Adesão a um programa de aconselhamento nutricional para adultos com excesso de peso e comorbidades

Creating supportive eating places: a systematic review of food service initiatives

Obesity and diet-related health problems are complex, multi-factorial issues. Individual food choices are shaped by the wider context, and food environment level change is needed to support individual behaviour change. The food service sector can play an integral role, changing aspects of the food environment and contributing to improved consumer health. This systematic review aimed to analyse food service schemes that aimed to improve consumer health. Ten electronic databases were systematically searched to identify articles, supplemented with checking of reference lists from similar reviews and forward and backward searches to identify articles describing food service sector schemes. Sixteen schemes were identified, documented in 36 articles/reports. The schemes aimed to improve consumer health through one of three approaches-informing, enabling or engineering. In this order, these approaches involved increasing levels of effort from food services, corresponding with decreasing levels of effort for consumers. Half the schemes were informing, relying on an informed consumer to make a healthy choice. Most informing schemes had been evaluated to determine their impact on consumer choice and/or health, the evidence showed these schemes were generally ineffective. The effect of the enabling or engineering schemes on consumer choice and health had not been measured. Instead, evaluations focussed on process or business engagement rather than behavioural change assessments. This review indicates the food sector has the potential to contribute to consumer health through enabling and engineering; however, detailed outcome assessments are needed to draw definitive conclusions.

Barriers to and facilitators for adherence to nutritional intervention: Consumption of fruits and vegetables

OBJECTIVES

The aim of this study was to investigate the barriers and facilitators for the adherence of participants to a nutritional intervention.

METHODS

A randomized controlled trial was carried out with participants from the Health Academy Program in Belo Horizonte, MG, Brazil. The intervention (7 mo) was based on the Transtheoretical Model and on Paulo Freire's pedagogy and offered 12 education activities with the purpose of promoting the consumption of fruits and vegetables. Adherene was determined by calculating the participation percentage (attendance at activities/number of activities).

RESULTS

In all, 1483 individuals participated and the average adherence was 58.3%. Low adherence was demonstrated by 24.3%, medium adherence by 26.5%, and high adherence by 49.2% of the participants. Adherence was associated with aging (odds ratio [OR], 1.97; 95% CI, 1.33-2.94), being unemployed (OR, 0.75; 95% CI, 0.58-0.95), not being under psychiatric treatment (OR, 0.77; 95% CI, 0.63-0.95), participant body satisfaction (OR, 1.27; 95% CI, 1.02-1.58) and participant attendance at the Health Academy Program for >1 y (OR, 2.78; 95% CI, 2.17-3.56). The qualitative analysis revealed the following facilitators for adherence: service structure, intervention methodology, bond-building among users and professionals, family support, and patient-associated aspects. The barriers to adherence included work, self-care, and care for another.

CONCLUSION

Adherence to the intervention was high, and the patient-associated aspects, the logistics of the Health Academy Program, and the methodology appeared to contribute to adherence. However, the timetable was a barrier for those who were working and for those who support their families.

Desenvolvimento de material educacional interdisciplinar para prevenção e tratamento da obesidade

Introdução: a obesidade é uma doença crônica e complexa de caráter epidêmico, sendo fator de risco para diversas doenças. O município de Juiz de Fora possui uma prevalência maior de obesidade que a da capital do Estado de Minas Gerais e também à média nacional, sendo necessárias estratégias de estímulo às práticas de vida saudáveis, pautadas nas ações educativas em saúde, envolvendo orientação nutricional, prática de atividades físicas, além da abordagem de aspectos biopsicossociais e culturais do indivíduo. Objetivo: desenvolvimento de programa de educação continuada e estímulo ao autocuidado do indivíduo em relação às suas condições de saúde. Relato de experiência: com base nas demandas dos pacientes atendidos nas consultas individuais, grupos operativos e salas de espera, uma cartilha educativa (“Guia de Prevenção – Prevenindo e tratando o excesso de peso”) foi criada pela equipe multidisciplinar do ambulatório de prevenção e tratamento da obesidade de um hospital universitário. Este material foi lançado oficialmente em setembro de 2018 e tem possibilitado a divulgação de vários temas relacionados à obesidade, como diagnóstico, prevenção e mudança do estilo de vida. Os principais beneficiários desse projeto são os pacientes assistidos nos ambulatórios, contudo poderá auxiliar em ações extra-muros, como atividades em escolas públicas municipais e ações pontuais no campus universitário, por exemplo, no Dia Internacional de Combate à Obesidade. Discussão: o material foi bem aceito e as principais dúvidas após a leitura foram em relação à definição de obesidade e o fato de não reconhecerem a fisiopatologia da doença como uma interação de fatores genéticos e ambientais. Conclusão: ações educativas complementares à prevenção e tratamento da obesidade, envolvendo os vários aspectos do cuidado, têm grande aceitação pela população abordada e representam ferramentas com potencial de melhora do autocuidado e autonomia do indivíduo.

Group-based food and nutritional education for the treatment of obesity in adult women using the family health strategy

ABSTRACT Objective The high prevalence of obesity and its association with chronic diseases is a major public health problem. This study aimed to evaluate a group-based Food and Nutrition Education Program for the treatment of excess weight in Brazilian women attending the Family Health Strategy. Methods This quasi-experimental intervention study was conducted among 172 women, including 87 women in the intervention group who participated in a nutritional education program that addressed topics in the area of nutrition. The Intervention and Control groups underwent an anthropometric evaluation at the beginning of the study and at the 6th month. Results At the end of the intervention, the intervention group showed a significant reduction in weight and Body Mass Index, while the control group showed an increase in these variables. Women who completed the intervention (n=71) showed a mean difference of -5.15 kg and a reduction of 2.04 points in the Body Mass Index. Still 50.7% of the participants in the intervention group achieved a weight loss greater than or equal to 5.0%, and 40.8% of them maintained this reduced weight for up to seven months after the end of the intervention. Conclusion This study emphasizes the importance of group-based food and nutritional education interventions to promote and maintain weight loss, and thus, prevent and treat chronic diseases.

