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The opportunity to put the ‘fence at the top of the cliff’ attracted Dr David Schaaf into public health. Now his research into the causes of heart disease has taken him full circle back to his old school in Mangere.

Dr David Schaaf

“We focus on young people because heart disease doesn’t just happen over night. The literature shows it happens a lot earlier in life. From a public health point of view we know that mortality from heart disease in Maori and Pacific Islands people is pretty high. So if the risk factors associated with heart disease are already happening in the young, then that’s where we’ve got to start our research and prevention.”

To this end, David has just completed his PhD examining cardiovascular risk factors in secondary students. The project involved ten south Auckland schools and sampled 2,500 students, 1,000 of whom were of Pacific Islands descent. Blood was taken from each student to test blood sugar levels and check for lipids, such as cholesterol, which are associated with heart disease. Information was also gathered from the students about what they ate and how they exercised. Finally, the aerobic fitness of students was assessed during a ten-minute exercise bike ride.

The findings were clear. By Year 11 (5th form) and Year 12 (6th form) Pacific students were at significantly higher risk of cardiovascular disease than students from other ethnicities. David Schaaf says his research showed the main determinant was their body mass index (BMI) or weight.

This research has led to David’s involvement in the OPIC (Obesity Prevention in Communities) project. The initiative is taking place in four countries – New Zealand, Australia, Fiji and Tonga. A baseline survey has established the lifestyle risk factors that contribute to weight gain. These findings, combined with those of the recent Children’s Nutrition Survey examining the nutritional habits of children aged five to 14 years old, have provided a fuller picture of what’s happening.

“The survey was a great help. It showed that from five to nine years old the health profile of the children was very good in terms of body mass index, physical activity and nutrition. They were eating what Mum and Dad were giving them and what their parents were giving them was ok.

“The trouble started with the 10 to 14 year-olds. Their nutrition, exercise and their general health profile was unhealthy compared to the young ones. They weren’t getting enough physical exercise.

“In terms of weight gain, the key contributors were television-watching, fizzy drinks, lack of exercise and unhealthy eating. Now we have the evidence to describe the problem, we can move to the next level, which is trying to do something about it. That’s what OPIC is all about.”

The project team looked for practical measures that could make an immediate difference in schools. Food sources were an obvious place to start.

“The research showed that if kids sourced their food from dairies and shops it was worse in terms of their weight gain than the tuck shop and, in turn, the tuck shop was worse than if they sourced food from home. The lessening of risk was really apparent from the research.”

David and his team have been working closely with four high schools in Mangere, including his old secondary school which is part of Southern Cross Campus.

Mike Williams is the principal at nearby Aorere College. Many of Mike’s 1,300 students are Pacific and the school has been aware of obesity problems for some time.

“We banned fizzy drinks from our canteen a long time ago and have been working with the vendors to promote healthy eating and drinking. We’re looking at the menus and giving a price advantage to healthier options, which was a conscious decision on the part of the school to forgo profit.

“We’re not preparing our kids well for the future if we ignore the obesity epidemic. If we don’t do something now, in ten years’ time the impact on this community and our health system will be horrific. So for us as a school, it’s about a major community issue that’s got to be dealt with.”

However, Mike Williams says the issue requires more than just unilateral actions and ‘quick fixes’.

“Solving obesity is a long-term issue. It’s about changing attitudes in our communities. It is difficult to legislate and make rules about eating, because they won’t work. That sort of approach just drives the current behaviour underground.

“That’s why we welcome OPIC and the involvement of Auckland University. We see OPIC as a long-term commitment to get below the superficial level and address the real causes and look for alternatives. That’s why we’ve bought into the project.”

“Last year, they ran a health awareness week here. They ran all the activities themselves without teacher involvement and every event was a success. They got outside speakers in, they ran giveaways and promotions. It was intensive and highly successful. So part of our learning has been to let the students go for it, because students really respond to their peers.

“This project has shown that the solutions aren’t always the ones that our generation will think of. If we’re going to change attitudes and values of students then it has to be done in ways that are relevant to them. We know it’s about eating, activity and lifestyles and we can reinforce these messages through the curriculum, but you need to involve students in packaging those messages to be effective,” says Mike.

The school is exploring a host of areas that might make a difference to students’ eating and lifestyle habits. These range from introducing lunchtime and holiday sports programmes for students to making students more aware of the impact food advertising has on them, as part of their English studies.

A key theme is that of choice – presenting students with cheap, easily accessible alternatives.

“At the end of the day, it’s the student that has to make the choice. They are one who has to go home and walk past the dairy and either buy the bottle of water or the fizzy drink. What they need are not rules, but better choices,” says Mike.

Leaning on one of the new fountains, David Schaaf is clearly delighted that his research efforts are leading to practical solutions at grassroots.

It’s all very well to tell students to drink water, but when we looked at why they weren’t, there were lots of very practical reasons why it wasn’t happening. The water fountains they had weren’t in the right places. Or they were broken or hard to use.

We had to bring the water source to the kids. We had to install three times as many fountains. We had to design a water fountain that students would want to use.”

Dr David Schaaf 

“Our research showed that if we want students to access water, we’ve got to make it much easier for them to do it. We had to bring the water source to the kids. We had to study where they were congregating, where they were walking. We had to put the fountains out by the sports fields, the gyms, the tuck shop. We had to install three times as many fountains. We had to design a water fountain that students would want to use. One that couldn’t be easily vandalised.”

Now the new fountains are being officially launched as part of social marketing efforts to achieve a culture shift. Every student is being given a ‘hi-tech’ water bottle and messages about the importance of hydration.

“The bottles look amazing. They’ve got carbon filters. We wanted something that would be a hook to help us pass on this information.”

The OPIC project runs until just 2008, says David, so a key issue is sustainability.

“A lot of research programmes like this are short term, but obesity doesn’t just happen over one or three years. One of the key outcomes for us is capacity building. So we’ve had four or five young researchers helping us. We’ve involved all the stakeholders at the schools, such as other non-government agencies. We’ve set up student health councils. We’re working with the local churches.

“This issue is so complicated and long-term that we must coordinate and concentrate our efforts. If we only have little pockets of activity, it won’t address the problem. Fighting obesity requires responses that are multi-dimensional and multi-setting. We’ve got to work together, evaluate properly and learn.

“Mangere is a hard area. I grew up in it. Every inch of progress that you can achieve on these issues makes a lot of difference in the community.”

Fighting obesity requires responses that are multi-dimensional and multi-setting. We’ve got to work together, evaluate properly and learn.”

Dr David Schaaf

At a Glance

The Pacific Obesity Prevention in Communities Project (OPIC)

Teams from the University of Auckland School of Population Health, the Fiji School of Medicine and Deakin University in Victoria, Australia are gathering evidence to support the best approach to comprehensive, community-based obesity prevention in young populations. OPIC will study young populations in Fiji, Tonga, New Zealand and Australia over a three- to four-year period and look at:

• the overall impact (including the cost effectiveness) of comprehensive, community-based intervention programmes on overweight/obesity prevalence in young populations
• the feasibility of the specific intervention components and their impacts on eating and physical activity patterns
• socio-cultural factors that promote obesity and how they can be influence the overall burden of childhood obesity (including loss of quality of life) and how resources can be best allocated to prevent obesity.

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