Targeting risk factors for type 2 diabetes in American Indian youth: the Tribal Turning Point pilot study

Pediatr Obes. 2018 May;13(5):321-329. doi: 10.1111/ijpo.12223. Epub 2017 Jun 21.


Background: American Indian (AI) youth are at high risk for type 2 diabetes.

Objectives: To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study.

Methods: We enrolled 62 overweight/obese AI children (7-10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes.

Results: Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m-2 , p < 0.001) but not intervention participants (+0.3 kg m-2 , p = 0.13); BMI z-score decreased in intervention (-0.17, p = 0.004) but not control participants (0.01, p = 0.82). There were no treatment effects for cardiometabolic or behavioural outcomes.

Conclusions: We demonstrated that a behavioural intervention is feasible to deliver and improved obesity measures in AI youth. Future work should evaluate TTP for effectiveness, sustainability and long-term impact in expanded tribal settings.

Keywords: American Indian; Native; behavioural research; obesity; paediatrics; prevention.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Anthropometry
  • Blood Glucose
  • Child
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Feasibility Studies
  • Female
  • Focus Groups / methods
  • Health Behavior
  • Health Promotion / methods*
  • Humans
  • Indians, North American
  • Insulin / blood
  • Life Style
  • Male
  • Motivational Interviewing / methods*
  • Pediatric Obesity / complications
  • Pediatric Obesity / therapy*
  • Pilot Projects
  • Risk Factors
  • Self Efficacy


  • Blood Glucose
  • Insulin