Multiprofessional Obesity Treatments in Brazil between 1990 to 2004: A Bibliographical Review
The objective of this work was to verify the scientific production on multiprofessional treatments of obesity from 1990 to 2004, in the databases Scielo, Lilacs and PubMed.
Methods: This research followed the model of bibliographic review and used as descriptors for the search Multiprofessional intervention of obesity; Multidisciplinary obesity intervention; Multidisciplinary obesity treatment; Multiprofessional obesity treatment; Multidisciplinary treatment of obesity; Multiprofessional treatment of obesity. The searches were conducted on the sites of Lilacs, Medline / PubMed, and SciELO, between the years of 1990 and 2004". We found 235 articles in research bases used and, after applying the inclusion and exclusion criteria, were selected as eligible 1 article that composed the final analysis. This included article evaluated a model of intervention performed by a multiprofessional team of treatment of obesity in Brazil.
Results and conclusion: based on the research carried out it is evident that the multiprofessional studies of treatment of obesity were incipient from 1990 to 2004.
Keywords: Obesity; Behavioral Therapy; Multiprofessional Treatment
Overweight rates among the population have increased significantly in recent decades, both in developed countries and the United States with about 35% of obese, and in developing countries, such as Brazil where the prevalence of obesity has increased in the last twenty years in all age groups . According to data from IBGE (2009), 36.6% of Brazilian children were overweight and 16.6% were obese, while the number grows exponentially also in adolescents, but at a slower pace, where, around 5, 9% of adolescents are obese. Data from VIGITEL (2014) indicate that 52.5% of Brazilians are overweight; such an index was 43% in 2006 in relation to obesity, 17.9% of the population is in this state [2, 3].
According to Fisberg (1995) obesity is classified as the accumulation of fatty tissue, located throughout the body, caused by nutritional changes, genetic factors or by endocrine-metabolic diseases . Obesity is a risk factor for chronic diseases due to its harmful action, since it contributes to the development of comorbidities such as elevated blood pressure and serum lipids . The concentration of predominantly abdominal fat is associated with higher metabolic changes that may increase the risk of ischemic cardiac diseases and diabetes than the higher fat concentration in the peripheral regions .
As a strategy, the Ministry of Health issued directives No. 424 and 425 of March 19, 2013, which aim to “prevent and treat overweight and obesity as the priority care line of the health care network of people with Chronic Diseases”. However, such Ordinances have not been put into effect so far. The Ministry of Health has also launched the Action Plan for Coping with Non communicable Chronic Diseases (DCNT). In Brazil, according to data from the Mortality Information System (2009), NCDs account for 72% of total deaths, a percentage that represents more than 742,000 deaths per year. The most common non communicable chronic diseases are cardiovascular diseases (31.3%), cancer (16.2%), chronic respiratory diseases (5.8%) and diabetes mellitus (5.2%), diseases directly linked to obesity .
According to the estimates up to the year 2025, Brazil will be the fifth country in the world in prevalence numbers and problems caused by obesity . In Brazil, the high financial costs, the percentage of expenses and the high costs of hospitalizations associated with obesity are similar to those of developed countries . Obesity stands out as one of the factors that most affects the health of the population.
In this respect, a significant portion of the increase in the prevalence of obesity can be attributed to the sociocultural aspects, since its causes may exert greater influence than the genetic factors, since the eating habits of friends and family can contribute to the acquisition of inappropriate habits, which leads to the onset of obesity .
With this growing scenario of overweight in the population, when verifying the literature on effective programs in the prevention and fight against obesity, it is verified that there is a gap about multiprofessional programs of treatment of the obesity in the period of 1990 to 2004. In this sense the objective of this systematic review was to verify the studies of the fight against obesity with multiprofessional design and its main outcomes from January 1990 to December 2004, in the scielo, lilacs and scielo databases.
The present work is characterized as a bibliographical review, which uses the literature as data source. The literature review integrates information from several studies conducted separately that may present conflicting and / or coincident results .
It was defined as the scientific question of this systematic review: “What studies to combat obesity with multiprofessional design and its main outcomes?”
The electronic databases used for literature review were: PUBMED / MEDLINE, LILACS and SciELO. The research was carried out with papers published between January 1990 and December 2004, using the following terms: “Multidisciplinary obesity intervention”, “Multiprofessional obesity treatment”, “Multiprofessional obesity treatment”, “ Multidisciplinary treatment of obesity “and” Multiprofessional treatment of obesity “.
The inclusion criteria previously established were:
1) Be in Portuguese, English or Spanish;
2) Be original article or short communication with original data (short communication);
3) Study the fight against obesity with multiprofessional design;
Excluded were that works that:
1) Did not characterize a conventional model of intervention, with a multiprofessional approach;
2) Have been developed to promote the prevention of obesity;
3) Were published before or after the period 1990-2004.
The selection of the manuscripts was done in two stages:
- 1st stage: Analysis by titles and abstracts;
- 2nd stage: Analysis by complete articles.
After the identification of the works, the relevant information was highlighted as follows:
Table 1 - General data of the article: study, year of publication, origin, areas involved, subjects, gender, age and physical activity;
Table 2 - Main endpoints of the article: authors, age, anthropometric, biochemical, physical fitness, comorbidities, nutritional and psychological / social;
Table 3 - Multiprofessional treatment and effects on the lipid profile: total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides;
Table 4 - Training model and protocol: author, duration, intensity, frequency, sex, dropout and control group.
In order to verify the scientific production on multiprofessional treatments of obesity in the period from 1990 to 2004, after the data collection, and applying the inclusion and exclusion criteria, only 1 article was elected for analysis in order to compose this study. In Table 1, we can analyze the general data of the selected study.
