Promising strategies for obesity prevention and treatment within American Indian communities.

In the United States, obesity prevention and treatment programs are dominated by individual-focused strategies. Yet epidemic proportions of obesity and high failure and dropout rates of conventional efforts prompt consideration of alternate approaches. A nonsystematic review of American Indian (AI) health promotion programs highlights a group-focused approach using three primary and two supportive strategies. These strategies are outlined as: (a) build and reinforce social cohesion and collective efficacy, (b) use the motivating force of friendly competition, and (c) aspire to change local norms and policies through assuring high visibility of alternate behaviors and engaging formal and informal leaders. Although evidence to demonstrate the impact of these efforts is limited and not currently available to public health audiences, AI communities' sustained acceptance and continued involvement in the programs suggest that these strategies are worthy of review and consideration by public health practitioners addressing obesity on a national level.