The Medicine Wheel, a sacred symbol in many North American Indigenous cultures, offers a holistic framework for health and well-being. Emerging research suggests that culturally tailored interventions based on the Medicine Wheel can promote positive changes in weight and overall health, particularly among Native American populations. This article explores the effectiveness of the Medicine Wheel model in weight loss and its potential to address health disparities by aligning lifestyle interventions with traditional ecological knowledge systems.
Understanding the Medicine Wheel
The Medicine Wheel, also known as the "four directions" teachings, represents the continuity and perpetuity of life. The wheel or circle is a sacred symbol. It is iconized in many Indigenous cultures across North America with different directions representing different aspects of our world and of ourselves, different seasons of the year and of our lives, different beings of the earth and tribes of humans with a balance among those necessary for health and wellbeing. It provides a way to orient oneself within traditional belief systems and seasonal changes. The four directions symbolize different aspects of our world (fire, earth, water, and air), the four seasons (spring, summer, autumn, and winter), four aspects of our humanity (spiritual, emotional, physical, and intellectual), and four stages of our lives (birth, youth, adult/elder, and death).
Medicine Wheel teachings warn that a lack of balance limits our ability to achieve optimal health. Just as one season is not more important than another, it is also true that no one aspect of ourselves or stage of our lives is more important than the others. Optimal functioning of ourselves and our world, the health and wellness of our spirits, emotions, bodies, and minds depends on a balance of all aspects with consequences resulting from imbalance. Individuals grow and change as they develop, only to revisit areas of themselves and grow and change more at each pass on the wheel. Deaths are endings and as is true with all endings - the end of our bodies, friendships, employment, education, projects, laws, and even stars - are followed by new life.
The Medicine Wheel Model for Nutrition
Professor Kendra Kattelmann of South Dakota State University (SDSU) credits former SDSU graduate student Kibbe Conti with developing the Medicine Wheel Model for Nutrition. The concept behind the Medicine Wheel that makes it promising as a nutritional model is the idea that everything should be in balance. This model interprets dietary guidelines through the lens of the Medicine Wheel, encouraging individuals to embrace a traditional pattern that helps control total energy intake and blood glucose levels.
The Medicine Wheel Model for Nutrition emphasizes four healthful components of a traditional hunter-gatherer diet, corresponding with the symbolism of the Medicine Wheel. Participants in the Medicine Wheel group were encouraged to consume a diet broadly patterned after the traditional Northern Plains Indian diet, with protein making up about 25 percent of calories, carbohydrates making up 45 to 50 percent and fat making up only 25 to 30 percent. This approach contrasts with standard dietary education, which is typically based on general dietary guidelines and not tailored to specific cultural traditions.
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Research on the Effectiveness of the Medicine Wheel
Several studies have investigated the effectiveness of the Medicine Wheel model in promoting weight loss and improving health outcomes among Native Americans.
South Dakota State University Study
A study published in the September 2009 issue of the Journal of the American Dietetic Association examined the impact of a culturally based nutrition intervention using the Medicine Wheel with the Cheyenne River Sioux Tribe. During a 6-month period from January 2005 through December 2005, participants from the Cheyenne River Sioux Reservation were randomized to an education intervention or to a usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition, a diet patterned after the traditional consumption of macronutrients for Northern Plains Indians: protein (25% of energy), moderate in carbohydrate (45% to 50% of energy) and low in fat (25% to 30% of energy). The education group experienced a significant weight loss and decrease in body mass index (BMI) from baseline to completion. The usual care group had no change in weight or BMI.
Kattelmann notes, "A diet patterned after the historical hunter-gatherer type diet, or even the early reservation diet (with the higher proportion of energy being supplied from protein), may provide better blood glucose control and lower the circulating insulin levels in Northern Plains Indians with type 2 diabetes." The study is one of the first to attempt to measure the influence of the traditional Northern Plains Indians diet in controlling type 2 diabetes. While the study was inconclusive about the strategy’s overall effectiveness in controlling type 2 diabetes, the culturally based nutrition intervention promoted small, but beneficial, changes in weight.
Implications for Diabetes Education
The SDSU research showed an intervention strategy based on the Native American spiritual concept of the Medicine Wheel brought positive changes for diabetics. The Medicine Wheel education group experienced a significant weight loss and decrease in body mass index (BMI) from baseline to completion.
Kibbe M. Conti's 2007 thesis, "The Medicine Wheel Nutrition Intervention: A Diabetes Education Study With the Cheyenne River Sioux Tribe," also concluded that a culturally based nutrition intervention promoted positive changes in weight control.
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Limitations and Challenges
While the Medicine Wheel intervention showed promise, researchers also faced challenges. Kattelmann said, “We still weren’t able to get them to the recommended levels of protein and carbohydrate that we had as our goals." Jamie Stang, Chair of the Public Health Nutrition Program at the University of Minnesota, School of Public Health, cites some of the dietary challenges faced by the American Indian population. "Limited access to grocery stores that offer low fat, low sugar or whole grain food products and a variety of fruits and vegetables is the most frequently cited barrier to healthy eating…The loss of hunting and fishing rights, unavailability of traditional foods such as wild game, loss of traditional agriculture due to water scarcity and poor soil condition and loss of traditional ways of procuring and preparing foods have also been identified as reasons for poor food choices.
