valeriaefiufv@yahoo.com.br

oilujsotnas@gmail.com

larissa17_12@hotmail.com

leomarquesqueiroz@gmail.com

guilhermelopes19oficial@gmail.com

guilhermenhimi@gmail.com

guipussi@hotmail.com

*Doutora em Ciências da Reabilitação pela Universidade Federal de Minas Gerais

Mestre em Educação Física pela Universidade Federal de Viçosa

Especialização em Reabilitação Cardíaca e Grupos Especiais pela Universidade Gama Filho

Graduação em Educação Física pela Universidade Federal de Viçosa

Educadora física do Agros - Instituto UFV de Seguridade Social

**Licenciado em Educação Física pela Universidade Federal de Viçosa - Campus Florestal

Especialização em Fisiologia do Exercício pela Faculdade do Grupo UNIASSELVI

Professor Substituto da Universidade Federal de Viçosa – Campus Florestal

***Licenciada em Educação Física pela Universidade Federal de Viçosa - campus Florestal

Mestranda em Educação Física, na área de atividade física e saúde pela 

Universidade Federal de Viçosa. Especialização em Fisiologia do Exercício, Treinamento Desportivo

e em Qualidade de Vida e Saúde pela Faculdade do Grupo UNIASSELVI

****Licenciado em Educação Física pela Universidade Federal de Viçosa - Campus Florestal

Graduando em Educação Física Bacharelado

pela Universidade Federal de Viçosa – Campus Viçosa

*****Estudante de Licenciatura em Educação Física

na Universidade Federal de Viçosa - Campus Florestal

******Licenciado em Educação Física

pela Universidade Federal de Viçosa - Campus Florestal

Graduando em Educação Física Bacharelado pela Faculdade Única de Contagem

*******Professor da Universidade Federal de Viçosa - Campus Florestal

Ex-Técnico da Seleção Brasileira de Ciclismo, modalidade BMX

pela Confederação Brasileira de Ciclismo

Graduado em Educação Física pela Faculdade

de Ciências da Saúde do Instituto Porto Alegre

Mestre em Treinamento Esportivo / Educação Física

pela Universidade Federal de Minas Gerais

Doutor em Ciências da Atividade Física e do Desporto

pela Universidade de León / Espanha cujo título foi revalidado pela USP

(Brasil)

Reception: 05/24/2020 - Acceptance: 12/25/2020

1st Review: 10/14/2020 - 2nd Review: 10/17/2020

Accessible document. Law N° 26.653. WCAG 2.0

Citação sugerida: Faria, V.C. de, Rocha,, J.C.P. de M. dos S., Guilherme, L.Q., Queiroz, L. da S., Oliveira, G.L. de, Paula, G.N.M. de, & Pussieldi, G. de A. (2021). Logical Model of a Program to Combat Child and Adolescent Obesity in Supplementary Health. Lecturas: Educación Física y Deportes, 25(272), 135-145. Recuperado de: https://doi.org/10.46642/efd.v25i272.2280

 

Abstract

    Actions to combat obesity in childhood and adolescence in the context of supplementary health are necessary and there is a scarcity in the literature of intervention models that address this theme. The aim of this study was to describe the intervention and the model of a program to combat obesity, by a health care operator. The Espaço MultiDiversão program is a modality offered by the Agros Service of Physical Activity and Health (Espaço Movimento), a partnership between the Federal University of Viçosa - Campus Florestal (UFV-CAF) and your health plan operator, which aims to serve the beneficiaries of 6 to 15 years of age residing in Florestal-MG. This program is developed in Florestal, Minas Gerais, Brazil, at UFV-CAF. The data presented in this study refer to the first class selected in September 2017. The interested are subject to physical evaluation and medical evaluation. The intervention happens under the coordination of a physical educator, and has a multiprofessional approach of the physical education, nutrition and psychology. In this logical model highlights the partnership of public and private institutions, which enabled the necessary resources for this intervention, and data are presented that justify the investment in programs in primary care.

    Keywords: Primary health care. Multidisciplinary team. Physical activity.

