A matter of fat

Diabetes, stroke and heart disease are the leading killers of Maori and Pacific people today. In short, the facts state we’re overweight, unhealthy, and leading sedentary lifestyles.

According to the Ministry of Health, one in four New Zealand adults is obese. From 1977 to 2003 the prevalence of obesity has doubled. Of those statistics, 41.7% of Maori adults and 63.7% of Pacific adults suffered from obesity, and Polynesian adults and children have higher rates of obesity than any other ethnic group.

“Our people love KFC, mayonnaise and salt,” says Dr David Schaaf.

“KFC and fast foods are high in fat, and the number one cause of weight gain is fat. If you must eat it, then take the bloody skin off!”

Schaaf is of Tongan (from Ha’apai) and German descent and in 2006 completed his PhD examining cardiovascular risk factors in secondary students.

Blood was taken from each student to test blood sugar levels and check for lipids, such as cholesterol. Information was also gathered from the Year 11 to Year 13 students about what they ate and how they exercised. The aerobic fitness of students was then assessed during a ten-minute exercise bike ride.

If the 2,500 sampled students, 1,500 of whom were of Pacific and Maori descent, he found the Polynesian ethnic groups were at a significantly higher risk of cardiovascular disease later in life than students from other ethnicities. And his research showed the main determinant was their body mass index (BMI) or weight.

In terms of weight gain, the key contributors were television-watching, fizzy drinks, lack of exercise and unhealthy eating.

“What this means is that if we want to prevent heart disease later on, we need to focus on preventing obesity in this age group now. If we can get rid of that, then there shouldn’t be any ethnic differences,” he says.

Obesity is defined as having an excessively high amount of body fat in relation to lean body mass. There has been a global shift in diet towards energy-dense foods that are high in fat and sugar, and low in vitamins, minerals and other nutrients. Highly processed foods are more readily available now than ever before. The World Health Organisation reports there has also been a trend of decreased physical activity due to the increased sedentary nature of workplaces, changing modes of transportation and increased urbanisation.

Heart Foundation Pacific Heart Beat spokesperson Mafi Funaki-Tahifote says the foundation is leading a course to help turn the alarming statistics around.

“These statistics are more than a number. They are real. These are our relatives, friends and communities,” says Mafi.

“Many students are blown away by the struggle our Pacific people have with heart disease, diabetes and obesity.”

Poor health

Dr Guy Naden (Whakatohea, Te Whanau a Apanui, Ngati Porou), GP and co-owner of All Health general practices in Auckland, says along with the obvious food and exercise factors, poor health can also be attributed to poverty, stress and poor living standards.

The Ministry of Health agrees. They state the greatest influences on health are income and poverty, employment and occupation, education, housing and ethnicity.

“People who move from one culture to another tend to have more stress in their lives and therefore get sick a lot more,” says Dr Naden. “Low income, cramped housing conditions, long work hours, multitudes of people living in one home - it doesn’t paint a good picture for our people’s health status.”

He says these factors are impacting indigenous peoples the world over.

“You can’t underestimate the power of overeating, of alcohol, or gambling, they have such negative effects on health. The anti-smoking and obesity messages have been thrashed so much people are getting sick of it. But we know we tend to gravitate to crap food, alcohol and the associated social problems. It’s been the downfall of many indigenous peoples.”

Dr Naden also believes doctors need to recognise cultural differences when assessing and treating patients.

“Its about recognising a Maori has special heart conditions you need to watch out for, checking weight, cholesterol and glucose regularly for Pacific patients, these things should be automatic for doctors. Such changes need to be in effect as well as changes to the environment, to help assist with individual change.”

Part of the argument is about social and political structures, says Shaaf. He uses south Auckland as an example.

“South Auckland has the highest population of Polynesian people. They live in a dense area. Everything that surrounds them contributes to their health. They have the highest density of fast food outlets, and the highest density of alcohol suppliers and gambling outlets. Unhealthy living becomes the default option.”

Self-responsibility

“Sometimes, particularly in older folk, people say if we’re going to die early, well that’s God’s will,” says Shaaf. “But that is a bad attitude to have. It is never too late to look at your health and make changes.”

It is recommended New Zealanders eat at three servings of vegetables and at least two servings of fruit per day, but a substantial proportion of Maori and Pacific people are still not meeting this minimum standard.

“Do you know you can train your tastebuds to get used to better foods, foods with less salt and less sugar? It’s just about going back to basics and asking yourself, do you really need that?”

A Kiwi suffers a stroke every hour

“New Zealand stroke rates are four times worse than other developed countries with over 32,000 people suffering as stroke each year,” says Professor Valery Feigin of AUT University. “Every hour someone in New Zealand is struck by a stroke.”

Stroke is the third largest killer in Aotearoa.

One thing we can do now

Dr David Shaaf says if there were one thing he would encourage people do to now to significantly change their health, it would be to stop smoking.

“We are a leading country in terms of smokefree initiatives. We are already on the wave, our Maori and Pacific people need to jump on board and ride it.

“The Ministry of Health push the physiological effects of smoking onto people; the cancer and the effects on heart, lungs and mouth. But our people need to look at it from a personal perspective. Think about your children, and what will happen to them if you die prematurely from smoking.”

General Practice for expert care

Dr Naden encourages every person to be enrolled with a General Practitioner (GP). This way your GP has your notes and medical history, past X-rays and a comprehensive background to your health.

“General practice is the central hub of medicine,” says Dr Naden. “The GP is there to give early diagnosis, order appropriate tests, and then prescribe the appropriate treatment; whether this is medication or further consultation with a specialist. We have a gate-keeping type role and should be first point of call.”

The care provided by GPs is partially subsidised by the government, but in most cases you will still have to pay a fee. This cost can vary from clinic to clinic. Beneficiaries and those on low incomes are eligible for a Community Services Card, which helps decrease medical costs. There is also a High User Card for patients who visit the doctor more than 12 times a year.

Over recent years, the trend of Maori and Pacific peoples not visiting a GP has started to shift.

“Maori and Pacific patients are coming in more often, particularly the young ones; they come as soon as they have sniffles. The older ones take longer to decide they need a check-up.”

While heart attack and diabetes rates are high, Dr Naden says he sees “more cases of gout than anything”. “Medical problems vary from person to person, individuals may be suffering from one thing and not realise because they’re busy worrying about something else.”

“The recommendation is to get a regular check,” he says. “Then you know the exact state of your health and can take the right measure to improve it.”

It starts with our kids

The Ministry of health survey states 20.9% of our kids are eating fast food each week with one in 14 children eating fast food more than three times in a week. Pair that with the fact two out of three children aged 5-14 watch two or more hours of television a day, and our kids are being set up for an unhealthy future.

A study on childhood obesity in New Zealand reported 11% of Pacific Island children are likely to be extremely obese.

University of Otago Department of Medical and Surgical Sciences research Dr Alisa Goulding says extreme obesity affects one in 10 Pacific Island children and one in 20 Maori children.

“These children are already so obese that it is bad for their health. We need to convey this to their parents because many of them don’t realise the risks.”

She reports these children are at high risk for diabetes, metabolic syndrome and other related conditions.

Simple changes like swapping fizzy drinks for water, replacing white with wholemeal bread and incorporating more fruit, vegetables and exercise into their lives are encouraged.

Dr Naden says a key component is having good leadership and good role models. If your children see you taking care of yourself, they will do the same.

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