Running Head: OBESITY AMONG CHILDREN IN MAORI COMMUNITIESChildhood obesity in MaoricommunitiesOBESITY AMONG CHILDREN IN MAORI COMMUNITIES 2A Literature ReviewKey words: Literature review, Māori, Children, Obese, interventionThe entire research work highlighted the fact that despite of a lot of peer-reviewed articles andpublished reports the health disparities for the Māori children, significant inequalities are stillobserved. Furthermore, obesity in general is one of the vital modifiable risk factor that tend tocontribute to vascular disorders and diabetes along with the other health conditions thatconsists of reduced life span and various types of cancer. Some of the research workhighlights clear differences in terms of distribution of economic, social, political as well asenvironmental determinants of health for Māori when contrasted with the non- Māori.IntroductionMāori children exhibit high risk of obesity as well as connected morbidities when constrictedto the children from other communities. While some of the researchers consider theconnection between poverty as well as obesity as paradoxical, it is not at all the poorpopulations who tend to suffer from the obesity, but the people who have the accessibility ofthe cheap foods. These types of food are quite high in sugar, salt, fat and they also have nominerals and vitamins (Littlewood, Canfell & Walker, 2020). However, personal choice playsone of the most important roles in this segment as well as the ability for participating in thephysical activity is always one of the greatest advantages for the children who are sociallyadvantaged. Some of the evidences also clearly indicate the fact that interventions that tend torely on the individual agency can also enhance the social inequalities with regard to theobesity. However, the role of government also have one of the most vital role in terms ofreversing the obesity in the Māori children as promotion and protection of health is one of themain responsibility that must not be left to the individuals, non-government companies whoOBESITY AMONG CHILDREN IN MAORI COMMUNITIES 3have limited finance, power as well as resources for doing so. Most of the studies haveconcluded that Māori children always tend to face huge amount of burden in terms of obesityalong with the obesity-related disease when contrasted with the children from non- MāoriNewzelander. In terms of interventions the researchers have suggested that significant amountof lifestyle modification is the key in terms of reducing morbidity related to obesity alongwith the cardiovascular disease among the Māori children. In New Zealand a lot of higherrates in terms of obesity are related for Māori children aged between 2-14 years. There aresome of the major consequences due to the obesity such as hypertension, dyslipidaemia, weakcardio-metabolic conditions as well as the type 2 diabetes. Obese Māori children are alsodisadvantaged by severe cardiovascular and physical constraints because of extra body weightalong with the effort that is involved in terms of moving huge mass, hence, limiting thecapacity of Māori children for complying with the recommendations that is provided by theWHO. Obesity in children can be highlighted as the global concern and people from Māoricommunity are represented in a dissappropriately manner among the ethnic group that islowest and they also have the highest record of obesity among the children (Sherriff et al.,2019).This study will mainly revolve around examining the prevalence of obesity among the Māorichildren, main causes and results as well as also exploring how the public health interventionscan be implemented in effective manner with regard to future (Glover et al., 2019).Particularly, this research question was also answered by the study: What are the causes of thechildhood obesity among the Māori communities and how it can be controlled?OBESITY AMONG CHILDREN IN MAORI COMMUNITIES 4MethodDesignFor this particular report mixed-methods systematic review tend to apply the principles withregard to the mixed-methods research for reviewing procedure. I have also studied from thevarious research traditions for combining to produce evidence for guiding the decisionmaking. Furthermore, it also focused on various types of evidence that is connected with aspecific topic (Howe et al., 2015).Search strategy as well as identification of included articlesThere were some of the databases searched with regard to this particular study such asSCOPUS, PUBMED along with the CINAHL were searched from the year 2007 to till date.Furthermore, keywords were also identified through the discussions with the authors as wellas the research librarian. However, for making the research work more meaningful basic termused for identifying Māori populations such as “Oceanic Ancestry Group” that is regarded as:“People whose origins of ancestors are basically in the islands of South and central pacificconsisting of