Anthropometric indices of First Nations children and youth on first entry to Manitoba/Saskatchewan residential schools – 1919 to 1953
F.J. Paul Hackett1,2, Sylvia Abonyi2,3 and Roland F. Dyck3,4*
1 Department of Geography and Planning, University of Saskatchewan, Saskatoon, SK, Canada; 2 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada; 3 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada; 4 Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
ABSTRACT
Background. First Nations people are experiencing increasing rates of obesity and type 2 diabetes but no anthropometric information exists from before the 1950s to provide context to these epidemics.
Objective. To compare anthropometric indices of First Nations children and youth on first entering residential schools with historical and contemporary reference groups.
Methods. This observational cross-sectional study used archival records from the Department of Indian Affairs to calculate body mass index (BMI), height for age (HA) and weight for age (WA) of all known children and youth undergoing physical examinations on first entering residential schools in Saskatchewan and Manitoba from 1919 to 1953. Proportions of children and youth in each BMI category were determined by age, sex, time period and residential school. Z-scores for HA and WA were determined by age group and sex. Finally, median heights and weights were compared with a non-Indigenous cohort from the 1953 Canadian survey.
Results. On admission to residential schools, 1,767 First Nations children and youth (847 boys, 920 girls) were more likely to have normal BMIs (79.8%) than Canadian children and youth today (66.5%), but lower rates of overweight/obesity (10.9% vs. 32.0%) and higher rates of underweight (9.3% vs. <2.0%). There was an overall trend of diminishing levels of underweight and increasing levels of overweight/obesity over time. Although 6.6% of boys and 7.9% of girls had HA Z-scores >−2, age-specific median heights tended to be higher than Canadian children and youth in 1953. Under 3% of children and youth had WA Z-scores of >−2.
Conclusions. A large majority of First Nations children and youth exhibited normal anthropometric indices on first entering residential schools in Manitoba and Saskatchewan from 1919 to 1953. These historical findings provide an important context to the current epidemics of obesity and type 2 diabetes and suggest that the nutritional conditions in these First Nations children’s communities were satisfactory during the residential school era.
Keywords: First Nations; indigenous; BMI; children; youth; residential school; diabetes; obesity; underweight; weight for age; height for age
Citation: Int J Circumpolar Health 2016, 75: 30734 – http://dx.doi.org/10.3402/ijch.v75.30734
Responsible Editor: Tracey Galloway, University of Toronto, Canada.
Copyright: © 2016 F.J. Paul Hackett et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
Received: 14 December 2015; Revised: 8 March 2016; Accepted: 18 March 2016; Published: 27 June 2016
Competing interests and funding: The authors have no competing interests.
Correspondence to: Roland F. Dyck, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, Canada S7N 2G4, Email: roland.dyck@usask.ca
Three editorials addressing this article have been published, and are available at:
http://www.circumpolarhealthjournal.net/index.php/ijch/article/view/32591
http://www.circumpolarhealthjournal.net/index.php/ijch/article/view/32592
http://www.circumpolarhealthjournal.net/index.php/ijch/article/view/32593
Since the 1970s, Canadian children and youth have experienced substantial increases in the prevalence of overweight and obesity. Using body mass index (BMI) categories, the 2009–2011 Canadian Health Measures Survey reported that 32% of boys and girls aged 5–17 were overweight and obese, increasing from 15% among 2- to 17-year-olds in 1978–1979 (1,2). Most regional data for Indigenous children and youth indicate that current overweight and obesity rates are even higher in this demographic (3–8). Indeed, a recent meta-analysis of Canadian Aboriginal populations found that 29.8% of those <18 years were overweight and 26.5% were obese (9). This marked population disparity in the prevalence of overweight/obesity is an important risk factor in the epidemic of type 2 diabetes in both First Nations children (10–12) and young adults (13,14).
In Canada, 3 groups of Indigenous people are constitutionally recognized under the descriptor Aboriginal: First Nations, Inuit and Métis. Although early anecdotal reports and images suggest that elevated overweight/obesity prevalence is a recent occurrence among these populations, little anthropometric information exists for any groups of adults or children in Canada prior to the 1960s (15–17). Notwithstanding this paucity of data, we were recently able to access archival records of First Nations children and youth from 1919 to 1953 when they first left their home communities to attend residential schools in Saskatchewan and Manitoba. Under the residential school system, children were intentionally placed at a distance from their home communities in order to facilitate assimilation into the broader Canadian society (18). The system attempted to achieve this objective by disrupting the parenting process and limiting opportunities for children to be exposed to their Indigenous language and culture. Corporal punishment and other forms of abuse were widespread. Although attendance at the schools was voluntary during the early years, in 1920, the government amended the Indian Act requiring all First Nations children aged 7–15 to attend residential schools (18). Physical examinations of children, including height and weight measurement, were conducted shortly after the first entry to these institutions.
To provide historical context to the recent epidemics of obesity and type 2 diabetes among First Nations people, the primary objective of this study was to determine BMIs and BMI categories of First Nations children and youth from the pre-1950s and relate these findings to those of their contemporary Indigenous and non-Indigenous counterparts. Our secondary objective was to evaluate the overall nutritional status of these residential school children based on BMI as well as weight for age (WA) and height for age (HA).
