Part 2: Summary of research into community perspectives

Evolving approach to child obesity

We engaged the services of an external research company to conduct focus group meetings in Orakei, Waitemata, and South Auckland. These areas were chosen because about 24% (based on 2006 Census data) of New Zealand’s Māori population and 67% (based on 2006 Census data) of the Pasifika population live there, and there is a high prevalence of obesity in these communities. There were four focus group meetings, and a total of 31 Māori and Pasifika parents took part. The participants’ children were between 5 and 14 years of age.  

The purpose of the research was to assess whether:

  • people are aware of the support and services that are available to improve health issues related to child obesity; 
  • there are barriers that prevent or deter people from accessing services and support to improve health issues; and
  • people are satisfied with the standard of service and the facilities provided, and whether they can provide feedback to service providers so that potential service gaps can be addressed.

After the focus group meetings, we sought further information from various public entities about the range of obesity-related services and programmes available.

Summary of services and programmes available

A number of obesity-related services and programmes are available in South Auckland. These range from nutrition and healthy-eating services to exercise and weight-loss programmes. Some services are publicly funded through the Ministry of Health or through District Health Boards (DHBs). These services and programmes include:

  • public health programmes promoting nutrition and physical activity, such as:
    • Active Families – an exercise and nutrition programme designed for families;
    • breastfeeding support and promotion;
    • promoting nutrition and healthy behaviours and practices in schools and workplaces;
    • supporting increased physical activity in Māori and Pasifika communities through church groups;
  • fruit in schools – supplying fruit to decile one and two schools;
  • food and nutrition guidelines;
  • Well Child/Tamariki Ora – pre- and post-natal support; and
  • B4 School Checks – a national programme for all four-year-old children that tests a range of indicators, including height and weight, to ensure that the child is in a good position to begin school.

Other services and programmes are funded within communities through local businesses and church groups. These include:

  • exercise classes, such as Zumba and youth exercise programmes;
  • breakfast clubs – schools providing breakfast to students, with help from local businesses;
  • healthy food initiatives, such as local businesses advertising healthy food options and encouraging customers to purchase these over unhealthy choices; and
  • fitness "boot camps" and other initiatives run through church communities. 

The following example is one of these services:

Fit-life Otara Boot Camp
The Fit-life Boot Camp is a free exercise and nutrition programme. This outdoor programme runs for 6-8 weeks, with a 6:00 am start, three days a week. Anyone can sign up for the programme. Although most participants are adults, children and teenagers are also able to attend. Participants include people who are obese or overweight and physically fit sports people looking to supplement their existing fitness regime. Most of those who attend are Pasifika or Māori.

The programme is delivered by professionals in the fitness industry who are from South Auckland. 
Originally funded by Counties-Manukau DHB, then run by a local church group, the Fit-life Boot Camp is now funded by East Tamaki Healthcare, a private primary health provider. 
The programme is promoted through Facebook and by word of mouth. 

Although we did not attempt to identify every publicly and community-funded service and programme in South Auckland, there appears to be a broad range available. 

Community perspective on services and programmes

Generally speaking, the people we spoke to recognised child obesity as an issue affecting the health and well-being of many children in New Zealand. The research also highlighted different perspectives on the issue in Māori and Pasifika communities.

Child obesity was of particular concern to the Pasifika parents in the focus groups. The Pasifika parents interviewed were much more likely to say that obesity (in general) was an issue within their immediate family than the Māori parents who participated.

The Māori parents in the focus groups believe that child obesity is mainly related to poverty, with many unable to afford to buy healthy, nutritious food for their families. Poverty was seen to be having a major effect on diet and the quality of food that children and families are eating. The Māori parents knew that children should be eating fresh fruit and vegetables, but the cost of these led to families picking quantity over quality. This was especially true for larger families. 

Contributing factors that Māori parents identified were the cost and convenience of low-quality foods and the over-abundance of take-away outlets in urban areas, as well as a general lack of physical activity. 

Although Pasifika parents also mentioned the same factors, the main issue for them was a cultural one, in which food and eating to excess plays an integral part: 

With us, we tend to go above and beyond ... and because of our poverty or our lack of income, we tend to go hard at the wedding or go hard at the 21st or the 80th because we're not sure how good the next meal is going to be. We overindulge.

... If you go to someone's house and they don't put on a good feed, you sort of think, “whoa, that wasn’t good” ... the food portrays the “family mana”.

Pasifika people have also historically viewed big babies and children as a sign of good health, strength, and the children being well cared for. However, having attended funerals of people who died from obesity-related illnesses, the Māori and Pasifika parents in the focus groups were very aware of the health implications of child obesity.

Māori and Pasifika parents said they would become concerned about a child’s weight if it was affecting the child’s physical or mental state.

Varying awareness of well-being services and programmes 

Pasifika parents in the focus groups (all of whom were from South Auckland) were aware of many programmes that could support children and their families to manage weight-related health issues. Most of the programmes and services these parents identified were community funded. This indicates an encouraging degree of community ownership and responsibility for combating obesity and other weight-related health issues.

In contrast, Māori parents interviewed from the Orakei and Waitemata areas were not aware of any services or programmes to improve health issues related to child obesity in their communities. 

Barriers to accessing services and programmes

Māori and Pasifika families told our researchers that there were barriers to their participation in services and programmes. These include:
Barrier Explanation
 Cost Cost is a significant barrier for Māori and Pasifika families. They said that, to enable greater access, services need to be either free or low cost.
Awareness of services  Word of mouth is the primary means of sharing information about health and well-being services among Māori and Pasifika. However, families told our researchers that other channels, such as promoting services through church or local iwi groups and advertising on TV and radio and social media, would be effective.
Not feeling comfortable with service providers Families told our researchers that obesity can be an embarrassing health problem, and they need to feel comfortable and connect with the service provider. Otherwise, they are unlikely to participate in the service at all. They said that the service provider needs to be friendly, welcoming, and ideally of the same ethnicity or at least from the local area and understanding of cultural needs.
Lack of motivation Families told our researchers that continued support is important to keep them engaged in exercise-based services. Goals with incentives would also help encourage uptake and lasting participation. 

General satisfaction with the standard of services and programmes

The types of programmes considered most successful were those that:
  • involved the whole family (that is, parent(s) and children together);
  • involved a combination of physical activity and practical advice/information about nutrition and how to prepare healthy (and appealing) meals;
  • involved more than one session a week;
  • involved on-going support and encouragement between sessions (through phone calls or text messages);
  • were run by professionals with ties to the local community; and
  • were provided free of charge.
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