Researchers are calling for stronger investment in kaupapa Māori-led eating disorder services, after new research has revealed Māori expertise and whānau-centred approaches remain underused in national policy and treatment pathways.
The University of Otago, Faculty of Medicine – Christchurch Ōtautahi-led study, published in today's New Zealand Medical Journal, is the first to map kaupapa Māori service experiences directly onto the government's refreshed New Zealand Eating Issues and Eating Disorders Strategy.
Research Fellow Mau te Rangimarie Clark
Led by Research Fellow Mau te Rangimarie Clark (Tainui/Ngati Pikiao/Ngati Kahungungu) of Otago's Department of Psychological Medicine in partnership with Christchurch Kaupapa Māori mental health provider Purapura Whetu, the study involved a wānanga with frontline kaimahi supporting Māori using Ngā Maiuri Kai – a Māori framework for understanding eating disorders grounded in Te Ao Māori concepts of balance, wellbeing and recovery.
"Māori experience eating disorders at rates comparable to, and in some cases higher than, non-Māori, yet remain significantly less likely to receive specialist treatment," Clark explains.
"Government recognition of Kaupapa Māori services within the New Zealand Eating Issues and Eating Disorders Strategy has been an important first step, but our findings show these services and their expertise remain significantly underused," he says.
The qualitative study identified six major themes affecting Māori experiences of eating disorders; food insecurity, the impact of trauma and co-existing conditions, whānau-centred models of care, barriers accessing specialist services, workforce shortages, and the lack of culturally appropriate screening tools.
Funded by a Māori Health Research Development Grant from the Health Research Council of New Zealand, the study developed 24 practical recommendations and mapped these against the current government strategy, showing how Kaupapa Māori approaches could be directly implemented across prevention, access, effectiveness and workforce development priorities.
"Achieving equity for Māori experiencing eating disorders will depend on whether Kaupapa Māori knowledge is genuinely embedded in commissioning, workforce development and treatment pathways across the health system," Clark argues.
The study highlights how food insecurity, poverty and trauma are deeply intertwined with disordered eating experiences for many whānau. Kaimahi described patterns of "DPB eating", where periods of food scarcity followed by access to money or food could trigger binge-eating behaviours, particularly for parents trying to prioritise feeding children ahead of themselves.
It says current mainstream approaches often fail Māori by focusing too heavily on weight-loss interventions while overlooking trauma, emotional wellbeing and wider social determinants of health. Participants also described concern about people being directed toward dieting, bariatric surgery or weight-loss medications without adequate psychological support.
Clark says participants repeatedly stressed the importance of Whakawhanaungatanga (relationship-building) in supporting recovery.
"Kaupapa Māori services work from a whānau ora model, where tāngata whaiora (people seeking wellness) are seen as experts in their own lives and healing journeys," he explains.
The study also found Māori with eating disorders are frequently excluded from specialist services because of strict eligibility criteria, especially when they present with complex mental health conditions, substance use, autism or trauma histories.
"Kaimahi talked about Māori being bounced between fragmented services that treat problems in isolation rather than recognising the interconnected realities of people's lives," he says.
Researchers are calling for longer consultation times, better integrated care, culturally safe workforce training, expanded peer-support programmes and the development of Māori-centred assessment and screening tools that better reflect Māori experiences of wellbeing.
Co-author Associate Professor Jenny Jordan says the findings reinforce the value of kaupapa Māori approaches already operating within communities.
"This study moves beyond describing the problem to identifying practical solutions. It shows how Kaupapa Māori providers are already delivering strengths-based, culturally grounded responses that align closely with the government's own strategy priorities," she says.
The paper builds on an earlier hypothesis paper, also led by Clark, exploring how rongoā Māori (traditional holistic healing) could potentially be integrated alongside Western psychotherapy approaches to support Māori experiencing eating disorders.
"All these approaches already exist within Kaupapa Māori services. What's needed now is sustained investment and policy commitment to support them," Clark says.