METHODS
Data source
This observational cross-sectional study examined BMI, HA and WA of children and youth on first entering residential schools in Saskatchewan and Manitoba from 1919 to 1953. Data were derived from microfilm copies of residential school entrance examinations filed with the Department of Indian Affairs in Ottawa (19). They included a general admission form recorded by school officials and a physical examination form completed by a physician. The physical examination was primarily intended to identify children with active tuberculosis and prevent the admission of such children to residential schools (20,21). The physical examination form included fields for age, sex, height and weight. However, no descriptions of weight and height measurements were provided, and it is not known whether the methods used were similar or consistent among schools and over time.
Because these data are publicly available, the University of Saskatchewan Research Ethics Board determined that a review was unnecessary. However, the manner by which this information was collected raises ethical sensitivities about its use that merit further consideration (see discussion). Most children and youth in this study were admitted to 1 of 5 Indian Residential Schools: Brandon Residential School (Methodist) in Brandon, Manitoba; Beauval Residential School (Roman Catholic), Beauval, Saskatchewan; Round Lake Residential School (Methodist), Whitewood, Saskatchewan; St. Anthony’s Residential School (Roman Catholic), Onion Lake, Saskatchewan; and St. Barnabas Residential School (Anglican), Onion Lake, Saskatchewan. Smaller numbers of boys and girls entered Saskatchewan Indian Residential Schools in Delmas, Okanese and Prince Albert. These children and youth likely represent most of the total number entering those schools over the study period because, by 1911, federal government policy directed that all students undergo a physical examination prior to being admitted (18,22). However, since approximately 150,000 First Nation, Inuit and Métis children attended about 130 residential schools across Canada during the residential school era (23), the children and youth in this study represent only a small fraction of the total.
Calculation and evaluation of anthropometric indices
Information from entrance physical examinations was transcribed and entered into a Microsoft Access database before transferring it to Microsoft Excel for final analysis. All information was de-identified and analysed in aggregate for the study. Height and weight were converted into metres and kilograms, respectively, and BMI was calculated using the formula BMI=(weight in kg)/(height in m2). Children and youth were placed into 5 BMI categories based on age-specific International Obesity Task Force cut-points corresponding to definitions of very underweight, underweight, normal weight, overweight and the obese among adults (24,25). Because the birth dates of the children and youth were not recorded, we used the mid-year BMI-for-year percentiles as the reference for each age recorded (for example, 7.5 for a child aged 7). Children and youth with no age, height and/or weight recorded were excluded from the analysis, as were individuals with implausible BMIs. The date of height and weight measurements was the date of the physical examination or, if that was illegible or not recorded, the date of school admission.
The proportions of children and youth in each BMI category were determined for the total population and by sex, age, age group, time period and residential school. We chose 1919–1929 (pre-depression), 1930–1938 (Great Depression), 1939–1945 (Second World War) and 1946–1953 (post-war) as the time periods since they corresponded to important national and international events. We also compared the median age-specific BMIs of residential school children and youth with the 50th percentile values of current World Health Organization (WHO) Growth Charts for Canada (26).
To assess the general nutritional status of residential school children, we used WA (27) and HA (28) Z-score calculators based on 1977 National Center for Health Statistics growth charts to determine the proportions of children by age and sex who were in >−2, −1 to −2, −1 to +1, +1 to +2 and >+2 Z-score categories. We further compared median age-specific heights and weights of residential school children and youth with data from the 1953 Canadian weight-height survey of predominantly non-First Nations children (17), as well as 50th percentile values from WHO growth charts. The 1953 survey data were used as a comparison because it is the earliest published record of weights and heights of Canadian children and closest in time to the residential school era. Because the 1953 survey did not provide individual data, we could not calculate BMIs, WAs or HAs from its results.
Statistical analysis
Our analysis was primarily descriptive in nature because of its small subgroups and the lack of a suitable reference and control group, in most instances. Moreover, our study population is likely a complete population rather than a sample. For children and youth first entering residential schools, proportions in each BMI category were categorized by sex, age group, time period and residential school. We presented these data using a log scale to more clearly define BMI differences within and between groups. Comparisons of median height and weight between residential school children and youth and the 1953 Canadian height–weight survey were also descriptive in nature. However, we compared overall sex differences in BMI, WA and HA categories using χ2 tests and a significance level of p≤0.05.
RESULTS
There were 2,079 residential school admission forms from which information was extracted for the initial database. After removing duplicates and files with insufficient data, there were 1,767 children and youth (920 girls and 847 boys), who were first admitted to a residential school from 1919 to 1953, and whose information was available for further analysis. On admission, most children and youth were aged 7–10 (Table I), but admission age ranged from 4 years (18 individuals) to 19 years (1 individual). The schools with the largest number of admissions were Beauval (394), Brandon (285), Onion Lake (680) and Whitewood (187). However, we also included children and youth admitted to Delmas (55), Okanese (48) and Prince Albert (118).
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