As documented in the current issue of the Journal of Public Health Management and Practice, no group of people in the United States has borne a greater burden during the rising childhood obesity epidemic than American Indians.1 Specifically, American Indian children have higher levels of overweight and obesity than their white, black, or Hispanic counterparts.2 Obesity, compounded by excessive caloric intake, high levels of sedentary behavior, and low levels of physical activity, produces high rates of diabetes and other negative metabolic outcomes.3 While promising research has suggested that a behavioral solution can be formulated to address childhood obesity in American Indians,4 dissemination of these "best practices" must be adapted for the cultural and geographic heterogeneity across the more than 500 tribes recognized by the US government in addition to the numerous nonrecognized tribes.2

Despite the recognized need for physical activity and obesity prevention programming in American Indian populations, surprising little research has been conducted in this area. A recent review by Coble and Rhodes,5 using strict inclusion criteria, identified only 35 published studies that examine correlates of physical activity in American Indian adults. The review identified only social support as a consistently reported, modifiable correlate of physical activity. While other correlates are identified in the literature, the field lacks a critical mass of published studies to establish any level of consistency. Even less research is available in children. A review of physical activity interventions in Native American populations in the United States and Canada by Teufel-Shone et al4 provides insight into this paucity of published research. In their review, the peer-reviewed literature was surveyed along with the gray literature (eg, web sites, conference proceedings, and white papers) to identify a broader array of interventions. This review identified 64 different physical activity interventions, with 37 of those interventions being conducted with youth 18 years or younger. While this review produced a number of interesting findings, 2 of them are especially pertinent. First, only 27 of the 64 interventions (42%) reported a measure of impact related to physical activity.4 Of these, only 3 reported significant increases in physical activity, all in populations of adults. What this review highlights is a lack of empirical support for interventions to promote physical activity in American Indian youth. A second and more overarching concern identified by Teufel-Shone and colleagues4 is the lack of consistent evaluation of these interventions. Approximately 40% of the interventions identified lacked an evaluation component,4 which compounds the general lack of impact for the interventions as a whole. This lack of consistent evaluation makes dissemination of "best practices" difficult because identification of such programs without demonstrated impact is problematic. In addition, sustaining funding for such programs often requires proof of impact or fidelity of implementation, and the lack of such evidence can make continuing proposals uncompetitive.

While the lack of comprehensive evaluation and demonstrated efficacy is troubling, there are promising findings to report. For example, interventions that involved sole or shared project leadership by tribal entities resulted in greater sustainability.4,6 This is in stark contrast to the very low number of sustained interventions that were originated and administered by universities or other outside agencies. These findings highlight the need, especially in culturally unique settings such as American Indian communities, for community participatory research methodologies to be employed. Unfortunately, developing these types of partnerships and sustaining them from project conceptualization to data analysis and dissemination can be difficult and time-consuming.7 Promising approaches such as the Native American Research Centers for Health, now in its seventh year, which seeks to build tribal research collaborations and capacity8 must be supported, sustained, and evaluated, if significant progress is to be made.

In the interest of identifying the path forward, a number of lessons learned are shared by authors in our current issue. Sallis9 provides a general overview of evaluation methods to assess physical activity in American Indian youth while acknowledging the limited resources of communities and practitioners. Expanding on these suggestions, Going10 shares practical insight into field-based physical activity assessment garnered from work on the Pathways program. In one of the commentaries, Adams11 presents insight into ways to work with American Indian families to identify and ameliorate barriers to physical activity based on experience gleaned from the Wisconsin Nutrition and Growth Study.11

There are still many obstacles to overcome before sustainable and effective programs to increase physical activity and reduce the burden of disease in American Indian youth can be developed. Those of us involved in public health research and practice in collaboration with our community partners can build upon the lessons of the past to develop a roadmap for the way forward. In partnership with tribal governments and local coalitions, we can illuminate the path to a brighter future for American Indian youth.

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