Could a Green Prescription be the answer to NZ's obesity crisis?

by Nicky Pellegrino / 06 February, 2018
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Green Prescriptions aim to combat lifestyle-related problems, including obesity and type 2 diabetes. Photo / Getty Images

There’s no need to wait for your GP to steer you towards a more healthy lifestyle.

It’s been 20 years since the Green Prescription was introduced in New Zealand, a period during which we’ve seen a steep rise in lifestyle-related problems such as obesity and type 2 diabetes. But that doesn’t mean the physical activity and health education programme hasn’t been having an effect.

“We have success stories coming through every week,” says Michael McCormack of Sport Auckland, the country’s largest provider of Green Prescription programmes. Some of the standouts include individuals who have lost a lot of weight, lowered their blood pressure and blood glucose and regained the energy to take a more active part in family life. But McCormack believes the initiative has the scope to help more people than it does currently and says, despite its longevity, there still isn’t enough awareness of what a Green Prescription can offer.

Although there are regional variations, in general the free support service includes an initial consultation and then three to six months of fitness workshops that include nutrition advice, ongoing support via phone and text and cheaper entry to council-owned gyms and pools.

The idea is to tailor a plan to each client’s needs and capabilities. For those who haven’t exercised in a while, that might mean starting off with gentle walking, whereas others get to experience dance fitness or basic circuit training.

“We have clients who weigh up to 200kg, so we’re encouraging participation, not elite athletes,” says McCormack.

A Green Prescription service targeted at families is also available. This runs for longer and involves hands-on activities for parents and school-age kids, such as cooking classes.

Unfortunately, says McCormack, most GPs and medical practice nurses are too time-pressured during consultations to really promote the service.

“In Auckland, they might only have 10 minutes with a patient and it’s not enough time to give information on how to manage blood sugar and blood pressure. There’s no time to talk about the benefits of Green Prescription, so they’re not able to promote it with any clarity or purpose.”

The programme has been fine-tuned over the years. There’s no need now to visit a GP for a referral. Instead, those wanting to make a positive lifestyle change can call 0800 ACTIVE (0800 228 483). Medical clearance will be organised for them and they’ll be enrolled.

Michael McCormack. Photo/Victor Carter

There is also more emphasis on prevention, with the service trying to reach people while they are still in the prediabetic stage.

“Another direction we’ve been working in is to help more women diagnosed with gestational diabetes to manage blood-glucose levels with exercise and nutrition throughout pregnancy. So that’s a new target for us,” says McCormack.

Contact with clients used to be over the phone, but now there are face-to-face meetings and the whole experience is more sociable. That’s important, says Margaret Williams, a lecturer in public health and counselling at Auckland University of Technology. She has benefited personally from a Green Prescription and has also done a study with Māori and Pakeha people newly diagnosed with diabetes.

“They really didn’t know anything about the Green Prescription and were anxious about their diagnosis,” she says. “They all preferred that initial contact to be face-to-face.”

Most of her participants were extremely inactive and had an average body mass index of 40. By the end of the trial, there was a small but favourable change in weight, cholesterol levels and waist circumference.

The general feedback was that they valued being able to access help and education. One woman who had lost weight told Williams she had cut down from six Weet-Bix to one for breakfast.

Inevitably, some people won’t make it through a whole Green Prescription programme, but the Sport Auckland retention rate is good, with 40% graduating.

Another 2016 study showed that completing the programme can have long-lasting effects, with participants two to three years on reporting an extra 64 minutes’ physical activity a week compared with those who had dropped out.

“The culture of inactivity is very difficult to work against,” says McCormack. “Once you get into poor nutrition and the cycle of having no energy, it’s difficult to get yourself out of that valley.”

There’s a perception that people don’t need support and can make changes independently. But, McCormack says, simply going for a couple of walks a week isn’t going to cut it for those trying to lose a lot of weight and change body composition.

“Nutrition is the biggest component, in my opinion. And you need to be doing some sort of physical activity every day.”

This article was first published in the January 6, 2018 issue of the New Zealand Listener.

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