Integrating Traditional Teachings into Lifestyle Interventions
Medicine Wheel teachings are indigenous teachings used by different tribes to serve numerous purposes, often focused on diverse areas of health and wellness. Integrating traditional teachings that have survived for centuries into culturally-tailored lifestyle interventions may be the solution to address health disparities in Tribal Nations. This approach recognizes the importance of the spiritual and social domains, as well as the family level, in facilitating improved lifestyle management among Indigenous populations in North America.
Addressing Spiritual and Social Determinants of Health
The SDPI-DP data demonstrated that spirituality was negatively correlated with weight at baseline. Indigenous populations in North American have exhibited fatalistic views including a resignation to acquiring diseases like diabetes that can be addressed in the spiritual domain. This spiritual aspect is likely a conditioned response and a resultant cultural norm following repeated exposure to premature death and loss within North American Indigenous communities.
Research also supports that family is a potentially important contributor to the attainment of positive health outcomes among Indigenous populations in North America, indicating the importance of the social domain for this population. Jiang et al. reported that lack of family social support was a major predictor of SDPI-DP dropout and linked to less weight lost post-intervention. In contrast, family support of dietary behaviors has been shown to improve diabetes control among Navajo members. Jiang et al. also reported in a later study that participants who lacked family support were at greater risk for not attending intervention sessions and loss to follow up, indicators of short- and long-term retention failure. Positive family social support was a predictor of greater weight loss over the course of the intervention, whereas psychosocial factors such as coping skills and trauma exposure were not predictors.
The Socioecological Model (SEM)
Recognizing that behavior change is multi-faceted and involves multiple levels of influence, the socioecological model (SEM) suggests multiple interdependent factors that interact within and across levels to influence human behavior. The SEM was adapted for health promotion and disease prevention to recognize multiple levels of influence on health behaviors. The levels of the model include intrapersonal/individual, interpersonal, institutional/organizational, community, and public policy factors. Both wellness and SEM theories suggest that well-being is achieved and programs are most effective when they are designed to address multiple levels of influence on health behaviors.
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From their inception, standard lifestyle interventions have historically focused on the physical and intellectual dimensions of health at the individual level. For example, increasing self-efficacy to eat healthier is an intellectual improvement, whereas healthier dietary behaviors is a physical improvement; both are intrapersonal factors. However, it is becoming more obvious, and in alignment with Medicine Wheel teachings and current health behavior theories, that targeting multiple dimensions and levels ensures a more comprehensive health promotion or disease prevention program.
The Medicine Wheel: A Path to Holistic Wellness
The Medicine Wheel offers ancient teaching and essentially behavioral theory may guide the development of evidence-based health interventions in the same way that modern theory is used. By incorporating the spiritual, emotional, social, and physical aspects of well-being, the Medicine Wheel provides a framework for addressing the complex challenges of weight management and chronic disease prevention. As research continues to explore the effectiveness of culturally tailored interventions, the Medicine Wheel holds promise as a valuable tool for promoting health equity and empowering individuals to achieve lasting wellness.
Modern Interpretations and Applications
The Southern Miss Medicine Wheel garden, established in 2005, is a modern-day representation of Medicine Wheel teachings and knowledge, and features plants native to the Deep South. This garden exemplifies how traditional knowledge can be adapted and applied in contemporary settings to promote health and well-being.
The Role of Lifestyle Modification Programs
Diet and physical activity lifestyle modification programs mitigate chronic disease risk and promote quality of life by improving associated cardiometabolic outcomes (weight, blood pressure, glucose, and lipid levels). Standard lifestyle modifications include enhancing self-efficacy for diet/physical activity behavior changes and improving healthy behaviors. The National Diabetes Prevention Program (NDPP) is the most renowned standard lifestyle modification program showing that behavior modification without medication was more effective at diabetes prevention compared to medication alone with sustained outcomes over time. As an example of a public health success, the NDPP has been adopted and supported for implementation across the US and translated to Indigenous populations across the US (Special Diabetes Program for Indian Diabetes Prevention; SDPI-DP). The SDPI-DP and NDPP outcomes in 80 tribes had similar post-intervention cardiometabolic improvements.
However, despite significant post-intervention improvements in health outcomes, Jiang et al. reported large dropout rates attributing participant-level factors of retention failure to a lack of family support, becoming diagnosed with diabetes, and self-reported disinterest in the program. Even with successes in the adoption of SDPI-DP across the nation, health disparities continue to exist among Tribal Nations in the Deep South. More fully integrating traditional teachings that have survived for centuries into culturally-tailored lifestyle interventions may be the solution to address health disparities in Tribal Nations.
Operationalizing Social and Spiritual Domains
Although it is clear that the social domain is important to promote lifestyle behavior change, the question remains, how do we operationalize the social domain toward the implementation and dissemination of evidence-based lifestyle interventions into public health settings? Similarly, there is limited evidence for effective spiritual adaptations to lifestyle interventions that consider Indigenous worldviews.