Whānau Pakari: a multi-disciplinary intervention for children and adolescents with weight issues

Abstract

Aim: Multi-disciplinary interventions remain the recommended management for children with obesity. The purpose of this research was to create and assess a multi-disciplinary intervention programme for children and adolescents with obesity in Taranaki, Aotearoa/New Zealand, using a mixed methods approach, incorporating a randomised clinical trial. Whānau Pakari means “healthy, self-assured families that are fully active”. The programme specifically targeted those over-represented in obesity statistics, namely Māori and those from most deprived households in the region, thereby addressing identified health inequities. Methods: Background audits informed the creation of Whānau Pakari. A randomised controlled clinical trial was embedded within the new service, offering home-based weight-related 6-monthly assessments and advice (control), or assessments and weekly group sessions for 12 months. Multi-source evaluation was undertaken to determine satisfaction, and an economic evaluation was performed, comparing Whānau Pakari with the previous conventional (hospital-based) model. Results: High rates of weight-related comorbidities, suboptimal eating behaviour, low physical activity, high screen time, and low health-related quality of life were found at baseline. Engagement with Whānau Pakari was associated with a significant decrease in body mass index standard deviation score in the low intensity control and high intensity intervention 12 months from baseline. Attendance ≥70% in the high intensity intervention doubled the effect. Improvements occurred in quality of life and cardiovascular fitness in both groups. Multi-source programme evaluation found high stakeholder, referrer and participant satisfaction. Economic evaluation demonstrated Whānau Pakari was cheaper and more effective compared with the previous conventional model of care. Conclusions: Whānau Pakari is an acceptable, appropriate intervention for children and adolescents with obesity. It is a mainstream service that achieved high levels of initial recruitment and engagement from at-risk groups, therefore improving health outcomes. Scalability and transferability appear possible. Whānau Pakari challenges the notion that a multi-disciplinary intervention programme only includes a group-based intervention with weekly sessions. Instead, it is a model where multi-disciplinary support from a team provides comprehensive assessment that identifies and manages weight-related comorbidities, which can assist in planning individualised interventions. This assessment and intervention model of service provision could be considered for New Zealand children and adolescents with obesity.