Cultural Food Practices and Their Potential Role in Mitigating Disordered Eating Among American Indian/First Nations Youth

Abstract

Purpose:

Explore the relationship between disordered eating and engagement in cultural food practices in a sample of American Indian/First Nations (AI/FNs) adolescents.

Methods:

Using interviewer-administered surveys data derived from Healing Pathways (N = 661), a longitudinal community-based participatory research study with Midwest AI/FN communities, we examined disordered eating, cultural food practices, and related sociodemographic variables in AI/FN adolescents using data from two time points/waves of this larger longitudinal study. We examined the structure of a disordered eating questionnaire using exploratory factor analysis to reveal psychometric properties of the questionnaire, resulting in three distinct disordered eating constructs “binge eating,” “obsessive food behaviors,” and “altered feelings about body.” Associations with cultural food practices and these disordered eating constructs were examined using adjusted and unadjusted linear regression models.

Results:

Greater engagement in cultural food practices was significantly associated with lower levels of “altered feelings about body” in both unadjusted (β = −0.27, standard error [SE] = 0.04, p < .001) and adjusted models (β = −0.11, SE = 0.05, p < .05). Identifying as female was linked to higher levels of both “obsessive food behaviors” (adjusted β = 0.36, SE = 0.12, p < .05) and “altered feelings about body” (adjusted β = 1.65, SE = 0.16, p < .001).

Discussion:

Participation in cultural food practices may potentially play an important role in creating and sustaining healthy eating behaviors for AI/FN youth. Future research should consider the impact of disordered eating on nutrition-related health behaviors, as well as the potential protective role of cultural food practices against unhealthy eating behaviors.

Since time immemorial, Indigenous foodways have sustained the health and well-being of American Indian/Alaska Native/First Nations (AI/AN/FNs) peoples through nutrient-dense traditional foods (e.g., venison, wild rice, whitefish), seasonal food practices (e.g., spear fishing, wild ricing, hunting), and spiritual responsibilities to care for their environments [1]. For AI/AN/FN communities, their foodways are not merely a means of survival, they are central to their identities, culture, and ways of life [2]. Many AI/AN/FN tribes followed seasonal rounds, engaging in seasonal cyclical food practices that deepened relationships with land, water, plants, animals, and one another [2]. Cultivating, harvesting, preparing, and sharing their traditional Indigenous foods not only nourished the bodies of AI/AN/FN peoples but also provided a way to pass on spiritual teachings, instill cultural values, and share intergenerational knowledge. Further, traditional foods and cultural food practices intersect with spiritual ceremonies, including coming of age ceremonies, which sustain the holistic wellbeing of AI/AN/FN peoples.

However, settler colonial expansion disrupted Indigenous food systems through manmade changes to land and waterways, the introduction of non-Indigenous species, and the imposition of Eurocentric beliefs about “healthy” foods and eating behaviors [3]. These settler colonial food systems and policies have restricted access to traditional foods and undermined relational food practices that have long supported Indigenous physical, emotional, and spiritual well-being [3]. The concept of historical oppression describes how past colonization policies, such as land dispossession, extend beyond discrete historical events to become intergenerational forms of marginalization and oppression that may be normalized or imposed into the daily lives of AI/AN/FN people [4]. Historical oppression includes contemporary conditions such as poverty and constrained access to food systems [4]. These conditions shape present day food environments characterized by food insecurity such as forced reliance on government commodities and food rations [5] and exposure to dominant Western dietary and body norms [4].

Settler colonial beliefs and narratives have long pathologized AI/AN/FN peoples, their foods, behaviors, and their bodies as “wrong” and “deficient,” devaluing Indigenous peoples’ ways of knowing, being, and nourishing [6]. For example, some AI/AN/FN cultural and spiritual practices like fasting, may be mis-characterized by dominant society as unhealthy or symptoms of disorder. The colonial disruption of Indigenous food systems, compounded by ongoing pressures to conform to Western dietary norms, may contribute to increased risk for disordered eating (DE) and eating disorders (EDs) in AI/AN/FN communities today [7–9].