 

Resumen

    Las acciones para combatir la obesidad en la infancia y la adolescencia en el contexto de la salud suplementaria son necesarias y existe una escasez en la literatura de modelos de intervención que aborden este tema. El objetivo de este estudio fue describir la intervención y el modelo de un programa para combatir la obesidad, realizado por un operador de salud. El programa Espaço MultiDiversão se presenta como una modalidad ofrecida por el Servicio Agros de Actividad Física y Salud (Espaço Movimento), una asociación entre la Universidad Federal de Viçosa - Campus Florestal (UFV-CAF) y su operador del plan de salud, cuyo objetivo es asistir a beneficiarios de 6 a 15 años que viven en Florestal-MG. Este programa se desarrolla en Florestal, Minas Gerais, Brasil, en UFV-CAF. Los datos presentados en este estudio se refieren al primer grupo seleccionado en septiembre de 2017. Las partes interesadas están sujetas a evaluación física y médica. La intervención se lleva a cabo bajo la coordinación de un educador físico y tiene un enfoque multiprofesional de educación física, nutrición y psicología. En este modelo lógico, se destaca la asociación de instituciones públicas y privadas, que proporcionaron los recursos necesarios para esta intervención, y se presentan datos que justifican la inversión en programas de atención primaria.

    Palabras clave: Atención primaria de salud. Equipo multiprofesional. Actividad física.

 

Resumo

    Ações para combater a obesidade na infância e adolescência no contexto da saúde suplementar são necessárias e há escassez na literatura de modelos de intervenção que abordem esse tema. O objetivo deste estudo foi descrever a intervenção e o modelo de um programa de combate à obesidade, realizado por uma operadora de saúde. O programa Espaço MultiDiversão apresenta-se como uma modalidade oferecida pelo Serviço Agros de Atividade Física e Saúde (Espaço Movimento), uma parceria entre a Universidade Federal de Viçosa – Campus Florestal (UFV-CAF) e sua operadora de plano de saúde, que visa atender os beneficiários de 6 a 15 anos de idade residentes em Florestal-MG. Este programa é desenvolvido em Florestal, Minas Gerais, Brasil, na UFV-CAF. Os dados apresentados neste estudo referem-se à primeira turma selecionada em setembro de 2017. Os interessados estão sujeitos a avaliação física e avaliação médica. A intervenção acontece sob a coordenação de um educador físico, e conta com uma abordagem multiprofissional da educação física, nutrição e psicologia. Nesse modelo lógico, destaca-se a parceria de instituições públicas e privadas, que possibilitaram os recursos necessários para essa intervenção, e são apresentados dados que justificam o investimento em programas na atenção primária.

    Unitermos: Atenção primária à saúde. Equipe multiprofissional. Atividade física.

 

Lecturas: Educación Física y Deportes, Vol. 25, Núm. 272, Ene. (2021)

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Introduction 

 

    Currently, there is a consensus that the excess weight of the population has negative consequences both for the individual and for society (Dias, & Verona, 2019), and this reinforces the importance of studies on obesity with regard to its causes, consequences and methods of intervention. In the area of ​​supplementary health, in Brazil from 2008 to 2016, there was an increase from 46.5 to 53.7% of overweight and from 12.5 to 17.7% of obesity in the beneficiaries of health plans over 18 years (Ministério da Saúde, 2017). Regarding obesity in childhood and adolescence, data from the Brazilian Institute of Geography and Statistics (IBGE), collected between 2008 and 2009 in Brazil, indicate that in the age group of 5 to 9 years old 37% were overweight and 15% were obese; and in the 10-19 age group, overweight rates were 34.8% for boys and 32% for girls, and obesity rates were 16.6% for boys and 11.8% for girls (IBGE, 2010). In this context, the National Supplementary Health Agency (ANS) has encouraged health insurance providers to promote actions to prevent and cope with obesity, among these actions the approach in childhood and adolescence stands out, (ANS, 2017)

 

    In this sense, the literature establishes that physical activity is extremely important for health, as it prevents diseases, improves motor, cognitive and affective development, in addition to promoting the physical and mental well-being of its practitioners (Torrado, Martins, Rendeiro, Marques, & Costa, 2016). On the other hand, insufficient levels of physical activity associated with changes in the population's lifestyle and diet can carry risks of developing chronic non-communicable diseases (NCDs) (Carneiro, Lima, Marinho, & Souza, 2016), such as obesity, diabetes, hypertension, among others. Specifically, among children, poor eating habits are the result of changes in the family and social environment (Fernández, 2006). Thus, there is a need to implement public health and supplementary interventions aimed at stimulating physical exercise and improving eating habits that cause overweight and obesity in the early stages of life. (Enes, Pegolo, & Silva, 2009; Duarte et al., 2018)

 

    In addition, the practice of healthy habits is necessary in the early stages of life since in adolescence important changes occur in the personality of the individual and for this reason it is considered a favorable phase for the consolidation of habits that may have direct implications for health in adult life (Enes, & Slater, 2010). However, to achieve this goal, it is essential to consider the psychosocial aspects related to obesity at this stage of life, which makes multiprofessional work and family support essential, (Rocha et al., 2017)

 

    In view of the need for actions to combat obesity in supplementary health and the scarcity in the literature of intervention models that act on this theme, the objective of this study was to describe the intervention and the logical model of a program to combat childhood obesity proposed by a healthcare operator.

