Good health is important for children and families now, but also for children’s continued good health and active contribution to society into adulthood. About 31% of children between 2 and 14 years old are classed as obese (about 10%) or overweight (about 21%). The prevalence of child obesity has increased from 8% in 2006/07 to 10% in 2011/12. A 2006 estimate of total costs in health care and lost productivity of all people who are overweight or obese has been estimated to be about $720 million to $850 million a year.
As part of the theme of my Office’s work in 2012/13 – Our future needs – is the public sector ready? – we wanted to carry out a performance audit to understand the public sector’s approach to combating child obesity. Child obesity is a multifaceted problem, with multiple agencies able to influence obesity-related issues. The performance audit intended to concentrate on the Ministries of Health and Education and Sport New Zealand (formally SPARC), because historically these three agencies had a leadership role that focused on physical activity and nutrition.
My staff found that the Ministry of Education and Sport New Zealand no longer focus on obesity to the extent they had in the past. At the time of my staff’s work, the Ministry of Health was continuing with a range of existing interventions while testing and evaluating new ideas and approaches to identify the most effective focus for New Zealand’s efforts to combat obesity. These changing circumstances limited what my staff could usefully audit. I am publishing this report on my website to provide an overview of the work we carried out.
The Ministry is considering how it can refine and strengthen its current range of health promotion-based programmes with interventions that target critical periods of human development for greatest effect. For example, greater emphasis on supporting women to achieve a healthy weight during and after pregnancy, and on child nutrition in the first few years of life to potentially prevent obesity in later life. Over time, the Ministry expects to add new programmes to its existing range.
In early 2013, we commissioned focus groups with Māori and Pasifika families in Auckland to get their perspective on the provision of obesity-related services. The families said that they were well aware of obesity and its potential causes. A range of publicly and community-funded services and programmes were available to support these families to manage weight-related health issues. Awareness of the services and programmes varied, and families faced some other barriers to accessing and using the services, such as cost, motivation, and establishing a supportive cultural connection with providers.
In this report we provide:
in Part 1, a little more detail about the Ministry of Health’s approach;
in Part 2, a summary of the research into community perspectives; and
in Part 3, some facts on child obesity.
I thank staff of the Ministry of Health, Ministry of Education, and Sport New Zealand for their assistance. In particular, I thank the Māori and Pasifika families in Auckland who generously gave their time to inform our work.
Key Results
There are four key findings:
1. Child obesity is widely recognised as an issue affecting the health and wellbeing of many children in New Zealand, particularly those in Māori, Pasifika, low-income and urban households.
Child obesity is of particular concern to Pasifika parents. The Pasifika parents we spoke to were much more likely to say that obesity (in general) was an issue within their own immediate family than were the Māori parents we spoke to.
Māori parents believe child obesity is mainly related to poverty, with many unable to afford to buy healthy, nutritious food for their families.
The cost and convenience of low quality foods and the over-abundance of take-away outlets in urban areas were also identified by Māori parents as contributing factors, as was 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. Pasifika people have also historically viewed big babies and children as a sign of health, strength and the children being well-cared for.
However, having attended funerals of people who had died due to obesity-related illnesses, Māori and Pasifika parents are very aware of the health implications of child obesity.
Despite this, the Māori and Pasifika parents we spoke to said they would not become concerned about a child’s weight unless there were signs that it was affecting the child’s physical or mental state.
2. The awareness of services and programmes varies.
The Māori parents we spoke to (from the Orakei and Waitemata areas) were not aware of any services or programmes in their communities that are available to improve health issues related to child obesity.
In contrast, the Pasifika parents we spoke to (all of whom were from South Auckland), were aware of many such programmes.
3. A number of barriers were seen to inhibit access and on-going participation in these types of services and programmes.
These include:
- Low awareness of the programmes and services available.
- Financial cost of attending programmes and services.
- Apathy or a lack of motivation in attending obesity-related programmes and services.
- Not being able to connect with the service provider because they are not from the local area, are not of the same ethnicity, or because they lack the enthusiasm or ability to keep participants motivated and engaged.
4. Where programmes and services have been accessed, participants are generally satisfied with the standard of service provided.
The types of programmes considered most successful were those that:
- Involved the whole family (i.e. 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 per week.
- Involved on-going support and encouragement between sessions (via phone calls or text messages).
- Were run by professionals with ties to the local community.
- Were provided free of charge.