Change in overweight and obesity over a decade according to sociodemographic factors in Brazilian adolescents / Mudança no sobrepeso e obesidade após uma década de acordo com fatores sociodemográficos em adolescentes brasileiros

Abstract The aims were to examine changes in the prevalence of overweight and obesity among students from 2001 to 2011, and to verify if these changes differ according to age group, area of residence, and family income. We analyzed two cross-sectional surveys conducted in 2001 and 2011 with brazilian adolescents. Sociodemographic and anthropometric characteristics were self-reported using a questionnaire. Multinomial logistic regression was used to analyze changes in overweight and obesity between the two surveys. The nutritional status was the outcome of the present study and the surveys (2001 and 2011) were the exposure. The odds of being overweight and obese were higher among boys and girls in urban areas in the 2011 survey compared to the 2001. Boys and girls with higher income were also more likely to present overweight and obesity in the second survey compared to the first. An increase of overweight and obesity was observed over a decade. We suggest that future interventions consider the area of residence and the family income to strengthen the effectiveness of actions developed to prevent and control these indicators among adolescents.

Resumo Os objetivos do estudo foram examinar as mudanças na prevalência de sobrepeso e obesidade entre os estudantes de 2001 a 2011 e verificar se essas alterações diferem de acordo com a faixa etária, a área de residência e a renda familiar. Analisamos dois levantamentos transversais realizados em 2001 e 2011 com adolescentes brasileiros. As características sociodemográficas e antropométricas foram autorrelatadas por meio de um questionário. Regressão logística multinomial foi utilizada para analisar as mudanças no sobrepeso e obesidade entre os dois inquéritos. O estado nutricional foi considerado o desfecho do presente estudo e os inquéritos (2001 e 2011) foram as exposições. As razões de chance de sobrepeso e obesidade foram maiores entre os meninos e meninas em áreas urbanas no inquérito de 2011 em comparação com 2001. Meninos e meninas com maior renda também apresentaram maior chance de sobrepeso e obesidade no segundo inquérito. Sugerimos que futuras intervenções considerem a área de residência e a renda familiar para fortalecer a eficácia das ações desenvolvidas para prevenir e controlar esses indicadores entre os adolescentes.

Panorama general y programas de protección de seguridad alimentaria en México / Overview and Protection Programs of Food Security in Mexico

Proporcionar seguridad alimentaria a la población representa un desafío global, especialmente para los países en vías de desarrollo debido a su insostenible crecimiento poblacional, bajo nivel de ingresos y tasa acelerada de urbanización. En México, un alto porcentaje de la población no tiene acceso a una canasta básica y por ende posee algún grado de inseguridad nutricional. Existen programas gubernamentales que han procurado mitigar este problema al proveer una cantidad suficiente de alimentos, sobretodo en poblaciones vulnerables como comunidades indígenas, rurales, niños y mujeres. Por otra parte, los alarmantes índices de obesidad y sobrepeso que han elevado la morbilidad de enfermedades crónicas como hipertensión y diabetes en la población, reflejan un problema relacionado con el hambre oculta, aquella donde hay una deficiencia de micronutrientes al enfocarse en una dieta alta en contenido energético, evidenciando la falta de calidad nutritiva en los alimentos y desinformación en la población mexicana. El presente artículo muestra la situación de seguridad alimentaria en México y algunos programas gubernamentales que procuran mitigar este problema, de los cuales solo algunos prestan poca atención a los aspectos nutricionales, restringiendo el derecho a una alimentación de calidad (AU).

Providing food security to the population represents a global challenge, especially for developing countries due to the unsustainable population growth, low incomes and accelerated urbanization rate. In México, a high percentage of the population does not have access to a basic basket and therefore has some degree of food insecurity. Government programs have tried to mitigate this problem by providing sufficient food, especially in vulnerable populations such as indigenous communities, rural communities, children and women. On the other hand, the alarming rates of obesity and overweight that have raised the morbidity of chronic diseases such as hypertension and diabetes in the population, reflect a problem related to hidden hunger, the one where there is a deficiency of micronutrients, focusing on a diet high in energy content, evidencing the lack of nutritional quality in foods and disinformation among Mexican population. This article shows the situation of food security in Mexico and some government programs intending to mitigate this problem, but only a few of them pay little attention to nutritional aspects, restricting the right to a qualitative nutrition (AU).

