Obesity in Pacific adolescents: a socio-cultural study in Auckland, New Zealand.

Abstract

The purpose of this thesis was to explore socio-cultural factors that may promote or prevent obesity in Pacific communities residing in New Zealand. Specific objectives were to describe the behaviours, knowledge, beliefs and values of Pacific adolescents and their parents, as related to food consumption, physical activity and body image and to compare the responses of obese Pacific adolescents and their parents to their non-obese or healthy weight counterparts. A mixed-methods approach was utilised to gather data. Information was collected from a questionnaire administered to 4215 students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project and sixty-eight individuals (33 students and 35 parents) from 30 Pacific households participated in individual interviews as part of the qualitative phase of the study. To meet the comparative objectives of the study, Pacific adolescents were recruited by obese (n=16) and healthy weight (n=17) status. The outcome of the analysis found that cost and affordability of food, time-constraints through employment obligations and lack of health education or experience negatively affected the health-promoting behaviours of Pacific adolescents and their parents (i.e. not meeting the current guidelines for healthy eating and regular physical activity). Healthy weight Pacific adolescents were significantly more active, consumed fruit and vegetables regularly and had habitual levels of breakfast and lunch consumption compared to obese Pacific adolescents. Obese adolescents were inactive, had takeaway family meals more often and skipped breakfast and lunch meals more frequently. Obese adolescents were also dissatisfied with their body weight, received more parental encouragement to lose weight and engaged in weight control behaviours more than the healthy weight cohort. Healthy weight adolescents and parents seemed to have more health-related knowledge and experience than obese adolescents and parents. There were no differences in the knowledge, values and beliefs about the health-protective effects of food and regular physical activity between obese and healthy weight Pacific adolescents and their parents. There was sound knowledge observed in the link between food and particular eating habits, physical inactivity and body size to obesity risk and study participants desired to increase their healthful behaviours, particularly amongst the obese. The key difference between healthy weight and obese adolescent households was in parental presence at home. Healthy weight adolescents came from households that were more likely to have a full-time or part-time parent at home. While obese adolescents were more likely to come from households that had both parents working full-time, particularly for sustained periods of time in shift-type working arrangements. Furthermore, all students and parents perceived overweight and underweight bodies undesirable for adverse health consequences, suggesting they understand the link between obesity and health. Most students and parents desired average-sized bodies that were functional, i.e. for adolescents, bodies that could be competent in sports and dance, for Pacific adults, bodies that could achieve daily tasks like housework, childrearing and meeting the needs of the family were desired and valued. This thesis finds that socio-environmental influences like socio-economic position, occupational type, health education and experience were much more instrumental influencers on health behaviours than socio-cultural factors. Attitudes, values and beliefs about food, physical activity and body image, which were comparable between obese and non-obese Pacific adolescents and their parents, were not as influential on health behaviours. Obese adolescents held the same attitudes, beliefs and values about food, physical activity and body image as their healthy-weight counterparts, but these factors were not protective for obesity-risk. To address obesity in Pacific youth in New Zealand, a number of macro-environmental changes are recommended to reverse obesity trends. Developing food pricing control policies to mitigate healthy food costs, revising sustained employment hour policies, making changes to school food and physical activity environments and incentivising healthy workplaces are some suggestions. This study suggests certain structural environmental factors related to poverty affects the health-promoting behaviours of Pacific communities in New Zealand. Future obesity intervention efforts for Pacific groups need to address poverty status and specific interventions that prioritise the elements of motivation, self-esteem, self-confidence and life-skills training as well as making policy changes to structural barriers is likely to be more effective.