If you’ve ever doubted the idea that it takes a village to raise a child, Taranaki-based paediatrician and clinical researcher Dr Yvonne Anderson might just change your mind. The recipient of the L’Oréal-UNESCO For Women in Science 2019 Fellowship, who spearheaded the Whānau Pakari initiative that’s been helping to combat NZ’s childhood obesity problem since 2012, is quick to acknowledge the team effort that’s got the programme to where it is today.
“It was delightful to be awarded the fellowship,” Anderson says. “But it also represents the work of a huge number of people in a great big team in Taranaki that have really believed in the work – The Liggins Institute at the University of Auckland, Sport Taranaki and the Taranaki District Health Board have all been collaborators and great supporters of the research and the clinical service.”
The collaborative, community- based approach is central to all that Whānau Pakari does, and it has surely contributed to the programme’s huge success. Rather than focus solely on the individual, Whānau Pakari applies a wider lens to the complex issue of childhood obesity.
“Children and their families are absolutely critical in this process,” says Anderson. “I think one of the biggest issues we’ve had in this journey around trying to address obesity is we haven’t listened to the actual lived realities of children and their families.”
Since the children impacted by obesity generally aren’t purchasing or cooking their own food, Anderson says they couldn’t afford to simply look at the child in isolation. “You need to see it as an intergenerational journey that is going to be much more focused on the whole family unit … than just one person in isolation,” she explains. “It was critical for us to be family-centred in our approach, and part of it was to address those iniquities that we see in health outcome data, and the over- representation of certain groups such as Māori and Pacific peoples and those from deprived households – as they do not have the same access to services.”
By realising that one of the key issues in terms of equity was access to services, Anderson and Whānau Pakari flipped the medical model of combating childhood obesity on its head. There’s no GP referral necessary – families can self-refer, and Anderson says this has been very successful in reaching those that need the most support.
“One of the other aspects of the programme was we moved healthcare outside of hospital walls and into the community without compromising on their quality of care. We de-medicalised the process, removing all the hospital visits, and paediatrician and dietitian appointments,” she explains. Instead, families work with a healthy lifestyle coordinator, who will start by taking a holistic evaluation, including a medical screening and dietary, nutritional and physical activity assessments.
Attendance at Whānau Pakari’s weekly activity sessions seems to be integral to the success of participants. Each session takes a holistic approach – and looks into everything from the importance of sleep, the language of obesity, virtual supermarket tours and vegetable gardens, as well as physical activity sessions. “These are critical in terms of trying to find the hook – the thing that’s going to keep these kids engaged once we leave them,” says Anderson. “If you come to the weekly activity sessions and the attendance is more than 70 per cent, your reductions in weight status double – and they are persistent over time. More importantly … the children are happier and fitter based on the quality of life outcome measures and cardiovascular fitness.”
While Whānau Pakari is playing an important role in the fight against childhood obesity, there are steps we can all take to destigmatise the issue. Though we’ve all had “don’t judge a book based on its cover” drilled into us since childhood, we still make snap judgements based on the appearance of others on a regular basis. But these quick judgements could be detrimental to the fight against childhood obesity.
“When you walk down the street, what unconscious biases occur when you see somebody who is struggling with weight issues? What judgements do we make about people – without understanding their background?” asks Anderson. She says fat shaming is a very real issue in New Zealand and believes, as a society, we assume that if somebody is overweight they are simply sitting on the couch all day eating the wrong kind of food.
“With weight issues that’s simply not the case,” she says. “What we know when we listen to children and their families is that their lived realities are very complex these days.”
Life is busier than ever before. Most of us will be familiar with the feeling of getting home at the end of a long day, too exhausted to make it to the gym or outside for a walk, and just reaching for the easiest dinner option – which is often not the healthiest pick. These challenges are only intensified for those living in deprived households.
“Family life is extremely busy,” says Anderson, “and so we need to actually understand the whole context in which people are living. If we just focus on weight, we’re missing the point in terms of working with families.”
While Anderson says the issue of obesity is extremely complex, she adds that this can actually overwhelm us and keep us from making progress. “When you get to the state of feeling like it’s an insurmountable, complex problem, we get in the state of almost relative paralysis of what to do next,” she says. “But I think there are actually some very simple, straightforward things that we can address.”
One of the first things we can overhaul is the way we talk about weight. “What we learned very early on is that we needed to stop talking about obesity, diet and weight loss – that wasn’t the language that people wanted to connect with,” Anderson says. Children and their families, she adds, don’t want to be identified with labels of ‘overweight’ or ‘obese.’ “You know, beauty comes in all shapes and sizes. So it’s critical we address those unconscious biases and the language around obesity if we want people to feel comfortable to reach out and achieve healthy lifestyle change”
AROUND THE WORLD
Unfortunately, we live in a world where shelves upon shelves of sugary drinks line the supermarket aisles, and fat-laden fast food is often a quick and affordable option – while the cost of fresh produce continues to rise.
“We’ve got a situation where children live in families, families live in communities. If those communities are obesity-promoting or obesogenic [tending to cause obesity] then it’s very hard to make those healthy lifestyle changes persistent,” says Anderson.
She explains that while we need to support families and give them the chance to partake in family-centred weight and healthy lifestyle initiatives such as Whānau Pakari, change really needs to be supported at a local and central governmental level, too.
“There are lots of simple examples. Where are the water fountains, and are they clean? We need to make sure that healthy choices are the easy choices in each environment where children and their families are interacting.”
As for what the future holds for Whānau Pakari, Anderson has her eyes set on combating the childhood obesity problem in New Zealand and abroad. She says the L’Oréal UNESCO For Women in Science 2019 Fellowship has come at a critical time. The team at Whānau Pakari are currently working on digitising the assessment, so their healthy lifestyle coordinators can have their own expert in their pocket.
“The recommendations and advice that we can give from their healthy lifestyle check can be much more individualised to the patient, and that child and family’s journey. With that platform, we may be able to achieve scalability across both New Zealand and internationally.”
In fact, Anderson and Whānau Pakari have already had a number of international visitors hoping to take something from their unique model.
“Part of what we’re trying to do is understand how something like a family-based and community-centred intervention programme can fit into the wider childhood obesity work, in terms of community interventions and addressing food and physical activity environment,” says Anderson.
In December they’ll host guests from Harvard and Duke universities. “We are spending time with each of these groups – knowledge sharing, working out how we could actually connect internationally, and looking at healthy lifestyle check application platforms to understand what works for different communities around the world,” Anderson says.