THE CARE OF OBESE ADOLESCENTS IN PRIMARY HEALTH CARE: PERSPECTIVES OF MANAGERS AND PROFESSIONALS

Oliveira, Vinícius Rodrigues de; Oliveira, Jonas Sâmi Albuquerque de; Xavier, Bárbara Letícia de Queiroz; Morais, Jéssica Baracho de Souza; Araújo, Juliana Iscarlaty Freire de; Soares, Amanda; Freitas, Claudia Helena Soares de Morais

doi:10.1590/ce.v29i0.93712

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ORIGINAL ARTICLE • Cogit. Enferm. 29 • 2024 • https://doi.org/10.1590/ce.v29i0.93712 copy

THE CARE OF OBESE ADOLESCENTS IN PRIMARY HEALTH CARE: PERSPECTIVES OF MANAGERS AND PROFESSIONALS^* * Article extracted from the master’s: “Práticas do cuidado ao adolescente com obesidade na Atenção Primária à Saúde”, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil, 2022.

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Lack of guidelines for the organization of care for obese adolescents.
Difficulties in health care in the face of obesity are prevalent.
The current potential is related to the multi-professional team.

ABSTRACT

Objective:

Describe and explore, from the perspective of managers and health professionals, the care offered to adolescents with obesity in the context of Primary Health Care.

Method:

A case study conducted in a municipality in the state of Ceará-Brazil. Data collection took place in 2022 through semi-structured interviews. The data were examined using Bardin Content Analysis.

Results:

The care of obese adolescents is fragmented, and each professional acts according to their own decision, as the municipality does not use protocols that subsidize the practice of care. Potentials for care were listed, the main one being the multidisciplinary team. Regarding the difficulties, the adolescent’s demand for health services was highlighted.

Conclusion:

It is necessary to (re) organize the care model for obese adolescents in the municipality. In addition, the study highlights the need for greater attention to adolescent obesity and causes reflections on the care provided to this adolescent.

KEYWORDS:
Obesity; Adolescent Health; Adolescent Nutrition; Primary Health Care; Comprehensive Health Care

Category	Sphere of action	Cargo	No. of interviewees
Health professional	Municipal	Nurse	08
		medic	07
		Nutritionist	02
Manager	Municipal	Secretary of Health	01
		PHC Coordinator	01
		PSE Coordinator	01
	State	Coordinator of the Decentralized Health Area (DHA)	01
	State	Technical responsible for Primary Care at DHA	01
Total number of participants			22

Potentialities	Quoted by	Speech at the interview
Service structure and multi-professional team	Nurses medics Nutritionists	The potential is the availability of a nutritionist, a physical educator, and even CPHC staff, if necessary. (Doctor 2) The potential is the multidisciplinary team [...] I, as a doctor, would not solve it alone. (Doctor 7) The professionals we have at the BHU have the potential to generate healthier adolescents. (Nurse 7)
Partnership between the health and education sector, mediated by the PSE	Municipal Managers State Managers Nurses Nutritionist	This partnership between health and education has recently strengthened, so in the school environment, it is suitable for raising awareness and working on the issue of education and health promotion. (Municipal Manager 2) The PSE, a health program in which you work on health within that school unit, is very good for getting teenagers to participate and understand the importance of taking care of themselves. (State Manager 2) The great potential is the networked team, the team where I talk about health and education together. Since the PSE was created, bringing health, especially to the school unit has had a strong impact. (Nurse 5)
Adolescent knowledge and easy access to information	Municipal Manager medic	[...] One of the potentialities is that, for the most part, they are enlightened people. (Municipal Manager 1) Access to information is very easy nowadays, everyone has access to information in the palm of their hand, so the internet itself is a form of ease. (Doctor 3)
Family assistance in the treatment of adolescents	Nurses	What helps is raising parents’ awareness first, because sometimes the child’s diet is in line with family nutrition. (Nurse 8)

