Metabolic Health in Indigenous Women: Understanding an Embodied Legacy of Colonialism

Written by Aamir Wahhab

Illustration by Eloy Bida, depicting the interconnectedness of Indigenous women, land, water, and traditional foods—foundations of both cultural identity and metabolic wellbeing. These enduring bonds reflect a worldview where health is woven through relationships with all living beings.

Indigenous women in Canada face some of the highest rates of diabetes, obesity, and cardiovascular disease in the country, often developing these conditions at younger ages and with more severe complications than both Indigenous men and non-Indigenous women.¹^-⁴ These disparities are especially visible during pregnancy: gestational diabetes occurs two to three times more often in Indigenous women, increasing the risk of premature birth, delivery complications, and lifelong diabetes for both mother and child.⁴

Yet these patterns cannot be explained by biology or individual behaviour alone. They reflect the cumulative impacts of colonialism, systemic racism, and the erosion of Indigenous women’s autonomy, which continue to shape metabolic health today.⁵

To understand these disparities, it is essential to examine how colonial history becomes biologically embedded. Researchers describe this as the embodiment of colonialism, the imprint of land dispossession, forced assimilation, and the disruption of Indigenous food systems on the body.⁵ Colonial policies that restricted food access, imposed starvation, and undermined traditional knowledge created profound intergenerational effects on maternal nutrition and metabolic health. 

These effects can be transmitted across generations through epigenetic mechanisms, which are changes in how genes are turned “on” or “off” in response to experiences such as nutrition, stress, or trauma, without altering the DNA sequence itself. These biological shifts can influence fetal development and metabolic function, meaning that the harms of colonialism can be passed from parent to child at the molecular level.⁶^-⁹ As a result, diabetes and cardiovascular disease among Indigenous women reflect the ongoing, embodied legacy of colonial injustice, in which historical control over Indigenous women’s bodies reappears as present-day metabolic illness.⁵

Despite this, mainstream medical narratives often focus on “poor lifestyle choices” or excess body weight. Yet among Indigenous peoples, BMI and waist circumference are inadequate predictors of metabolic disease,¹⁰˒¹¹ and outcomes are better understood when social determinants, such as poverty, food access, and the impacts of colonial trauma, are considered.¹² Emphasizing weight loss as the primary intervention fails to acknowledge the historical realities of forced food deprivation, malnutrition, and trauma experienced through colonization and residential schools.¹³ A culturally grounded understanding of metabolic health instead recognizes the inseparability of physical, emotional, spiritual, environmental, and community wellbeing, prioritizing balance and respect for the body over weight-centered approaches.¹³^,¹⁴

The forces that shape metabolic inequities operate across multiple levels. Distal causes such as colonialism, systemic racism, and the loss of land and governance rights structure the conditions of daily life.¹⁵ These generate intermediate causes, including underfunded health systems, overcrowded housing, and restricted access to nutritious foods.^15,16 At the surface lie proximal causes, such as smoking, diet, and chronic stress, often framed as personal choices but in reality shaped by deeper structural determinants.¹⁵ Interventions that focus solely on individual behaviour risk reinforcing harmful narratives of personal responsibility while ignoring the systems that create vulnerability.¹⁵

Food systems illustrate these layered impacts clearly. Traditional Indigenous diets are composed of locally harvested plants, fish, and game and once supported strong metabolic health and cultural wellbeing in Indigenous communities.¹⁶ Colonial interference disrupted these systems, leading to food insecurity, dependence on processed foods, and the erosion of traditional food practices.^16,17 Today, many Indigenous communities face limited access to fresh produce, high costs of nutritious foods, and unsafe or unreliable water sources, all of which undermine food sovereignty and health.^16,18

Environmental contamination compounds these challenges: exposure to persistent organic pollutants and heavy metals has been associated with two- to three-fold higher diabetes prevalence among Indigenous women.^18,20 These contaminants act as endocrine disruptors, impairing metabolic function and amplifying the effects of nutritional and social deprivation.^18,20

Indigenous women are not inherently predisposed to diabetes or cardiovascular disease. They are made vulnerable through social, economic, and environmental inequities rooted in colonialism.⁵ The urgent question is not why Indigenous women experience higher rates of metabolic illness, but what systems created these conditions in the first place.⁵ Metabolic health in Indigenous women is not simply a medical issue—it is a matter of social and colonial justice. Recognizing this demands a shift away from blaming individuals and toward transforming the structures that continue to endanger Indigenous women’s health.⁵

Indigenous communities are already leading the movements that will shape healthier, more just futures. Community-led, gender-specific health programs developed by and for Indigenous women have demonstrated improvements in cardiovascular behaviours, empowerment, and sustained engagement.^21-23 Moreover, indigenous-led food sovereignty initiatives, grounded in traditional foods and cultural knowledge, have been shown to enhance diet quality, food security, and metabolic outcomes.^16-17 Most importantly, advancing environmental justice, including reducing contaminant exposure and ensuring access to clean land, water, and food, is essential to supporting metabolic health.¹⁸ Meaningful change requires confronting how colonialism and the social determinants of health continue to shape Indigenous women’s wellbeing.¹⁵

True healing and equity depend on returning authority to Indigenous communities, uplifting Indigenous women’s leadership, and restoring relationships with land, culture, and traditional food systems. These factors are not only determinants of metabolic health—they are pathways to sovereignty, dignity, and generational healing.

