Helping kids love healthy food
Childhood obesity is a huge problem in New Zealand. One regional programme is getting results and gaining national attention. Helen Harvey reports.
Dani McLeod walks in from school and heads straight for the fruit bowl.
Gone are the days when Dani, 7, and mum Michelle Robb stopped off on the way home for a pie.
Life has changed in the Robb/McLeod household in the last three months.
Hot chips have made way for brown rice. Pizza is homemade. And Robb has started making her own pasta, putting cucumber skins in with the flour.
Dani has joined Wha¯ nau Pakari, which means ‘‘healthy self-assured families that are fully active’’.
It’s a community-based, family-centred assessment and intervention programme for 4 to 16-year-olds wanting to overcome weight issues.
Nearly 1000 children have gone through the programme, which was set up in 2012, a collaboration between the Taranaki District Health Board (TDHB) and Sport Taranaki to fight childhood obesity in the region.
Back then, according to data from the 2011-13 NZ Health Survey, the obesity rate for Taranaki children was double the national rate. In 2018 Taranaki almost 20 per cent, or 4500 Taranaki children were affected by obesity, the second highest figure in the country.
But obesity, weight loss and diet are not spoken about during the 12 month programme. Instead they talk about lifestyle change and how to make it stick.
Robb decided the whole family would need to get involved in the programme or it wouldn’t work. At first she thought changing what she cooked, what the family ate, would mean more work. But it didn’t – she’s just changed ingredients.
Dinner the night before was rice and butter chicken with pumpkin seed wraps. And she’s cut down portion sizes.
The first two or three weeks were a struggle as she came to grips with healthier food options. And giving up hot chips was hard, she says. ‘‘Not going to lie.’’
But it’s made a big impact on her family. They have a lot more energy, she says.
‘‘It’s been great. We’re a lot more active now.
‘‘We were active before Wha¯ nau Pakari, but now we actually make time to go to the park and play with our kids. Our next step is trying to get Dani into sport at school.’’
Dani was shy, but is now more outgoing, Robb says.
Whanau Pakari goes for a year and consists of six months of fun weekly sessions and about three home visits.
Participants who attended more than 70 per cent of the sessions had significant reductions in BMI adjusted for age and gender over time, Dr Yvonne Anderson, pediatrician at TDHB, and clinical senior research fellow at the Liggins Institute, says.
‘‘And overall, the children’s quality of
life has improved.’’
Research on how well the children were doing two years after they began the programme is with a journal for review. And collecting the data for the five-year outcomes has just finished.
Nationally, an estimated 94,000 children aged 2-14 years are obese.
Children living in most deprived neighbourhoods are twice as likely to experience obesity than those from the least deprived areas. And Ma¯ ori are over represented in the statistics.
New Zealand has just been ranked second-worst in the OECD for child obesity, with 39 per cent of Kiwi kids classified as overweight or obese.
The Child Obesity Atlas estimates childhood obesity rates will more than double by 2030 if current trajectories are correct, Anderson says.
However, solving the problem is not straightforward.
There are many factors around why a child has weight issues, she says. That’s why Wha¯ nau Pakari has a multi disciplinary team involving a paediatrician, dietician, psychologist, and physical activity specialist, which enables the programme to be individualised for each family.
‘‘It’s a multi-factorial problem requiring a multi-sectorial approach, and I believe we haven’t yet managed to achieve this.
‘‘We need to ensure public health, clinicians, policy makers, researchers and communities work together, and work to bring prevention and intervention measures into a unified approach. We also need to evaluate our efforts, as this will assist in providing answers as to what works, and allow focus of resources over time,’’ she says.
‘‘Change is hard and if we focus on healthy lifestyle change that’s a much more appealing and sensible way to approach such a stigmatised issue.’’
Anderson began Wha¯ nau Pakari when she returned home from working in the United Kingdom.
‘‘I was struck with was the number of children with weight issues in my clinical practice and it was very clear that the approach we were taking in the UK in terms of addressing weight issues was definitely not going to work for those most over-represented in obesity New Zealand statistics.’’
So, one size doesn’t fit all, and while Wha¯ nau Pakari is unique and has started receiving national and international recognition, it’s not a ‘‘silver bullet’’.
It doesn’t work for everybody, she says.
Anderson says she’s been invited to share the work with district health boards throughout New Zealand, but she wouldn’t propose a national roll out.
