Burlandy Luciene, Teixeira Márcia Regina Mazalotti, Castro Luciana Maria Cerqueira, Cruz Myrian Coelho Cunha, Santos Claudia Roberta Bocca, Souza Simone Raimondi de, Benchimol Luziene Simões, Araújo Thays da Silva, Ramos Doralice Batista das Neves, Souza Thamillys Rodrigues
Faculdade de Nutrição, Universidade Federal Fluminense, Niterói, Brazil.
Secretaria de Estado de Saúde do Rio de Janeiro, Rio de Janeiro, Brasil.
Cad Saude Publica. 2020;36(3):e00093419. doi: 10.1590/0102-311x00093419. Epub 2020 Mar 13.
Brazil has developed policies for the prevention and control of obesity through the Brazilian Unified National Health System. This study analyzed the characteristics of proposed "models of care" reported by health professionals in primary care in the state of Rio de Janeiro. The methods included interviews and focus groups with professionals and managers in primary care and the thematic areas of food and nutrition in the 92 municipalities (counties) of Rio de Janeiro state and document analysis of federal and state legislation and guidelines. The analysis was oriented by the organizational and technical dimensions of care and the principles of comprehensive healthcare. The main challenges reported by health professionals pertained to adherence to the therapeutic process and feelings of frustration and powerlessness; multidisciplinary teamwork; and unpreparedness for dealing with the complexity of the health-disease process related to obesity. Some principles and guidelines based on the government policy documents are strategic for addressing these challenges, especially: shared responsibility between health professionals and users, which can help avoid the extremes of blaming and/or victimization; appreciation of other gains besides weight loss, which can redefine treatment adherence; and multidisciplinary teamwork to develop a contextualized understanding of the health-disease process and its multiple conditioning factors and for the health professionals to be able to cope with their own feelings and stigmas towards the person with obesity.
巴西通过巴西统一国家卫生系统制定了肥胖预防和控制政策。本研究分析了里约热内卢州初级保健机构的卫生专业人员报告的拟议“护理模式”的特点。研究方法包括与里约热内卢州92个市（县）的初级保健专业人员和管理人员以及食品与营养主题领域人员进行访谈和焦点小组讨论，以及对联邦和州立法及指南进行文件分析。该分析以护理的组织和技术层面以及全面医疗保健原则为导向。卫生专业人员报告的主要挑战涉及坚持治疗过程以及挫折感和无助感；多学科团队合作；以及应对与肥胖相关的健康 - 疾病过程复杂性的准备不足。基于政府政策文件的一些原则和指南对于应对这些挑战具有战略意义，特别是：卫生专业人员与使用者之间的共同责任，这有助于避免指责和/或受害者心态的极端情况；重视除体重减轻之外的其他益处，这可以重新定义治疗依从性；以及多学科团队合作，以便对健康 - 疾病过程及其多种制约因素形成情境化理解，并使卫生专业人员能够应对他们对肥胖者的自身感受和污名化。
