Manejo da obesidade infantil no contexto da Atenção Primária à Saúde: uma abordagem baseada na intervenção intensiva de múltiplos componentes

Abstract

Obesity is a socially produced disease and that the environment contributes greatly to the increase in its prevalence, and this has increasingly implicated in public health. Globally, over one billion people are living with obesity, including 39 million children. Given the numerous factors associated with nutritional status, multi-component approaches are more likely to impact food choices, behavior, and, ultimately, nutritional status. Among the various causes, obesity is closely linked to the shift from fresh and minimally processed foods to ultraprocessed foods (UPF). Reducing the consumption of these foods can be an effective strategy in managing childhood obesity. It is important to note that interventions implemented within the framework of Primary Health Care (PHC) are ideal for promoting health, as well as preventing and treating childhood obesity. Objective: To develop and evaluate an intensive multi-component intervention for the treatment of childhood obesity in children aged 6 to 10, within the context of PHC in Betim, Minas Gerais. Article 1: To identify the strengths and weaknesses in managing childhood obesity from the perspective of PHC professionals in Betim, Minas Gerais. Methods Article 1: A descriptive, qualitative study was conducted using three focus groups via videoconference. Participants were asked to complete an online form with questions regarding sociodemographic characteristics (gender, age, education level) and professional activity (profession, type of contract, working hours, and years of service). Two trained researchers used a ten-question script for the interviews. The interviews were recorded, transcribed, and analyzed using content analysis. Results Article 1: Fourteen professionals participated, 78.5% of whom were female, with a median age of 38. Most were physical education professionals (42.8%). Seven categories and eight subcategories were identified in the management of childhood obesity, with 60 weaknesses and 20 strengths reported. The subcategory "Work processes" was the most frequently cited weakness (n=30). As for strengths, the category "School: a space for health promotion" was highly regarded (n=9), as schools were seen as key venues for promoting healthy eating habits. Conclusion Article 1: PHC professionals considered schools to be potentially effective spaces for managing childhood obesity. Objective Article 2: To evaluate the effect of a controlled, multi-component intervention on the nutritional status and UPF consumption of children with obesity receiving PHC services. Methods Article 2: A randomized clinical trial was conducted with a sample of children with obesity attending PHC units (UBS) in Betim, Minas Gerais, Brazil. A sample of 20 UBS was randomly selected, deemed sufficient and representative of the 37 UBS in the municipality. The UBS were randomly assigned to either the control or intervention groups. Children with obesity (z-score ≥ +2 for BMI/age) aged 6 to 10 years were included. The sample size for each group was calculated as 39, with an estimated final sample size of at least 47 participants for both the control group (CG) and the intervention group (IG), accounting for a 20% dropout rate. Children were allocated to the CG or IG based on their reference UBS. Children from control UBS were assigned to the CG, while those from intervention UBS were assigned to the IG. For the IG, monthly activities included four weekly sessions (≥26 hours of contact) and five individual consultations. Children in the CG were monitored similarly to ensure comparable contact time (up to 9 hours of contact). Sociodemographic data, nutritional assessments, and UPF food consumption were collected using a questionnaire covering 11 food groups. Descriptive analyses were performed, and an intention-to-treat analysis was conducted to compare mean UPF consumption, BMI/age (z-score), and BMI (kg/m²) between and within the CG and IG after the intervention. Results Article 2: The intention-to-treat analysis showed that the intervention was effective in reducing UPF consumption in the IG compared to the CG, with a statistically significant decrease in consultation 3 [95%CI: -0.95 (-1.87; -0.04)], consultation 4 [95%CI: -1.35 (-2.215; -0.49)], and consultation 5 [95%CI: -0.94 (-1.83; -0.05)]. 12 However, no statistically significant differences were observed in BMI or BMI/age (z-score) between or within the groups (p>0.05). Conclusion Article 2: The study demonstrated that the multi-component intervention effectively reduced UPF consumption. While there was no significant reduction in BMI/age among children with obesity, the intervention contributed to maintaining their BMI, which should be considered in future strategies for managing childhood obesity within PHC settings.