Multidisciplinary intervention in obese adolescents: predictors of dropout

Objective

To identify biological and psychosocial factors associated with dropout in a multidisciplinary behavioral intervention in obese adolescents.

Methods

A total of 183 adolescents (15.4±1.6 years), pubertal (Tanner stage 3 or 4) and obese (34.7±4.0kg/m²), were enrolled in a 12-week behavioral intervention, which included clinical consultations (monthly), nutritional and psychological counseling (once a week), and supervised aerobic training (three times/week). The studied variables were weight, height, body mass index, body composition (skinfold), cardiorespiratory fitness (direct gas analysis), blood lipids and self-reported symptoms of eating disorders (bulimia, anorexia and binge eating), anxiety, depression, body image dissatisfaction and quality of life. Statistical analysis included binary logistic regression and independent t-tests.

Results

Of the adolescents, 73.7% adhered to the program. The greatest chance for dropout was observed among adolescents older than 15 years (odds ratio of 0.40; 95%CI: 0.15-0.98), with more anorexia symptoms (odds ratio of 0.35; 95%CI: 0.14-0.86) and hypercholesterolemia (odds ratio of 0.40; 95%CI: 0.16-0.91) at baseline.

Conclusion

Older adolescents, with more symptoms of eating disorders and total cholesterol have less chance to adhere to multidisciplinary treatments.

Intervenção nutricional pautada na estratégia de oficinas em um serviço de promoção da saúde de Belo Horizonte, Minas Gerais

OBJETIVO: Avaliar as oficinas como uma estratégia de intervenção nutricional, com foco na aquisição de informações em nutrição e na percepção de mudanças de hábitos alimentares. MÉTODOS: Estudo de intervenção com usuários de uma Academia da Cidade de Belo Horizonte, Minas Gerais. Realizaram-se quatro oficinas, com frequência mensal e duração de trinta minutos cada uma, pautadas no "Guia Alimentar para a População Brasileira" e nos "Dez Passos para uma Alimentação Saudável". Aplicaram-se questionários para avaliar a aquisição de informações em nutrição antes e depois da execução das oficinas, investigar a percepção de mudanças de hábitos alimentares após três meses da intervenção e identificar as principais dificuldades verificadas nesse processo. Um observador apontou a viabilidade de execução das oficinas. RESULTADOS: O número de participantes das oficinas variou de 71 a 132. Houve maior ocorrência (80%) de mulheres, com média de 55,8 (±10,6) anos. Identificou-se incremento estatisticamente significante na média total de acertos das questões do questionário de avaliação da aquisição de informações em três dos quatro encontros. Ademais, 90,9% dos participantes referiram alguma mudança de hábito alimentar, destacando-se a redução no consumo de óleos, gorduras e frituras (29,5%) e o aumento na ingestão de frutas e hortaliças (22,5%). A redução no consumo de açúcares e doces foi apontada como a recomendação mais difícil de ser seguida (21,1%). A avaliação do observador denotou a necessidade de modificar o espaço utilizado para as atividades. CONCLUSÃO: A intervenção apresentou potencial para aquisição de informações em nutrição e mudança de hábitos alimentares, alterações que devem ser mais bem investigadas com a continuidade das ações.

Reducing risk factors in overweight adult users of the family health strategy of the Distrito Federal

OBJECTIVE: To evaluate the results of a multidisciplinary program to promote healthy habits on anthropometric and biochemical parameters on participants of the Family Health Strategy of the Distrito Federal. METHODS: The sample consisted of 279 overweight and obese adults of both sexes divided into two groups: intervention (IG, n=198) and control group (CG, n=89). The IG received standard Family Health Strategy care plus a multidisciplinary health promoting program that included dietary interventions and physical activity, called Set Waist Program. The control group received only standard ESF care. Data were collected at baseline and after 4 and 8 months of follow up. Body mass index, waist circumference, fasting blood glucose and lipid profile were assessed. RESULTS: Prevalence of obesity (63.3% to 49.4%, p=0.027) and waist circumference (102.2cm to 94.8cm, p<0.0001) were significantly reduced in IG. Total cholesterol, LDL and HDL-cholesterol were reduced in both groups. CONCLUSION: Reductions in anthropometric measures were maximized through simple interventions that stimulated lifestyle changes. These results suggest that multidisciplinary initiatives such the Set Waist Program can be incorporated into other Family Health Strategy teams to optimize the control of obesity and health promotion. Participant compliance is an issue that deserves further investigation.

[Nutrition and physical activity counseling practice and adherence of primary care users]

The present study aimed to investigate counseling content provided by healthcare professional for primary healthcare users, as well as users' difficulties in adhering to the counseling, through a cross-sectional study design. Interviews were conducted with 499 users at a primary healthcare unit and 59.3% of them said that counseling had been provided especially by physicians (93.6%), and it was based on healthy nutrition and physical activity practice (48.9%). Counseling was more frequently to users with greater numbers of morbid conditions (p = 0.001). The main factors that made adherence difficult for users were lack of time (27.5%) and the need to change habits (23%). It was identified that counseling is still at initial stage within primary care, and there is a need for healthcare professionals, especially the nurse of the family health team to be more proactive in this process,focusing mainly on health promotion.