Economic burden of obesity: a systematic literature review

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.(AU)

Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States

PURPOSE: To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS: This study was conducted using the 2003–2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS: Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861–$895] and $257 (95% CI: $251–$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253–$260) and $26 (95% CI: $26–$27) per person per year, respectively. CONCLUSION: Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.

Bariatric surgery. Analysis of hospital admissions for obesity in the Brazilian Public Health System (SUS) in Sao Paulo

PURPOSE: To characterize the comorbidities associated with hospitalizations for obesity and the relationship of these co-morbidities with bariatric surgery and hospitalization costs during the period between 2000 and 2010 in Sao Paulo that were financed by the Brazilian Public Health System (SUS). METHODS: We used data from the Hospital Information System of the Unified Health System (SIH-SUS) for selected individuals hospitalized for obesity according to International Classification of Diseases (ICD10). RESULTS: The total cost of hospitalizations was approximately two million dollars, with 67% of the total cost for bariatric and reconstructive surgery. Women accounted for 87% of hospitalizations, and 77% of subjects were aged between 30 and 59 years; the main comorbidity found was hypertension, and the procedures performed were bariatric surgery and reconstructive surgery (post-bariatric surgery). CONCLUSION: Obesity is a major public health problem that affects people of productive age, causing high costs of hospitalization, which reinforces the requirement for preventive interventions beginning from childhood. .

Há irracionalidades no consumo de inibidores de apetite no Brasil? Uma análise farmacoeconométrica de dados em painel / Are there irrationalities in the consumption of anti-obesity drugsin Brazil? A pharmaco-econometric analysis of panel datasets

Este estudo busca analisar os determinantes do consumo de inibidores de apetite (anfepramona, femproporex, mazindol e sibutramina) por meio da estimação de um modelo dinâmico de dados em painel para as capitais brasileiras e do Distrito Federal (DF) no período de 2009 a 2011. Os resultados revelam que o consumo de inibidores de apetite não acompanhou a distribuição geográfica dos indivíduos com excesso de peso e com obesidade nas unidades estudadas. Do consumo recorrente de inibidores, 79% são explicados pelo ocorrido no passado. Dentre as variáveis que explicam o consumo de inibidores, destacam-se os percentuais de adultos com obesidade e que dos que consomem frutas e hortaliças e a taxa de cobertura de planos de saúde. A análise farmacoeconométrica sugere que há problemas no uso racional dos inibidores de apetite nas capitais brasileiras e no DF, seja no que tange ao consumo desses medicamentos com outros fármacos - considerados ilegais pelo Conselho Federal de Medicina e pela Anvisa - e, também, na indicação terapêutica de uso desses produtos.

The scope of this study is to analyze the determinants of the use of appetite suppressants (amfepramone, femproporex, mazindol and sibutramine) through the estimation of a dynamic panel dataset model for the Brazilian state capitals and the Federal District (DF) in the period from 2009 to 2011. The results show that consumption of appetite suppressants did not follow the geographic distribution of overweight and obese individuals across the capitals and DF. There is a recurrent consumption of appetite inhibitors, in which 79% of the current consumption of these drugs is explained by past consumption. Among the variables that explain the use of inhibitors, the percentage of obese adults, the percentage of adults who habitually consume fruit and vegetables, and the coverage rate of health plans stand out. The pharmaco-econometric analysis suggests that there are problems in the rational use of appetite suppressants in the Brazilian state capitals and the Federal District with respect to both the combined consumption of these drugs with other medicines - deemed illegal by the Federal Council of Medicine and ANVISA - and in the therapeutic prescription of these products.

