"It Matters Who Defines It"-Defining Nutrition through American Indian, Alaska Native, and Native Hawaiian Worldviews

Adequately assessing nutrition is deeply important for understanding and addressing health inequities, especially for American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) peoples who have been subjected to the malnourishing effects of settler colonialism. Mainstream approaches to nutrition rely heavily on indicators of physical diet consumption, while ignoring the contributions of food to spiritual, social, and emotional health. Considering only physical aspects of dietary consumption paints a narrow picture of AI/AN/NH foodways and nutritional health further contributing to deficit-based narratives about AI/AN/NH peoples. To adequately understand and address the nutritional health of AI/AN/NHs, strengths-based approaches to nutrition that are rooted in Indigenous ways of knowing are urgently needed.

The objective of this study was to define nutrition through AI/AN/NH worldviews.

Three focus group discussions (n = 3) and in-depth interviews (n = 6) were conducted with 26 purposively identified AI/AN/NH food sovereignty experts and knowledge holders. Data collection and analysis were conducted iteratively. Through a process of open, focused, and axial coding, primary themes and supporting subthemes were established and refined, and a conceptual framework (the Indigenous Nourishment Framework) was developed to reflect the relationships between primary themes, subthemes, and the overall meaning of nourishment for AI/AN/NHs.

The Indigenous Nourishment Model contains 4 main domains of nourishment (physical, spiritual, emotional, and relational), and 8 subthemes representing concepts, practices, and beliefs, which contribute to overall nourishment.

Despite the importance of physical aspects of nutrition, our findings assert that spiritual, emotional, and relational well-being are inseparable and integral to the overall goal of nourishment for AI/AN/NHs. The resulting Indigenous Nourishment Framework developed with a diverse group of AI/AN/NH food knowledge holders reflects the strengths of AI/AN/NH foodways and builds upon existing approaches to nutrition by offering new directions for approaching and measuring nutrition.