Challenges for obesity management in a unified health system: the view of health professionals

Abstract

Background Obesity is an increasingly prevalent chronic condition. Its multiple causes and the complexity of its treatment pose challenges for health professionals. Objective To explore and describe the challenges for obesity management in the Brazilian Unified Health System according to health professionals. Methods An exploratory quantitative web-based study, carried out in 2018 with health professionals, developed from the first stage of a national project that aims to examine the management of obesity in Brazil. The questionnaire was self-applied. Invitations to participate in the research were sent by the Ministry of Health, Health Department of Minas Gerais and members of the research group. We collected data on sex, age, professional category, region and level of care. The challenges were investigated using a Likert scale and categorized into structure and work process. Results We evaluated 1323 professionals, of which about 45% were dietitians, 90.2% were women, and 83.1% self-reported working in primary health care. The main barriers cited included a high demand for curative and individual assistance, the presence of comorbidities, and the absence or insufficient access to instructional materials, professional qualification and lack of support. Conclusion Obesity management is a critical challenge for all professionals. Barriers were related to the work process and structural aspects and reinforce the need to empower health teams. We propose that permanent education activities should be established, as well as the development of instructional materials that are applicable to routine work. Finally, the results may be used to develop policies and strategies to improve obesity management.

Developing a protocol based on the Brazilian Dietary Guidelines for individual dietary advice in the primary healthcare: theoretical and methodological bases

“…Despite the strengthening of these actions over the years, however, there are still challenges for the qualification of nutritional care in primary healthcare in Brazil. 15 30 If, on the one hand, there is difficulty for healthcare professionals to carry out actions on healthy eating promotion, whether due to lack of qualification and training or constraints in the daily routine; on the other hand, the content of dietary recommendations—materialised in the form of traditional, prescriptive, nutrient-centred food guides—makes this approach even more difficult to be implemented by multiprofessional teams. These difficulties, however, are not unique to Brazil.…”

“…10 Among the main barriers identified to the incorporation of nutrition actions, we highlight lack of time, inadequate knowledge on nutrition, low self-efficacy for counselling patients about diet, insufficient professional qualification and absence of practical supporting materials. [9][10][11][12][13][14][15] In this sense, it is recognised that the creation of clinical guidelines can be an effective action to increase the implementation of Dietary Guidelines and to reduce inappropriate practice and improve the quality and efficiency of nutrition care. Guidelines from the WHO states that they should be developed with a systematic approach, evidence-based and with planned dissemination, implementation and evaluation strategies.…”

Developing our understanding of nutrition in depression

“…Molendijk et al, 2018). Given that changing diets is difficult to achieve (Lopes et al, 2021), the current evidence does not support the widespread use of nutritional interventions in depression. The second issue is that understanding is lacking in how exactly nutrition should intervene in depression i.e.…”

“…social deprivation, relationship breakdown, traumatic life events), nutritional change, while challenging, is achievable (e.g. in obesity: Canuto et al, 2021;Habib-Mourad et al, 2020;Lopes et al, 2021). However, two issues remain in giving population level findings clinical bearing.…”

O processo de trabalho na Estratégia Saúde da Família voltado às pessoas com sobrepeso e obesidade em São Paulo

“…Com relação à formação dos profissionais de saúde e ao acesso a materiais de apoio ao trabalho, o investimento insuficiente na formação permanente e o distanciamento entre os materiais técnicos que já foram produzidos pela gestão e sua utilização na prática do serviço apontam fragilidades para a produção do cuidado qualificado. Lopes et al 26 citam a falta de qualificação profissional sobre obesidade e a ausência de materiais de apoio para a prática dos profissionais de saúde, como barreiras para o cuidado voltado para pessoas com obesidade no SUS.…”