Background: Given the current worldwide epidemic of obesity, there is a demand for interventions with higher impact, such as those carried out in the primary health care (PHC) setting. Here we evaluate the effect of intervention performed according to the stages of change of the transtheoretical model (TTM) for weight management. Methods: This randomized controlled trial in Brazilian PHC offered free physical exercise and nutrition education. The participants were women, aged 20 years or older who were obese or overweight, users in PHC service. The intervention group (IG, n = 51) received the same orientation as the comparison group (CG, n = 35) plus individual health counseling based on the TTM aimed at weight loss, which lasted 6 months. The outcome measures were anthropometric, food, and nutrient profiles. Inflammatory parameters were evaluated in a random subsample. The inter-group and intra-group differences were evaluated using interntion-to-treat analysis, and analysis of covariance (ANCOVA) used to assess intervention effectiveness. Results: There was a difference between groups of − 1.4 kg (CI95%: − 2.5; − 0.3) in body weight after the intervention. About 97% of women in the IG reported benefits of the intervention and presented positive changes in diet, biochemical markers, and anthropometry. The IG showed better body mass index, resistine, and blood glucose results compared to the CG during follow-up. Conclusion: The individualized TTM-based intervention, combined with usual care, was an effective strategy in PHC. These results should encourage the use of interdisciplinary practices; nevertheless, research to identify additional strategies is needed to address barriers to weight maintenance among obese low-income women. Trial registration: The trial is registered with Brazilian clinical trials under the code: RBR-8t7ssv, Registration date: 12/12/2017 (retrospectively registered).

Ecological studies are essential for understanding the environment-diet relationship. The purpose of this study was to describe environmental conditions and their relationship with fruit and vegetable (FV) consumption among Brazilian public health service users in the city of Belo Horizonte. We evaluated food stores contained within 1600 m buffer zones at 18 Health Academy Programme sites, from 2013 to 2014. Variables at the community (density, proximity and type) and the consumer (sectional location of FV; availability, quality, variety, price and advertising of FV and ultra-processed foods) nutrition environment were measured by direct observation, while aggregate data from users (income and FV consumption) were obtained by interview. Data were analysed using the Kernel intensity estimator, average nearest neighbour value and Local Moran's Index for local spatial autocorrelation. We interviewed 3414 users and analysed 336 food stores. Major geographical variations in the FV consumption were identified. Average consumption was higher (site 2A: 410.5 ± 185.7 g vs. site 4B: 311.2 ± 159.9 g) in neighbourhoods with higher income and concentration of food stores, and better index of access to healthy foods. Sites with poor FV consumption had the most stores with poor access to healthy foods (index in the first tertile, ≤ 10). In conclusion, negative characteristics of the food environment, as seen in the present study, may contribute to low FV consumption, suggesting the need for the development and consolidation of public policies aimed at creating healthy environments through built environment interventions that increase access to and consumption of healthy foods like FV.

Resumo Objetivou-se identificar diferenças no consumo alimentar, segundo marcadores de alimentação saudável e não saudável, entre adultos residentes nas áreas urbanas e rurais do Brasil. Realizou-se estudo transversal com dados da Pesquisa Nacional de Saúde (2013). A alimentação foi avaliada por marcadores de alimentação saudável e não saudável. Estimou-se as prevalências (%) e modelos de regressão logística sequencial foram ajustados para estimar odds ratio (OR) e intervalos de confiança (IC95%). Verificou-se maior consumo de frutas e hortaliças, peixes, refrigerantes e substituições de refeições nas áreas urbanas, enquanto que, o consumo de carne com gorduras e feijão foi maior nas áreas rurais. Análises ajustadas mostraram maior consumo regular de feijão e de carne com excesso de gordura; e menor consumo de refrigerantes, de frutas e hortaliças e de substituição de refeições por lanches nas áreas rurais em comparação com as urbanas. Tendências semelhantes foram observadas nas macrorregiões do país. As diferenças no consumo alimentar de brasileiros residentes em áreas rurais e urbanas denotam a importância de fomentar políticas de alimentação que respeitem e valorizem as tradições e a cultura alimentar.