“He’s a little skinny and he’s a little wide.”: a mixed design investigation of American Indian student perceptions of healthy bodies

Donetta J. Cothran, Pamela Hodges Kulinna

Research output: Contribution to journalArticlepeer-review


Background: Childhood is a critical developmental time of wellness patterns, yet little is known about what children know and believe. Even less is known about non-majority cultures like American Indian youth. The purpose of this study was to explore American Indian students’ understandings of nutrition and physical activity. Methods: This mixed methods study took place in 10 schools in an American Indian community in the Southwestern U.S. Ninety American Indian students in grades 3–12 (8–19 years old) were interviewed. The interview included an 8-point body size chart. Numerical data were analyzed via t-test statistics while a constant comparison process and analysis was used for the interview data. Results: Students rated approximately 85% of students in Category 5 or smaller on the scale while placing 60% of adults at or above that size. There was a general trend of a larger body type for boys seen as healthy compared to that for girls. Students generally believed that their classmates were larger than the healthy body size. For students, a healthy body was the result of compliance with “eat right and exercise” rules. They exhibited little understanding of nutrition or physical activity and there were few developmental differences in understanding. Health was a corporeal concept and violators of the eat right and exercise rules were seen as lazy. Conclusions: Students held narrow and corporeal focused notions of health focused on simple rules. People who violated the rules were “lazy”, a concept that seemed to underlie multiple constructs and a finding that holds true in other investigations. Students also reported few adult role models, a topic that should be explored with expanded family groups to better represent the multi-generational (e.g. grandparents, uncles, aunts) family housing common in the community. The findings are limited to a single American Indian community and a mixed design of relatively small numbers. This addition to the literature from a non-majority cultural group expands our knowledge of student perspectives on health. These findings can be used to create more effective curricula and interventions. Schools need more effective, but also alternately framed approaches that promote broader views of health.

Original languageEnglish (US)
Article number239
JournalBMC public health
Issue number1
StatePublished - Dec 2023
Externally publishedYes


  • American Indian
  • Children’s health
  • Qualitative

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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