Desafios e potencialidades da rede de atenção à saúde no cuidado a pessoas com sobrepeso e obesidade no município de São Gonçalo - RJ

Abstract

Overweight has become a major public health issue in Brazil and worldwide, with increasing prevalence across all stages of life. This situation calls for urgent investments in healthcare for individuals living with these conditions, encompassing health promotion, treatment, prevention, comorbidity management, and rehabilitation. This study aimed to analyze the organization of care for people with overweight and obesity in the municipality of São Gonçalo-RJ, focusing on the development and implementation of a specific Line of Care, and identifying its main challenges and potentialities. A qualitative case study approach was adopted, with an analytical-interpretive perspective grounded in the theoretical frameworks of Health Care Networks, comprehensiveness of care, and dimensions of care management in health. Data collection included secondary data from official databases and municipal internal sources to characterize the health service organization and the municipality’s epidemiological profile. In addition, 13 semi-structured interviews and four focus groups were conducted (involving 38 participants), including managers from the Municipal Health Department and Primary Health Care professionals. The analysis was structured into the following dimensions: Systemic: organization of the Health Care Networks and integration among levels of care; Organizational: actions, programs, protocols, work flows and work processes aimed at overweight and obesity care; Professional: health worker’s perceptions of obesity, the bonds established and practices of shared responsibility; and macro and micro processes: the trajectory of the Line of Care for Overweight and Obesity (LCOO), from its development to the challenges encountered during implementation. The results show that although the municipality has an extensive care network and strategies such as multiprofessional teams, School Health Program and infrastructure improvements, significant fragmentation remains across levels of care, with no standardized protocols for overweight and obesity management and weaknesses in the coordinating role of Primary Health Care. The development of the LCOO was driven by the Technical Area of Food and Nutrition, which recognizes obesity as a public health issue but lacks political strength in the municipal scenario. It´s implementation faces obstacles such as professional turnover, political interference, precarious employment conditions and lack of continuing health education policies, among others. Daily practices are based on isolated actions, often dependent on individual professional initiatives. It is concluded that consolidating the LCOO in the municipality requires intersectoral efforts, strengthening Primary Health Care governance, institutionalizing protocols and practices, enhancing coordination across Health Care Networks service points and investing in service organization, workforce expansion and training and overcoming limitations in the specialized care network. The findings can guide local management and other similar experiences to organize their LCOO.