Australasia, Micronesia etc.” (Stoner et al., 2013).Throwing light on the above-mentioned discussion it can be said that the search strategy wasflourished as well as implemented using the PICO (Intervention, Population, Outcome, andComparison) format:Population- Māori community children aged from 2-12 years (Theodore, McLean &TeMorenga, 2015).Comparison- health service, imitative and no programInterventions- Initiative for preventing obesity among Māori children and healthservice/programOBESITY AMONG CHILDREN IN MAORI COMMUNITIES 5Outcomes- BMI, weight, body composition, behavioural, psychologicalAll of the keywords were used in a combination and also alone.Methods and selection criteriaThe abstracts along with the titles of the authors were thoroughly reviewed and the articleswere only considered if they met the specific criteria such as: Original reports or if it is theblueprint of the original research work, subjects revolved around children aged between 2-12years, the subject of the sub-groups or subjects were basically under ‘Oceanic AncestryGroup’ consisting of the Māori community, health services, intervention, or initiatives fortreating or preventing obesity among Māori communities.The following information was extracted from each of the article for excellent synthesis:study design, intervention (country), characteristics of the participants and the participantretention (Rush et al., 2003). Furthermore due to the heterogeneity between the design of thestudy as well as the outcome measures for the treatment interventions, a qualitative synthesiswith regard to the results were conducted as quantitative meta-analysis approach was assumedto be quite inappropriate (Anderson et al., 2017).FindingsThe description of the studiesAs per 2017, almost 20% children from the Māori community are obese when contrasted withthe other communities (Anderson et al., 2016). The research strategy submitted 26 articlesthat consisted of 24 studies that were more or less similar. Moreover, these studies wereclassified into the tab of qualitative and quantitative. Few studies are presented out of 26studies in the below segment:OBESITY AMONG CHILDREN IN MAORI COMMUNITIES 6 ReferencesCountrystudiedSampleDatacollectionStudy aimsand designEthicalconsiderationsLittlewood,Canfell &Walker,2020NewZealandThe entiresample sizemainlyranged from18 to 6629(mean 1431)In pilotedformsThe main aimwasreviewingandidentifyingand thedesign wasmixedmethodEthicsapproval wasnot required asthe review wasavailablepublicallySherriff etal., 2019AustraliaA cohortstudy basedis NSWpopulation(Childrenless than 17years)Data from theWesternAustralianChildren’sDiabetesDatabaseThe main aimwasdesigningsome of theinitiativesthat will beminimizingthe obesityamong thechildren intheAboriginalcommunitiesEthicsapproval wasnot requiredHowe et al.,2015NewZealandThe samplesize of thisresearchwork wasnot at allsufficient forassessinganydifferencesbetweenPacificchildren andMaorichildren. Butthe samplesize provided55% ofpower fordetecting thedifferences687participantsfrom infant’sethnicity whohave formedeligiblesampleThe main aimof this studyunderstoodthe ethnicdifferenceswith regard tothe early riskfactors of lifeof obesitymay hencehelp forinformingstrategies thathas one of themain goals atstopping theinequalities inthe ethnicityof obesity asan adult. Thisstudy usedsurvey as itsresearchdesignThe ethicsapproval wasmainly donefrom theMasseyUniversityHuman EthicsCommittee,New Zealand.Glover etNew37SimpleThe main aimThis particular OBESITY AMONG CHILDREN IN MAORI COMMUNITIES 7 al., 2019Zealandparticipantsand theparticipantswere all agedunder 20yearsrandomsamplingof the studywas exploringtheviewpoints ofthe Maoriparents aswell as theothercaregivers interms of therelativeimportance ofhealth andwealth.Furthermore,another aimof the paperwas howdecisions aremade interms of theunhealthy andhealthyfoods.The sampledesign thatwas used isquestionnaireand focusgroup methodstudy wasapproved bythe Universityof AucklandHumanParticipantsEthicsCommitteeStoner et al.,2013NewZealandThe samplewas mainlygatheredfrom 200nonindigenousas well asMaoripopulationThe datacollection tookplace over atime period of7 daysapproximately.Questionnairewas used inthis studyThe main aimof the studyrevolvedaroundinvestigatingthe efficacyof a healthprogram interms of theobesity in theMaori andPasifikachildren. TheCOMPASSinterventionwas evaluatedusing therandomizedcontrol trialstudy.This particularstudy receivedthe ethicalapproval wasobtained fromthe regionalHealth andDisabilitiesEthicsCommittee.Furthermore,theaccountabilitycontract willbe quiteindependentwith regard tothe consentform. OBESITY AMONG CHILDREN IN MAORI COMMUNITIES 8It can be said that all the above-mentioned studies the aims of the study was same despite ofthe different research question. However, some of the studies identified the rate of obesityMaori community children and children from other communities as well. On the other