Doctors are calling for changes in how we prepare obese patients for bariatric surgery, with massive inequities discovered in access to the life-saving procedure.
Nearly three-quarters of Pacific people enrolled in Auckland City Hospital's bariatric surgery programme between 2007 and 2016 pulled out, research has found, compared to a dropout rate of only 39 percent for Pākehā and 50 percent for Māori. Pasifika men are worst-off, with only 13 percent of those enrolled actually making it as far as having surgery.
The surgery is one of the most-effective procedures overweight people can undergo, fixing type 2 diabetes in around 80 percent of patients, for example.
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"It's what you might call stomach stapling - reduction of the stomach mass, or rediversion of the intestines to reduce the desire to eat and the need to eat, and therefore achieving weight loss," incoming director of the Maurice Wilkins Centre for Molecular Biodiscovery Prof Peter Shepherd told The AM Show on Thursday.
National Party MP Paula Bennett famously lost 50kg after undergoing a gastric bypass in 2017.
Before the surgery can take place however, patients often need to attend appointments, improve their diets and lose some weight. Partly because so many of them fail to meet these requirements, only seven in 10,000 morbidly obese Pacific people in New Zealand actually get bariatric surgery - compared to 30 Pākehā.
Dr Shepherd said the pre-surgery process, much like the rest of the health system, is set up to suit people with a "Pākehā-centric view of the world".
"The types of ways we make people go to appointments at certain times, which don't fit with people's lifestyles or the needs of their families, and the distances they have to come for those appointments; the stress; and the way it's presented to them, the cultural context in which it's presented to them can be very, very foreign and very sort of cold and unfamiliar."
He said "being more culturally sensitive and adaptable" would result in better outcomes at no greater expense to taxpayers.
"If we just set some rules and say 'stick to them or you miss out on your opportunity', we're going to end up right where we are now and these inequities are going to continue...
"We as consumers and taxpayers will achieve better health outcomes for our people, and that will reduce burdens on the health system and it will have huge impacts on those individuals who are able to access that surgery. This is a win-win - it's about being flexible, thinking outside the box and not sticking to the rigidity of our old ways of doing things."
Dr Tamasin Taylor of AUT has been funded about $300,000 to conduct research into finding a better way of handling morbidly obese Pacific people's path to surgery.
"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," she said.
"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 under-representation of Pacific staff are particular barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families."
Around two-thirds of Pacific adults are obese, according to the Ministry of Health, compared with one-third of adults overall.
Newshub.