A obesidade nos domicílios brasileiros: um estudo sobre determinantes alimentares e consequências financeiras baseado na Pesquisa de Orçamentos Familiares 2008-2009 / Obesity in Brazilian households a study about dietary determinants and financial consequences based on Household Budget Survey 2008-2009

A obesidade é um problema de saúde pública com múltiplos determinantes e consequências. Objetivos: 1) Analisar a relação entre a disponibilidade domiciliar de produtos alimentícios processados e ultraprocessados e a prevalência de excesso de peso e obesidade; 2) Descrever o gasto familiar privado com saúde, segundo a presença de indivíduos obesos nos domicílios; e 3) Estimar a influência da presença de indivíduos obesos nos domicílios sobre o gasto total com medicamentos (obtidos nos setores privado e público). Métodos: Tese composta por três manuscritos baseados em dados da Pesquisa de Orçamentos Familiares (POF) 2008-2009. O primeiro manuscrito utilizou os 550 estratos amostrais da POF como unidade de análise e modelos de regressão linear para avaliar a relação entre a disponibilidade calórica domiciliar de produtos processados e ultraprocessados e a prevalência de excesso de peso e de obesidade, ajustados para variáveis de confusão. Ainda, foram estimados os valores preditos dos desfechos, segundo quartos de disponibilidade de produtos ultraprocessados. Os demais manuscritos consideraram os 55.970 domicílios como unidade de análise. O segundo manuscrito descreveu a distribuição do gasto privado mensal com saúde, considerando o gasto com medicamentos e com assistência à saúde, segundo a presença de obesos nos domicílios. O terceiro analisou a influência da obesidade sobre o gasto mensal per capita com medicamentos, obtidos nos setores privado e público, por...

Obesity is a public health problem with multiple determinants and consequences. Objectives: 1) To analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight and obesity; 2) To describe the private spending on health, according to the presence of obese individuals in households; and 3) To estimate the influence of the presence of obese individuals in households over the total spending on medicines (obtained in the public and private sectors). Methods: Thesis comprising three manuscripts based on data from the Brazilian Household Budget Survey (HBS) 2008-2009. The first manuscript used the 550 sampling strata of HBS as the unit of study and linear regression models to evaluate the relationship between household caloric availability of processed and ultra-processed products and the prevalence of excess weight and obesity in the stratum, adjusted for confounding variables. Furthermore, predictive values of outcomes were estimated according to quartiles of the household caloric share from ultra-processed products. The other manuscripts considered the 55,970 households as the unit of study. The second manuscript described the distribution of private spending on health, considering the spending on medicines and healthcare, according to the presence of obese individuals in households. The third manuscript analyzed the influence of obesity on the household spending on medicines, obtained...

Socioeconomic Costs of Overweight and Obesity in Korean Adults

This study was conducted to estimate the socioeconomic costs of overweight and obesity in a sample of Korean adults aged 20 yr and older in 2005. The socioeconomic costs of overweight and obesity include direct costs (inpatient care, outpatient care and medication) and indirect costs (loss of productivity due to premature deaths and inpatient care, time costs, traffic costs and nursing fees). Hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, stroke, colon cancer and osteoarthritis were selected as obesity-related diseases. The population attributable fraction (PAF) of obesity was calculated from national representative data of Korea such as the National Health Insurance Corporation (NHIC) cohort data and the 2005 Korea National Health and Nutrition Examination Survey (KNHANES) data. Direct costs of overweight and obesity were estimated at approximately U$1,081 million equivalent (men: U$497 million, women: U$584 million) and indirect costs were estimated at approximately U$706 million (men: U$527 million, women: U$178 million). The estimated total socioeconomic costs of overweight and obesity were approximately U$1,787 million (men: U$1,081 million, women: U$706 million). These total costs represented about 0.22% of the gross domestic product (GDP) and 3.7% of the national health care expenditures in 2005. We found the socioeconomic costs of overweight and obesity in Korean adults aged 20 yr and older are substantial. In order to control the socioeconomic burden attributable to overweight and obesity, effective national strategies for prevention and management of obesity should be established and implemented.

Acercamiento antropológico de la alimentación y salud en México / Anthropological approach to nutrition and health in Mexico

