North Carolina has the largest American Indian population east of the Mississippi River. Members of eight tribes call the state home.

Now many of the tribal leaders are partnering with nutrition researcher Sheila Fleischhacker and others with the American Indian Healthy Eating Project to develop policies that will improve nutrition and food access for American Indian communities across the state.

American Indians suffer disproportionate rates of diet-related diseases, including diabetes, heart disease, and obesity. American Indians are twice as likely to develop diabetes, three times more likely to die from it, and 1.6 times more likely to be obese than non-Hispanic whites.

Poverty, genetics, dietary changes over time, and, in some cases, government policies are a few of the reasons for this, Fleischhacker says.

Where we live can affect the foods we eat and ultimately our risk for developing chronic diseases. But few studies have examined the types and locations of food outlets available to American Indian communities, and few researchers have worked with tribal leaders to promote access to healthful, affordable foods.  

So Fleischhacker and community liaison Ashley McPhail used census data to find areas across North Carolina where high concentrations of American Indians live. They drove some 1,500 miles, crisscrossing several counties to find and catalog each of the places nearby where residents can buy food. 

They found that some communities were situated in what are known as food deserts—areas that are ten or more miles from the nearest grocery store. They also found that for many American Indian communities, convenience stores with grills, Super Walmart stores, dollar stores, and fast food restaurants were some of the most common places to stock up or get a meal.

That kind of food landscape—dominated by calorie-rich, nutrient-poor fare—makes it tough to buy and prepare healthful, affordable food on a regular basis, Fleischhacker says. 

Tribal leaders have worked with the project’s researchers to create tribally specific, sustainable strategies to improve their communities’ access to healthful, affordable foods. They’ve established farmers’ markets, education programs, newsletters, and other grassroots approaches to healthful eating and active living.

John Scott-Richardson, a member of the Haliwa-Saponi tribe and program coordinator at the North Carolina Museum of History, acts as a community liaison with the project. “I was always told if we teach and help, we also learn and apply,” he says. “This is a widespread issue, not just with native people. Eating poorly and trying to cut corners in the long run weighs everyone down. There then are no strong people to carry on the business of the tribe and people. So at the core is health. Without it we can’t begin on the road to progress.”



Sheila Fleischhacker is an adjunct assistant professor of nutrition at UNC’s Center for Health Promotion and Disease Prevention. The American Indian Healthy Eating Project is funded by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation. The seven participating tribes are now teaming up with the state’s four urban Indian organizations, the NC Commission of Indian Affairs, the Center for Health Promotion and Disease Prevention, and UNC’s American Indian Center on a new initiative called Healthy, Native North Carolinians, funded by the Kate B. Reynolds Charitable Trust.