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

The perceptions of healthcare practitioners on obesity management in Peninsular Malaysia: a cross-sectional survey

BACKGROUND

Practitioners' perceptions of patients with obesity and obesity management shape their engagement in obesity care delivery. This study aims to describe practitioners' perceptions, experiences and needs in managing patients with obesity, determine the extent of weight stigma among health practitioners, and identify the factors associated with negative judgment towards patients with obesity.

METHODS

A cross-sectional online survey was conducted from May to August 2022 with health practitioners commonly involved in obesity management in Peninsular Malaysia, including doctors in primary care, internal medicine and bariatric surgery, and allied health practitioners. The survey explored practitioners' perceptions, barriers and needs in managing obesity, and evaluated weight stigma using the Universal Measures of Bias - Fat (UMB Fat) questionnaire. Multiple linear regression analysis was used to identify demographic and clinical-related factors associated with higher negative judgment towards patients with obesity.

RESULTS

A total of 209 participants completed the survey (completion rate of 55.4%). The majority (n = 196, 94.3%) agreed that obesity is a chronic disease, perceived a responsibility to provide care (n = 176, 84.2%) and were motivated to help patients to lose weight (n = 160, 76.6%). However, only 22% (n = 46) thought their patients were motivated to lose weight. The most frequently reported barriers to obesity discussions were short consultation time, patients' lack of motivation, and having other, more important, concerns to discuss. Practitioners needed support with access to multi-disciplinary care, advanced obesity training, financing, comprehensive obesity management guidelines and access to obesity medications. The mean (SD) of the UMB Fat summary score was 2.99 (0.87), with the mean (SD) domain scores ranging between 2.21 and 4.36 (1.06 to 1.45). No demographic and clinical-related factors were significantly associated with negative judgment from the multiple linear regression analyses.

CONCLUSION

Practitioners in this study considered obesity a chronic disease. While they had the motivation and capacity to engage in obesity management, physical and social opportunities were the reasons for not discussing obesity with their patients. Practitioners needed more support to enhance their capability and opportunity to engage with obesity management. Weight stigma in healthcare settings in Malaysia should be addressed, given the possibility of hindering weight discussions with patients.

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

RESUMO O objetivo do artigo é analisar as características dos processos de trabalho na Estratégia Saúde da Família direcionados às pessoas com sobrepeso e obesidade no município de São Paulo. Ancorado no referencial teórico da saúde coletiva sobre processo de trabalho, foi desenvolvido um estudo exploratório com abordagem qualitativa. Foram realizadas onze entrevistas com profissionais de uma unidade básica de saúde, na zona leste da cidade de São Paulo, entre os meses de julho e agosto de 2019. A partir da análise temática, o artigo apresenta os resultados e a discussão em três categorias analíticas: objeto de trabalho, instrumentos de trabalho e organização do trabalho. O cuidado às pessoas com sobrepeso e obesidade é mediado pelo baixo investimento em qualificação dos profissionais de saúde sobre o tema, pela falta de materiais técnicos de suporte ao trabalho e pelo modelo de gestão pautado pela produtividade e cobrança de resultados quantitativos. Conclui-se que os profissionais de saúde apresentam pouco domínio sobre seu processo de trabalho, cuja finalidade acaba sendo a mudança de comportamento e a perda de peso corporal, em vez de considerar as necessidades de saúde dos usuários e profissionais, produzindo, por vezes, insatisfação e desgaste com o trabalho.

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

To describe the methodology of development of a protocol for application of the Brazilian Dietary Guidelines by primary healthcare professionals in individual dietary advice. A five-step approach was followed: (1) format definition; (2) definition of the instrument for assessment of individuals’ food consumption; (3) Dietary Guidelines’ content extraction; (4) protocol content development; (5) content and face validity. An example from Brazil was displayed with the development of a protocol to guide healthcare professional decision-making when providing nutrition advice based on the Brazilian Dietary Guidelines. The instrument of the Brazilian Nutrition Surveillance System (SISVAN) was chosen to the food consumption assessment, which contains questions about the consumption of seven healthy or unhealthy food groups and one question about eating modes. The Guidelines’ content extraction process led to the identification of recommendations related to the food consumption markers assessed by the SISVAN questionnaire. Then, a protocol was developed in a flowchart format, in which the professional’s conduct is guided by the answer given to each question of the SISVAN instrument. For each ‘non-compliant’ answer (unhealthy eating practice), the professional is instructed how to provide recommendations and identify obstacles. Lastly, experts and healthcare professionals highlighted pertinence, clarity and usability of the protocol. This study provides the blueprint for the phase-wise development of protocols of application of the Dietary Guidelines and may contribute to promote healthier eating and ending malnutrition in all its forms.

