Corpos, obesidades e práticas integrativas e complementares em saúde: etnografando modos de cuidado em um centro de referência da rede SUS

Abstract

Objective: This study aimed to understand how Complementary Therapies act in the production of care for people with obesity in a Specialized Ambulatory Care service, in which there are different spaces of care, with different medical rationales and therapeutic practices. Methodology: This is ethnographic research carried out between January and July 2019, carried out at the Obesity Outpatient Clinic, in the Obesity Outpatient Clinic of the Medical Residency in Endocrinology and in the Outpatient Clinic for Complementary Therapies (CT), belonging to a service of Specialized Ambulatory Care (AAE) for people with obesity, located in the city of Salvador, Bahia. The present work was configured, primarily, in an ethnographic investigation that interfaces with the Social Sciences in Health. The perspective of Bruno Latour's Actor-Network Theory (ANT) (2012), considering the agency of actors (human and non-human) and spaces, as well as the (inter)actions between them, supported the theoretical- methodological aspect of the research by favoring the observation, description, and microanalyses of the textures of care processes. Results and Discussion: For the purposes of this thesis, the results will be presented in the form of an article and book chapters, except for Chapter 1, which describes the study locus, its structures, clinics and teams. The first article, which explores the experience of ethnography about caring for people with obesity in an SEA service, observed that at the moment when my skinny body met obese bodies, there was a (between) body, and it was this body that came into contact. scene and presents itself as a challenge of the process, given that the understanding of one's own body, and consequently of obesity, is also built in the relationship with the other. My presence, not just my body, but who I was and the insignia it carried, would affect what I observed; I would be affected by the agency of actors present in the SEA service; and my results would be outcomes of these two facts. The second article sought to understand how the different modes of collective embracement are coordinated in the production of care for people with obesity based on the experience of the CT Outpatient Clinic and the experience of the Obesity Outpatient Clinics. It was observed that user embracement still preserves a technical and instrumental dimension aimed at user embracement of new users and providing information. However, in the CT Outpatient Clinic, the use of other devices was also observed, such as, for example, the inclusion of veteran users in the collective reception as protagonists of the reception, thus producing a space for valuing unique experiences and the knowledge of users who can collaborate with the feeling of belonging to the space and the collective construction of user embracement. It was noted that there was production of interpersonal bonds as a therapeutic action and the appreciation of the family-user-team bond as a strengthening of the interrelationship of horizontal knowledge and of different agencies in the production of care. In the third article, it was proposed to reflect on the place of body weight in the production of care, with a view to seeking new care strategies for people with obesity, confronting experiences in the different outpatient clinics studied. The proposal to create versions and ways of providing care for people with obesity emerges from the understanding that it is not just weight that matters. In this sense, the allusion to the “middle way” seemed to be an unveiled strategy when it comes to provoking shifts in the modes of care in search of strategies that do not consider the reduction of body weight as the only way to achieve health, which does not that stigmatize bodies and that do not promote inquisitive eyes on them. Following this reflective line, the measurement of body weight by health professionals must prioritize the singularities, contextualities and intersectional markers that delineate the living beings. Complementarily, there is also a fourth article, a systematic review and meta-analysis, which was driven to scrutinize the “state of the art” of studies on ICP, obesity, and quality of life, which showed that the overall mean differences of the studies that evaluated the effect of acupuncture in the physical, social and environmental dimensions of quality of life did not identify a statistically significant association. Final considerations: It is noteworthy that the redistribution of forces, by enabling veteran users to share their experiences with the CT, present in the collective user embracement promoted by the CT outpatient clinic, makes the act a powerful space for dialogue. Collective embracement is considered a powerful claim that can collaborate in facing the difficulties in dealing with the fat body and act in opposition to the prejudice and stigma of the fat body in the medical and family context. About approaches to caring for people with obesity, regardless of medical rationales and therapeutic practices, the middle path seems to be a promising perspective when it comes to provoking shifts in care modes. Finally, when trying to understand how the CT act in the production of care, it was possible to perceive that, although in a secondary way, the PICS outpatient clinic proved to be a power in expanding care practices for people with obesity. The CT outpatient clinic considers that the unique experiences and the understanding of the plurality of actions of people with obesity in the world are important elements in the construction of joint strategies that seek the power of the other's existence and that, even considering body weight, if it proposes to go beyond it, mobilizing the search for comprehensive health care.