3.0 Extent to which Māori and Pasifika parents see child obesity as an important issue for their community

3.1 Health-related issues affecting Māori and Pasifika children in New Zealand

Summary

According to the parents we spoke to, there are many health-related issues affecting Auckland’s Māori and Pasifika children. In this context, poverty was an underlying concern for many parents, with many implications resulting, including their ability to buy food of high quality and nutritional value. 

However, child obesity was only identified as an issue on an unprompted basis by Pasifika parents.

The primary issue identified by Māori parents as affecting the health of children in their community was poverty

Māori parents said poverty was having a major impact on the diet and the nutritional value of the food eaten by children in the Auckland area, with many low-income parents struggling to provide healthy and wholesome meals for their families. 

While Māori said parents knew their children should be eating fresh fruit and vegetables, financial constraints led many families to prioritise quantity over quality when purchasing food. Fresh fruit, vegetables and high quality meats were considered too expensive, particularly for larger families with many mouths to feed. 

Putting food on the table and sending the kids to school with lunch is a hard one.

The cheaper the food is, the more you’re going to buy. I’d rather go to the Mad Butchers and buy $10 sausages that are fully processed and get 50 of them, instead of going to Pak n Save and giving them $10 and you get five.

Go for what you can afford. What you can get, in bulk. If you could only afford that, then you just have to make a feed out of that.

Other health-related issues commonly identified by Māori parents as affecting children in their community included:

• Glue-ear
• Asthma
• Eczema
• Bronchitis
• Whooping cough
• Family violence 
• Depression and suicide.

While poverty was also mentioned by Pasifika parents, child obesity was more likely to be mentioned by this group 

When asked to identify what health-related issues were affecting children in their community, child obesity was one of the first issues identified by Pasifika parents without prompting. Whilst they felt poverty was a contributing factor behind obesity, for Pasifika parents the main hurdle was a cultural one. This is discussed in more detail in section 3.2.

Other health-related issues identified by Pasifika parents as affecting children in their community included:

• Glue-ear
• Asthma
• Eczema
• Bronchitis
• Rheumatic fever
• Diabetes.

3.2 Views on child obesity

Summary

Further discussion confirmed that child obesity is widely recognised as an issue affecting many of New Zealand’s children, particularly amongst Māori, Pasifika and low-income families. Child obesity was also considered to be more prominent in urban areas (i.e. Auckland) than in rural New Zealand, or in the Pacific Islands.

Māori are aware that obesity is an issue for Māori and Pasifika children, particularly those who are urban-based 

When prompted, both groups of Māori parents we spoke to acknowledged that child obesity was an issue in the wider Auckland area. However, parents from the Orakei area said child obesity was not an issue in their particular community. In fact, they struggled to think of any children in their area who were overweight. 

This particular community is a very close-knit and centred around their local marae. The local iwi is actively involved with many of the families in their area, encouraging them to be physically active and motivated to make healthy choices in life. Healthy eating policies are in place for all iwi-based activities and hui, and also within their köhanga reo. The application of these policies was evidenced in the choice of food provided at the focus group itself. The hosts were unaware of the topic of the research, yet the food provided was healthy and nutritious and included a range of fresh fruit and vegetables. 

These parents also commented that obesity was not an issue for their children as they were all physically active. There were a number of local sports teams their children belonged to, and because it was considered a safe, child-friendly community where everyone looked out for one another’s children, they were also encouraged to spend a lot of time playing outdoors.

Looking around here, the kids have been alright – they pretty much ‘burn’ it all off. The kids are quite active around here. It’s quite a big massive area not just one little box in your own back yard.

We’re more aware of it and that’s why our kids are into fitness. We allow them to mix and mingle and to play for 5 hours a night. They come home at 9 o’clock just before it gets dark.

We have heaps of sports teams. Every season we’ve got different types of sports going so that tamariki can be active.

They did however acknowledge that obesity was an issue for other children in the wider Auckland area, particularly Māori and Pasifika children. Comparisons were also made between children living in the city as opposed to the more rural areas, where child obesity was considered less of an issue. Respondents felt that rural-based children were less likely to be obese because they are more active, have less fast-food outlets and ready access to fresh fruit, vegetables and meat. They also felt that rural children tend to have a more positive and relaxed mental outlook compared to those in the city who are more exposed to peer pressure to look and behave in a certain way.