Eating behaviors range from DE to clinically diagnosable EDs. DE describes a spectrum of problematic eating-related behaviors that may not meet clinical diagnostic thresholds, whereas ED refers to psychiatric disorders defined by Diagnostic and Statistical Manual for Mental Disorders (DSM-5-TR), including anorexia nervosa, bulimia nervosa, and binge ED [10]. Disordered eating encompasses a range of behaviors, including chronic dieting, overeating, vomiting, laxative use, and binge eating [11,12]. While these behaviors may not meet the clinical thresholds required for an ED diagnosis (e.g., low body weight or chronicity of symptoms), they remain a significant concern due to their associations with poor mental health and nutritional deficiencies, and for their potential to progress into a diagnosable ED [13]. These behaviors are often framed as individual psychopathology or behavioral concerns. However, they are also deeply shaped by historical and structural forces, including the disruption of Indigenous foodways. Today, in the U.S., AI/AN individuals are twice as likely to experience food insecurity compared to non-Hispanic Whites [14]. Although limited research explicitly explores DE behaviors among AI/AN populations, food insecurity has been associated with DE in adolescents more broadly [15]. Collectively, settler colonial disruptions to Indigenous foodways have contributed significantly to food insecurity, declining physical health, and altered relationships with food, body, and identity [16–18] conditions that may both exacerbate existing DE behaviors and create vulnerability to developing them within Indigenous communities.

EDs typically emerge during late adolescence [19] with a lifetime prevalence of 2.7% among U.S. female adolescents, approximately twice that observed in males [20]. Late adolescence represents a critical developmental window during which there is an increased vulnerability for DE behaviors to persist into adulthood [21]. Much of the existing literature regarding DE, however, is predominately focused on white feminine ideals of thinness and thereby overlooks the growing body of literature advocating for more inclusive and diverse perspectives [22]. Research with other Indigenous populations, such as Māori in New Zealand, similarly demonstrates how ED frameworks and treatment environments often prioritize non-Indigenous experiences, creating barriers for Indigenous individuals and their families seeking care [7]. Importantly, DE and EDs affect individuals across all genders and racial/ethnic groups yet remain understudied in most minoritized populations. Recent reviews of eating disturbances among Indigenous people across high-income settler colonial countries also highlight the limited research examining DE and ED in Indigenous populations and emphasize the need for culturally grounded models and tools [8].

Most studies of EDs and DE fail to include AI/AN/FN participants and do not consider the historical context of health disparities for AI/AN/FN people. Some studies indicate that AI/AN adolescents exhibit higher rates of ED symptoms than non-Hispanic White populations and similar rates of body dissatisfaction [9]. A large study of 9th–12th graders found that 62.9% of AI/AN female and 42.6% of AI/AN males engaged in DE behaviors [12]. Additionally, AI/AN women have been found to experience higher rates of binge eating and similar rates of ED symptoms than White populations [23]. For Canadian FNs, the data are regarding DE is even more limited [24]. Additionally, commonly used assessment tools have rarely been adapted to reflect culturally specific and historically grounded DE experiences. Despite these preliminary findings, a critical gap remains in understanding the risks and protective factors associated with DE among AI/ANs, particularly in relation to cultural values and traditions, including the role of traditional foods and food practices.

Despite historical and ongoing food system disruptions, AI/AN peoples continue to practice and revitalize their traditional foodways and cultural values, many of which have been associated with positive mental health outcomes [25,26]. Because traditional food practices are embedded within cultural and spiritual frameworks that emphasize connection to land and community, they may also shape how young people experience food and their relationship with their own body and their identity. By examining the relationship between DE and engagement in traditional food practices, this study explores whether participation in culturally grounded foodways is associated with DE among a group of AI/FNs youth in the U.S. and Canada. DE was assessed using a questionnaire approved by participating communities’ and we examined its structure using exploratory factor analysis. However, factor analysis alone does not alone establish cultural validity. Centering AI/FN youth in this analysis addresses key gaps in the literature and provide valuable insights into how traditional foodways may strengthen protective factors, support holistic well-being, and inform more culturally responsive interventions.

