 

programming.

Preschoolers should learn 

through physical activity 

to master basic motor 

skills, such as climbing, 

running easily, pedaling, 

and going up and down 

stairs.

Preschoolers require at 

least 60 minutes of active 

play every day.

Preschoolers should spend 

no more than 60 minutes 

in sedentary activity.

Preshoolers need access to 

playmates.

Preshoolers need ageappropriate toys and play 

equipment that will make 

physical activity fun and 

safe.

Screen time is not 

necessary for the 

development of 

preschoolers. Parents 

should limit their screen 

time to no more than 60 

minutes daily.

Parents should limit 

preschoolers’ TV viewing 

to age-appropirate 

programming.

Children and adolescents 

should do 60 minutes or 

more of physical activity 

every day.

Most of the 60 minutes 

or more a day should 

be either moderate- or 

vigorous-intensity aerobic 

physical activity.

As part of their daily 

physical activity, children 

and adolescents should 

do vigorous-intensity 

activity at least 3 days per 

week. They also should 

do muscle-strengthening 

and bone-strengthening 

activity at least 3 days a 

week.

Children and adolescents 

should limit their 

sedentary time (watching 

TV, playing video games, 

etc.) to 1 to 2 hours per 

day.

1

“Bright Futures in Practice: Physical Activity.” Arlington, VA: National Center for Education in Maternal and Child Health, 2001.

2

HealthyChildren.org. American Academy of Pediatrics. Web. Accessed January 28, 2011.

3

“Physical Activity Guidelines Advisory Committee Report, 2008.” Washington, DC: U.S. Department of Health and Human 

Services, 2008. 

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

Actions for Communities, Individuals, and Families
ACTIONS TO PROMOTE REGULAR AND LIFELONG PHYSICAL ACTIVITY

Table 4. Physical Activity Guidelines Across the Lifespan: Adults

Adults1, 2

(18 to 64 years)

Older Adults1

(65 years and older)

Pregnant and 

Post Partum Women1

Adults should do 2 hours and 30 

minutes of moderate-intensity, 

or 1 hour and 15 minutes (75 

minutes) of vigorous-intensity, 

aerobic physical activity a week—

or an equivalent combination of 

moderate- and vigorous-intensity 

aerobic physical activity. Aerobic 

activity should be performed in 

episodes of at least 10 minutes, 

preferably spread throughout the 

week.

Additional health benefits are 

provided by increasing to 5 hours 

(300 minutes) a week of moderateintensity aerobic physical activity 

or to 2 hours and 30 minutes 

a week of vigorous-intensity 

physical activity—or an equivalent 

combination of both.

Adults should also do musclestrengthening activities that involve 

all major muscle groups performed 

on 2 or more days per week. 

Parents can set a good example 

for their children by not watching 

more than 2 hours of TV a day. 

Recent research states that adults 

who watch more than two hours of 

screen entertainment a day increase 

their risk of heart disease.

Older adults should follow the adult 

guidelines.

If this is not possible due to 

limiting, chronic conditions, older 

adults should be as physically active 

as their abilities allow. They should 

avoid inactivity (like watching TV).

Older adults should do exercises 

that maintain or improve balance if 

they are at risk of falling. 

Healthy women who are not 

already doing vigorous-intensity 

physical activity should get at 

least 2 hours and 30 minutes (150 

minutes) of moderate-intensity 

aerobic activity a week. Preferably, 

this activity should be spread 

throughout the week.

A woman who regularly engages in 

vigorous-intensity aerobic activity 

(or high amounts of activity) can 

continue her activity, provided that 

her condition remains unchanged 

and that she talks to her health care 

provider about her activity level 

throughout her pregnancy. 

1

“Physical Activity Guidelines Advisory Committee Report, 2008.” Washington, DC: U.S. Department of Health and 

Human Services, 2008.

2

Journal of the American College of Cardiology, 2011, Volume 57 (3), page 292. See also Circulation: Journal of the 

American Heart Association, 2010, Volume 121 (3), page 384.

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 19

Actions for Communities, Individuals, and Families
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 2010. 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

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

Actions for Communities, Individuals, and Families
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/

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 21

Actions for Communities, Individuals, and Families
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

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

Actions for Communities, Individuals, and Families
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. 

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 23

Actions for Communities, Individuals, and Families
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

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

Actions for Communities, Individuals, and Families
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

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 25

Actions for Communities, Individuals, and Families
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. 

