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The Health Select Committee's inquiry into Obesity and Type ll Diabetes - examining the Nursing response
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Like almost every developed and developing country New Zealand is faced with an increasing health burden in respect of obesity and type ll diabetes. Physical activity and nutrition initiatives play an increasingly important role in combating the effects of obesogenic environments, yet these approaches fall outside the traditional boundaries of nursing/midwifery practice. The aim of this research was to explore how New Zealand nurses/midwives, who have an interest in the treatment of obesity and associated type ll diabetes, have embraced the importance of physical activity and nutritional interventions and/or if hidden tensions exist within their narratives. In regards to New Zealand obesity and associated type ll diabetes, initiatives have been proposed at an individual, community and population level. The 2006 New Zealand Health Select Committee (HSC) Inquiry into Obesity and Type ll Diabetes was a review of the effectiveness of current strategies and elicited a wide range of submissions. It presented an opportunity to examine nursing and midwifery beliefs on physical activity and nutritional initiatives at all of the above levels. When examining the research on obesity, two main themes emerged. One theme of the literature was from a positivist approach and discussed obesity in terms of crisis and risk with an emphasis on diagnosis and treatment. The second theme emerged from the feminist and post-structuralist literature, this discussed obesity in terms of power relationships, Foucault’s ’medical gaze’, and feminine subjectivities. To fully encompass both of these themes, a mixed method approach was employed. The mixed methods approach comprised two studies: a quantitative descriptive analysis, and discursive analysis using a feminist post-structural lens. Study 1 examined submissions to the 2006 New Zealand Health Select Committee Inquiry into Obesity and Type ll Diabetes by nurses/midwives, to determine how holistic and public health orientated their opinion is to proposed nutrition and physical activity solutions to obesity and type II diabetes. Study 2 examined through discursive analysis of the same submissions; objects, subjects and power relationships that manifest the nurses/midwives constructions of obesity and nursing. The descriptive analysis of the nursing/midwifery submissions to the HSC inquiry in Study 1, demonstrated that the nursing submissions were both holistic and public health orientated in their approach. Nutritional initiatives were more widely supported than physical activity initiatives. ‘Children and youth’ were identified as most in need of obesogenic initiatives to reduce future health consequences. The nursing/midwifery submissions further believed that political initiatives would have more impact than other current health modalities. Study 2 suggested that while some of the nursing and midwifery submissions appeared to support improved nutrition and increased physical activity initiatives. Other submissions viewed diet and exercise regimes as regulatory and/or disciplining. Additional the nursing role within the particular subjectivities of the submitters was blurred with the mother’s role this was most evident when the nurse/s submissions spoke as mothers. Implications of the above findings suggest that to create transformational opportunities for vulnerable groups affected by obesity and type ll diabetes, nursing/midwifery practice must continue to lobby cohesively and at a political level. It also presents health policy makers and lobbying groups with an opportunity. If policy makers and lobbyists are genuinely interested in the promotion of physical activity and nutritional initiatives, using the health benefits for women and children as a catalyst, will result in nursing and midwifery practice being more fully engaged with such initiatives.