Methods

Study design and participants

Data for these analyses were drawn from Healing Pathways (HPs), a longitudinal community-based participatory research (CBPR) study of AI/FN families in the Great Lakes region of the United States and Canada who share a cultural identity. For the purposes of our study, we will use the term Indigenous to describe our study sample of AI/FN youth. HP is a CBPR partnership between university researchers and eight reservation/reserve communities. Community Research Councils (CRCs) in each community collaborated with university researchers to adapt survey measures, pilot test instruments, recruit participants, contextualize findings, and identify interviewers/data collectors for this project. This project’s approach to CBPR has been described elsewhere and has included extensive conversations between our community and university team members to address community and researcher concerns for addressing safety, privacy, and confidentiality [27]. All interviewers and our academic-based team completed human subjects’ protection training and have participated in additional training sessions that explicitly address the dual responsibilities of protecting participant confidentiality while navigating their role as community members. All team members formally agreed to uphold strict participant confidentiality, and all study data were collected and stored in accordance with institutional and Tribal data governance policies. Participants included tribally enrolled children and their caregivers recruited from the eight partner communities by our community research team (CRC members and community interviewers/data collectors). Parents provided consent for youth up until the age of 18 and youth provided assent to participate, both parental consent and youth assent were required for participation. At baseline (Wave 1), 735 children (mean age = 11.09 years) were recruited, representing 79.4% of the eligible sample frame at baseline. Trained community members conducted annual interviews (i.e. quantitative surveys) with adolescents and at least one of their caregivers separately over an 8-year period (Waves 1–8). Due to the nature of survey methodology, interviewers/data collectors were trained not to provide additional context or definitions beyond what was in the survey text. Participants were able to ask questions but interviewers were trained to respond “whatever it means to you…” Therefore, results and methods may need to be interpreted with this in mind. Data collection is ongoing, with a total of 12 waves spanning 2 decades. The present study, with the exception of demographics which were collected at baseline (Wave 1), derives primarily from Waves 7 and 8 (2008–2010), which comprises 661 participants (89.9% of baseline sample). The remaining 10.1% of participants from baseline who did not participate in these waves were lost to follow-up for several reasons (e.g., some moved away for college or jobs, unfortunately some participants were deceased). All procedures were approved by the Institutional Review Boards of the University of Nebraska (2002–2016) and the CRCs.

Data collection procedures

Community-based interviewers completed multi-day training sessions on research ethics, survey methods, and data collection protocols, followed by individual practice sessions and ongoing supervision. Data were collected through structured, interviewer-administered paper-and-pencil surveys. Surveys collected information on caregiver and adolescent demographic characteristics, family changes, mental and behavioral health outcomes, and substance use. Details on the HP study design and procedures are described in Walls et al. (2020) and Whitbeck et al. (2014) [28,29].

Measures

DE questionnaire: To assess DE symptoms, adolescent participants responded to 16 items regarding various food behaviors and beliefs (e.g., do you induce vomiting to get rid of food eaten? Do you use fasting or not eating for 12 hours to control your weight?) with three response options: never (0), sometimes (1), often (2). The items were not verbatim from the Diagnostic and Statistical Manual for Mental Disorders or the Eating Attitudes Test-26 [30] but do closely resemble concepts expressed in these and cover broad symptoms of anorexia nervosa, bulimia nervosa, restrictive eating, and concerns about body image. As we have described, the measure used in this study was not a validated tool and consisted of items adapted by CRCs to align with cultural and social contexts of their communities. Although cultural adaptation of this measure was aligned with our CBPR approach and our commitment to gathering meaningful data for the communities we work with, this specific measure may not be comparable to other DE measures in other studies. A full list of these items is available in Appendix A.

Traditional food variables: Adolescent participants were asked whether they had participated in cultural activities, including those related to food. Items assessed participation in cultural food practices like hunting, spearfishing, wild ricing, berry picking, maple tapping and more. A complete list of these activities can be found in Appendix B. Response options were (0) no and (1) yes. A count of traditional food practices was created by summing the nine items together.

Demographic characteristics: Demographic variables included adolescent participant age, gender (female = 1, male = 0), yearly household income divided by number of people in the household (household income per capita) at enrollment (i.e., baseline or Wave 1), and residence on reservation/reserve land (1) versus off reservation/reserve land (0) at baseline. These variables were included as covariates in all regression analyses.

