Abstract
ABSTRACT Objective: Describe and evaluate the nutritional care provided for overweight adults by the Primary and Secondary Health Care services of Santos, São Paulo, Brazil. Methods: This study was carried out between 2013 and 2015 integrating quantitative and qualitative approaches; it was divided into two phases: (1) characterization and (2) evaluation. In phase 1, a census of Primary Health Care Units (n=28) and Secondary Health Care Units (n=4) was conducted using interviews with health service managers and/or health professionals. Data were analyzed using exploratory data analysis. In phase 2, in-depth interviews were conducted with health service managers and/or health professionals investigating a sample of the Primary Health Care services and the totality of Secondary Health Care services provided. Thematic analysis was carried out using the theoretical framework for comprehensive health care proposed by Pinheiro & Mattos. Results: A total of 40 professionals were interviewed: 36 in the primary health care services and 4 in the secondary health care services. Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease. It was observed that the referral and counter-referral system and intersectorial collaborations were ineffective. In Secondary Care services, nutritional care is focused on clinical care using traditional approaches to nutrition education. Limiting factors for promoting comprehensive care were identified at the two levels of care: unproductive actions, lack of actions for health promotion and protection, and little dialogue between the Primary and Secondary care services. Conclusion: Overweight is not an outcome based on Primary and Secondary Care, but rather on prescriptive practices, which are not very effective in promoting users’ autonomy. It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care.
Highlights
Chronic, Noncommunicable Diseases (NCDs) are a serious public health problem worldwide, and obesity is one of their main causes and a modifiable risk factor [1,2,3].Based on epidemiological knowledge, several countries have proposed interventions for obesity prevention and control [4,5,6].In Brazil, the adult obesity rate has reached more than 50% [7]
Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease
It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care
Summary
Noncommunicable Diseases (NCDs) are a serious public health problem worldwide, and obesity is one of their main causes and a modifiable risk factor [1,2,3].Based on epidemiological knowledge, several countries have proposed interventions for obesity prevention and control [4,5,6].In Brazil, the adult obesity rate has reached more than 50% [7]. Noncommunicable Diseases (NCDs) are a serious public health problem worldwide, and obesity is one of their main causes and a modifiable risk factor [1,2,3]. Several countries have proposed interventions for obesity prevention and control [4,5,6]. NUTRITIONAL CARE OF OVERWEIGHT ADULTS 513 o enfrentamento das doenças crônicas não transmissíveis no Brasil (2011-2022)” (Strategic action plan for combating noncommunicable chronic diseases in Brazil [2011-2022]) [8] proposes integrated health surveillance and promotion and comprehensive care actions to combat NCDs and monitor their modifiable risk factors, including unhealthy eating behaviors and obesity. Primary Care is the key locus for interventions to prevent and manage overweight or obesity. Primary Care Units are responsible for the coordination and organization of the Rede de Atenção à Saúde (RAS, Health Care Network), which includes Secondary and Tertiary Care, establishing the doctrinal principle of comprehensive care [11,12]
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