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

Actions for Communities, Individuals, and Families
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

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 27

Actions for Communities, Individuals, and Families
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 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

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

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

Actions for Communities, Individuals, and Families
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

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 29

Actions for Communities, Individuals, and Families
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/

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

Actions for Communities, Individuals, and Families
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

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 31

Actions for Communities, Individuals, and Families
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

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

Actions for Communities, Individuals, and Families
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) 

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

Actions for Communities, Individuals, and Families
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

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

Actions for Communities, Individuals, and Families
INDEX

Index

5–2–1–0 model 5, 13, 17, 23, 29

- A -

Access 7, 10–12, 14–16, 25–26, 28, 30

Activity (see physical activity)

Adolescents v, 4–5, 18, 23, 25, 31

Adults iii, v, 1, 3–5, 19, 21, 24, 29, 31

Advocate 11, 13, 17

Awareness Campaign iii, 32 

- B -

Behavioral justice 2

Best practices 20–24, 26, 29–31

Beverages iii, v, 3, 5, 10–13, 17, 28

Bicycles, bikes 15

Birth weight 4

Body fat 3

Body mass index (BMI) v, 3, 9, 23, 26, 29

BodyWorks 24

Breastfeeding 4–5, 10–12, 22–23, 28, 30, 34

Built environment 7, 14

Businesses 11–12, 15

- C -

Calories v, 3, 5, 10–13

Children and youth v, 1, 4–5, 11, 15, 18, 23–24, 

31

Collaboration 6

Community vi, 6–8, 10–12, 14–16, 20–22, 24, 

 26–30, 32–34

Community health representatives (CHRs) 9, 

33–34

Cost of obesity v, 2

- D -

Data 1–2, 30, 34

Diabetes Education in Tribal Schools (DETS) 

curriculum 11, 15, 27

Diabetes iii, v, 1–2, 4–7, 11, 15–16, 20–24, 

 26–27, 29–34

Diet/dietary 9, 11–12, 20, 31, 33

Dietitian 33

- E -

Eating 

behavior 10

 healthful food v–vi, 2–3, 5, 7–8, 10–13, 

 20, 24–25

 parental influence 9, 12–13

 patterns 11

 portion size 4

Elders/elderly v–vi, 4–5, 8, 16, 24, 29

Energy balance v, 3

Environment/environmental influences vi, 2–3, 

6–7, 11–12, 14, 18, 25, 28–29, 33–34

Evaluation 25, 31

- F -

Families vi, 6–8, 12–13, 15, 17, 20, 22–25, 

27–28

Fetuses v, 3–4

Fitness 14–15, 24

Five-two-one-zero model 5, 13, 17, 23, 29

Food

 access 7, 10–12, 25, 28

 affordable 10, 13

 availability 10

 fast food 4–5

 healthful 7, 10–13, 20

 insecurity/hunger 4

 portion sizes 4, 13

 security 10

 traditional 12

Fruits and vegetables vi, 5, 7, 10–13, 17

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

Actions for Communities, Individuals, and Families
INDEX

- G -

Gardens/gardening 10, 12

Goal vi, 13, 21, 28, 32

Guidelines 9, 11–12, 14, 16–21, 23, 31

- H -

Head Start 11, 15, 17, 22–23, 26, 33–34

Health/healthy

body weight 5

 promotion 21, 28, 33–34

 toolkits 15, 24, 28, 29

Health care providers

 counseling by 31

 education 16, 19

 obesity screening and 1, 31

 training 31, 32

 treatment of obesity 23

Health care system vi, 6, 7

Healthy weight

 defined v, 2

 maintaining a v, 3–6, 24, 29

 management 12, 20, 24, 29, 31

- I -

IHS Strategic Plan 25

Incentives 10, 16

Individuals vi, 2, 6–8, 12–13, 17, 19 

Infants v, 4–5, 10, 18, 22, 31

Intergenerational vi, 8

- J/K/L -

Leaders/leadership iii, vi–vii, 6, 8, 10, 13–14, 

17, 29, 32–34

Let’s Move! iii, 8, 32

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

 18–19, 21, 28

Lifestyle iii, vi, 5–6, 10–11, 13, 17, 21, 24

Low birth weight 4

Lunch (see school lunch)

