Introduction. The nutrition transition refers to the global shift from traditional foods to processed, westernized foods along with sedentary lifestyles. Few studies have compared the nutritional concerns of indigenous communities in Ecuador and Panama, despite alarming rates of overweight, obesity, and type II diabetes – the third leading cause of mortality in both countries in 2015 (GBD, 2015). Understanding obesogenic lifestyles comprises a crucial step in developing appropriate health initiatives. Methods. A qualitative, community engaged study was conducted to explore nutritional concerns among indigenous communities in Ecuador (Andean Kichwas; n=59) and Panama (Ngäbe-Buglé; n=50). A total of eight focus groups, conducted separately with men and women (ages 18 - 65) were conducted in each country. Focus group questions explored perceptions of diet and nutrition. Data was analyzed using applied thematic analysis. Results. Participants in Ecuador were primarily concerned about “desculturización” (loss of cultural identity), urbanization, and the consequent westernization of their diet. Participants in Panama explained that poverty, unemployment, lack of access to potable water, poor food quality, safety, and availability increased the likelihood of household food insecurity and child malnutrition, leading to what they described as “desnutrición”. Conclusion. Urbanization in Ecuador and unemployment in Panama appear to be economic drivers of household dietary behavior and disease risk among indigenous communities. The implications of urbanization and westernization in Ecuador, versus water and food safety and unemployment in Panama, as possible synergistic drivers of the nutrition transition, food insecurity and their associated health risks, will be discussed.