Because of the association between body weight and many chronic and metabolic illnesses such as cardiovascular disease and diabetes, weight and other weight or body fat-related measurements such as BMI (body mass index) or waist circumference are commonly used to screen and assess health risks.
Weight loss is now linked with health, happiness, and will power, while over-weight or obese is linked to ‘unhealthy’, poor choices, and a lack of will power. Our modern fascination for weight loss has led to stigma of those who are overweight or obese, and considering Māori are among those with the highest prevalence of ‘overweight’ and ‘obesity’, the line between ‘weight-ism’ and racism can become somewhat blurred.
There is a massive amount of research linking BMI, weight, and waist circumference, to diabetes, heart disease and other aspects of poor health, so aren’t we justified in waging a ‘war on obesity’? Although this association is well established, whether increased weight (or even fat) is actually the ‘cause’ of these lifestyle illnesses is less clear. What’s more, many studies have shown that weight loss is extremely difficult and nearly impossible for some people, while others have shown that healthy habits like regular physical activity can improve health even when no weight is lost.
Nevertheless, the commercialisation of weight loss continues to drive a news feed full of before and after pictures, and new weight loss product after new weight loss product.
For Māori, who have highlighted holistic views of health relating to whenua, whakapapa, wairua, hinengaro and whānau (as well as tinana), a weight focused approach to health or illness does not necessarily align with ‘our’ way of viewing health. Accordingly, there has been a swell of initiatives drawing on traditional knowledge and cultural values to drive health promotion in Aotearoa. This is particularly apparent within various physical activity initiatives where the connection to whakapapa, and traditional knowledge and values, have become the driver for lifestyle change.
Yet, despite these movements, the outcome measures used to assess such initiatives almost always default to some weight-related measure, whether weight itself or BMI. Decolonising health initiatives and the outcome measures which shape them may be necessary to achieving health equity and ensuring a ‘war on obesity’ isn’t just another justification for a ‘war’ on Māori.
Dr Isaac Warbrick (Ngāti Te Ata, Te Arawa, Ngā Puhi) is an exercise physiologist, Senior Research Fellow and Director of Taupua Waiora Centre for Māori Health Research. His most recent publications have questioned whether ‘weight’ and ‘weight loss’ are appropriate ‘health’ measures for Māori, suggesting that outcome measures should better reflect cultural values.