Statistical analysis

We used Mplus [31] (Muthén & Muthén, 2023) and Stata 18 SE [32] (StataCorp, 2023) to perform exploratory factor analysis to identify the underlying latent structure of the DE Questionnaire. To determine the number of components to extract and therefore which factor solutions to explore, we used principal components analysis, [33] scree plots, [34] and parallel analyses [35]. Principal components analysis resulted in three eigen-values greater than 1.0, the elbow of the scree plot indicated two or three components, and the parallel analysis indicated a three or four factor solution. Therefore, three and four factor solutions were examined through exploratory factor analysis. Exploratory factor analyses criteria were determined a priori and consisted of the following: each item had to load on to at least one factor at greater than 0.40 to be retained, items loading on more than one factor at greater than 0.30 would be removed, and each factor had to have sufficient loadings from three or more items [36]. Given the interrelated nature of the constructs examined in the DE questionnaire, factors were assumed to be correlated and therefore a geomin rotation was specified. A four-factor solution was deemed inadequate after removing two low and cross-loading items due to the fourth factor having no strong loadings from remaining items. A three-factor solution emerged as the best fit of our data. Factor 1, titled “binge eating” (α = 0.694), consisted of four items related to typical binge eating symptoms. Factor 2, “obsessive food behaviors” (α = 0.677), consisted of six items related to various DE behaviors. Factor 3, “altered feelings about body” (α = 0.848), consisted of four items related to negative beliefs and feelings about food and one’s body. Internal consistency analyses conducted separately by gender indicated adequate reliability for factor 3 (altered feelings about body) in both boys (α = 0.80) and girls (α = 0.84). For factor 1 (binge eating) and factor 2 (obsessive food behaviors), reliability was acceptable among girls (α = 0.74 and 0.71, respectively) but lower among boys (α = 0.63 and 0.60). These factors were included as the outcome for the regression analysis.

The relationship between traditional food participation and DE was analyzed using a linear regression model with robust standard errors (SEs). Unstandardized regression coefficients (b) and SEs were estimated, and standardized coefficients (β) were calculated to facilitate comparison of effect sizes across predictors. For each factor, we ran unadjusted and adjusted models. The unadjusted models included only traditional food as the independent variable. The adjusted models accounted for potential confounding by gender (binary: male/female), per capita income (continuous), and location (binary: on reservation/off reservation). Statistical significance was determined using a two-sided alpha level of 0.05; associations were considered significant if p < .05. Model assumptions including normality, homoscedasticity, and multicollinearity were tested to ensure the validity of the regression results.

Results

Sample description: The analytic sample for this study included 661 participants between the ages of 16–20 (Table 1). The gender distribution was nearly equal, with 48.7% identifying as male and 51.3% as female. The majority of the participants (90.9%) resided on reservations or reserves, while 9.1% lived off-reservation. The average household income per capita at Wave 1 was $5,649.03 (SD = $4,844.22). Factor loadings for the DE measure are presented in Table 2.

Table 1.

Descriptive statistics of American Indian/First Nations adolescent sample (N = 661) from baseline (Wave 1)

	% or mean (SD)
Age	17.2 years
15	0.5%
16	21.9%
17	42.0%
18	30.4%
19	5.2%
Gender
Male	48.7%
Female	51.3%
Country
United States	89.0%
Canada	11.0%
Location
Off reservation/reserve	9.1%
On reservation/reserve	90.9%
Household income per capita	$5,650.03 (4,844.22)

Table 2.