Māori from the Waitemata area also felt that child obesity was more prominent amongst Māori and Pasifika children, low income families, and that it was more of an issue amongst urban-based children as opposed to those who live in rural areas. However, this group also reported that child-obesity was an issue in their own community and for some, in their own homes.

This group of parents mainly attributed the issue of child obesity to poverty and easy access to fast foods. They felt it was ironic that the foods promoted by the Government as being the healthy options are the very foods they cannot afford. 

Pasifika parents see child obesity (and obesity in general) as one of the most important issues affecting their community 

Pasifika respondents saw child obesity as a major issue for their community. However, while they felt Pasifika people are becoming more aware of the issue and beginning to take steps in the right direction, the biggest barrier is a cultural one, in which food (and excess) plays a major role. 

I think it’s changing now; the children’s well-being is taking over. There’s been a big push even within our community. I’ve seen people out in the street now that I wouldn’t normally see hitting the roads, walking as Pasifika families. You wouldn’t have seen that in Otara 5 or 10 years ago. 

We’re all Islanders and it’s part of our culture. You know, we were brought up on pisupo (corned beef) and the kalo (taro). There is a risk when it comes to kids. What can I say? That’s what we eat. We’re all raised in that tradition. 

All Pasifika gatherings involve food. At special events and occasions (i.e. weddings, funerals, and birthdays), the hosts and their extended family are expected to provide an excess of food for their guests. In turn, the guests are expected to show their appreciation for the food by eating as much of it as they can.  

Because if you go to someone’s house and they don’t put on a good feed, you sorta think, ‘whoa, that wasn’t good’ and then when people come to your house for dinner, you’re expected to do the best that you can. It’s like the food portrays the ‘family mana’. 

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. 

Our grandparents were always feeding us. I was like that with my kids, always make sure that they’re full. I was telling my husband ‘you know Palagi (Pakeha), they have this little serving like with a potato, piece of meat and veges and they’re full … and a bit of dessert. But for us, we have to have the biggest plate with heaps on it and you’re always asking the kids, ‘are you full? You want something else to eat?’ We just feed them until they’re really full. So we eat until we drop, until we can’t really do anything. 

It is also important to note that to Pasifika people, a big baby or child has traditionally been viewed as strong, healthy and well cared for. In contrast, a small baby or skinny child is considered weak, unhealthy and possibly neglected.

Growing up, the perception was, that being big was being ‘healthy’. That your parents had looked after you well because you were big. 

If you have a baby and the baby is chubby – that’s a good thing. If you have a skinny baby – they’re like, ‘are you feeding it?’ 

In this regard, respondents felt that mothers needed more education and advice about good nutritional care for their babies. One respondent who works with young Pasifika mothers said there was a common misconception amongst Pasifika families that if a baby cries it must be hungry or not getting enough nutrition from breast milk alone. As a result, the baby is often given solids very early in life and encouraged to eat more than they actually need.

I work with a lot of young mums and I’ve noticed that they are feeding their kids solids before they’re even one. Starting from 3 months because they don’t even know when to feed them solids. Parents and grandparents are saying ‘the baby’s hungry! You’re breast milk is not filling the baby up!’ Some of these babies are eating Happy Meals before they are one years old.  

Some Pasifika parents also mentioned that they themselves did not have treats or luxuries when they were growing up. So when they became parents, they wanted to give their children the things they felt they had missed out on. Because food is such an important part of Pasifika culture, these ‘treats’ are often based around food. 

I’ll buy them McDonald’s now and then as a treat. I say a ‘treat’ but then you get worried when they start throwing the [Happy Meal] toy away saying ‘oh, I’ve got that toy! I’ve got all of those one’s!’ 

Recognising the fact that their own behaviour and that of their families before them, had inadvertently encouraged obesity amongst Pasifika children, a common Samoan phrase was quoted in both Pasifika focus groups, “Alofa valea” or “Killing them with kindness” (literal translation is “stupid love”).

Some of us, they feel proud when their kids are big. But it’s wrong. And they just keep feeding them and feeding them. My brothers girls need to go the hospital nearly every week because of their breathing, because they are so big. And I always say to my brother you are alofa valea.

Although this research was completed on a qualitative basis, and therefore has no statistical validity, it is interesting that around half of the Pasifika parents said child obesity was an issue within their immediate or extended family. 

