As a child, Iris Sherer never learned about proper nutrition. For her, family gatherings always meant overeating, and the food was never very healthy.
A member of the Leech Lake Band of Ojibwe, Sherer was taught to eat whatever was put in front of her.
"I'm from the old way, and the old way is you respect people when they offer you something like that," said Sherer, of Cass Lake. "You go ahead and eat it, especially if it's an elder. You don't refuse that."
But the bad habits Sherer acquired as a child caught took their toll, and five years ago doctors diagnosed her with diabetes. For a few years, she didn't do anything to take care of herself. Now she works at eating the sorts of healthy foods that keep her disease under control.
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Sherer has a lot of company among Native American adults, 70 percent of whom are overweight or obese, according to the latest data from the Centers for Disease Control. That's slightly higher than the 68 percent of adults in the United States who are overweight or obese.
Native American adults are nearly three times more likely than whites to be diagnosed with Type 2 diabetes, a disease closely linked to obesity. They're also twice as likely to die from the disease, according to the Department of Health and Human Services.
In northern Minnesota, the Ojibwe are making some progress addressing the problem. Sherer belongs to a support group for weight loss and healthy eating that teaches participants how to keep track of their calorie and fat intake.
On a recent day, she and four other women gathered in a small conference room at the Indian Hospital in Cass Lake to talk about eating.
"One tablespoon of fat, even if it's a good fat, is 120 calories," said Ruby Lowry of Cass Lake.
"Oh my God," Sherer said.
Most of the women are in their 50s and 60s. All have been battling weight problems for years. All have Type 2 diabetes except one, who is pre-diabetic.
Sherer tries to take what she learns from the support group and share it with family members. Most of them also are overweight and diabetic, she said.
"I mean everyone in my family," Sherer said. "Me, my sisters, my one brother. We all have diabetes. And I try to educate my children. I'm trying to break the cycle."
Obesity and diabetes used to be considered adult problems. But increasingly they affect more of the nation's young people. In the past 30 years, childhood obesity rates in the United States have tripled. Nearly a third of children are overweight or obese. The rate is even higher among Native American children, approaching 50 percent.
Dietician Roxanne Robinson, coordinator of the Cass Lake Hospital Diabetes Center, sees the problem first hand.
"I've had seven, eight, nine year olds with obesity who need an intervention," Robinson said. "And then I've had 12-, 13-year-olds with Type 2 diabetes already, so, yeah, diabetes can be controlled, but nobody really knows if you're going to start out at 13 with diabetes what your path is going to be like."
When a person has Type 2 diabetes, their body does not produce enough insulin. Without insulin, blood sugars get too high. Diabetes can be controlled with insulin injections, exercise and a healthy diet. But if left unchecked, the condition can lead to kidney problems, amputations, and blindness.
There's no single reason why Native Americans have the highest rates of diabetes in the country. Studies suggest Indians are genetically predisposed to the disease.
But diabetes was rare in Native Americans at the turn of the 20th century. When Indians were pushed onto reservations they were pressured to give up their hunting and gathering traditions. That meant a dramatic shift in diet, from wild game and forest greens to unhealthy foods heavy in fat, salt and carbohydrates.
Native American health experts say that while the news is bad, there are signs of improvement. People in Indian communities are becoming better educated about diabetes and are taking better care of themselves, said Dr. Steve Rith-Najarian is a diabetes expert with the federal Indian Health Service in Bemidji.
"There is a success story about the degree to which the communities and individuals have taken ownership of diabetes," Rith-Najarian said. "Twenty-five years ago it was rare to be doing self blood glucose monitoring. Now, it's very commonplace."
Diabetes rates among Native Americans appear to be stabilizing, Rith-Najarian said. The rates of kidney complications and the need for dialysis are on the decline. Limb amputations that were once commonplace in Indian communities have declined on some reservations by as much as 80 percent, according to Indian Health Service.
Some of the credit for those improvements goes to people like Jody Devault, a health educator at the Leech Lake tribal diabetes clinic who also has diabetes.
As Devault pricked her finger to draw a tiny drop of blood, she used a small electronic device to check her body's sugar level.
"I check my blood sugars up to eight times a day," said Devault, 42, a Leech Lake Band member.
Devault developed diabetes when she was only 20. She went several years without treatment and gained a lot of weight. Then her eyesight started failing and she began to lose sensation in her feet. She said her problems were largely connected to her diet.
"All I was eating was Banquet pot pies, Coco Puffs, white bread, white rice, elbow macaroni, pizzas, potato chips," she said. "I thought I was eating healthy, but I wasn't. I was killing myself with the food that I was eating."
Devault began exercising and eating more fresh fruits and vegetables. She dropped 150 pounds and was able to reverse many of her health problems.
Now Devault promotes a healthy lifestyle everywhere on the reservation. She advocates for more home gardens. She's pushing for healthier school lunches. She coordinates diabetes summer camps for kids and diabetes education in the schools -- and encourages kids to take the message home to their parents.
Devault often hears excuses from parents who say healthy foods are either not accessible or are too expensive. Lifestyle change isn't easy, but those obstacles can be overcome through better planning and more health conscious shopping, she said.
"If you remove the pop that they stick in there, and if you remove that sugared cereal that they're buying $5, $6 a box, if you remove those potato chips and you remove those pizzas, you can buy that healthier food," she said. "Get rid of the Little Debbie's and throw in some fruits and vegetables."
There are other efforts to teach Native Americans about healthy eating. The latest comes from the Bemidji-based Indigenous Environmental Network, which obtained a $250,000 grant for a multi-pronged approach to diabetes prevention.
One of them involves a classroom at the Niigaane Ojibwe Language Immersion School on the Leech Lake reservation, where students and their teachers speak only Ojibwe in the classroom.
Teacher Adrian Liberty recently asked the elementary age students if they know that edible plants like wild ginger grow right in their back yards.
Liberty told the children that their ancestors used to eat plants from the woods all the time -- things like dandelion, cattails, cedar, plantain and hog peanut. The goal is to show students how to identify and prepare these edible greens, and promote other traditional Ojibwe foods like deer, rabbit, fish and berries.
Such foods sustained Ojibwe people for thousands of years, he said. But the tribe lost much of that tradition over the past 150 years, when the federal government started giving Indian tribes commodity foods like white flour and lard.
Indians then began frying bread out of those unhealthy ingredients, a practice still around today.
"We as Anishinaabe people, we have to take a look at ourselves, because some of the things that we have started to own as Anishinaabe culture are so bad for us," Liberty said. "Fry bread. I mean, my God, is there a worse kind of food that we can eat? It's just filled with everything that's killing us. But somehow we have embraced this, that this is part of our culture."
The grant-funded effort by the Indigenous Environmental Network also involves developing a local food network in the region that includes the Leech Lake, Red Lake and White Earth reservations. The idea is to connect tribal members with those local growers and producers.
No one believes any of these efforts will solve the problems of obesity and diabetes overnight. The hope is that collectively, they'll have a long term impact on the health of Native Americans.
Minnesota Idea Open
Minnesota Public Radio News reported this story as part of a project being directed by the Minnesota Community Foundation. Along with other partners, the foundation has launched a contest -- the Minnesota Idea Open -- that asks Minnesotans to offer ideas to help combat obesity in their communities. Implementation of the winning idea is funded with a cash award. April 9 is the last day to submit ideas. For more information visit: www.mnideaopen.org