Results of exploratory factor analysis of disordered eating items

Item	Exploratory factor analysis loadings			Descriptive statistics
	Factor 1: Binge eating	Factor 2: Obsessive food behaviors	Factor 3: Altered feelings about body	% Never	% Sometimes	% Often
Do you have uncontrollable urges to eat and eat until physically ill?	0.72	0.07	0.04	77.63	21.77	0.60
Do you have episodes of eating a large amount of food in a short time (bingeing)?	0.87	−0.17	0.01	56.76	39.79	3.45
I cannot control my eating.	0.61	−0.02	0.24	74.06	20.54	5.40
I have gone on binges where I felt I could not stop eating.	0.70	0.03	0.20	86.21	12.14	1.65
Do you induce vomiting to get rid of food eaten?	0.25	0.55	−0.02	95.34	4.21	0.45
Do you spit out food after chewing in order to prevent digestion?	0.27	0.52	−0.03	95.65	4.05	0.30
Do you use fasting or not eating for 12 hours to control your weight?	0.02	0.69	0.05	84.86	12.44	2.70
Do you use fad diets to control your weight?	0.01	0.78	−0.03	93.98	5.41	0.60
Do you restrict your calories to control your weight?	−0.28	0.93	0.02	75.64	20.30	4.06
Are you obsessed or preoccupied with what you are eating and with dieting?	0.00	0.69	0.13	82.26	15.34	2.41
I am terrified of gaining weight.	−0.02	0.30	0.58	59.01	30.03	10.96
I feel guilty after overeating.	0.20	0.29	0.54	67.57	25.38	7.06
I feel unsatisfied with the shape of my body.	0.00	0.02	0.88	48.13	35.23	16.64
I feel fat.	0.02	−0.03	0.97	48.28	36.58	15.14
Mean score for each factor (SD)	1.17 (1.44)	0.83 (1.42)	2.26 (2.30)

Bolded values emphasize which of the three factors each particular item most strongly loads onto and ‘belongs’ to.

Linear regression: Table 3 presents unstandardized beta coefficients (β) their corresponding SEs and standardized beta coefficients. For factors 1 (binge eating) and 2 (obsessive food behaviors), engagement in traditional food practices was not significant in the unadjusted or adjusted models. However, greater engagement in traditional food practices was significantly associated with lower scores on factor 3 (altered feelings about body) in both unadjusted (β = −0.27, SE = 0.04, p < .001) and adjusted models (β = −0.11, SE = 0.05, p < .05). Female gender was not significantly associated with factor 1 (binge eating) in adjusted model, but was positively associated with factor 2 (obsessive food behaviors; adjusted β = 0.36, SE = 0.12, p < .05) and factor 3 (altered feelings about body; adjusted: β = 1.65, SE = 0.16, p < .001), indicating higher DE scores among females. Household income was not significantly associated with any of the factors in adjusted or unadjusted models. Location (1 = on reservation/reserve versus 0 = off reservation/reserve) was significantly associated with factor 1 (β = 0.70, SE = 0.22, p < .001) and factor 3 (altered feelings about body; β = 1.76, SE = 0.16, p < .001) in the unadjusted models, but was only significantly associated in the adjusted model with factor 1 (binge eating; β = 0.91, SE = 0.27, p < .001). The association between location and factor 3 (altered feelings about body) scores observed in unadjusted models was attenuated after adjusting for traditional food practices and sociodemographic covariates, suggesting that differences by location may partly reflect variation in cultural food engagement rather than residence itself.

Table 3.

Linear regression models predicting disordered eating (N = 661)

	Unadjusted Factor 1	Adjusted Factor 1		Unadjusted Factor 2	Adjusted Factor 2		Unadjusted Factor 3	Adjusted Factor 3
	b (SE)	b (SE)	β	b (SE)	b (SE)	β	b (SE)	b (SE)	β
Trad. Food	−0.15 (0.03)	0.03 (0.03)	0.04	−0.02 (0.03)	0.02 (0.04)	0.03	−0.27*** (0.04)	−0.11 (0.05)	−0.11
Female	0.12 (0.11)	0.27 (0.14)	0.09	0.34** (0.11)	0.36* (0.12)	0.01	1.78*** (0.16)	1.65***(0.21)	0.36
Income	0.00 (0.00)	0.00 (0.00)	−0.04	0.00 (0.00)	0.00 (0.00)	0.18	0.00 (0.00)	0.0 (0.00)	0.08
Locationa	0.70*** (0.22)	0.91*** (0.27)	0.18	0.35 (0.22)	0.37 (0.24)	0.13	0.76* (0.32)	0.53 (0.34)	0.07
Constant	1.27*** (0.10)	1.00*** (0.16)		0.91*** (0.09)	0.48** (0.18)		3.06** (0.15)	1.55*** (0.24)

Adjusted models control for gender, household income per capita, and location.