 

Methods 

 

    The proposed intervention model meets the ANS guideline regarding the adoption of multiprofessional teams in the development of health promotion and risk and disease prevention programs (ANS, 2009), and, in addition, this intervention meets the panorama of the actions recently developed by health insurance operators health, in which the most explored health care areas are children and adolescents. (ANS, 2008)

 

The Espaço Movimento 

 

    In the city of Florestal, Minas Gerais, Brazil, since 2013 there has been the Agros Service for Physical Activity and Health (Espaço Movimento), a partnership between the Federal University of Viçosa - Campus Florestal (UFV-CAF) and its health plan operator. The proposal for this Service was assessed and approved by the Ethics Committee in Research with Human Beings of the Federal University of Viçosa under registration number 487,635, as determined in resolution 466/12 of the National Health Council, which is in agreement with the Helsinki declaration. The purpose of Espaço Movimento is to promote health and prevent risks and diseases to the beneficiaries of this health operator through regular and scheduled physical activity, and also, through a calendar of events in conjunction with the entire Florestal community, to promote physical activity and health education. More information about this Service can be obtained in the study by Faria et al. (2017) which presents its logical model between 2013 and 2015, aimed at the adult audience.

 

    In September 2017, a new modality of regular activity, the Espaço MultiDiversão, was added to this logical model (Faria et al., 2017), which aims to serve children and adolescents from the perspective of combating obesity and preventing its complications. The name of the modality came up during the team presentation meeting with the parents and guardians of the participants, thus referring to the general proposal of the Espaço Movimento for Multiprofessional care, and because it is for children and adolescents, it was defined that interventions prioritize fun.

 

Target audience 

 

    The Espaço MultiDiversão is designed to serve all beneficiaries of this health care provider from 6 to 15 years of age residing in Florestal. To establish the age group, the experience in the consultations and the suggestion of the pediatrician of this health operator was considered. The program was disseminated through posters, leaflets and during medical consultations.

 

Pre-intervention procedures 

 

    Initially, those interested in the program, accompanied by their guardian, undergo a physical evaluation with the physical educator, which is composed of an anamnesis to assess the general health history; assessment of body mass and height for the calculation of body mass index (BMI) and subsequent classification of nutritional status (World Health Organization, 2007a, 2007b); and by applying the physical activity level questionnaire (IPAQ). (Matsudo et al., 2011)

 

    Afterwards, the participants undergo a medical evaluation to evaluate the clinical history and physical examination, and with the medical clearance, children and adolescents are able to participate in the program.

 

Intervention 

 

    The intervention takes place under the coordination of a physical educator, and has a multiprofessional approach to physical education, nutrition and psychology. Physical activity takes place twice a week in two periods, morning and afternoon, lasting one hour each session, and is taught by students of the Physical Education course at UFV-CAF. The activities are carried out in groups, and can be divided into subgroups, always with a playful and recreational nature.

 

    Each physical activity session is structured in the following sequence: 5 to 10 minutes of warm-up, in order to prepare the participants' bodies for the next steps, as well as, to prevent injuries; 40 to 50 minutes of the main part with games and games aimed at the motor and physical development of the participants, with an emphasis on caloric expenditure; 5 to 10 minutes of activity back to calm. The progression of activities occurs according to the monitors' perception of students.

 

    The approach to nutrition and psychology with children and adolescents happens regularly once a month, alternating the specialty, on the day and time established for physical activity, through group dynamics with issues relevant to coping with obesity. Considering that the interventions that integrate the family have better results in combating childhood and adolescent obesity (Sichieri, & Souza, 2008), parents or guardians are also invited to participate in the dynamics of nutrition and psychology at a different time than children.

 

Results 

 

    Figure 1 shows the logical model of the EspaçoMultiDiversão adopted in its first year of intervention.

