Protocol of Randomized Controlled Community Trial (RCCT) for obesity management in Brazilian primary health care.

BACKGROUND: Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care. METHODS: Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS". DISCUSSION: The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory. TRIAL REGISTRATION: RBR-3vzsyqq and RBR-6pg682m.

Weight bias and identity characteristics among students at a public university in Southern Brazil / Discriminação relacionada ao peso e suas vinculações com características identitárias entre estudantes de uma universidade pública no sul do Brasil

ABSTRACT Objective Despite the consequences of weight discrimination for health inequities, its relationship with identity characteristics remains poorly understood. We investigated whether and to what extent discrimination attributed to body weight is linked to sociodemographic and identity factors. Methods This cross-sectional study is based on a representative sample of undergraduate students from the Federal University of Santa Catarina. Information on perceived discrimination was collected using the brief version of the Explicit Discrimination Scale. Socioeconomic and demographic data were also collected. Results: The results showed that 22.8% of the sample reported experiencing discrimination for being "fat or thin" throughout their lives. Perceived weight discrimination was higher among respondents whose household heads had completed up to high school education, and among those who were overweight and rated their health as "poor." Conclusion Perceived weight discrimination was associated with significant factors linked to the stigmatization and pathologization of body weight. These findings should be considered in more inclusive approaches aimed at counteracting the embodiment of social inequalities.

RESUMO Objetivo Apesar das repercussões da discriminação pelo peso serem reconhecias nas iniquidades em saúde, sua relação com outras características identitárias ainda é pouco compreendida. Investigamos o quanto a experiência de discriminação relacionada ao peso corporal está vinculada a fatores sociodemográficos e aspectos identitários. Métodos Trata-se de um estudo transversal, baseado em amostra representativa dos graduandos da Universidade Federal de Santa Catarina. As informações sobre percepção de discriminação foram obtidas com a Escala de Discriminação Explícita, em sua versão reduzida. Dados socioeconômicos e demográficos também foram coletados. Resultados Os resultados demonstraram que 22,8% dos respondentes perceberam ter sido discriminados por "ser gordo ou magro" ao longo da vida. Esse tratamento diferencial esteve mais fortemente vinculado à percepção de discriminação por "apresentar determinado comportamento" ou "modo de se vestir". No modelo de regressão ajustado, a discriminação percebida por "ser gordo ou magro" foi maior para a faixa etária de 23 a 27 anos; para os respondentes cujos chefes do domicílio tinham até o ensino médio completo; e para aqueles com excesso de peso e autoavaliação de saúde "ruim". Conclusão A discriminação percebida por "ser gordo ou magro" esteve relacionada a importantes características e condições que se associam com o estigma e a patologização da gordura corporal. Tais achados devem ser considerados em abordagens mais inclusivas de combate à incorporação de injustiças sociais.

Indigenous protagonism in the context of food insecurity in times of Covid-19 / O protagonismo indígena no contexto da insegurança alimentar em tempos de Covid-19

ABSTRACT In Brazil, indigenous peoples present a complex reality characterized by a marked social vulnerability that is manifested in health and nutritional indicators. In this scenario, poor sanitary conditions prevail, with a high burden of chronic noncommunicable diseases; infectious/parasitic diseases; and nutritional disorders, including malnutrition and anemia. This situation is reflected in numerous aspects of food insecurity, placing this population in a position of particular vulnerability to the coronavirus disease 2019 pandemic and its effects. The objective of our study was to present a set of preliminary reflections on food insecurity and indigenous protagonism in times of Covid-19. The pandemic has deepened the inequalities that affect the indigenous peoples, with a direct impact on food security conditions. Amid the effects of the pandemic, indigenous protagonism has played a fundamental role in guaranteeing these peoples' rights and access to food, denouncing the absent and slow official responses as acts of institutional violence, which will have serious and lasting effects on the lives of indigenous peoples.

RESUMO No Brasil, os povos indígenas apresentam uma realidade complexa e caracterizada por uma acentuada vulnerabilidade social, manifesta em indicadores de saúde e de nutrição. Neste cenário prevalecem condições sanitárias precárias, com elevada carga de doenças crônicas não transmissíveis, doenças infecto-parasitárias e agravos nutricionais diversos, incluindo desnutrição e anemia. Esse quadro se reflete em inúmeras faces da insegurança alimentar, situando-os em uma posição particularmente vulnerável à pandemia e seus efeitos. O objetivo deste trabalho é apresentar um conjunto de reflexões, em caráter preliminar, sobre a insegurança alimentar e o protagonismo indígena em tempos de Covid-19. A pandemia vem aprofundando as iniquidades que os atingem, com impactos diretos nas condições de segurança alimentar. O protagonismo indígena tem tido um papel fundamental na garantia de seus direitos e acesso à alimentação, denunciando a ausência e a lentidão das respostas oficiais como ações de violência institucional, que terão graves e duradouros efeitos nas trajetórias destes povos.