SE = standard error.

^*p < .05;

^**p < .01;

^***p < .001.

^aResidence on reservation compared to off reservation.

Discussion

This study provides novel insights into the relationship between DE and traditional food practices in AI/FN communities. While much of the existing literature on DE and EDs focuses on risk factors, our study offers novel insights into potential protective factors, emphasizing the strengths already present within AI/FN communities. Further, our study highlights the need to explore cultural validity of measures, while balancing the need for comparable data across study populations. These findings highlight the importance of culturally grounded approaches that can be leveraged in future health intervention, particularly for adolescents.

Our findings suggest that engagement with traditional food practices are associated with certain aspects of DE captured by our adapted measure, specifically altered feelings about one’s body and disordered thoughts. While no significant associations were found between traditional food practices and binge eating (factor 1) or obsessive food behaviors (factor 2), we did find a negative association between traditional food practices and altered feelings about body (factor 3). These findings may reflect that binge eating (factor 1) and obsessive food behaviors (factor 2) are primarily behavioral, whereas altered feelings about one’s body (factor 3) is rooted in psychosocial aspects influenced by Western societal norms of thinness and individual perceptions. Our findings suggest that engagement with traditional food practices are negatively associated with negative feelings about one’s body, meaning there may potentially be a positive role for traditional food practices in psychosocial well-being. It may be, for example, that traditional food practices include reinforcement of cultural values that promote a connection to one’s body and food that is rooted in not just physical well-being, but spiritual, emotional, and relational well-being [37]. This could play a role in preventing the escalation of body dissatisfaction into more severe eating behaviors such as binge eating and obsessive food behaviors. Further, for many adolescents and young adults, their feelings about their body may be highly correlated with their perceptions of self-worth and/or self-esteem [38]. Although we were not able to make these connections in our study, it is possible that engagement with traditional food practices may promote confidence, self-worth, self-esteem, or a strong sense of identity which may promote positive body image.

The role of gender in DE within AI/AN/FN communities remains an area for further investigation. Our study found that female gender was significantly and positively associated with obsessive food behaviors (factor 2) and altered feelings about body (factor 3). These results support previous literature that indicate that DE is often framed as a female issue [20]. However, our study is limited in that it does not account for two-spirit and gender diverse individuals, who may have different experiences with DE. Furthermore, our adapted DE questionnaire may not fully capture gender-specific differences in body dissatisfaction, as typically DE research is focused on women. Given the magnitude of effects for gender were much larger than the effects for participation in cultural food practices, more rigorous community-engaged work is needed to understand how gender identity may impact eating behaviors and even participation in cultural food practices. Further the effect size attenuation after adjusting for covariates is substantial, meaning there could be a potential role of confounding variables and more research is needed to understand any potential relationships between DE and cultural food practices.

DE does not appear in isolation and is shaped by historical and sociocultural factors. Colonial disruptions to Indigenous foodways, alongside systemic inequities in food access, have contributed to complex relationships with food and body image within AI/AN/FN communities. Historically, public health interventions within AI/AN/FN communities have centered weight-focused narratives that could reinforce fatphobia and apply body-mass index-based criteria while emphasizing exercise as a way to pursue thinness [39–41]. Future research should explore perceptions of DE and EDs in AI/AN/FN communities, encouraging deep examination of how these concepts are defined and how these definitions and their related symptoms may or may not align with AI/AN/FN perceptions of acceptable eating behaviors. Meaningful research on DE and ED in AI/AN/FN populations requires that researchers work alongside communities to respectfully distinguish culturally and spiritually significant practices like fasting from restrictive eating patterns associated with DE. Future interventions should consider explicitly addressing food insecurity and its role in eating behaviors (including DE), incorporating culturally informed approaches to support well-being within AI/AN/FN communities. Previous research has explored the use of culturally specific risk and protective factors and their role in AI/AN/FN health largely through indicators of personal well-being, self-efficacy, connectedness within and beyond families, and connection to culture [42]. However, very few measures exist that measure connection to AI/AN/FN cultural foods and food systems, making it difficult to determine what role Indigenous foods and food systems may play in mitigating negative emotions related to one’s body or eating habits. Future research should explore how consumption of and connection to AI/AN/FN traditional/ancestral foods and food practices may relate to self-esteem, body image, and eating behaviors.

