Outcomes of a culturally informed weight-loss competition for New Zealand Indigenous and Pacific peoples: a quasi-experimental trial.

BACKGROUND: Reducing obesity prevalence among marginalised subgroups with disproportionately high obesity rates is challenging. Given the promise of incentives and group-based programmes we trialled a culturally tailored, team-based weight-loss competition with New Zealand Maori (Indigenous) and Pacific Island people. METHODS: A quasi-experimental 12-months trial was designed. The intervention consisted of three six-months competitions, each with seven teams of seven members. Eligible participants were aged 16 years and older, with a BMI ≥30 kg/m2 and being at risk of or already diagnosed with type-2 diabetes or cardiovascular disease. Height, weight and waist circumference were measured at baseline, 6 and 12 months. RESULTS: Recruitment of a control group (n = 29) versus the intervention (n = 132) was poor and retention rates were low (52 and 27% of intervention participants were followed-up at six and 12 months, respectively). Thus, analysis of the primary outcome of individual percentage weight loss was restricted to the 6-months follow-up data. Although not significant, the intervention group appeared to lose more weight than the control group, in both the intention to treat and complete-case analyses. CONCLUSIONS: The intervention promoted some behaviour change in eating behaviours, and a resulting trend toward a reduction in waist circumference. TRIAL REGISTRATION: ACTRN12617000871347 Registered 15/6/2017 Retrospectively registered.

Adherence to daily dietary and activity goals set within a Maori and Pacific weight loss competition.

BACKGROUND: New Zealand Pacific and Maori populations measure disproportionately high on the international body mass index (BMI). Information is needed on what behavioural weight loss goals to recommend and how to attract and retain them in interventions. Our team weight loss competition trial for participants with a BMI ≥30 used cash prizes to incentivise completion of nine daily behaviour goals. This paper evaluates the theoretical merit of and adherence to these goals. METHODS: A qualitative component evaluation methodology was used. Trial data on team activity, demographics and anthropometric outcome data were extracted to determine frequency of daily goal completion by teams throughout the competition and to describe participant characteristics. T-tests were used to compare completion rates of the challenges, challenge completion by day of week and between weekdays and weekends. To examine adherence to the daily challenge activity over 24 weeks the total amount of completed challenges adjusted for number of active teams was plotted by week. A Body Shape Index (ABSI) was used to determine individual anthropometric change from baseline to 8, 16 and 24 weeks. Program documents were analysed to identify barriers to adherence and retention of participants. RESULTS: Of 19 teams (N = 130) who began only five teams performed daily goals across the whole 24 weeks. Adherence was highest during the first 8 weeks. No difference in performance between goals was found suggesting they were equally viable, though tasks worth less points were performed more frequently. Goal completion was higher on weekdays. The behaviour goals appeared to have theoretical merit in that more members of high performing teams experienced a positive change in their ABSI. CONCLUSIONS: Incentives offer a promising strategy for encouraging retention in weight loss interventions. This study suggests that participants in a competition will perform incentivised tasks. The findings however, are limited by missing data and high drop out of individuals and whole teams. Further research is needed on how to increase retention.

An innovative team-based weightloss competition to reduce cardiovascular and diabetes risk among Maori and Pacific people: rationale and method for the study and its evaluation.

BACKGROUND: Obesity rates for New Zealand (NZ) Pacific and Maori (NZ indigenous people) are among the highest in the world. Long-term results of weight management programmes for adults have been modest but primarily focused on individuals. This paper describes the rationale and methodology for a trial of a culturally tailored team-based weightloss competition conducted online with community level support. METHODS/DESIGN: A quasi-experimental design was used to compare an intervention and control group. Three six-month competitions with seven teams of seven Maori or Pacific people (N = 147) were run. Eligible participants were: Maori or Pacific, 16 years of age and above, obese (BMI ≥30 kg/m2) and either at risk of or already diagnosed with type 2 diabetes (HbA1c >50 mmol/mol) or cardiovascular disease.The intervention facilitated group use of an internet-based competition offering financial incentives, education and support. The primary outcome was percentage of individual weight lost at 12-months. Secondary outcomes were percentage reduced total cholesterol and glycated haemoglobin (HbA1c). Data collected at baseline, 6-months and 12-months included: height, body weight, blood lipids and HbA1c, eating and dieting habits, family support, food access, alcohol use, nutrition literacy, activity levels, perceptions of weight, stress and sleep, and, perceived contagion effect. Process evaluation tasks will inform acceptability. DISCUSSION: An attractive, easy to understand weight change programme that effectively reduces disease risk among Maori and Pacific is desperately needed. Web-based delivered support and information to largely self-directed teams could also ease exponential rises in costs to the health system. TRIAL REGISTRATION: Trial Id: ACTRN12617000871347.

Health consequences of tobacco use for Maori--cessation essential for reducing inequalities in health.

AIM: Tobacco use remains the largest preventable cause of death and disease in New Zealand. The aim of this paper was to identify all known health consequences of smoking, including exposure to other people's smoke, focusing on Maori. METHOD: A review of the scientific literature, 'grey' literature, and, Government health data and reports. RESULTS: Smoking has been causally linked with cardiovascular disease (CVD), many cancers, and several respiratory diseases, and, rates are higher for Maori than non-Maori. There are many consequences for smokers loved ones, including, pregnancy and birth complications, SUDI, and increased respiratory infections, cancers and CVD for children and adults. Maori have higher rates of still-birth and SUDI. CONCLUSION: This paper summarises all health consequences, to the smoker and their family. Supporting smoking cessation among Maori, particularly women and parents, may be one of the quickest pathways to health improvements for Maori.

Women's knowledge of and attitude towards disability in rural Nepal.

PURPOSE: What is perceived to be a disability is both culturally specific and related to levels of development and modernity. This paper explores knowledge and attitudes towards people with disabilities among rural women in Nepal, one of the poorer countries in South Asia. METHOD: Four hundred and twelve married women of reproductive age (aged 15-49 years), from four villages in two different parts of Nepal, who had delivered a child within the last 24 months preceding the study, completed a standard questionnaire. RESULTS: The majority of the participants only considered physical conditions that limit function of an individual and are visible to naked eyes, such as missing a leg or arm, to be disability. Attitudes towards people with disability were generally positive, for example most women believed that disabled people should have equal rights and should be allowed to sit on committees or get married. Most respondents thought that disability could result from: (i) accidents; (ii) medical conditions; or (iii) genetic inheritance. Fewer women thought that disability was caused by fate or bad spirits. CONCLUSIONS: There is need to educate the general population on disability, especially the invisible disabilities. There is also a need for further research on disability and its social impact. IMPLICATIONS FOR REHABILITATION: • There is need to educate the general population on disability, especially the invisible disabilities and its rehabilitation. There is also a need for further research on disability and its social impact.