- M -

Media vi, 7, 11, 20, 32

Medical Nutrition Therapy 30

Messages 11, 14, 20

Mothers 4–5, 9, 12

- N -

Newborns v, 4

Nutrition v–vi, 1–2, 5–7, 10, 12, 20, 22–24, 

 26–28, 30, 32–34

- O -

Obese/Obesity

 contributing factors vi, 2, 5–6

 defined 3

 general iii, 2, 4–5, 10, 20, 22–23, 26, 28

 impact of v, 1–2

 programs iii, 25, 32

treatment and prevention of 23, 25–26, 

28–29, 31–32

Oral health v, 1, 13, 22

Overweight

contributing factors vi, 5–6

 defined 3

general iii, 1, 4, 9–10, 26

 impact of 1–2

treatment and prevention of 23, 25–26, 29, 

31

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

Actions for Communities, Individuals, and Families
INDEX

- P -

Parents/parenting vi, 5, 9, 11–12, 15, 17–18, 

22–23, 25–26, 29

Partnership/partners iii, vi, 6–7

Physical activity

 guidelines 14, 16, 18–19, 21

 Physical Activity Kit (PAK) 14–16, 21, 28

 physical education 15, 17, 26–27

 recommendations 21, 30

Play 4, 6, 10, 17, 25, 29

Policy, policies vi, 7, 10–12, 14–15, 17, 20, 25, 

 28–29

Pregnant, post partum women 4, 19

Preschool 2, 18

Prevention 20–25

Public health 6, 8, 32

- Q/R -

Quality 6–7, 15, 21, 23, 27, 31

Recommendations 20–21, 23–26, 29–31

Reimbursement 30

Research iii, 4–5, 20

Resources iii, v, vii, 1–2, 10, 16, 20–32

- S -

School

 for community use 10–11, 15

 lunch 11

 physical activity 27

 policies vi, 7, 15

Screen time (after school) 4, 5, 13, 17

Self-esteem 5

Social-ecological model 6–7

Stress (psychosocial) 3, 6, 13

Surgeon General’s Vision for a Healthy and Fit 

Nation iii, 25

- T -

Toddlers v, 4–5, 18, 22–23

Toolkits 24, 28–29

Traditions/traditional

 foods/diets 12

 physical activities 27, 29

Trails vi, 7, 17

Treatment 11, 20–24, 26, 29–31

Tribes/Tribal

 leaders vi, 6, 8, 10, 14, 29

 policy 10, 14

 resolutions 28

TV/television viewing 4–5, 13, 17

- U/V -

Vegetables (and fruits) vi, 5, 7, 10–13, 17

Vending machines 11

Vision iii, 1, 6, 25, 33

- W -

Walking/walkways vi, 7, 11, 14–17, 29

Water 10, 13

Weight iii, v–vii, 1–9, 12–13, 20, 23–24, 26, 29, 

31, 33

 bias/stigma 5

Wellness 8, 11, 22, 24–25, 27

Women, Infants, and Children (WIC) program 

10, 22

Women/women’s 4, 6, 19, 23–24

Worksite/workplace vi, 6–7, 10–12, 14, 16, 23, 

25, 28

- X/Y -

Youth v, 1, 3, 5, 10–11, 15–16, 23, 25–27, 31

- Z -

Zoning ordinances vi, 7

Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives 37

Actions for Communities, Individuals, and Families
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: Suzanne Lewis and son, Gila River Indian Community (Source: “An Easy Guide to Breastfeeding 

for American Indian and Alaska Native Families,” Office on Women’s Health, HHS) 

Second row (l. to r.): Tohono O’odham Nation Head Start Program (Source: “Voices from Our 

Communities; Messages of Hope,” 2009 Calendar, IHS and the National Institute of Diabetes and 

Digestive and Kidney Diseases); Hualapai Tribal Nation Youth Wellness Program (Source: Health for 

Native Life, IHS); Tribal Journey 2007: Paddle to Lummi (Source: Chris Stearns, Navajo)

Third row (l. to r.): Carufel family bikers, Lac du Flambeau Ojibwe (Source: Tina Handeland); Mille Lacs 

Band of Ojibwe harvesting wild rice (Source: Health for Native Life, IHS); Zuni Pueblo walker (Source: 

Cecilia Kayano); Choctaw Nation Healthy Heart Program walkers (Source: “On the Path to a Healthier 

Future,” 2007 Report to Congress, IHS)

P. iii. Yvette Roubideaux, M.D., M.P.H., Director, IHS (Source: IHS)

P. 2. Youth of the Six Nations Territory Unity Run (Source: Health for Native Life, IHS)

P. 4. 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: Health for Native Life, IHS)

P. 6. U.S. Surgeon General Regina M. Benjamin, M.D., M.B.A. (Source: Office of the Surgeon General)

P. 8. First Lady Michelle Obama (Source: The White House)

P. 9. Dione Harjo and her family (Source: Dione Harjo)

P. 10. Sisseton-Wahpeton Oyate workplace community garden (Source: Angela Erdrich)

P. 11. Round Valley Indian Tribes afterschool cooking workshop (Source: Gale Marshall)

P. 12. Worksite nutrition class (Source: IHS Healthy Heart Demonstration Project)

P. 12. Suzanne Lewis and son, Gila River Indian Community (Source: “An Easy Guide to Breastfeeding for 

American Indian and Alaska Native Families,” Office on Women’s Health, HHS) 

P. 13. Dinner time at the Cawstons’ home (Source: Health for Native Life, IHS)

P. 14. Snowqualmie youth snowshoeing expedition (Source: Heidi Bohan)

P. 14. Seminole community walk (Source: Health for Native Life, IHS)

P. 15. Up the climbing wall, King Island Native Community of Alaska (Source: Kelly Keyes)

P. 16. Western Tribal Diabetes Project Native Fitness Training Event, Northwest Portland Area Indian 

Health Board/Nike, Inc. (Source: “On the Path to a Healthier Future,” 2007 Report to Congress, IHS)

P. 16. Carufel family bikers, Lac du Flambeau Ojibwe (Source: Tina Handeland)

P. 17. Croff and Whiteman Family, Blackfeet horse relay racing (Source: “On the Path to a Healthier 

Future,” 2007 Report to Congress, IHS)

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

Actions for Communities, Individuals, and Families
Produced by:

www.thehillgroup.com

www.dncx.com