hand,other studies suggested the interventions that can be quite beneficial for the children of thesecommunities (Stoner et al., 2016).The studies that were qualitative in nature used questionnaires with open ended question asthe method of data collection. The age of the participants was below 20 years as most of thestudies considered children for examining ‘obesity’. Furthermore, each of the study was quiteethical as it did not harm anything (Chiavaroli et al., 2019).Critical appraisalAs stated earlier 25 articles are used for this study and it is directly identified as proper viaquality assessment analysis. One of the main factors that were discussed in all of the studieswas the trustworthiness. Some of the studies had some limitations with regard to the methodsand specifically it was because of the sample sizes. All the samples of the studies includedchildren from Māori community who were suffering from obesity. However, for constrictingobese children from other communities were also included (Howe et al., 2015).The main reasons behind obesity, its impact and how it can be controlledamong the Maori childrenIn New Zealand it has been observed that ethnic factors are the main reason due to whichthere is a high risk of obesity among the children of Māori communities. However, there are alot of health related issues that is connected with obesity among these children such aspsychological, cardio metabolic as well as the gastrointestinal problems (Littlewood, Canfell& Walker, 2020). Childhood obesity is one of the most serious and urgent challenge not onlyOBESITY AMONG CHILDREN IN MAORI COMMUNITIES 9in New Zealand where most of the Māori communities live but it is also a serious threatacross the globe. The children from the Māori communities are more affected when contrastedwith the non- Māori children, with the gap in the weight status between the two groups iswidening day by day and it highlights the fact that there is enhanced risk in terms ofmetabolic disorders in later life. The adults from the Māori communities are already at therisk in terms of the premature death from the vascular disease and it consists of high amountof smoking as well as poor quality diet and the same is followed by their children (Berry etal., 2018). The Māori community’s children are quite vulnerable toward the following chronicdiseases such as: Hypertension, dyslipidaemia, micro albuminuria, kidney failure, type 2diabetes, enhanced risk of impaired of glucose tolerance, insulin resistance, sleep apnea, highcholesterol as well as asthma. However, the obesity of the children in the Māori communitiesis also related to the following factors: psychological problems for instance depression andanxiety, social problems such as stigma and bullying along with the low self-esteem and lowreported quality of life in these communities. The future health risks with regard to the Māoricommunity’s children are quite high (Rush et al., 2012). The children of this community whoare suffering from obesity are most likely to become the obese adults and the adult obesity isconnected with enhanced risk in terms of some of the serious health problems such as cancer,type 2 diabetes and heart disease among others. Moreover, if children from Māoricommunities have obesity then they have high chances of getting obese in their adulthood andthe diseases will be severe. It is needless to say that community acts as one of the biggestelement for affecting the individuals in terms of making healthy choices. Violent behavioursin children among the Māori communities influence them to gain weight and it consists ofeating low nutrients foods, high calorie foods and not sleeping properly (Phadnis, Phillips &Willoughby, 2012).OBESITY AMONG CHILDREN IN MAORI COMMUNITIES10Throwing light on the above-mentioned discussion it can be said that the complicatedinterplay with regard to the socio-environmental factors that tend to contribute toward theobesity among the children in the Māori communities also consist of the financial relatedstress connected with the urbanisation, insecurity regarding food, overcrowded housing aswell as lack of proper access in terms of health services. On the contrary, it can be argued thatobesity in the children in the Māori communities can be directly related with the severalillnesses (Mihrshahi et al., 2017). New Zealand is regarded as one of the nations with highestnumber of obese children but Māori and Indigenous people from all across the globe face a lotof health related burden. Sometimes the culture and the colonial history are regarded as theprime factor in terms of causing obesity among the children in the Māori communities. In therecent times, the eating patterns of the children in the Māori communities have changed at analarming rate as they are quite inclined in terms of consuming cheap processed food which ishigh in fat and sugar and their physical activities have also reduced as they have gainedweight (Butler et al., 2019). The dietary patterns among the Māori communities are quite lowand this particular community also have a diet high in saturated and total fat. It can be saidtheir poor diet also indicates their poor economic status as well as the higher cost of thehealthier foods for instance, vegetables, fruits, and low dairy products. It is suggested by theinternational evidence that the strategies placing the responsibility on people for makinghealthy choices of food as well as being physical active are not quite likely to reduce thedisparities in the final results (Rodriguez, George & McDonald, 2017).It is quite evident that if the government with proper leadership along with propercollaborative program for the Māori-specific obesity interventions that will be properlyaddressing this particular problem and then it can be solved. More specifically proper supportand funding are also quite important for continuously facilitating the building of Māori healthworkforce for coordinating, developing as well as evaluating the programs (Anderson et al.,OBESITY AMONG CHILDREN IN MAORI COMMUNITIES112016). Furthermore, it has been observed that the government of New Zealand haveintroduced some of the interventions that are making difference for the Māori community’shealth. Public and Community Health tend to embrace a model of excellent practice that tendto promote as well as bring together the value of contemporary and traditional point of viewon the wellness of the Māori communities and present research for improving the servicedelivery (Glover et al., 2019). Additionally, observing the condition of the children in Māoricommunities with regard to obesity the following are some of the more segments on whichthe government must work: Creating food environment that is extremely healthier byavailability of unhealthy and healthy foods as well as marketing of the unhealthy foods toMāori children and at the same time developing the food procurement procedures that arehealthy, reducing the socioeconomic discrepancy that is driving the inequalities in the healthand also creating built environments that will be promoting enhanced physical activity.However, it can be one of the most significant challenges for the government but if it iscoordinated well then it is quite likely to have positive impact (Boulton et al., 2011).DiscussionLimitations and strengths of this reviewOne of the main strength of this entire report is the freshness as it used treatment interventionsalong with synthesising global evidence for the children of Māori communities. Findings ofthis review are mainly transferable to the poor populations in the developed countries thathighlight obesity among the children. However, implementing the spectacular engagement ofthe community and also intervention co-design procedure may be quite advantageous in termsof taking care of the childhood obesity within the Māori communities (Poppitt, Silvestre &Liu, 2014). On the other hand, the main limitation consists of including fewer articles alongwith the risk of bias within the studies, which have limited the ability for developingOBESITY AMONG CHILDREN IN MAORI COMMUNITIES12particular, excellent recommendations that are applicable in a huge amount of settings withregard to the obese children in Māori community along with the treatment in this population.Another limitation was due to the word count limitation all the studies I was unable toaccumulate all the detailed findings in the table regarded as “description of the studies” but Itook ideas from all 25 studies for conducting this study (Jani et al., 2018).Findings discussionIt has been observed that as per the researchers the entire Māori community faces hugeamount of burden due to obesity-related disease and also obesity when contrasted with thenon- Māori communities. Additionally, Māori children are also quite less likely to live in theenvironment that is healthy. Obesity is found out to be the biggest contributor to the gap interms of the health status among the children in Māori communities (Haring et al., 2016).Implications for the future researchThis particular study may have implications for the social service workers or researchers inthis field. Furthermore, the future research will be optimizing the interventions for tacklingthe childhood obesity in the Māori communities that highlights huge amount of health andsocioeconomic disadvantage that enhances the risk of population for the long-term obesity(Gibson et al., 2011).Conflict of interest statementIt is declared by the researchers that there is no such conflict of interestOBESITY AMONG CHILDREN IN MAORI COMMUNITIES13ReferencesAnderson, Y. C., Wynter, L. E., Butler, M. S., Grant, C. C., Stewart, J. M., Cave, T. L., … &Hofman, P. L. (2016). Dietary intake and eating behaviours of obese New Zealandchildren and adolescents enrolled in a community-based interventionprogramme. 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