Pacific peoples in New Zealand have the highest drop-out rate for weight loss or bariatric surgery despite being the most affected by obesity-related health conditions.
University of Auckland Pacific emerging researcher Dr Tamasin Taylor, of Samoan heritage, has received the Health Research Council (HRC) Sir Thomas Davis Health Research Fellowship to test if a Pacific-led, pre-surgery support initiative could turn this around, improving Pacific patient retention rates and treatment outcomes starting with the bariatric surgery programme at Auckland City Hospital.
This new fellowship follows on from Dr Taylor’s current HRC-funded Pacific postdoctoral research, due to be completed shortly, which has identified the systemic, social and economic barriers New Zealand’s Pacific patients face when they are referred to publicly funded bariatric surgery programmes.
“My current study explored the reasons behind why the pre-surgery stage of bariatric surgery [around three to six months before surgery] is the key point at which Pacific patients are significantly vulnerable to disengaging with public health services and dropping out,” she said.
Between 2007 and 2016, about 73 per cent of Pacific patients enrolled in Auckland City Hospital’s bariatric surgery programme dropped out before undergoing their surgery, and 87 per cent of Pacific males. This was in comparison to a drop-out rate of 39 per cent for New Zealand Europeans and 50 per cent for Māori, says Dr Taylor.
A nationwide study found that between 2009 and 2014 only .7 of morbidly obese Pacific peoples out of 1000 received bariatric surgery in comparison to three out of 1000 morbidly obese New Zealand Europeans1. This translates to 7 in 10,000 morbidly obese Pacific peoples compared to 30 in 10,000 morbidly obese New Zealand Europeans. Dr Taylor says this is the case even though Pacific populations in New Zealand have the highest rates of obesity-related conditions such as type 2 diabetes, sleep apnoea, hypertension and kidney disease – conditions which can all be significantly improved or resolved through bariatric surgery treatment. For example, bariatric surgery has been shown to resolve type 2 diabetes in around 80 per cent of patients following surgery2.
Currently in New Zealand, the surgery preparation requirements for publicly funded bariatric surgery programmes varies between district health boards. However, they generally include the need to attend pre-surgery appointments and group support meetings, make demonstrable changes to diet and physical activity, and, in some cases, lose a set percentage of excess weight.
Dr Taylor says one of the problems with these requirements is that they are treated as equally attainable for all patients.
“The reality is that Pacific patients are more likely to be disadvantaged as many face greater structural barriers within hospital programmes and significant social and economic barriers. Clinical environments and an underrepresentation of Pacific staff are particular barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families.”
Stigma surrounding surgery, social pressures from family and friends, and a lack of positive role models also act as barriers to going through with surgery,” says Dr Taylor, who is currently preparing a paper for publication about these findings based on interviews with health professionals and patients.
“While bariatric surgery isn’t the population-level answer to obesity, it is crucial that patients who are referred for surgery and accept a place on the bariatric surgery programmes are adequately supported to get through the pre-surgery stage,” says Dr Taylor.
As part of her two-year Sir Thomas Davis Health Research Fellowship, Dr Taylor will develop a Pacific-led preoperative support group for Pacific patients enrolled in the bariatric surgery programme at Auckland City Hospital, with input from the surgery team led by specialist bariatric surgeon Mr Grant Beban. The group will also have substantial participation from former successful Pacific bariatric surgery patients.
HRC manager of Pacific research investment, Tolotea Lanumata, says if successful, this research has the potential to impact on Pacific patients’ uptake of bariatric surgery. It could also be applied to other areas of health where Pacific patients are experiencing barriers to engaging with health services.
“Reducing the health inequities facing our Māori and Pacific populations is a major focus of the Government’s New Zealand Health Research Strategy and Tamasin’s research ties in perfectly with this objective. Removing or reducing the barriers facing Pacific bariatric surgery patients will hopefully empower them to succeed with their weight loss and enable both them and our health system to reap the benefits,” says Ms Lanumata.
Dr Taylor’s study is one of 25 HRC Pacific Career Development Awards announced today for a combined total of $2.9 million – an almost $1 million increase on last year, reflecting the growing talent base of up-and-coming Pacific health researchers and the HRC’s commitment to support them. See below for the full list of recipients or go to www.hrc.govt.nz/funding-opportunities/recipients and filter for ‘Pacific Health Research’ and ‘2020’.