Exploring perceptions about Mindfulness and Mindful Eating Programs for low-income women with overweight in primary health care

Background: Obesity and overweight are public health problems of multifactorial etiology, aggravated by the challenge that is maintaining weight loss. Used in the context of general health, mindfulness-based interventions (MBIs) have also showed positive effects when targeting changes to overweight-related eating behaviors. Methods: This study consists of a pragmatic randomized controlled trial conducted with 284 women from primary health care units. Data were collected from the last session with 16 focus groups, considering each intervention group (mindfulness or mindful eating) Aim: This article aims to present the perceptions of low-income overweight women who participated in Mindfulness and Mindful Eating intervention groups in primary health care according to each type of intervention. Results: Seven themes were identified: course challenges; valorization of the teacher's attitudes; mindfulness understanding; self-awareness development; change of expectations; development of a different food-weight relationship; and discover of a wide range of benefits. Conclusion: Mindfulness and Mindful eating interventions affect not only an individual's relationship with body and food, but also life and human relations. The results indicate the feasibility of the intervention, which addresses a large number of patients who lack treatment options for overweight or emotional and psychological issues associated with this condition. MBIs such as mindful eating are applicable in primary health care facilities, targeting overweight women and supporting treatment by addressing a repressed demand in the system. Similar to mind-body therapies, these interventions allow for comprehensive care.ClinicalTrials.gov, (NCT02893150) on 30 March 2017.

Developing our understanding of nutrition in depression

Research to date has convincingly demonstrated that nutrition impacts depression. Population-based studies have shown that diet, food types, dietary supplements, gut bacteria, endocrine systems and obesity all play a role in depression. While nutrition could provide an important therapeutic opportunity in depression, clinical trials have not shown clinically meaningful results, and it appears unlikely that nutrition is a central determinant of depression. Conversely, however, prior research is inconclusive to inferring that nutrition does not have a clinically significant effect. This would require elucidating precisely when nutrition affects depression which necessitates an alternative, more granular, model for the nutrition–depression interaction. The network theory of mental disorders, which studies how mental disorders arise from a causally related network of symptoms and external factors, is proposed as an alternative model for understanding the complexity of the nutrition–depression link. This approach would uncover which relationships, between aspects of nutrition and depression symptoms, warrant further study at a population and laboratory level. Furthermore, from within nutrition science, is a movement dubbed ‘New Nutrition Science’ (NNS) that aims to integrate biological, social and environmental determinants of nutrition. NNS is important to nutrition–depression research which has yet to reveal how social factors impact the nutrition–depression interaction. Network theory methodology is fully compatible with the network modelling already used in NNS. Embracing both network theory and NNS in future research will develop a full and complex understanding of nutrition in depression.

Dietary guidelines for the elderly in Primary Health Care: development and validation of a protocol based on the Food Guide for the Brazilian Population

Abstract Objective Develop and validate a protocol for the use of the Food Guide for the Brazilian Population (FGBP) in the dietary guidelines for elderly people during individual clinic appointments in Primary Health Care (PHC). Methods The elaboration followed six methodological steps, namely: (1) protocol format definition; (2) definition of the instrument for assessing food consumption; (3) extracting applicable Food Guide recommendations for individual dietary guidelines; (4) evidence systematization on dietary and nutrition needs of the elderly; (5) development of nutritional guidelines messages for the elderly; (6) content and apparent validation and data analysis. Results As products of the steps, the protocol structure was defined and dietary guidelines were elaborated based on the nutritional and health needs of the elderly population, considering the functional capacity and physiological and social changes of this life cycle. The protocol was well assessed by experts and health professionals as to clarity, relevance (content validity index > 0.8) and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with elderly Brazilians. Conclusion The protocol can contribute to the qualification of dietary guidelines in PHC, dissemination of information from the Food Guide and promotion of comprehensive care and healthy aging of the population.

Orientação alimentar da pessoa idosa na Atenção Primária à Saúde: desenvolvimento e validação de um protocolo baseado no Guia Alimentar para a População Brasileira

Resumo Objetivo Desenvolver e validar um protocolo de uso do Guia Alimentar para a População Brasileira na orientação alimentar da pessoa idosa durante as consultas clínicas individuais na Atenção Primária à Saúde (APS). Métodos Esta construção seguiu seis etapas metodológicas, sendo elas: (1) definição do formato do protocolo; (2) definição do instrumento de avaliação do consumo alimentar dos indivíduos; (3) extração das recomendações do Guia Alimentar aplicáveis para orientação alimentar individual; (4) sistematização de evidências sobre necessidades de alimentação e nutrição da pessoa idosa; (5) desenvolvimento de mensagens de orientação alimentar para a pessoa idosa; (6) validação de conteúdo e aparente e análise dos dados. Resultados Como produtos das etapas, foi definida a estrutura do protocolo e construída as orientações alimentares baseadas nas necessidades nutricionais e de saúde da população idosa, considerando a capacidade funcional e alterações fisiológicas e sociais desse ciclo de vida. O protocolo foi bem avaliado por especialistas e profissionais de saúde nos critérios de clareza, pertinência (Índice de validade de conteúdo >0,8) e aplicabilidade. Além disso, os participantes deram sugestões para melhoria da clareza das mensagens e para ampliar a aplicabilidade do instrumento com pessoas idosas brasileiras. Conclusão O protocolo pode contribuir para qualificação da orientação alimentar na APS, disseminação das informações do Guia Alimentar e promoção do cuidado integral e envelhecimento saudável da população.