En este artículo presento un panorama de la alimentación en México, particularmente sobre la ciudad de México desde una perspectiva antropológica considerando aspectos socioculturales y económicos. Inicia con una breve revisión de los estudios antropológicos sobre alimentación en México, para reconocer tanto los aportes metodológicos como los principales problemas de estudio. Posteriormente, se presentan algunos datos de contextualización del país y de la ciudad que enmarcan los datos nutricios y alimentarios característicos. En las siguientes secciones se proponen algunas explicaciones sobre algunos de los fenómenos alimentarios contemporáneos, donde la obesidad es la característica principal en una sociedad de reciente acceso al consumo masivo, al mismo tiempo que se enfrenta al ideal cultural de delgadez. Los datos sobre la alimentación en México y los fenómenos sociales relacionados dan cuenta de la complejidad del fenómeno alimentario y de cómo los procesos macrosociales afectan las decisiones cotidianas de la gente. El análisis antropológico de la alimentación en la población mexicana ha permitido mostrar la relación entre estos procesos históricamente y en fechas recientes. Son la muestra de la utilidad de la metodología antropológica para estudiar la alimentación contemporánea, llena de contradicciones, que tienen que ver con el desarrollo del capitalismo y la sociedad de consumo, la promoción al consumo, y el acceso inmediato a él, la medicalización de la vida cotidiana, las ideas sobre el control corporal, y la imagen como un elemento de estatus.

This paper presents an overview of food in Mexico, particularly in Mexico City, from an anthropological perspective considering sociocultural and economic aspects. It begins with a brief review of anthropological studies on food in Mexico to recognize both the methodological contributions as the major problems of study. Subsequently, are presented some facts of contextualization of the country and city that frame the distinctive food and nutritional data. The following sections propose some explanations of some of the phenomena of contemporary food, where obesity is the main feature in a society of recent consumer access, while facing the cultural ideal of thinness. The data on food in Mexico and related social phenomena account for the complex nature of food and how macro-processes affect people's everyday decisions. The anthropological analysis of food in the Mexican population has been allowed to show the relationship between these processes historically and recently. They are the sign of the usefulness of anthropological methodology to study contemporary food, full of contradictions that have to do with the development of capitalism and consumer society, consumer promotion, and immediate access to it, the medicalization everyday life, ideas about body control, and image as an element of status.

Fatores socioeconômicos associados ao excesso de peso em população de baixa renda do nordeste brasileiro / Socioeconomic factors associated with overweight in a low-income population of northeast Brazil

Objetivo deste estudo foi descrever a prevalência do excesso de peso e os fatores possivelmente associados em adultos residentes em áreas de exclusão social. A amostra foi composta por 3.214 indivíduos de 20 a 69 anos residentes em assentamentos subnormais de Maceió-AL, na região Nordeste do Brasil. Na avaliação nutricional, foi utilizado o índice de massa corporal (IMC). Encontrou-se prevalência de excesso de peso de 41,2 por cento, (46,2 por cento mulheres vs. 32,6 por cento homens, p<0,001). A análise indicou, tanto entre os homens quanto entre as mulheres, maior chance de excesso de peso nas faixas de idade mais avançada (Razão de Prevalência [RP]= 1,62, IC95 por cento 1,37-1,90 e RP= 1,55, IC95 por cento 1,41-1,69, respectivamente), e entre os procedentes da zona rural (RP= 1,27, IC95 por cento 1,07-1,51 e RP=2,23, IC95 por cento 2,01-2,47, respectivamente). O risco de excesso de peso mostrou-se diretamente associado ao nível de escolaridade no sexo masculino (RP=0,78, IC95 por cento 0,63- 0,97) e inversamente no sexo feminino (RP=1,40, IC 95 por cento 1,17-1,66). Foi evidenciado risco maior de excesso de peso entre os homens de maior renda (RP= 1,29, IC95 por cento 1,09-1,53). No geral, as variáveis relacionadas às condições de moradia e aos bens de consumo evidenciaram que pequenas melhorias estão associadas ao maior risco de excesso de peso. Mesmo dentro dessa população de baixo nível socioeconômico, melhorias nas condições de moradia podem constituir-se em fatores de risco para o excesso de peso em adultos de ambos os sexos, enquanto que a educação se comporta como fator protetor no sexo feminino e a renda como fator de risco no sexo masculino.

