Editor’s note: This story is part of NWPB's efforts to report not just on problems, but on how our communities are seeking solutions. Want to see more stories like this? Let us know at [email protected].
For years, McCoy Oatman kept a pair of pants in his closet that he never wore.
“I could barely squeeze my leg into 'em, you know? And I thought, ‘Oh, I'll just keep these. Maybe one day I'll lose weight,’” he said.
Oatman had yo-yo dieted for years, he said. He developed prediabetes, and at his heaviest, his size started to make daily life difficult.
“I have three daughters, so being active there in dance and karate, and being able to be part of that with them — even like, tying their shoes,” he said. “At my biggest, just trying to tie my shoes, (I would) get outta breath.”
But last year, Oatman became one of the first participants in a diabetes management pilot program at the Nez Perce Tribe’s Nimiipuu Health clinic.
The program offered comprehensive support: cooking classes, medication management and exercise classes — plus access to behavioral health support and wellness education. Months later, when Lapwai hosted a 5K, he was there — about 80 pounds lighter.
“Me and my oldest daughter ran in that 5K,” he said.
These days, he said, those pants he saved are too big. And for the first time, he’s been able to keep most of that weight off.
“I went from being prediabetic to where I’m just not even in the realm of that now,” he said. “I didn't really think that was ever gonna be possible for me.”
Learning something new
Learning how to take better care of your body can be hard, said Julie Keller, a dietitian at the clinic.
She recalled a cooking class during the first pilot where patients were supposed to cook quinoa.
“I had five different people come to my office and tell me that they'd put it out in a bowl for squirrels because they had no idea what to do with it,” she said.
Education is a big part of the diabetes management program, Keller said. Their first 16-week pilot showed early improvements for patients.
That included 17 out of the 19 patients losing weight, and about half seeing some reduction in their hemoglobin A1c levels — that is, the measure of blood sugar over time used to diagnose diabetes.
A second pilot recruited more patients from the larger community instead of the health center’s staff, which accounted for many in the first pilot. It showed modest but still notable improvements in weight and some early reductions in blood sugar levels.
Those A1c changes were small in both cases, clinic staff noted, and not large enough to be considered statistically significant. However, considering the short time period of that pilot study, the changes suggested that sustained engagement in the program could result in bigger changes.
One of the biggest challenges for the program is retention, Marissa Verduci, diabetes program coordinator, said. People get busy managing their daily lives, taking care of children, balancing work responsibilities and personal challenges. Nimiipuu Health’s program incentivized engagement with gift cards for gas and groceries, Verduci said.
“As long as you completed it and had a way of showing us that you did complete it, you were eligible to win gift cards,” she said.
Retention has remained one of the biggest barriers for similar programs over the years. A 2013 study looking at other diabetes management programs across the country for Native Americans also found that retention was a major barrier.
Building trusting relationships over time and working with individuals to address their unique needs is essential, Verduci said.
“There's a lot of distrust in the medical system itself because of the things that community members have gone through,” she said. “The more that we can establish and focus on those relationships within the clinic, the more that we can build back that trust.”
Cappie Allen, a clinical pharmacist, is the primary diabetes educator for the Yellowhawk Tribal Health Center at the Confederated Tribes of the Umatilla Indian Reservation.
She said in her program, a “warm handoff” where providers introduce patients they refer to her in person helps with retention.
“Seeing the person that they would be no-showing if they didn't come to that appointment, I think, was very helpful in starting to get people to buy into the program,” she said.
Yellowhawk doesn’t have exactly the same model as Nimiipuu Health, but Yellowhawk’s program also provides patients access to registered dietitians, fitness classes and cooking classes.
They also provide transportation to a local farmers market, health education classes that are incentivized by grocery store gift cards, and appointments. The clinic also recently began offering Frontier Veggie RX to a limited number of families, which provides monthly benefits to purchase fruits and vegetables.
Some tribal clinics may also have more flexibility than other providers to offer unique tools to patients. At Yellowhawk, continuous glucose monitors are a commonly used educational tool for the diabetes program, even for patients who don’t need it for insulin or medication management.
“A lot of places kind of restrict the use of that to somebody using it for insulin,” Allen said. “Since the beginning of our program, we really saw value in using the continuous glucose monitor, really, for anybody who has diabetes as an educational tool.”
Getting the word out
Another powerful motivator, especially in tribal communities, is word of mouth, Verduci said.
“That's something that is so strong in this community,” Verduci said. “People are gonna talk about their experience with something, whether it be good, whether it be bad.”
Several people became interested in the diabetes management program after seeing Oatman’s success, Keller said.
“McCoy's accidentally been a great recruiter for our program,” Keller said. “People see him out and think he looks amazing.”
That recruitment is perhaps especially critical because Native American people are about three times more likely than white adults to have 2 diabetes, according to data from the Centers for Disease Control and Prevention.
One reason is that historically, reservation allotments and federal policies often limited access to traditional whole foods in favor of processed rations like flour, lard and sugar.
“I dunno if you've ever had fry bread,” Oatman said. “People say that’s traditional food, but it's not. It's just from you what was given to us, and we made what we could.”
Food insecurity also makes diabetes management harder, Verduci said. Many tribal communities are in food deserts, so finding affordable food is harder. Lapwai has one grocery store, and the next closest is about 15 miles away.
“That does make it harder to make those healthier choices,” Verduci said.
Shannon Turner, another patient who went through the pilot program, said she’s off her diabetes medication because she doesn’t need it anymore. She found the mental health support and culturally informed guidance to be especially helpful.
“Culturally, our community — we eat. Events are surrounded by food. When you go to powwow, you feed everybody. Like, that’s what we’re supposed to do,” she said. “I think what the program has really focused (on), and helped (with), is that we can still do those things, but we can do them in a healthier way.”
Nimiipuu Health isn’t the only tribal clinic to find success. At the Confederated Tribes of the Umatilla Indian Reservation’s Yellowhawk clinic, patient data showed those enrolled in the diabetes management program between 2019 and 2023 achieved improvements in Hemoglobin A1c values over time.
There’s also evidence of similar programs working at a national scale. A 2020 report to Congress on the Special Diabetes Program for Indians, which funds both of those clinics’ programs, showed that average blood sugar levels at Native American health programs decreased by an average of 10% over roughly two decades.
It also showed that, for the first time, diabetes rates among Native Americans decreased, starting in 2013.
Nimiipuu Health’s diabetes management program is open to patients with funding until 2027, which clinicians say they plan to reapply for.