As a stand out, the article entitled “Group psychotherapy in patients with metabolic syndrome” was inaccessible for the removal of some information, as a method of critically comparing and evaluating an intervention, since, from the established criteria, only this foray presented by the scientific bases. Given this, and as can be seen in Table 2, only one study that met the inclusion criteria and was completely accessible.
The structuring of the work was guided by a reeducation of eating habits, together with physical exercises monitored, structured and with practical diversities, in order to reduce risk factors present in the participants’ body composition. The target audience consisted of 25 obese youth (13 men and 12 women), aged between 12 and 18 years. The intervention related to physical education was given by the activities of water aerobics, swimming, hiking and sports games.
The intervention time is also another trigger for the effectiveness of the accepted study program, presented 8 months of intervention.
Another factor to be highlighted focuses on the period in which these works of programs for the prevention and treatment of obesity are ongoing. Only in 2002 is the publication of a study of the genre focused on the theme. Table 2 shows data on the selected article and the observed outcomes
Author Age range Anthropometry Biochemical variables Physical fitness Comorbidities Nutritional variables Psychological / social variables
A study conducted in Brazil with a sample of 25 adolescents (12 to 18 years old) who were overweight or obese according to WHO criteria (1991), for this age group. The participants of the research were submitted to a multidisciplinary treatment, lasting 8 months, conducted by professionals in medicine, nursing, physical education, nutrition, psychology and biochemistry. The treatment protocol was composed of nutritional intervention and physical exercise practice. Regarding the nutritional aspects, a hypo caloric diet of 1900 kcal was administered, and every two weeks there was a group meeting in order to guide the participants in relation to good and healthy eating habits. The application of the physical exercises was performed by a professional of the area and happened twice a week. Each meeting lasted 1 hour and 30 minutes, and the exercises varied between general water activities, swimming, walking and sports games. In addition, participants were instructed to maintain diversified physical activities throughout the week as a complement to the program. Table 3 shows the impact of multiprofessional treatment on the subjects in the lipid profile.
For a better quality of life, decrease in morbidity and mortality, it is necessary to reduce the amount of body mass, especially fat in obese patients. In this context, physical exercise becomes an important alternative in the control and treatment of obesity and is directly related to the total energy demand induced by muscular work, associated with the adequate combination of frequency, intensity and duration of physical exertion . Therefore, aerobic exercise becomes an excellent way to boost energy expenditure and control body weight, due to the increase in lipid oxidation . Weight reduction, although not significant in some cases,
improved the lipid profile and reduced blood pressure. Such improvement can be attributed to the duration of ninety minutes of the interventions, which resembles the studies done by Donnely, et al. (2009) and Aguilar, et al. (2010) in which activities lasting ninety minutes in adolescents caused a reduction in BMI and Total Cholesterol [15,16]. It should be noted that physical activity in amounts over 60 minutes daily will provide additional health benefits and in cases of body weight reduction, quantities of 90 minutes may provide more efficient results .
The intensity of exercise was not objectively determined in the study, a factor that hinders its reproducibility. Twice weekly frequency did not appear to be sufficient, corroborating a study by Berntsen, et al. where after five months of intervention in adolescents aged 7-17 years, only observed a reduction in fat percentage . According to the authors due to their multifactorial etiology, the treatment of Obesity can promise greater benefits if carried out through a Multiprofessional strategy, corroborating with Lofrano-Prado, et al. who, after six months of multiprofessional intervention, observed a significant reduction in BMI and body weight in girls and boys, a fact that remained after one year of the same intervention process. In order to achieve therapeutic success, a treatment program involving a multidisciplinary team should be developed to develop a close relationship with the American Dietetic Association; (Canadian clinical practice guidelines on the management and prevention of obesity in adults and children) [19,20].
The realization of Cognitive Behavioral Therapy as well as the intervention in the family life style favored the adherence to the Program and consequently in the results obtained by reducing the caloric intake and increasing the practice of physical activities. According to Abreu (2003), Cognitive Therapy has demonstrated efficacy by working from the operant structure of the patient, aiming to organize the contingencies for weight changes and behaviors, in principle, related to self-control of eating behaviors, and broad situational context, deepening for all the discomfort .
The family contributed significantly to changing habits and lifestyle. The performance of parents in Obesity Treatment programs seems to be a determining factor, according to the study by Gustafson, et al who, through a review of thirty four studies, observed an association between parents’ influence and levels of physical activity in adolescents [22-24]. It was observed that some bias compromised the results of the interventions so that the absence of results presented, mainly on the reduction of body weight from the gender, made it impossible to separate the influence of the treatment in question and the physiological factor, since the sexual development that occurs during adolescence promotes endocrine metabolic changes that influence the distribution of body fat in both boys and girls Malina; Bouchard (2002) [25,27]. However, the noncompliance of the Complementary Program proposed for the weekends to adolescents and parents impaired the volume of the Physical Exercise Program, as well as low acceptance of the walk by the adolescents [28-30].
In the period from 1990 to 2004, only one article was observed in the main research bases indexed by the inclusion and exclusion criteria adopted in the present study. The results showed the effectiveness of the multi professional treatment program for obesity in hemodynamic factors and body composition. Variables such as intensity, dropout, physical fitness, and comorbidities, nutritional, psychological and social variables were not evaluated.
It is clear that since this is an earlier period, few studies have focused on studying the disease that would become the 21st century pandemic. The growing number of studies that currently focus on this theme denotes the concern of researchers and public policies for health in restraining the one that is the greatest challenge to all overweight nations and with it the chronic non-communicable diseases, major causes of death today.