The findings have significant implications for adolescent health research, particularly regarding early identification and intervention for DE among AI/FN youth. While our sample did not frequently endorse items composing the binge eating or obsessive food behaviors factors as often, the majority participants reported they sometimes or often feel fat or feel unsatisfied with the shape of their body. These symptoms could indicate mental stress and altered feelings about body which may lead to DE behaviors or EDs. Given the heightened risk for body dissatisfaction and DE behaviors during adolescence, targeted prevention efforts that integrate culturally relevant food practices may be beneficial. Adolescence represents a critical period for shaping long-term relationships with food, and programs that emphasize the reclamation of traditional food knowledge and practices could serve as a form of resilience building for AI/AN/FN youth. While connectedness at the individual, family, and community levels are key to Indigenous survival and well-being, [26] systemic change must also occur through policy and practices to support Indigenous food sovereignty. Existing programs such as those integrating edible school gardens, traditional food programs, and education [43,44] already play a role in passing cultural knowledge onto the next generation. Expanding these efforts to include interventions that focus on DE and body dissatisfaction and the psychological aspects of food relationships could further enhance their impact.

Limitations

Several limitations should be considered when interpreting the findings. First, the data were collected approximately 15 years old, which limits our ability to contextualize our findings within present-day trends. Even though the data are not current, our study still provides valuable historical insights that can inform future longitudinal research examining trends in DE and traditional food practices over time. Second, the instrument used to assess DE was not a standardized validated tool; rather, it was adapted by CRCs to align with local cultural contexts. While this approach enhances cultural relevance and community acceptability, it also limits comparability with other datasets on DE and EDs. Further, the alpha scores for the factors from the DE questionnaire were variable by factor and when examined by gender, therefore results should be interpreted with caution. Although we examined the statistical structure of the measure using exploratory factor analysis within this sample, this approach does not establish cultural validity. Additionally, one item asks about fasting, an important cultural and spiritual practice for many AI/AN/FN peoples, meaning that item may be capturing engagement with cultural and spiritual practices rather than a symptom of DE. Further, in this study, we only have quantitative data to support our findings, and we suggest that future studies exploring DE in AI/AN communities consider integrating qualitative inquiry to more holistically understand experiences around eating behaviors and cultural food practices. While our study utilizes a strong sample of AI and FN youth, findings may not be generalizable to all Indigenous Peoples and are worthy of additional culturally specific research. Lastly, the cross-sectional nature of the data makes it difficult to determine causality—whether engagement in traditional food practices reduces the likelihood of DE, or whether individuals who engage in these practices are inherently less likely to experience DE for other reasons.

Future directions

Our analyses provide important directions for future research and public health practice. Given the limitations of our quantitative data and our culturally adapted measure, we were unable to explore the mechanisms through which traditional food practices may potentially serve as protective factors against DE. Future qualitative and rigorous longitudinal mixed-methods research should investigate potential mechanisms for how traditional food practices may protect against DE. For example, future studies could explore how traditional food practices like hunting, fishing, foraging, and gardening influence body image, self-efficacy, and other psychosocial factors that may be related to DE. Additionally, future longitudinal health studies in AI/AN/FN communities should consider incorporating validated measures of DE to improve comparability across studies and better understand how participating in traditional food practices early in childhood or adolescence may influence DE later in life. Finally, developing and testing culturally grounded interventions that integrate traditional food practices could provide valuable evidence for incorporating these practices into nutrition and physical health programs.

Supplementary Material

Supplementary data related to this article can be found at https://doi.org/10.1016/j.jadohealth.2026.05.006.

IMPLICATIONS AND CONTRIBUTION.

Engagement in cultural food practices is linked to fewer body-related eating concerns among American Indian/First Nations adolescents. This study provides new evidence that cultural traditions may protect against disordered eating, offering critical insights for designing culturally relevant interventions to support adolescent mental and nutritional health in Indigenous communities.