Groups work to ditch the soda in tribal communities, where water scarcity feeds childhood obesity
Dorian Hale is playing outside his family’s hogan – a one room home on the Navajo Nation reservation in Shiprock, N.M..
He’s currently obsessed with the movie "Cars." He pushes a toy Lightning McQueen car through the soft, red mud.
“What does he say?” Rontel Hale, his mother, asks.
“VROOM! VROOM! … ‘Chow!” Dorian responds, trying his best to mock McQueen’s famous “Ka-Chow!” catchphrase.
His mother says Dorian’s growing well for a three-year-old.
“He’s a taller and bigger boy,” she says. “When I would go to his appointments, they would always tell me, like, he's going to grow over 6-foot-2.”
Not every kid on the Navajo Nation, an area roughly the size of West Virginia, is on such a healthy trajectory. Dorian and his mom have benefitted from an initiative designed to counter the factors – including the lack of access to clean drinking water – that contribute to the prevalence of childhood obesity on the Navajo Nation and across Indian Country.
Roughly a third of the population doesn't have reliable access to clean drinking water due to a lack of infrastructure and a legacy of neglect by the U.S. government. They have to either haul water from community wells or drive for hours to the nearest store.
“If water is so hard to access, then what is a replacement?” said Renee Goldtooth-Halwood, the director of evaluation and research at the Notah Begay III Foundation (NB3), a Native children’s health group. “And so for a lot of communities, sometimes it was those sugary beverages.”
Sugary drinks – like soda, sports drinks and iced teas – are often cheaper than water and more accessible. Some community members are also wary of water contamination, so they turn to bottled and often sweetened products.
This has staggering effects for children. In 2021, the New Mexico Department of Health found that childhood obesity for American Indian third graders increased to more than 42%. In addition, the NB3 foundation reports that more than 85% of Navajo kids have at least one sugary drink a day.
The problem extends well beyond the Navajo Nation. Overall, American Indian and Alaska Native kids are 30% more likely than non-Hispanic white kids to be obese.
“We also had another statistic that said that … this is the first time that [Native] children will not outlive their parents,” Goldtooth-Halwood said. “That's scary … that really sounds the alarm. What can we do?”
In 2017, the Johns Hopkins Center for Indigenous Health launched a study to see if providing water and educating parents would help prevent early childhood obesity.
In the first part of the study, home health coaches gave more than 50 young mothers six interactive lessons every week from a curriculum called Family Spirit that promotes healthy infant feeding and growth, including sugar moderation.
“You take your sugar cubes out, it looks just like this,” said Leonela Nelson, one of the coaches and program supervisor as she shared the cubes in her hand. “And you're like, ‘You know what? This is what you're putting into your body … a lot of the participants said that that was the most impactful part of the lessons and having those conversations.”
The families also received home deliveries of water to supply their entire family.
Nelson said one of the main challenges mothers brought up was how their moms spoiled their babies.
“There was a lot of conversation along the lines of how to have these conversations with your parents in a respectful way of, ‘You know what, like this is my child. I want them to be healthy,’” she said.
The results of the Johns Hopkins study were striking. The children of parents who received water and one-on-one coaching were found to have a lower body mass index, drank fewer sugar-sweetened beverages and they were breastfed for longer.
The study was so successful that in 2018, Johns Hopkins expanded the study. It began with participants from three communities – including Rontel Hale, who was pregnant with Dorian – enrolling prenatally and coaches giving them more than 30 lessons from the program's nutrition curriculum. But, there was no water delivery due to funding and time constraints.
Tanya Jones was Hale’s home health coach. She said Hale was interested from the very beginning and they quickly became close.
“There was a bond there,” Jones said. “If she had problems, family problems, she was comfortable talking to me about that."
Jones recalls Hale answering a question in the study that asked what she liked most about her coach's visit. "And there were probably a handful of times where she’d say, ‘Just seeing you.’ Yeah, that blew my mind.”
Jones, who is Diné, said she feels like she gets a second chance at mothering through these lessons.
“You go home knowing that you help someone in some way,” she said. “I'm far from being a perfect mother, but having the opportunity to teach, for them to give me this curriculum…I'm very humbled.”
Hale said the coaching and curriculum made a big difference.
“Doing these little lessons, it's a lot of help,” she said. “It also helps not just you, but also helps your little ones.”
Hale has already shared her experience with her sister so she and her kids can benefit, too.
“You still need that support of going to somebody,” she said. “And that's where I would give her some of the lessons that were given to me.”
It's not the only program that's promoting water access and consumption as a way to combat childhood obesity.
A few years ago, the NB3 Foundation launched the Water First! Learning Communities. It included a cohort of eight Native organizations, most centered around the Rio Grande basin, that received $100,000 to help encourage more water consumption in their communities over two-and-a-half year period .
“They know that water is a connection to their body, to the land, to the community, and how important it is to kind of nourish your body with that,” said Simone Duran, the grant program coordinator at NB3 and a member of the San Felipe Pueblo.
One group from the Jemez Pueblo ran a school water challenge to encourage kids to drink fruit-infused water. Another group, the Tamaya Wellness Center in the Santa Ana Pueblo of New Mexico, put up signs at the center to prevent students from having sugary beverages at center events. The signs are still in place long after the grant project ended.
“It's really cool to see that they have the sign that said no sugary sweetened beverages allowed in their center,” Duran said. “We're like, oh … that has made an impact.”
Over the course of the Water First! Learning Communities program, the Native organizations would meet to bounce ideas off one another and support each other in the process. At the end, they presented their findings to their communities.
But these campaigns take time and success can be hard to gauge.
“You're taking away sugar, you're asking people to stop drinking sugar,” Goldtooth-Halwood said. “This cohort, they actually had to face that. Like, how do you talk to your community when they're not totally bought in?”
Still, Duran believes they have a ripple effect in the community.
“If the community sees what they are doing, they're being encouraged by the youth, they are more willing to kind of make small steps, small changes,” Duran said. “It's not going to happen overnight where the entire community is drinking water.”
“We know our communities have that kind of love and passion for their communities, that they're going to do whatever it takes to uplift their health, particularly for their children,” Goldtooth-Halwood added.
The NB3 Foundation has continued to fund additional cohorts of Native organizations, expanding the effort to communities in the Midwest and on the West Coast.
Back in Shiprock, Hale is excited to watch Dorian as he continues to grow. She hopes others in her community can experience the study the way she did.
“It means a lot, because I know a lot of people don't really have the access or they don't have the resources …or they don't know about it,” she says. “For me, it feels like a big deal.”
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.
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