Researchers are calling for urgent investment into kaupapa Māori-led eating disorder services after a major new study found Māori expertise and whānau-centred approaches remain significantly underused across New Zealand’s health system.
The University of Otago Faculty of Medicine – Christchurch Ōtautahi-led study, published in the New Zealand Medical Journal, is the first to directly map kaupapa Māori service experiences against the Government’s refreshed New Zealand Eating Issues and Eating Disorders Strategy.
Led by Research Fellow Mau te Rangimarie Clark of Tainui, Ngāti Pikiao and Ngāti Kahungunu, the study was carried out in partnership with Christchurch kaupapa Māori mental health provider Purapura Whetū. Researchers held a wānanga with frontline kaimahi supporting Māori experiencing eating disorders using Ngā Maiuri Kai, a Māori framework grounded in Te Ao Māori understandings of balance, wellbeing and recovery.
The findings challenge long-standing assumptions around eating disorders in Aotearoa and highlight major inequities affecting Māori access to treatment and culturally safe care.
Researchers found 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.
The study identified six major themes shaping Māori experiences of eating disorders: food insecurity, trauma and co-existing mental health conditions, the importance of whānau-centred care, barriers accessing specialist services, workforce shortages and the absence of culturally appropriate screening tools.
One of the strongest themes to emerge was the relationship between poverty, food insecurity and disordered eating.
Kaimahi described patterns known as “DPB eating”, where periods of food scarcity followed by access to money or food triggered binge-eating behaviours, particularly among parents prioritising feeding tamariki ahead of themselves.
Researchers say these experiences expose how eating disorders are often deeply connected to broader social determinants of health including poverty, housing insecurity, colonisation and intergenerational trauma.
The study also criticises mainstream approaches that focus heavily on weight-loss interventions while overlooking trauma, emotional wellbeing and the wider realities shaping Māori health experiences.
Participants raised concern about Māori being directed toward dieting programmes, bariatric surgery or weight-loss medications without adequate psychological or cultural support.
Researchers found Māori with eating disorders are frequently excluded from specialist services due to strict eligibility criteria, particularly when they also experience substance use, autism, trauma histories or complex mental health conditions.
Clark says many Māori are effectively bounced between fragmented services that treat issues in isolation rather than understanding the interconnected realities of people’s lives.
The report argues kaupapa Māori services already offer many of the solutions needed but remain under-recognised and under-resourced.
Whakawhanaungatanga, relationship-building and whānau ora models were identified as central to recovery, with kaupapa Māori providers viewing tāngata whaiora as experts in their own healing journeys rather than passive recipients of care.
Researchers developed 24 practical recommendations mapped directly against the Government’s eating disorder strategy, showing how kaupapa Māori approaches could be embedded across prevention, workforce development, access and treatment systems.
Recommendations include longer consultation times, integrated care pathways, culturally safe workforce training, expanded peer-support programmes and the development of Māori-centred assessment and screening tools.
Associate Professor Jenny Jordan says the research moves beyond simply identifying inequities and instead demonstrates how kaupapa Māori providers are already delivering strengths-based solutions aligned with the Government’s own strategic priorities.
The paper also builds on earlier work exploring how rongoā Māori and traditional healing approaches could work alongside Western psychotherapy models to better support Māori experiencing eating disorders.
Researchers say the challenge now is whether policymakers are willing to move beyond recognition and commit to sustained investment and structural change.
The findings arrive amid growing debate around Māori health equity, culturally grounded healthcare and the future direction of Te Whatu Ora following recent restructuring and policy changes across the public health system.
For Māori health advocates, the report reinforces broader concerns that mainstream health services continue struggling to meet Māori needs despite repeated evidence supporting kaupapa Māori-led approaches.
The study’s authors argue achieving equity for Māori experiencing eating disorders will depend on whether kaupapa Māori knowledge is genuinely embedded into commissioning, workforce development and treatment pathways throughout the health system.
As cost-of-living pressures, food insecurity and mental health challenges continue affecting whānau across Aotearoa, researchers warn the need for culturally grounded, whānau-centred support has never been more urgent.
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