The purpose of this research was to describe the overweight prevalence and factors potentially associated to it in adults residents in areas of social exclusion. The sample consisted of 3,214 individuals, aged 20 to 69 years, in shanty town in Maceió-AL, Northeast of Brazil. Body mass index (BMI) was used in the nutritional evaluation. Overweight prevalence of 41.2 percent was found (46,2 percent females vs. 32,6 percent males, p<0.001). The analysis indicated there is higher chance of getting overweight, both for males and females, in higher age ranges (Prevalence Ratio [RP]= 1.62, CI95 percent 1.37-1.90 and RP= 1.55, CI95 percent 1.41-1.69, respectively), and among those from rural areas (RP= 1.27, CI95 percent 1.07-1.51 and RP=2.23, CI95 percent 2.01-2.47, respectively). In males, the overweight risk is directly associated to the schooling level (RP=0.78, CI95 percent 0.63-0.97), whereas, in females it is inversely associated (RP=1.40, CI95 percent 1.17-1.66). A higher overweight risk was evidenced among men of higher income (RP= 1.29, CI95 percent 1.09-1.53). In general, small improvements in variables related to housing conditions and consumption goods are associated to higher overweight risk. Even in populations of low socioeconomic level, improvement in housing conditions can become an overweight risk factor in adults for both genders, whereas education is a protective factor for women and the income a risk factor in men.

Influencia de la obesidad en los costos en salud y en el ausentismo laboral de causa médica en una cohorte de trabajadores / Influence of obesity on health care costs and absenteeism among employees of a mining company

Background: The health associated costs of obesity can represent between 2 percent and 9 percent of the total health costs of a given country. Aim: To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Patients and wethods: Prospective study of 4.673 men, employees of a mining company, aged 49 ± 7 years that were followed for 24 ± 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Results: Mean annual health care costs for obese workers were 17 percent higher (p <0.001) compared to workers with normal weight and 58 percent higher (p <0.001) for workers with severe and morbid obesity. Mean annual days of sick leave increased by 25 percento in the obese (p =0.002) and by 57 percento in subjects with severe and morbid obesity (p <0.001). For health care costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95 percento confidence intervals (95 percent CI) 4.9 to 7.9), hypertension (OR 3-99; 95 percent CI3-4 to 4.6) and severe and morbid obesity (OR 2.55, 95 percento CI 1.9 to 3-4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95 percent> CI 1.2 to 2.0), hypertension (OR 1,34, 95 percent> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95 percento CI 1.1 to 2.1). Conclusions: Obesity increases significantly health care costs and absenteeism.

The burden of hospitalization due to overweight and obesity in Brazil

Os custos de hospitalização associados ao sobrepeso/obesidade e às doenças associadas no Brasil foram estimados utilizando-se os dados das hospitalizações de homens e mulheres de 20 a 60 anos do Sistema de Informações Hospitalares do Sistema Unico de Saúde (SIH-SUS) para o ano de 2001. O SUS cobre mais de 70 por cento das hospitalizações. A fração atribuível a hospitalizações associadas com obesidade/sobrepeso ou doenças relacionadas foi estimada com base na combinação dos riscos relativos de coortes americanas e européias. O custo direto total do sobrepeso/obesidade foi estimado pela soma do risco atribuível à população para cada morbidade multiplicada pelo valor de reembolso de cada morbidade. O total de custos foi equivalente a 3,02 por cento dos custos totais de hospitalização em homens e 5,83 por cento em mulheres, correspondendo a 6,8 e 9,3 por cento de todas as hospitalizações (excluindo gestantes). O excesso de peso no Brasil tem um impacto nas hospitalizações e nos custos similar ao observado em países desenvolvidos. Sendo a transição nutricional um processo em andamento no Brasil, o sobrepeso teve maior impacto nos custos do que a obesidade.

This article estimates the burden of hospitalization associated with overweight and obesity in Brazil. The analysis of all hospitalizations for men and women from 20 to 60 years of age was based on the National Healthcare Expenditure Database (SIH-SUS), covering more than 70 percent of all hospital admissions. Data were for the year 2001. Attributable fraction of hospitalizations associated with diseases related to obesity and overweight was based on the combined risks of United States and European cohorts. The population-attributable fraction for each disease studied was multiplied by values reimbursed to the hospitals and summed to obtain total direct costs. Overall costs of overweight and obesity represent 3.02 percent of total hospitalization costs for men and 5.83 percent for women, corresponding to 6.8 and 9.3 percent of all hospitalization (excluding pregnancy). Diseases associated with overweight and obesity had a significant impact on hospitalizations and economic costs in Brazil, and overall percentages were similar to those from developed countries. Since the nutritional transition is still under way in Brazil, overweight had a higher impact than obesity on disease prevalence and costs.

