Now, University of Otago (Christchurch) researchers are calling for stronger investment in kaupapa Māori-led eating disorder services.
Study leader and Otago psychological medicine research fellow Mau te Rangimarie Clark worked in partnership with Christchurch mental health provider Purapura Whetu, to study frontline staff supporting Māori by using Ngā Maiuri Kai — a Māori framework for understanding eating disorders which are grounded in Te Ao Māori concepts of balance, wellbeing and recovery.
The study, published in the New Zealand Medical Journal, is the first to map kaupapa Māori service experiences directly on to the government’s refreshed New Zealand Eating Issues and Eating Disorders Strategy.
"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," he said.
"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 said the 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.
The study highlighted how food insecurity, poverty and trauma were deeply intertwined with disordered eating for many families.
Staff described patterns of "DPB eating", where periods of food scarcity were followed by access to money or food, which could trigger binge-eating behaviours.
The study also found mainstream approaches often focused too heavily on weight-loss interventions while overlooking trauma, emotional wellbeing and wider social determinants of health.
Participants were concerned about being directed towards dieting, bariatric surgery or weight-loss medications without adequate psychological support.
Mr Clark said participants repeatedly stressed the importance of whakawhanaungatanga (relationship-building) in supporting recovery.
Māori with eating disorders were frequently excluded from specialist services because of strict eligibility criteria, especially when they presented with complex mental health conditions, substance use, autism or trauma histories.
Staff said Māori were being bounced between fragmented services that treated problems in isolation, rather than recognising the interconnected realities of people’s lives, he said.
The study’s researchers have called 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.
