| Summary: | Background: Food insecurity for Indigenous households across Canada is an ongoing challenge and the associated impacts on health and wellness represent an important public health issue. For Indigenous populations living both on and off-reserve, the diet-related health concerns of food insecurity include obesity, poor dietary quality and chronic disease. Objective: To better understand the factors and processes underlying food insecurity and obesity in First Nations living on-reserve in order to contribute to an evidence-based discussion of strategies for protecting traditional food practices and addressing inequities in health and nutrition. Methods: Secondary data analysis was conducted from the First Nations Food, Nutrition and Environment Study (FNFNES), which applied a cross-sectional study design intended to be representative of First Nations living on-reserve in Canada (south of 60°). Data were analysed from the social, health and lifestyle questionnaire and food security questionnaire components of the FNFNES. Multivariate logistic regression, approached within a holistic framework of First Nations health and wellness, was used to examine the determinants of food insecurity and associations with obesity among individuals living in food insecure households. Analyses were conducted of First Nations communities in British Columbia, Manitoba, Ontario and Alberta. Results: Forty-six percent of First Nations households were food insecure, with 9.5% of households classified as marginally food insecure, 27.9% moderately food insecure and 8.9% severely food insecure. Socio-demographic characteristics significantly associated with food insecurity included age, gender, region, main source of income, years of education, presence or absence of children in the household, road access and household traditional food activity. Rates of obesity were highest among marginally food insecure households (56%). Compared with food secure households, marginally food insecure households had significantly higher odds of obesity (OR 1.5, 95% confidence interval 1.19, 1.97), after adjustments for socio-demographic variables. Conclusions: The relationship between food insecurity and obesity highlight the need for multifaceted approaches that focus on income and the provision of affordable and accessible healthy foods, with particular consideration for quality and cultural appropriateness. Indigenous food sovereignty provides a promising framework for developing culturally appropriate strategies that enable community capacity to address food insecurity and diet-related health conditions. Medicine, Faculty of Population and Public Health (SPPH), School of Graduate
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