I know that sometimes it hurts them (children) when we go to buy clothes. With their age group, there are clothes that won’t fit them. For an Island girl, they’re not too big. They’re only 14 and 13. I don’t want them to keep on putting it on. They say ‘Mum, it’s you! You keep on feeding us’ … that makes me feel really bad. 

When I see them, I see me … I have high blood pressure now and you know, I don’t want them to go through what I have gone through … I’ve got to change for them and for me. 

As well as the cultural issue, child obesity was also attributed to the cheap cost and easy accessibility of takeaways and convenience food. “Good” or healthy food was considered expensive and time consuming to prepare. 

It’s really big. For my family, it’s really easy for kids to walk out and buy junk food and stuff. There are heaps of takeaways. In Otara there’s heaps of takeaways and it’s easier for kids and families to pick up, go home and eat and it’s a bit cheaper for them than actually buying ‘healthy’. 

It was also mentioned that in today’s world, families have little time to prepare or monitor what their children are eating. Both parents are often working, juggling other commitments and so food needs to be quick and easy. Mornings in particular were very rushed and often resulted in the parents giving the child a couple of dollars to buy themselves something to eat on the way to school.

Pie and a soft drink - the perfect breakfast! At least with the pie, you know they’re getting something warm.

3.3 Health implications of child obesity 

Summary

Māori and Pasifika respondents are well aware of the health implications associated with child obesity and obesity in general. Most reported having attended the funeral of a friend or family member who had died due to an obesity-related illness.

Māori parents are aware of the health implications associated with child obesity

The following illnesses and conditions were mentioned by Māori as being associated with obesity, for children and adults alike:

• Diabetes
• Breathing/respiratory problems (Asthma)
• Heart disease
• Skin problems (i.e. eczema) 
• Mental health issues (depression, low self-esteem)
• Death.

At both focus groups with Māori, respondents mentioned having attended funerals of people who had died from obesity-related illnesses.

It’s been a big shift from what I remember as a kid with what we eat now. It also stems from us going to tangi. Our old people, some of them have died from diabetes, cancer, heart diseases - a lot of deaths from bad food.

When asked about the health implications of children being overweight, one respondent reported having taken her 11 year old son to the doctor recently due to concerns about his weight and the effect it was having on his breathing. At 11 years of age, the boy’s weight had reached 87 kgs.

This led to a discussion amongst participants about, at which point they would consider a child’s weight to be a problem. One respondent said you could not label very young children as being overweight because most of them would ‘grow out of it’. Others agreed that weight was not an issue until there were signs that it was directly affecting the child concerned, either in a physical sense (i.e. if they develop health problems, breathing problems, etc.) or if it was affecting their mental health (i.e. if they become withdrawn, depressed, are being bullied or excluded by their peers, etc.).

Your boy [referring to another respondent], he’s the same – he’s a big boy. You can tell that he’s going to grow into it. You can’t label him as obese. It’s just the way he is.

Pasifika parents are also well aware of the health implications associated with child obesity

Pasifika parents were also well aware of the consequences of obesity. At least half of the participants interviewed either had diabetes themselves, or had lost a family member to diabetes. Others said they had a family history of heart problems.

I think it is changing. People are sort of more aware now because of all the sicknesses that are happening like diabetes, high blood pressure and dialysis. There are a lot of people in the community who are going through that … people losing loved ones. 

Similar to the response from Māori, Pasifika parents identified the following illnesses and health-related issues associated with obesity in general:

• Diabetes
• Breathing/respiratory problems (Asthma)
• Heart disease
• Psychological issues (depression, bullying).

I work with children and they’re really wonderful but they can be mean sometimes. Because they’re so honest, they tell kids how they really feel, but they’re very shallow – they take things at face value and so if you look different, if you’re the “fat kid” at school, then you’re going to get picked on and be the ‘butt’ of the joke, an outcast. 

Pasifika parents also held similar views to Māori in terms of identifying the point at which their child’s weight would become a concern. Although aware of the health consequences of obesity, it is not until the child is actually showing symptoms or signs that their weight is affecting them that parents are likely to become concerned about their child’s weight or to see it as an issue.

I think sometimes people think it’s cute for kids to be that size. I don’t think they take into account that it can be health hazard.

Some Pacific people would get quite offended even talking about this topic, obesity. Because they’re like, that’s normal! What’s the problem?

I started talking to my daughter about how she felt. Her self-confidence and self-esteem had started to drop and that’s when I identified that as an indicator - that something has to be done.