Indians took to buying “sugar, coffee and canned goods to replace traditional foodstuffs lost ever since whites had settled in their territories.”
Neither Hrdlika nor Russell suggested that the U.S. government rations might be the cause of obesity. But if the Pima diet on government rations was anything like that of tribes reduced to similar situations at the time on which data exist—including the Sioux on the Standing Rock Reservation in the Dakotas— then almost 50 percent of their calories came from sugar and flour.
Obesity in association with “widespread poverty” was documented again on the Pima reservation in the early 1950s by Bertram Kraus, a University of Arizona anthropologist working with the Bureau of Indian Affairs. According to Kraus, more than 50 percent of the children on the Pima reservation could legitimately be described as obese by their eleventh birthday. The local Anglos, Kraus wrote, got leaner as they got older (at the time, at least); this was not the case with the Pima. Kraus lamented the absence of dietary data to assess the nutritional state of the tribe, but this situation was remedied a few years later by Frank Hesse, a physician at the Public Health Service Indian Hospital on the Gila River Reservation. Hesse noted that the Pima diet of the mid-1950s was remarkably consistent from family to family and consisted of “mainly beans, tortillas, chili peppers and coffee, while oatmeal and eggs are occasionally eaten for breakfast. Meat and vegetables are eaten only once or twice a week.” Hesse neglected to assess sugar consumption, but he did note that “a large amount of soft drinks of all types is consumed between meals.” Hesse then concluded that 24 percent of the calories consumed by the Pima (the soft drinks not included) were from fat, which is certainly low by modern standards.*69
Over the next twenty years, the prevalence of obesity and diabetes among the Pima continued to rise, now coincident with a change in the foods distributed by government agencies and sold in the reservation trading posts. By the late 1950s, according to the Indian Health Service in Tucson, “large quantities of refined flour, sugar, and canned fruits high in sugar” were being distributed widely on the reservations, courtesy of a surplus commodity food program run by the U.S. Department of Agriculture. When mechanization of the local agriculture industry brought a cash economy to the Pima, the local stores and trading posts “started to carry high caloric pre-packed sweets, such as carbonated beverages (i.e., ‘soda pop’), candy, potato chips, and cakes.” “Soda pop is used in immense amounts,” as one 1962 study described it.
In April 1973, when the evils of dietary fat were still widely considered hypothetical, the NIH epidemiologist Peter Bennett appeared before George McGovern’s Senate Select Committee on Nutrition and Human Needs to discuss diabetes and obesity on the Pima reservation. The simplest explanation for why half of all adult Pima were diabetic, said Bennett, was the amount of sugar consumed, which represented 20 percent of the calories in the Pima diet. “The only question that I would have,” Bennett had said, “is whether we can implicate sugar specifically or whether the important factor is not calories in general, which in fact turns out to be really excessive amounts of carbohydrates.” Bennett’s opinion was consistent with that of Henry Dobyns of the D’Arcy McNickle Center for the History of the American Indian, who is considered the foremost authority on Pima history. In 1989, Dobyns described obesity and diabetes in the tribe as being “to some extent a result of inadequate nutrition” and added that this inadequate nutrition had come about because “many of the poorer individuals subsist on a diet of potatoes, bread, and other starchy foods. Their traditional diet is beyond their reach, for they cannot catch fish in a dry riverbed and they cannot afford to buy much meat or many fresh fruits and vegetables.”
Studies of the Sioux of the South Dakota Crow Creek Reservation in the 1920s, Arizona Apaches in the late 1950s, North Carolina Cherokees in the early 1960s, and Oklahoma tribes in the 1970s all reported levels of obesity comparable to that in the United States today, but in populations living in extreme poverty. “Men are very fat, women are even fatter,” as the University of Oklahoma epidemiologist Kelly West said of the local tribes of the 1970s. “Typically, their lifetime maximum weight has been 185 percent of standard.”
