Original ArticleUnderstanding obesity in the context of an Indigenous population—A qualitative study
Introduction
Obesity is an ever increasing cost burden on the public health purse [1]. The World Health Organisation (WHO) has declared obesity as a global epidemic with trends indicating that it, along with many other non-communicable diseases (NCDs), is increasingly being associated with amplified mortality and morbidity risk [2], [3]. While escalating obesity incidence is concerning for all, its disparate prevalence amongst the more than 154 million Indigenous peoples globally is even more problematic [4]. While there is a growing body of literature investigating obesity, there is a paucity of evidence specific to Indigenous peoples to elucidate their contextual understandings of obesity, and subsequently inform public health initiatives that better align to their ways of being.
Numerous extrinsic factors have been identified as obesity determinants for Indigenous peoples, however, its prevalence has continued to rise [5], [6], [7]. In the pacific region, NCDs, in particular obesity, pose significant economic threats with a recent report estimating losses related to NCD mortality to reach between 8.5 and 14.3% of gross domestic product by 2040 [8]. The disparate prevalence of obesity and other NCDs amongst Indigenous populations in the region clearly suggests that existing population health strategies aimed at mitigation, borne within the confines of non-Indigenous ideology, have been economically wasteful and ineffectual [4], [8].
It is widely accepted that obesity is multi-factorial, being influenced by physiological, behavioural, psychological and environmental drivers [9], [10]. The prevailing public health messages for weight management have largely centred on dieting, caloric restriction and exercise, which focus their attentions on the personal responsibility narrative of obesity [11], [12], [13]. The emphasis on personal responsibility within these public health messages can promote feelings of guilt, shame, and a personal sense of failure when successful weight management is not achieved [14]. While well intentioned, these approaches do not account for the sociocultural associations of Indigenous populations with obesity, highlighting the requirement for further research in this area. Clearly, the epidemics of obesity are complex and amongst Indigenous peoples globally, intrinsic mechanisms are currently unknown. Once understanding of the intrinsic obesity drivers for Indigenous peoples is realized, inferences can be made towards developing potentially more effective intervention strategies.
New Zealand currently has the third highest incidence of obese adults with obesity among Organisation for Economic Cooperation and Development (OECD) nations, with its Indigenous peoples rating disproportionately even higher, at nearly twice that of the non-Indigenous population [15]. By utilising Indigenous knowledge systems and qualitative research theory, this research extends on previous efforts with that population and aimed to identify the intrinsic mechanisms that specifically relate to Indigenous peoples interpretation of obesity [16]. It was hoped that this study would decolonise the narrative and support a WHO recommendation to augment more established, quantitative epidemiological forms of evidence, with the use of culturally relevant approaches to convey both the individual and collective experience of obesity and wellbeing for Indigenous peoples [17].
Section snippets
Methods
The consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist underpinned the reporting of this research [18]. Indigenous knowledge acquisition processes within a qualitative framework, directed the methodological implementation of this study to ensure the process of engagement aligned with, and was responsive to Indigenous epistemologies. Participants were informed of the purpose of the research, that their participation was voluntary, consent obtained, and that any
Results
Twenty-four participants met the inclusion criteria and were interviewed, however, only 15 transcriptions generated the narratives for analysis (Table 2).
Data from fifteen participants were used in the final analysis (Table 3). Tribal affiliations of participants extended from Ngāti Kuri (New Zealand’s most northern tribe) to Ngāi Tahu (New Zealand’s southernmost tribe). Interview audio-recordings ranged between 23 and 98 min, and were collected over an eight-month period. No repeat interviews
Discussion
Using qualitative analysis, this study sought to contextualise obesity for Indigenous peoples as a precursor to investigate a potential way forward to address its disparate prevalence in that population. Similar to non-Indigenous populations, Indigenous understandings of obesity are multi-factorial. What was unique about the findings of this study were insights into the importance of relational aspects and connectedness to each other and the environment, as determinants for obesity expression
Conclusion
By utilising Indigenous knowledge systems and qualitative research theory, we identified some intrinsic mechanisms at play and contextualised obesity for an Indigenous population. This study suggests that a culturally sensitive collective health care approach for obesity management with Indigenous peoples, as opposed to existing colonial individualistic models, may be central to alleviating the disproportionate prevalence of obesity in that population. The insights generated may have
Statement of institutional review board approval of the study protocol
This study has been approved by the University of Otago Human Ethics Committee. Ethics Committee Reference Code: H14/037.
Statement of financial disclosure and conflict of interest
The authors have no conflicts of interest that are directly relevant to the content of this research.
Limitations
Indigenous peoples are not homogenous and inferences should only be made in light of future research with comparable populations. The study may be limited by the nature of the relatively small sample, most participants were reasonably well educated, and the views of Indigenous peoples with different tribal affiliations or a BMI <30 kg/m2 who have not been captured in this study, may well be different to those perspectives described herein.
Acknowledgements
We acknowledge the University of Otago’s Institutional Review Board who provided ethical approval for this study [reference number: H14/037]. We thank the Indigenous community of New Zealand who contributed to this study. We are also grateful to the Department of Internal Affairs—Lottery Health Research Fund [grant #237391], Physiotherapy New Zealand—Scholarship Trust Fund, as well as the University of Otago—School of Physiotherapy, which helped fund this project.
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