O1036: The Chickasaw Nation’s Empowered Living Clinic to Improve First Americans’ Health

Background: Indigenous children have the highest prevalence of obesity in the US, yet access to comprehensive treatment for this population is limited. Obesity rates among youth within Chickasaw Nation’s Department of Health range from 33% for preschool-aged children to 50% among 12-18 year-olds, underscoring the imperative need for access to enhanced services focused on treatment.

Methods: In 2016, the Chickasaw Nation established the Empowered Living Clinic, providing a specialized clinic dedicated to pediatric weight management for youth ages 2-18 years. The interdisciplinary team includes a pediatrician, medical family therapist, dietitian, and physical therapist. The team offers comprehensive care through whole-child and family-based approaches and prioritizes non-stigmatizing care and addressing social determinants of health among First American children in rural Oklahoma. The team integrates clinical expertise in weight management with a deep understanding of tribal and community-based resources. A registry was established through the Chickasaw Nation IRB and in partnership with the University of Oklahoma Health Sciences Center to track outcomes, including body mass index (BMI), body composition (by InBody), and cardiometabolic markers (lipids, ALT, and HbA1c).

Results: 123 patients have consented to participate in the registry from 11/2016-12/2023. 53% are female; 49% are 12-18 years of age. At baseline, 73% of patients had a BMI ≥ 120th of the 95th percentile, classifying them with severe obesity. 61% had an elevated ALT, indicating fatty liver disease, and 34% had prediabetes based on their HbA1c level. Dyslipidemia is also prevalent with 42% of patients having a low HDL level and 32% of patients with hypertriglyceridemia. Follow-up data from baseline to last visit showed improvement in BMI measures and cardiometabolic outcomes. 54% of patients had a decrease in BMI percentile and 29% of patients had a decrease in BMI. Body composition also improved with 31% of participants having a reduction in fat mass. Follow-up labs showed 62% of patients had improvement in their triglyceride levels, while half of patients had a decrease in their ALT levels (52%) and HbA1c levels (54%). Preliminary analyses do not show significant differences in outcomes by age, gender, or duration in clinic.

Conclusion: The Empowered Living Clinic provides access to comprehensive care for obesity treatment in alignment with the AAP Clinical Practice Guideline on Obesity for First American children within Chickasaw Nation. The clinic’s holistic perspective on health management has contributed to its sustainability. Improvements in BMI, body composition, and cardiometabolic markers among participants have allowed for expansion of services within Chickasaw Nation. Dissemination of the Empowered Living Clinic model to other Indian Health Service clinics may help address access and treatment barriers for obesity treatment among Indigenous youth.