Creating Healthy Food, Building Healthy Families: An Evaluation of a Healthy Cooking Healthy Lifestyle Programme in New Zealand
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Obesity has become an increasingly significant challenge as it continues to defeat public health sectors within developed and developing countries. The New Zealand Health Survey 2016/17 reported the prevalence for overweight and obese adults from 2006/07 to 2016/17 increased 5%, to 67%. Significant were the disparities for those living in the most deprived areas, with adult obesity up 5% to 44%, and extreme obesity up 3% to 11%. Overweight and obese children in the least deprived areas increased by 1% to 21%, in the most deprived areas it increased 8% to 49%. Globalisation is a primary driver of obesity, as expanding economic systems are increasing the amounts, availability, and the marketing of energy-dense mass-produced ultra-processed foods. Established diets, which include significant amounts of fresh fruits and vegetables, have transitioned to these foods, as many consumers abandon cooking meals from scratch, for the convenience of the branded processed foods. The purchasing of these energy-dense ultra-processed foods for many households has become significant as they can be considered enjoyable, more affordable, simple and fast to make. The nutritional value of these foods can be very poor, and they can be high in added salt, sugars and fats. Studies show that the socioeconomic status of populations is a significant factor, concerning dietary patterns and the purchasing of these foods, when examining the rising incidence of obesity. The higher income consumers may have resources to address obesity within the family, such as gyms, learning cooking through purchasing books and paying for educational classes, however the low-income consumers are likely to have fewer resources to address the problem. Barriers identified for these low-income consumers to eat quality healthy foods are the cost of these foods and having a lack of healthy cooking knowledge and skills. The Healthy Cooking Healthy Lifestyle Programme, developed in 2009, is a health support service for Bay of Plenty Māori communities. The aim of the programme is for participants to develop healthy cooking knowledge and skills which they can then utilise with their families. Delivered in the setting of the participants local Marae, the programme uses a motivational learning approach, empowering participants to apply what is learnt at home. This includes cooking family meals from scratch, with many of the different, more affordable vegetables available. The aim of this study was to evaluate the effectiveness of this programme from the perspectives of the participants using the service. The study used a mixed methods approach as the methodology, with data collection tools being a survey and four focus groups. Eighteen parents or caregivers of children from three groups living within Bay of Plenty lower socioeconomic communities participated. Two groups, from different marae, had programmes held at the marae, while the other group, from a low decile school, attended in a church hall kitchen. The study questioned, “Do primary caregivers use more vegetables in the family meals after learning, from an interactive cooking programme, a range of skills and information for preparing and cooking different vegetable-based meals from scratch?” Analysis of the results showed the participants gained in number of benefits in different ways from their experiences on the programme. Benefits included: • the delivery method for the programme, in line with Self Determination Theory, worked to enhance autonomous motivation, and was appropriate as a motivational theory for the learning. • building self-efficacy to apply what they learnt at home, including cooking family meals from scratch with more vegetables. • learning about different vegetables, including frozen vegetables, which were often not used at home, as an affordable and enjoyable option. • learning about cooking methods to get the most out of vegetables, including retaining and developing better vegetable flavours. This was appreciated by the families, and they used these vegetables more when cooking. The study found that the programme was beneficial to families, and the family members responsible for cooking, in raising awareness of vegetable eating and cooking, building self-confidence in cooking, and teaching specific techniques for cooking vegetables. However, this is just one programme which addresses the vital need for better eating in the home. It does not have the scope to address the issue for wider society. Ultimately it requires government, as well as the commercial food sector, and the public, to make changes together. Instead, historically New Zealand governments have lacked taking significant action on the food system, including regulation on many of the high risk ultra-processed foods. Many of the support services for healthy eating and healthy action developed between 2004 and 2008, especially for the vulnerable low socio-economic groups, have been stopped. This study supports the calls to achieve health equity through the development of a comprehensive national healthy eating and healthy lifestyle strategic plan to tackle the high prevalence of obesity. Policy is also needed for food regulation, and it is essential for empowering more high-risk communities with healthy cooking healthy lifestyle education. This will improve their capacity to cook healthily and improve their repertoire in cooking the more affordable healthy foods, which they can learn about on these programmes. Recommendations include empowering individuals living in communities where health and social inequities are at their highest, with healthy cooking knowledge and skills, as this can provide these individuals with a better understanding, and the ability to self-manage a sustainable healthy eating lifestyle. This empowerment will be transformational for those individuals who are purchasing many ultra-processed foods, because they don’t believe they have the knowledge, skills and tacit skills, and ultimately the confidence, to cook the many unfamiliar, yet more affordable, vegetables (or prepare salads) correctly so they can be enjoyed by their family and whānau.