References

1. Reading J. Confronting the growing crisis of cardiovascular disease and heart health among Aboriginal peoples in Canada. Can J Cardiol. 2015;31(9):1077–1080.

2. Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E, et al. Type 2 diabetes and Indigenous peoples. Can J Diabetes. 2018;42(Suppl 1):S296–S306.

3. Kolahdooz F, Sadeghirad B, Corriveau A, Sharma S. Prevalence of overweight and obesity among Indigenous populations in Canada: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2017;57(7):1316–1327.

4. Voaklander B, Rowe S, Sanni O, Campbell S, Eurich D, Ospina MB. Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis. Lancet Glob Health. 2020;8(5):e681–e698.

5. Sinclaire M, Lavallee B, Cyr M, Schultz A. Indigenous peoples and type 2 diabetes: a discussion of colonial wounds and epistemic racism. Can J Diabetes. 2023;47(5):451–454.

6. Voaklander B, Rowe S, Sanni O, Campbell S, Eurich D, Ospina MB. Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis. Lancet Glob Health. 2020;8(5):e681–e698.

7. Wicklow BA, Sellers EA. Maternal health issues and cardio-metabolic outcomes in the offspring: a focus on Indigenous populations. Best Pract Res Clin Obstet Gynaecol. 2015;29(1):43–53.

8. Schafte K, Bruna S. The influence of intergenerational trauma on epigenetics and obesity in Indigenous populations: a scoping review. Epigenetics. 2023;18(1):2260218.

9. Weckman AM, Farrugia P. Inequities in Canadian maternal-child healthcare are perpetuating the intergenerational effects of colonization for Indigenous women and children. Front Glob Womens Health. 2025;6:1513145.

10. Lajeunesse-Trempe F, Piché M-E, Poirier P, Tchernof A, Ayotte P. Adiposity phenotypes and associated cardiometabolic risk profile in the Inuit population of Nunavik. Nutrients. 2024;16(5):725.

11. Riediger ND, Clark K, Lukianchuk V, Roulette J, Bruce S. Fasting triglycerides as a predictor of incident diabetes, insulin resistance, and β-cell function in a Canadian First Nation. Int J Circumpolar Health. 2017;76(1):1310444.

12. Anand SS, Abonyi S, Arbour L, Balasubramanian K, Brook J, Castleden H, et al. Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study. Lancet Planet Health. 2019;3(12):e511–e520.

13. Cyr M, Riediger N. (Re)claiming our bodies using a Two-Eyed Seeing approach: Health-At-Every-Size (HAES®) and Indigenous knowledge. Can J Public Health. 2021;112(3):493–497.

14. Gomes Z, Hart D, Downey B. Indigenous women’s perspectives on heart health and well-being: a scoping review. CJC Open. 2023;5(1):43–53.

15. Reading CL, Wien F. Health inequalities and social determinants of Aboriginal peoples’ health. Prince George, BC: National Collaborating Centre for Aboriginal Health; 2009.

16. Gyawali B, Mkoma GF, Harsch S. Social determinants influencing nutrition behaviours and cardiometabolic health in Indigenous populations: a scoping review of the literature. Nutrients. 2024;16(16):2750.

17. Sebai I, Deaconu A, Mobetty F, Nardocci M, Ing A, Batal M. Measurement of diet quality among First Nations peoples in Canada and associations with health: a scoping review. Nutr Rev. 2024;82(5):695–708.

18. Bradford LE, Bharadwaj LA, Okpalauwaekwe U, Waldner CL. Drinking water quality in Indigenous communities in Canada and health outcomes: a scoping review. Int J Circumpolar Health. 2016;75(1):32336.

19. Cordier S, Anassour-Laouan-Sidi E, Lemire M, Costet N, Lucas M, Ayotte P. Association between exposure to persistent organic pollutants and mercury, and glucose metabolism in two Canadian Indigenous populations. Environ Res. 2020;184:109345.

20. Marushka L, Hu X, Batal M, et al. The relationship between dietary exposure to persistent organic pollutants from fish consumption and type 2 diabetes among First Nations in Canada. Can J Public Health. 2021;112(Suppl 1):168–182.

21. Ziabakhsh S, Pederson A, Prodan-Bhalla N, Middagh D, Jinkerson-Brass S. Women-centered and culturally responsive heart health promotion among Indigenous women in Canada. Health Promot Pract. 2016;17(6):814–826.

22. Wicklum S, Sampson M, Henderson R, Wiart S, Perez G, McGuire A, et al. Results of a culturally relevant, physical activity-based wellness program for urban Indigenous women in Alberta, Canada. Int J Indig Health. 2019;14(2):169–204.

23. Frehlich L, Amson A, Doyle-Baker P, Black T, Boustead D, Cameron E, et al. Spread of Makoyoh’sokoi (Wolf Trail): a community-led, physical activity-based, holistic wellness program for Indigenous women in Canada. J Health Popul Nutr. 2023;42(1):80.