Obesity and Prediabetes Rates Rise Among Northern Great Plains Children

The Escalating Metabolic Crisis in Pediatric Indigenous Populations

Pediatric metabolic health has emerged as a critical priority for clinicians as obesity-related comorbidities increasingly manifest in school-aged populations. While national cancer mortality rates have generally declined, Native American communities continue to face significant health disparities, including mortality rates for liver and kidney cancers that are two to three times higher than those seen in White populations [1]. These long-term outcomes are often rooted in early-life metabolic dysfunction, such as metabolic dysfunction-associated steatotic liver disease (a condition characterized by excess fat accumulation in the liver linked to insulin resistance) and type 2 diabetes [2, 3]. Although lifestyle interventions like consistent physical activity are known to mitigate these risks, systemic barriers and sedentary behaviors continue to drive unfavorable body composition in youth [4, 5]. Understanding the specific trajectory of these metabolic markers within high-risk communities is essential for targeted clinical prevention. A new study now provides longitudinal data on the shifting prevalence of obesity and glycemic instability among American Indian children.

Longitudinal Screening of Reservation Youth

The researchers conducted a multi-year evaluation to determine the prevalence of obesity, prediabetes, and diabetes among American Indian children living on a single reservation in the Northern Great Plains. This longitudinal screening program spanned four school years, beginning in 2019–2020 and concluding in 2022–2023. The study population included American Indian students in grades kindergarten through 11 whose families provided parental consent for clinical monitoring. By tracking these metrics over several years, the authors aimed to identify shifts in metabolic health during a period of significant public health transition, providing a clearer picture of how early-onset metabolic disease progresses in a real-world clinical setting. Clinical assessments for the participants focused on primary indicators of metabolic dysfunction and glycemic control. The researchers collected data on height, weight, and body mass index (BMI) percentiles, which are adjusted for age and sex to identify weight categories in pediatric populations. Additionally, the team measured hemoglobin A1c (HbA1c) levels, a standard clinical test that provides an average of blood sugar levels over the previous two to three months. To analyze the data, the researchers utilized chi-square tests (a statistical method used to determine if there is a significant association between categorical variables, such as weight class and school year). These tests were applied to identify differences in BMI percentiles and HbA1c levels, compare outcomes between sexes, and evaluate longitudinal changes over the four year study period.

High Prevalence of Early-Onset Obesity

The longitudinal screening data reveal a stark escalation in weight-related metabolic risks compared to historical benchmarks. In 2015, the Indian Health Service reported an obesity prevalence rate of 29.7% for American Indian and Alaska Native children aged 2 to 19 years. However, the current findings indicate that the prevalence of obesity among these American Indian students is now significantly higher than those 2015 Indian Health Service rates. Between the 2019–2020 and 2022–2023 school years, the percentage of students presenting with any class of obesity (class I, II, or III) ranged from 41.8% to 50.3%. These figures represent a substantial shift in the baseline health of the student population, suggesting that nearly half of the children screened meet the clinical criteria for obesity. The breadth of the crisis is further evidenced by the total percentage of students categorized as having either overweight or obesity. Throughout the four year study period, the proportion of students with overweight or class I, II, or III obesity ranged from 60.9% to 68.6%. Clinicians should note that these metabolic challenges are not confined to older adolescents; rather, they are pervasive across all developmental stages. The researchers found that students in every grade from kindergarten through 11 exhibited overweight as well as classes I, II, and III obesity. This distribution was consistent across the age spectrum, as students at every age from 6 to 17 years were identified within the overweight and all three obesity classifications. The presence of class III obesity (the most severe form of obesity, defined as a body mass index at or above 140% of the 95th percentile) in children as young as 6 years old underscores the need for early clinical screening and aggressive metabolic intervention to prevent the early onset of cardiovascular and endocrine complications.

Rising Glycemic Instability and Diabetes Risk

The longitudinal data reveal a sharp escalation in glycemic dysregulation among the screened youth, particularly regarding the transition toward overt metabolic disease. The percentage of students with a hemoglobin A1c level from 5.7% to 6.4%, the clinical range for prediabetes, significantly increased from 4.7% to 9.9% (P = .001) between the 2019–2020 and 2022–2023 school years. This doubling of prediabetes prevalence occurred over a relatively short four year interval, indicating a rapid shift in the metabolic baseline of the community. Clinicians should note that these findings were not restricted to older adolescents; the researchers identified prediabetes in students at every age from 5 to 17 years, suggesting that the physiological precursors to diabetes are now manifesting in early childhood. For students who presented with a hemoglobin A1c level of at least 6.5%, which meets the diagnostic threshold for diabetes, the study identified specific demographic and clinical characteristics. Within this cohort of students with diabetes-range glycemic levels, 70% were male, indicating a notable sex-based distribution in severe cases. The clinical etiology of these cases was predominantly metabolic; while 18.8% were diagnosed with type 1 diabetes, 81.2% were diagnosed with type 2 diabetes. These current prediabetes rates suggest a possible increase in the future incidence and prevalence of diabetes for these children. The authors conclude that without targeted interventions, the high volume of students currently in the prediabetic range will likely lead to a substantial rise in the regional disease burden of type 2 diabetes, necessitating a shift toward more robust community-based screening and early therapeutic management.

References

1. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA A Cancer Journal for Clinicians. 2025. doi:10.3322/caac.21871

2. Chalasani N, Younossi ZM, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012. doi:10.1002/hep.25762

3. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023. doi:10.1097/hep.0000000000000520

4. Poitras VJ, Gray C, Borghese MM, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology Nutrition and Metabolism. 2016. doi:10.1139/apnm-2015-0663

5. Tremblay MS, LeBlanc AG, Kho ME, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity. 2011. doi:10.1186/1479-5868-8-98