Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand.
Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand.
Ethn Health. 2023 May;28(4):562-585. doi: 10.1080/13557858.2022.2078482. Epub 2022 May 24.
Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake.
Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach.
From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment.
Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Māori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.
肥胖及其后果是一个日益严重的问题， disproportionately 影响毛利人和太平洋岛民，这是多因素系统性原因造成的，包括殖民化的影响和全球化的影响。针对这些人群的肥胖干预措施的综合证据有限。本研究的目的是确定评估干预措施，以预防和管理毛利人和太平洋岛民成年人的肥胖，评估这些干预措施的有效性，并确定其采用的促进因素和障碍。
从开始到 2021 年 6 月，对数据库（Medline、PubMed、EMBASE、CINAHL、Scopus、CENTRAL）、主要非索引期刊和纳入文章的参考文献进行了系统评价。使用人群、干预、对照、结局（Population, Intervention, Control, Outcome）格式定义了纳入标准，并对研究/出版物特征进行了定义。使用叙述性综合法提取和分析定量和定性数据。使用改良的 GRADE 方法评估研究质量。
从 8190 篇文章中，确定了 21 篇文章符合纳入标准，其中 18 篇文章可进行定量分析，5 篇文章可进行定性分析。研究结果存在异质性，大多数研究质量较低。一些研究报告称体重和体重指数有小但统计学上显著的改善。确定的主要促进因素包括社会联系、实现可持续的生活方式改变、以文化为中心的干预措施以及激励措施，包括金钱和乐趣。干预措施采用的障碍包括由于内在计划因素（如缺乏社会支持和设备故障或丢失）难以维持对计划的遵守。
正常体重轨迹是随着时间的推移逐渐增加。几年后体重略有下降或没有增加可能对降低糖尿病进展或改善糖尿病患者的血糖控制有积极的结果。我们建议紧急实施毛利人和太平洋岛民主导、文化上量身定制的减肥计划，促进整体、小而可持续的生活方式改变，在适当的社会背景下进行。
