Background
Multi-disciplinary healthy lifestyle interventions remain recommended best practice for support of children and young people affected by obesity. Equitable solutions are critical to address inequities in obesity statistics. “Whānau Pakari” means ‘healthy, self-assured families that are fully active’. It is a healthy lifestyle program for children and young people with obesity in Taranaki, Aotearoa/New Zealand. Evaluation includes a multiple methods approach, incorporating an RCT.
Methods
The program specifically aims to support those over-represented in obesity statistics, namely Māori and those from most deprived households. Community consultation informed the creation of Whānau Pakari. The service offered home-based weight-related 6-monthly assessments and advice (low-intensity control), or assessments and weekly group sessions for 12 months (high-intensity intervention). Multi-source evaluation determined stakeholder satisfaction, and an economic evaluation was performed.
Results
Participation from Māori (47%) and those from most deprived households (28%) was high. Engagement with Whānau Pakari was associated with a decrease in BMI SDS in the low-intensity control (-0.12, 95% CI -0.2 to -0.03) and high-intensity intervention (-0.10, 95% CI -0.19 to -0.02) 12 months from baseline. Attendance ≥70% in the high-intensity intervention doubled the effect (-0.22, 95%CI -0.36 to -0.09, p=0.04), persisting to 24 months (-0.22, 95%CI -0.38, -0.06). At 60 months, increased water intake and HRQOL persisted in both groups. Multi-source program evaluation found high stakeholder, referrer and participant satisfaction. Economic evaluation at 12 months demonstrated Whānau Pakari was cheaper and more effective than the previous conventional model of care.
Conclusions
Whānau Pakari is an acceptable and appropriate intervention for children and young people with obesity. It is a contemporary model that utilises community collaboration, achieving high levels of recruitment and engagement from key population groups. Embedding screening for weight-related comorbidities within a community-based program allows for respectful efficient care, and scale-out with place-based considerations and community co-creation appears possible.