 

 

    In this logical model, the partnership between public (UFV-CAF) and private (health operator) institutions stands out, which provided the necessary resources for the development of the Espaço MultiDiversão. The importance of this partnership was already presented in the first study carried out by this working group (Faria et al., 2015), in which it was identified that the intervention proposed for adult individuals was beneficial to the health of its participants. Thus, in order to take advantage of the benefits of this partnership and expand the scope of care provided by Espaço Movimento, from children to the elderly, the implementation of the Espaço MultiDiversão stands out.

 

    There were 45 participants seen in the program over the first year, with an average age of 9.49 years, a minimum of 6 and a maximum of 15 years. The results of the classifications of the level of physical activity and nutritional status, by sex and total, obtained in the pre-intervention physical assessment, are described in Table 1.

 

	Female (n=25)	Male (n=20)	Total (n=45)
Physical activity level (IPAQ)
Insufficiently Active	21 (84%)	11 (55%)	32 (71,1%)
Active	3 (12%)	8 (40%)	11 (24,4%)
Very active	1 (4%)	1 (5%)	2 (4,4%)
Nutritional status (IMC)
Regular weight	15 (60%)	5 (25%)	20 (44,4%)
Overweight	6 (24%)	6 (30%)	12 (26,7%)
Obesity	4 (16%)	9 (45%)	13 (28,9%)

 

    According to the register of beneficiaries of this health operator accessed on September 1, 2017, the period in which the program started, there were 118 beneficiaries aged 6 to 15 years living in Florestal, so in its first year of intervention, the program attended 38.13% of those. In addition, according to Table 1, it is important to consider that out of the 45 patients attended, there is a high prevalence of insufficiently active children and adolescents (71.1%) and overweight (55.6%).

 

Discussion 

 

    From the logical model presented, it is possible to observe the importance of the existing public and private partnership (University and Health Operator) to guarantee all the necessary resources for an intervention proposal that intend to go beyond regular physical activity, but which also has purpose of providing health education opportunities for children and adolescents, and their parents or guardians. This is in line with other studies (Pohl, Beschorner, Couto, Lenhard, & Santos, 2020; Barbosa, & Malik, 2015) that highlight the importance of intersectorality and that mention that this type of partnership represents an opportunity to improve health care, in addition to satisfying the public served.

 

    Considering the products reached in the first year, especially the relative frequency of 83 monthly participation of children and adolescents, which represents an average of only 23% of use of the activities offered monthly, one of the challenges of the program is to regularize the participation of participants in the activities, which is directly dependent on the commitment of parents or guardians to the proposal, since their support and encouragement is an important factor for young people to join the program (Souza, & Mezzadri, 2009). A possible explanation for this low frequency is the fact that the intervention occurs outside the school environment and so far without the participation of other health services, which are pointed out, together with family members, as fundamental contexts to combat obesity in adolescence (Neves, Rodrigues, São Bento, & Minayo, 2020). In this sense, as a positive aspect of the products, the partnership invitation made by the Florestal Health Secretariat to the Espaço MultiDiversão stands out.

 

    Although the proportion of beneficiaries served in the first year has not been so significant, which tends to increase with time and new partnerships, the data from the pre-intervention physical assessment show a high prevalence of insufficiently active individuals (71%) and with excess of weight (55.6%), which justifies the investment in developing a program to combat childhood and youth obesity on the part of this supplementary health operator, because, thus, it is expected a better quality of life in childhood and less future expenses with treatments triggered obesity.

 

    A limitation of the present study was that it did not present the effects of the intervention on the children's nutritional status. However, this intervention proposal provides for annual physical and medical reassessments, so these results will be presented in a future study. On the other hand, this study stands out because it meets the position of Lew et al. (2019), who point out the need for studies that present details to assist in the implementation of interventions to combat childhood obesity in different contexts, and even that incorporate the dialogue between professionals and parents.

 

Conclusion 

 

    Considering the description of the intervention and the logical model presented in this study, it can be concluded that, regardless of the context, in order to establish a program to combat childhood and youth obesity, it is important to develop partnerships, have a multiprofessional team, and also, insert the family actively in the proposal intervention. Finally, it is expected that this proposal will serve as a model and incentive for other health operators, as well as for other private or public institutions, which are interested in investing in primary health care and saving on the treatment of future complications.

 

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Lecturas: Educación Física y Deportes, Vol. 25, Núm. 272, Ene. (2021)