Difficulties	Quoted by	Speech at the interview
Seeking a health service and establishing a relationship/bond between the professional and the adolescent	State Managers Municipal Managers Nurses Doctors Nutritionist	They don’t feel anything and they don’t go to the BHU. (State Manager 2) I think the difficulty is establishing a closer link between the professional, the adolescent, and the BHU. (Municipal Manager 1) The main difficulty is the issue of searching for the adolescent himself. (Nurse 3) Relationships are like that, very fragile [...] I think the difficulty would be just that, the loss of contact, of follow-up. (Doctor 1) [...] This audience is an audience that has a certain difficulty in coming to the BHU [...], so it’s a matter of interest. (Nutritionist 2)
Adherence to treatment	Nurses medics	The difficulty is their lack of commitment. Normally, they seek it when there is a problem, because they are being bullied, or they have issues of self-esteem, but they start and never complete the treatment. (Nurse 1) There is difficulty in patients’ compliance, especially in this regard, to adherence to treatment. (Doctor 5)
Covid-19 pandemic	State Managers Municipal Manager Nurses Nutritionists	Although we know there is a lot to work with teenagers, in these two years of a pandemic that we have experienced, Covid has taken care of practically everything. (State Manager 2) During these two years of the pandemic, we have been orphaned from the practice of education and health promotion. (Municipal Manager 2) Before the pandemic, when we could go to schools and carry out nutritional assessments at school, this made it much easier, but with the pandemic, it became difficult. (Nurse 2) The pandemic issue made it a little difficult. (Nutritionist 2)
Food insecurity	Nurses Doctors Nutritionists	[...] Sometimes inadequate food is much more accessible than adequate food itself (Nutritionist 1) You have behavior to be done, so you offer the service but don’t offer the condition for the person to do the right thing, especially with food [...] The patient asks: how am I going to follow this diet if I have no condition, if I only have the basics and the basics involve rice, beans, and salt. (Nurse 6) As a difficulty, I imagine the economic issue. (Doctor 7)
Lack of professionals at the Expanded Family Health Center (NASF)	Municipal Manager Nurses Doctors Nutritionist	With the defunding of the NASF, most of the teams were disbanded, so today we only have the resident NASF and one more NASF, and yet the professionals are in much smaller numbers. (Municipal Manager 1) I used to work at the NASF, which was a team composed of a nutritionist, physical educator, psychologist, and physiotherapist, but the SUS has been dismantled, and these professionals underwent changes in the sector, and some were even disbanded from the municipality. Before that, we had health education groups in schools, which was the most practical way to work with the public. (Nutritionist 2) At the NASF, we only have a nutritionist, but before, we had a psychologist and a physical educator who helped a lot; now, at the moment, I only have one nutritionist who is our NASF. (Nurse 7)
Counter-referral process failed	Nurses Doctors	There is no counter reference as it should be, it doesn’t come, it doesn’t exist, but since we are connected to the person, and they are there for a good while here at the BHU, we always seek to know. (Nurse 8) The counterreferral of the specialist to the BHU is a bit precarious. When the patient arrives, we ask what was said by the specialist and what was prescribed; this is a great difficulty. (Doctor 7)
Negative influence of the family environment	Municipal Manager Nurses Nutritionist	The greatest difficulty is the obesogenic environment, the family environment; the adolescent is not isolated in this situation, the family influences. (Municipal Manager 3) Family members don’t help; they often like to see the chubby teenager. (Nurse 7) The difficulty is that obesity itself is multifactorial, and therefore requires a lot of things, in addition to the health professionals themselves, such as family support [...] (Nutritionist 1)

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[1] Corresponding author: Vinícius Rodrigues de Oliveira Universidade Federal do Rio Grande do Norte Campos Univertsitário, Br-101, s/n - Lagoa Nova, Natal - RN E-mail: viniciusrodriguesvro@gmail.com

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THE CARE OF OBESE ADOLESCENTS IN PRIMARY HEALTH CARE: PERSPECTIVES OF MANAGERS AND PROFESSIONALS* * Article extracted from the master’s: “Práticas do cuidado ao adolescente com obesidade na Atenção Primária à Saúde”, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil, 2022.

HIGHLIGHTS

ABSTRACT

Objective:

Method:

Results:

Conclusion:

THE CARE OF OBESE ADOLESCENTS IN PRIMARY HEALTH CARE: PERSPECTIVES OF MANAGERS AND PROFESSIONALS^* * Article extracted from the master’s: “Práticas do cuidado ao adolescente com obesidade na Atenção Primária à Saúde”, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil, 2022.