What are the strategies to combat obesity in Brazil?

Responsible researcher: Viviane Pires Ribeiro

Article title: OBESITY AND PUBLIC POLICIES: THE BRAZILIAN GOVERNMENT'S DEFINITIONS AND STRATEGIES

Authors of the article: Patricia Camacho Dias, Patrícia Henriques, Luiz Antonio dos Anjos and Luciene Burlandy

Location of intervention: Brazil

Sample size: 18 documents

Sector: Education

Type of Intervention : Analysis of strategies to combat obesity in Brazil

Variable of main interest: Obesity

Assessment method: Others - Document Analysis Method

Assessment Context

In recent decades, obesity has gained prominence on the national and international public agenda, being characterized as an event of global proportions and increasing prevalence. In Brazil, overweight and obesity reached 56.9% and 20.8% of the adult population in 2013, it is also observed that overweight and obesity have been increasing in all age groups and at all levels of income, especially in the population with lower family income.

The increasing prevalence of obesity has been attributed to several biopsychosocial processes, in which it is influenced not only by the individual and their choices, but also by the political, economic, social and cultural environment. In Brazil, obesity has become the object of public policies and the Ministry of Health, through the Unified Health System (SUS), is the main proponent of actions, following the international trend.

Between 2011 and 2014, the Interministerial Chamber of Food and Nutrition Security (CAISAN) was responsible for formulating the intersectoral plan to combat obesity, supporting an intersectoral strategy that systematizes recommendations for Brazilian states and municipalities. CAISAN, the National Food and Nutritional Security Council (CONSEA) and the National Conferences are part of the National Food and Nutritional Security System (SISAN). SISAN was established in 2006 with the aim of organizing actions implemented by different ministries, covering everything from food production to consumption.

Intervention Details

Unlike studies on obesity in Brazil that approach the topic from the perspective of epidemiology, evaluating the impact of specific measures and presenting an overview of the actions that have been implemented mainly by the health sector, Dias et al. (2017) analyze how obesity has been addressed in SUS and SISAN policies, including concepts, indicators, action strategies and institutional articulation, especially related to food and nutrition.

The analysis was based on references from the field of policy analysis that conceive politics as a process and practice, an expression of conflicts and convergences of power, interests and ideas. The authors used documentary analysis, because according to them, government documents are relevant for policy analysis, as they express governmentality strategies and reflect possible agreements at a given moment.  

Methodology Details

To carry out the analysis of national strategies to combat obesity in Brazil, within the scope of the Unified Health System and the National Food and Nutritional Security System, Dias et al. (2017) adopted the document analysis method, using government documents produced in the last 15 years – documents that address obesity as a public policy issue.

The authors analyzed 13 documents produced within the scope of SUS and 5 from SISAN, based on the following analytical dimensions based on document analysis references: conceptions about obesity and its conditions; proposed interventions; principle of intersectorality and arguments used.

The websites of the Ministry of Health (http://portalsaude.saude.gov.br/) and the Ministry of Social Development and Combating Hunger (http://www.mds.gov.br) were searched and the “ macrostrategies” (which define actions for SUS and SISAN), according to the following descriptors: obesity, chronic diseases, health promotion and food and nutrition. Specific regulations for the school network were also included, considering the relevance of this space for combating childhood obesity.

Results

The results found by Dias et al. (2017) show that tackling obesity by public authorities in Brazil has historically been linked to the health sector and has recently been reconfigured based on new approaches led by instances of the National Food and Nutritional Security System. Within the scope of SISAN, obesity is conceived as a social problem of food insecurity and new ways of producing, selling and consuming food are proposed to change eating practices in an integrated way. While within the scope of the Unified Health System, obesity is approached as a risk factor and as a disease, with individualized and socio-environmental approaches, aiming to change eating and physical activity practices.

According to the authors, the new approaches led by SISAN instances are fundamental for tackling a problem that, in fact, is particularized and materialized in the individual. However, it has favored biomedical interventions traditionally restricted to the biological dimension and focused on the treatment of an already established disease that, in itself, has not been effective in reducing its prevalence. Individual or group consultations, bariatric surgery, drug interventions, even if they could be widespread, would not be enough to affect the main conditions of the problem. Furthermore, adherence to individualized treatment is low, largely because individuals continue to be subjected to the same environmental pressures that compete unequally with personal motivation to modify eating and behavioral practices.

It is observed that certain health promotion proposals tend to be “sectoral” because they are based on the prevention of the disease “obesity” and its risk factors and aimed mainly at changes in diet and physical activity, based on efforts individual. However, health promotion proposals guided by the socio-environmental approach to health, aiming to guarantee healthy environments and living contexts can favor proposals for intersectoral coordination through measures such as guaranteeing access to adequate and healthy food in workplaces, schools and the regulation of food advertising.

Therefore, efforts to build intrasectorality and intersectorality are essential, as they can contribute to greater integration and effectiveness of the set of prevention and control measures. In the Brazilian scenario, the SUS proposals point to an integrated and intrasectoral approach to obesity, while the SISAN proposals reinforce intersectorality in a broader perspective that challenges the current sectoral institutional structures.

Public Policy Lessons

In the set of policies analyzed by Dias et al. (2017), the authors observed both proposals from the health sector, which favor individualized and socio-environmental measures, and those from SISAN, which emphasize transformations in the way food is produced, in its supply and commercialization. In this context, the SISAN approach encompasses several institutional spaces of the federal government and, therefore, makes the political process more complex, by requiring greater coordination between sectors and expanding potential points of conflict.

Dias et al. (2017) state that the fact that obesity is the object of intersectoral food and nutritional security policy in Brazil can favor the management of the multiple processes that condition the problem and affect the terms of the sectoral policies themselves. Therefore, the authors highlight the challenge of implementing regulatory and fiscal measures that are fundamental for the transformation of dietary and physical activity practices, and also the challenges inherent in the institutional and sectoral structures themselves, in force at different levels of government, which They also make it difficult to plan, finance and implement integrated strategies that affect the food system.

References

DIAS, Patricia Camacho et al. Obesity and public policies: the Brazilian government's definitions and strategies. Public health notebooks, v. 33, p. e00006016, 2017.