‘‘It’s the framework that is the key. If you have a framework of an assessment that can replace the medical appointments, the dietician appointments and still do the same work – a non-judgmental, not stigmatising and peoplecentred approach – that framework could then potentially be utilised by other centres. And they could wrap their own, by communities for communities, intervention around that framework.’’
Pasifika are over represented in obesity statistics too, but Taranaki has a low population demographic, so lifting the whole of Wha¯ nau Pakari framework and putting it into Counties Manukau wouldn’t necessarily get the same results.
There has to be an appreciation of the community’s needs. But this framework is certainly transferable, she says.
As time went on Anderson realised there was a need for more research and a way to evaluate and measure the outcomes, so she completed a PHD, winning awards along the way.
She has just won the prestigious L’Ore´ al-UNESCO For Women in Science (FWIS) New Zealand fellowship for 2019.
The $25,000 grant that comes with the fellowship will be used to create a digital platform for a healthy lifestyle check in the home.
The fellowship will fund research into understanding expectations of caregivers and children around health data consent and storage, which will immediately inform the new application build.
One issue Anderson’s research discovered was Kiwi kids with weight issues spend more than double the recommended time in front of a screen.
Cutting down her screen time was one of the goals Caitlyn Farley, 13, set when she first started at Wha¯ nau Pakari six months ago.
The other was to ease up on the sugary drinks.
Last year she was in hospital because she had migraines and the doctor suggested she join the programme.
She still gets headaches sometimes when she is tired. But the unexplained headaches have all but gone. And her asthma hasn’t been flaring up as much, she says.
At the weekly sessions she did lots of activity that took her out of her comfort zone, such as rock climbing and boxing.
Now Caitlyn goes to Box Fit twice a week with her mother, Lynice Anderson, and goes swimming.
But the biggest change is around diet.
She has cut down on the chocolate, but admits she finds it hard going through the checkout at the supermarket.
‘‘That’s the hardest part, seeing them there. I tell myself I need to stick to this.’’
Caitlyn loves cooking now and tries foods she once would have turned her nose up at.
‘‘They told us when you try something new your tastebuds aren’t just going to click and like it. You have to try it 15 times to get your tastebuds used to it.’’
Lynice says Caitlyn’s weight was the reason the doctor suggested Whanau Pakari.
‘‘I found it hard because I don’t want to use that word around her.’’
Caitlyn can feel her clothes are
‘‘We don’t call it shopping on a budget. It’s smart shopping to make money go that bit further.’’
baggier than they were, but no-one has talked to her about weight. They talk goals and why she wants to improve her health.
They’re not flash cooks, Lynice says. But they are now cooking from scratch.
‘‘I’ve learnt quite a lot from Wha¯ nau Pakari. They’re very good at breaking it down to a level she understands. They’re amazing. They make them realise it’s not up to Mum or Dad, you have to take part. Caitlyn related really well to them.
‘‘I am proud. She has worked really hard, and now we’re doing it together.’’
They’ve finished the first six months and they’re confident they can continue on their own, Lynice says.
They were struggling with reading labels, so dietician Niamh McCormack visited and did a oneon-one with them.
As well as label reading McCormack gives tips on navigating supermarkets and helps people plan their weekly meals.
‘‘We don’t call it shopping on a budget. It’s smart shopping to make money go that bit further.’’
McCormack runs the weekly sessions and does home visits to give individualised support or if families can’t make it to the sessions.
Some of her families eat takeaways because they’re not comfortable cooking, while others are cooking and baking too much, she says.
‘‘I’m tailoring my advice to what skills they have in the kitchen. I give families recipes. I have a really great relationship with five plus a day and they send me down seeds and resources for vegetable gardening for some families who are trying to grow their own.’’
She advocates for healthier versions of food people usually eat, such as stir fries, nachos and pizza.
‘‘Cooking nachos, add in extra beans. Go away from package food as much as possible, so yes buy made-up wraps but cut them into triangles and put them into oven so make nice healthier chips.’’
Her suggestion that gets the biggest reaction is to put kiwifruit, skin and all, into a smoothie.
‘‘They say ‘oh my god, what is she doing?’ But you don’t taste it when you whiz it up. The skin is full of fibre.
‘‘That helps you feel full and helps your digestive system as well. I get them to try things and if they like it great. If don’t we’ll find something else they like.’’