The early study of the Sioux, by two investigators from the University of Chicago, is particularly interesting, because it was one of the few published studies of diet, health, and living conditions in such a population, and it appeared the same year that the U.S. Department of the Interior released the results of a lengthy investigation of Native American living conditions. “An overwhelming majority of the Indians are poor, even extremely poor,” the Interior Department reported, “living on lands from which a trained and experienced white man could scarcely wrest a reasonable living.” The University of Chicago report said most of the Sioux lived in one-or two-room shacks; 40 percent of the children lived in homes without toilet facilities; water had to be hauled from the river. Little milk was consumed, although canned milk was included in the government rations. Butter, green vegetables, and eggs were almost never eaten. No fruit was consumed.*70 Twenty-five to forty pounds of beef were issued per person as government rations each month, but this was “not an indication of the amount consumed by each person,” the report noted, “for the families who receive rations are not left alone to eat them. Issue day is visiting day for the families not on the ration roll, and often the visit lasts until the friends’ or relatives’ rations of meat are gone. The ration family, therefore, may be compelled to live on bread and coffee for the remainder of the month.”
The staple of the Sioux diet on the reservation was “grease bread,” fried in fat and made from white flour, supplemented by oatmeal, potatoes, and beans, some squash and canned tomatoes, black coffee, canned milk, and sugar. “Almost two-thirds of the families, including 138 children, were receiving distinctly inadequate diets,” the report concluded. Fifteen families, with thirty-two children among them, “were living chiefly on bread and coffee.” Nonetheless, 40 percent of the adult women, over 25 percent of the men, and 10 percent of the children “would be termed distinctly fat,” the University of Chicago investigators reported, whereas 20 percent of the women, 25 percent of the men, and a slightly greater percentage of the children were “extremely thin.”
By the 1970s, when studies of obesity in populations began in earnest, the general attitude was that obesity was simply a fact of life in developed nations. “Even a brief visit to Czechoslovakia,” reported a Prague epidemiologist at the first International Conference on Obesity, in 1974, “would reveal that obesity is extremely common and that, as in other industrial countries, it is probably the most widespread form of malnutrition.”
The observation that this was also true in poor populations in nonindustrialized countries, that obesity frequently coexists side-by-side with malnutrition and undernutrition, shows up with surprising consistency. In a 1959 study of African Americans living in Charleston, South Carolina, nearly 30 percent of the adult women and 20 percent of the adult men were obese although living on family incomes of from $9 to $53 a week. In Chile in the early 1960s, a study of factory workers, most of whom were engaged in “heavy labor,” revealed that 30 percent were obese and 10 percent suffered from “undernourishment.” Nearly half the women over forty-five were obese. In Trinidad, a team of nutritionists from the United States reported in 1966 that one-third of the women older than twenty-five were obese, and they achieved this condition eating fewer than two thousand calories a day—an amount lower than the United Nations’ Food and Agriculture Organization recommendation to avoid malnutrition. Only 21 percent of the calories in the diet came from fat, compared with 65 percent from carbohydrates.
In Jamaica, high rates of obesity, again among adult women in particular, were first reported in the early 1960s by a British Medical Research Council diabetes survey. By 1973, according to Rolf Richards of the University of the West Indies, Kingston, 10 percent of all Jamaican men and nearly two-thirds of the women were obese in a society in which “malnutrition in infancy and early childhood remains one of the most important disorders contributing to infant and childhood mortality.”
Similar observations were made in the South Pacific and throughout Africa. In Rarotonga in the South Pacific, for instance, in the mid-1960s, on a diet of only 25 percent fat, over 40 percent of the women were obese and 25 percent were “grossly obese.” Among Zulus living in Durban, South Africa, according to a 1960 report, 40 percent of adult females were obese. Women in their forties averaged 175 pounds. In a population of urban Bantu “pensioners,” the mean weight of women over the age of sixty was reported in the mid-1960s to be 165 pounds.