1Rahiri, J. L., Lauti, M., Harwood, M., MacCormick, A. D., & Hill, A. G. (2018). Ethnic disparities in rates of publicly funded bariatric surgery in New Zealand (2009–2014). ANZ Journal of Surgery, 88(5), E366-E369.
2Dixon, J. B., Zimmet, P., Alberti, K. G., Rubino, F., & International Diabetes Federation Taskforce on Epidemiology and Prevention. (2011). Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabetic Medicine, 28(6), 628-642.
2020 Pacific Health Career Development Awards
Sir Thomas Davis Te Patu Kite Rangi Ariki Health Research Fellowship
Dr Jesse Kokaua, University of Otago, Wellington
Lighted paths: Education and pathways to better health for Pacific families
24 months, $256,775
Dr Tamasin Taylor, The University of Auckland
Improving publicly funded Pacific bariatric surgery patients' retention rates
24 months, $296,503
Pacific Clinical Research Training Fellowship
Dr 'Etuini Ma'u, The University of Auckland
Estimating the cost of dementia care in New Zealand and modelling future costs and needs
48 months, $319,087
Pacific Health Research Postdoctoral Fellowship
Dr Zaramasina Clark, Research Trust of Victoria University of Wellington
Identifying biomarkers of aneuploidy in embryos
36 months, $385,232
Miss Jessica Pasisi, University of Waikato
Niuean happiness: A hiapo approach to Niuean mental health and wellbeing
36 months, $359,179
Pacific Health Research PhD Scholarship
Mrs Taulaga Auva'a-Alatimu, The University of Auckland
Improving Pacific youth wellbeing: co-creation & evaluation of a digital tool
36 months, $128,600
Ms Jacinta Fa'alili-Fidow, The University of Auckland
Exploring resilience among Pasifika children within the GUiNZ Study
24 months, $85,128
Mr Gavin Faeamani, Massey University
Lifestyle program for Pacific
36 months, $125,790.40
Mrs Amy Henry, University of Otago, Christchurch
Health and the Ta'unga: Cook Island palliative health knowledge in New Zealand
36 months, $134,921
Ms Manusiu Latu, The University of Auckland
Developing Tongan and Samoan-centred ways to improve primary health care access
24 months, $85,658
Miss Albany Lucas, University of Otago, Wellington
Sleep, health, communication, and wellbeing for Pacific children and families
36 months, $132,661
Amy Maslen-Miller, The University of Auckland
Revitilisation of the Samoan traditional diet
36 months, $126,868
Mrs Sarah McRobie, The University of Auckland
Counselling survivors of sexual violence trauma: Developing a Pasifika model
36 months, $127,418
Ms Taimi Tuimalealiifano, The University of Auckland
Exploring adaptive thermogenesis in New Zealand-based Samoans
36 months, $127,550
Mrs Julie Winter-Smith, The University of Auckland
Epidemiology of cardiovascular disease among Pacific people in New Zealand
33 months, $118,050
Pacific Health Research Masters Scholarship
Ms Tutangi Amataiti, University of Otago, Wellington
Improving adherence to a reduced carb diet for women with gestational diabetes
12 months, $30,951
Miss Tilda Leleai, University of Otago
Pacific and Māori populations undergoing cardiac surgery in the SDHB region
12 months, $28,845
Miss Audrey Po'e-Tofaeono, The University of Auckland
Exploring the views of New Zealand-born Samoan youth on alcohol consumption
12 months, $31,000
Pacific Health Research Knowledge Translation Grant
Dr Dianne Sika-Paotonu, University of Otago, Wellington
Towards a new penicillin for rheumatic fever prevention
6 months, $5,000
Pacific Health Research Summer Studentship
Miss Jessica Fowler, The University of Auckland
Health seeking and unmet need for Pacific children accessing primary health care
2 months, $5,000
Miss Fuatino Heath, University of Otago, Wellington
Global Health Classroom as a tool for global child health learning
3 months, $5,000
Miss Monleigh Ikiua, The University of Auckland
A systematic review of alcohol research in the Pacific Islands
3 months, $5,000
Ms Leilani Pereira, University of Otago, Wellington
Exploring appropriate ways to recruit Pacific people into research
3 months, $5,000
Miss Ruby Tukia, University of Otago, Wellington
Oral health of elderly Pacific people among New Zealand nursing home residents
3 months, $5,000
Miss Emily Yee, Massey University
Barriers and cultural values for Pacific women accessing breast cancer care
2 months, $5,000