Intervenções públicas de saúde voltadas a obesidade: revisão de escopo, avaliação da teoria e da implantação em municípios na Bahia.

Abstract

PROBLEMATIC: Obesity is characterized as a social, pandemic, multi-causal phenomenon, understood as a disease or risk factor for other diseases, constituting a challenge to public health. Thus, public health interventions have been implemented to seek prevention and/or control of the increase in obesity in populations, as well as care for people who live with excess weight. In Brazil, 2013, the Care Line for Overweight and Obesity was instituted as a strategy for organizing care, based on thematic networks. OBJECTIVE: To investigate the scope, theoretical plausibility and implementation of public health interventions addressed to the condition of overweight and obesity. METHODOLOGY: For the analysis of academic production, a review of the scope of the literature was carried out in the MEDLINE/PubMed, Web of Science and LILACS databases. The selected studies were organized according to their characteristics and analyzed based on the Public Health Strategies applicable to obesity in Brazil, based on Poulain (2013). In the second moment, the assessment of the Line of Care theory for overweight and obesity was carried out, through direct logical analysis. The logical model of the intervention and the theoretical model of care for the condition of overweight and obesity in PHC were prepared, subsequently compared, in order to recognize potential points and weaknesses of the intervention, as well as the strength of the causal link between the action and its effects. Using the elaborated logical model as a reference, was also conducted an evaluation was carried out of the degree of implementation of care actions for people with overweight and obesity, in primary health care, in 160 municipalities in Bahia, distributed in nine health macro-regions. An evaluative matrix was used, with scores ranging from 0 to 100, into four categories: Not Implanted (0 to ≤ 25.0), Incipient Implantation (25.0 to ≤ 50.0), Intermediate Implantation (50 to ≤ 75.0), Advanced Implantation (75.0 to 100). The degree of implementation was associated with geographic, social and health indicators. RESULTS: The scope assessment identified 15 types of interventions aimed at preventing and treating obesity, with greater frequency of actions developed in the school environment. There was a focus on strategies that use the line of the environment, through regulatory legislative measures, with a view to framing conducts and those focused on individuals and populations at risk through educational actions for health promotion. In Brazil, the theoretical evaluation of the line of care for overweight and obesity highlighted the need for better defined objectives, more structured means of action, adequate funding, awareness of managers, professionals and the community on the subject, as well as objectives aimed at work practices, to achieve the proposed completeness. Greater emphasis needs to be given to actions aimed at pregnancy, childbirth and early childhood development, related to obesity. The assessment of the degree of implementation revealed incipient implementation for most municipalities (n=64; 40.0%), in five of the nine health in Bahia macro-regions. In the subcategories of analysis, health promotion and prevention of overweight and obesity showed the better implantation, while stigma reduction and care qualification had the lowest scores. CONCLUSION: Despite its high prevalence, the condition of overweight and obesity and their respective care actions in PHC is still not a public priority. The behavioral idea of guidance through health education for a healthy lifestyle prevails in public policies, indicating a movement of accountability of the individuals. It is imperative to deepen the debate on the social structures that determine obesity, together with actions to change the systems of representations of the obese body, without neglecting care. Furthermore, it is necessary to invest in financial, physical and human resources, especially in work processes and permanent education, to qualify the care provided.