Obesity in Thailand.

Obesity is emerging as a morbid disease in developing and Westernized countries. Because of its comorbidity diseases, it is cost-effective to prevent and manage this disease earlier. In Thailand, this alarming disease has long been studied, but the prevalence is still higher than that in the past. Physicians should recognize it well and have a definite direction to face and combat this dangerous disease. The present paper demonstrates its definition, prevalence, health hazard, economic cost and strategies to deal with it in the present and future.

Obesity: diagnosis and prescription for action in the English-speaking Caribbean

La obesidad ha sido una epidemia silente de alcance mundial durante los últimos 30 años. A diferencia del sida, que apareció de repente y lleva el estigma de ser una enfermedad infecciosa y letal, la obesidad, como epidemia, se ha comportado de manera insidiosa. Por no ser una infección -en el sentido más aceptado de la expresión- y por conducir a un desenlace mortal de manera indirecta y solapada, se ha hecho caso omiso de que constituye un importante problema de salud. Este artículo describe brevemente la magnitud real de este problema en los países caribeños de habla inglesa; su enorme impacto sobre la salud, la calidad de vida, la morbilidad, la mortalidad y el costo de la atención sanitaria; sus causas principales, y posibles remedios. En el Caribe, este problema se debe en parte a la creencia de que la obesidad es reflejo de salud y que se prefiere a las mujeres obesas. Además, la transición epidemiológica en el Caribe -que ha pasado en solo una generación de ser una región agrícola pobre a una sociedad en desarrollo basada en el turismo, y de una sociedad muy activa físicamente con dieta limitada, a una de baja actividad física y exceso de alimentos- ha tenido un efecto impresionante. Existen muchas barreras para lograr la prevención de la obesidad en el Caribe. Por un lado, no hay suficiente información acerca de los factores de riesgo, la morbilidad y la mortalidad, y son pocos los estudios que proponen métodos de intervención eficaces. Por otro lado, los sistemas de salud de los países caribeños carecen de suficientes nutricionistas, educadores de salud, fisioterapeutas y quinesiólogos. Entre las barreras ambientales figuran la falta de parques y otros espacios abiertos, la escasez de aceras y áreas para ciclistas, así como la presencia de delincuencia en las calles. En respuesta a esta situación, en este artículo se recomiendan medidas urgentes que deben ser concertadas a escala regional en siete frentes específicos, que van desde reconocer que la obesidad es un problema de salud pública que atañe a los médicos, hasta la importancia de la prevención y la necesidad de pasar a un enfoque multidisciplinario y multisectorial para abordar su solución

Custos do tratamento ambulatorial de obesos no Hospital Universitário da Universidade Federal do Rio de Janeiro (UFRJ) / Costs of ambulatory obese's treatment at the University Hospital of Federal University of Rio de Janeiro (UFRJ)

Este estudo foi realizado no Hospital Universitário da Universidade Federal do Rio de Janeiro, ambulatório de Nutriçäo, constando da análise de dados do prontuário de 96 pacientes, correspondendo a 14 por cento dos obesos atendidos no período de um ano. O objetivo foi a determinaçäo da relaçäo custo/efetividade do tratamento. A diferença bruta da perda de peso, em média, do peso inicial para o final foi de 3,26ñ5,3Kg, e o tempo de tratamento dentro do hospital teve como média 58ñ40,4 meses. Através do teste do qui quadrado (x²) estabeleceu-se uma correlaçäo entre o custo anual por paciente e as seguintes variáveis: idade, sexo, regularidade no tratamento, local de trabalho, índice de Massa Corporal (IMC) inicial e outras patologias. Näo se encontrou qualquer correlaçäo estatística entre o custo por paciente e as variáveis citadas acima. Obteve-se para cada quilograma perdido um custo de US$327,31, uma relaçäo extremamente alta, onde o aparato hospitalar se encontra acionado em situaçöes nem sempre necessárias. Se, por um lado, o custo independe do trabalho do profissional nutricionista, por outro a perda de peso fica aquém da maioria dos trabalhos pesquisados. É necessária uma análise mais aprofundada das causas deste alto custo, mas fica patente a necessidade de reavaliaçäo contínua e de uma maior integraçäo com o sistema primário de saúde.