Diagnóstico de obesidade e determinação de requerimentos nutricionais: desafios para a área de Nutrição

Abstract

The nutritional profile of the Brazilian population has changed. Although malnutrition with respect to a deficit in stature/height and with respect to a deficit in body mass in relation to stature/height still exists in vulnerable segments of the population and at unacceptable levels, it continues to decline in all regions. Overweight/obesity is a nutritional problem that is of the greatest concern, both due to the rapid and progressive increase of its prevalence and because the phenomenon occurs at all stages of life. It is above all of the greatest concern in children and adolescents. This internationally observed phenomenon is caused by environmental changes, particularly with regard to physical activity and eating habits and presents a framework of positive energy balance (energy intake greater than energy expenditure). This situation leads to the modification of the agenda for food, nutrition and health in the country to tackle the expected increase in chronic non-transmissible diseases. Some actions of the Ministry of Health already reflect the new epidemiological situation. The development of a system for monitoring chronic diseases (VIGITEL) seeks to ensure permanent monitoring of the healthy behavior of the population and evaluation of health promotion actions. The National Health Survey (NSP) is programmed for 2013 and it will feature a domicile questionnaire focusing on non-transmissible chronic diseases, the lifestyle of the adult population and will include anthropometric measurements and laboratory tests.The articles presented in the current issue of Ciência e Saúde Coletiva include several important aspects of this new agenda in terms of the research, the methods or the services. The topics involve aspects of the role of Nutrition in the area of primary health care, the perception of obesity, food safety and a healthy diet. Two other topics in articles in this issue highlight methodological gaps that deserve to be examined in the area of Nutrition: body composition and energy requirements.Initially, obesity is defined in one way -the state of excess body fat that affects health -and then measured in another -the relationship between body mass and height expressed as the body mass index (BMI). The use of BMI was suggested due to the ease of obtaining it, and due to its relationship to body composition (quantity of body fat) and health problems. However, evidence is accumulating in the sense of documenting the fact that the relationship between BMI and body fat is not universally equal, which leads one to think of specific cutoff points for each population, as indeed has already been accepted by the WHO for the Asian population. The development of simpler methods for estimating body composition will make it possible to establish specific cutoff points for obesity for each population or, preferably, the migration to the use of body composition in population studies in the near future.Possibly the greatest challenge for the field of Nutrition, in times of high prevalence of obesity, is the determinatio...

Estado nutricional dos alunos da Rede Nacional de Ensino de Educação Infantil e Fundamental do Serviço Social do Comércio (Sesc), Brasil, 2012

“…Atualmente, percebe-se um antagonismo de tendências na prevalência de desnutrição e obesidade no Brasil, com o declínio da ocorrência da desnutrição em crianças e adultos e aumento do sobrepeso e obesidade em todos os segmentos da população 1 , característica marcante do processo de transição nutricional 2 , fenôme-no observado praticamente em todas as populações do mundo 3 . A Organização Mundial da Saúde (OMS) define obesidade como uma doença caracterizada pelo excesso de gordura corporal que traz prejuízos à saúde 4 , sendo o resultado de um quadro de balanço energético positivo prolongado 5 . Este desequilíbrio decorre da inter-relação entre os fatores genéticos e socioambientais que influenciam diretamente a resposta fisiológica e o comportamento dos indivíduos 6 e traz consequências sérias à saúde 7 .…”

O mundo não é um spa: sobre a ética do desejo na clínica da obesidade

“…A obesidade é entendida como uma epidemia mundial, pois, hoje, o excesso de peso é considerado um dos principais fatores que contribuem para a mortalidade e para o agravo de outras doenças crônicas não transmissíveis, inclusive doenças cardíacas, diferentes tipos de câncer, acidente vascular cerebral, doenças respiratórias crônicas e diabetes (Anjos, 2013). Mas o enfrentamento dessa questão costuma ocorrer pela via da responsabilização do cidadão, do controle individual da dieta, da acusação pelo sedentarismo e da moralização dos "estilos de vida", colocando sempre o foco na escolha individual e culpando a própria vítima pela enfermidade.…”

Prevalence of underweight, overweight, and obesity among 2, 162 Brazilian school adolescents

“…The nutritional profile of the Brazilian population has changed in recent years. [ 1 ] Overweight and obesity are present among all age groups. [ 1 2 ] Controlling overweight and obesity in adolescence is a challenge for physicians and nutritionists.…”

“…[ 1 ] Overweight and obesity are present among all age groups. [ 1 2 ] Controlling overweight and obesity in adolescence is a challenge for physicians and nutritionists. Eating habits in this age group are characterized by a preference for fast foods with a high fat and carbohydrate composition, with an increased rate of calories and low nutritional value.…”