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).

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.

OBJECTIVE: To analyze the quantity and diversity in the consumption fruits and vegetables, as well as its relationship with the consumer’s purchase characteristics and food environment. METHODS: Baseline study stemming from a controlled and randomized community trial investigating a sample representative of Primary Health Care services (Health Academy Program) of Belo Horizonte, state of Minas Gerais. The intake of fruits and vegetables was analyzed in servings/day, whereas diversity was assessed by the Food Frequency Questionnaire. Users were also questioned on the frequency, purchase location and availability of these foods at their households. To assess the consumer’s food environment, commercial establishments within a 1.6 km radius around the program unit sampled were audited. RESULTS: 3,414 adults and older adults (88.1% women) were investigated, as well as 336 commercial establishments, in 18 units of the Health Academy Program. The average consumption of fruits and vegetables was adequate [5.4 (SD = 2.1) servings/day] but monotonous, with average daily intake of two different types. In the establishments audited, a good diversity (77.7% and 85.0%) and variety (74.5% and 81.4%) of fruits and vegetables was observed, although with lower quality of vegetables (60.4%). After adjusting for sociodemographic variables, we identified that knowledge on food crops (p = 0.006), increased monthly availability of fruits at households (p < 0.001), and greater variety of fruits (p = 0.03) and quality of vegetables (p = 0.05) in commercial establishments could improve the quantitative intake of fruits and vegetables, whereas a greater variety of fruits (p = 0.008) would increase consumption diversity. CONCLUSIONS: The intake of fruits and vegetables was quantitatively adequate but monotonous, being influences by the consumer environment. Such results highlight the need for improving educational actions in health services and programs, in addition to acting on the consumer environment, aiming to promote and maintain the adequate and diversified consumption, as recommended by Brazilian guidelines for proper and healthy eating.

This study aims to describe the adequacy of basic health units (UBS) in Brazil regarding structure and work process for obesity management and to evaluate user satisfaction with primary health care services. This cross-sectional study was conducted with data from the 2013-2014 National Program for Improving Primary Care Access and Quality (PMAQ) - an initiative to assess primary health care teams’ performance. Data were collected between 2013 and 2014 through interviews with primary health care teams and users. All indicators of adequate care for obesity were defined within the article scope, based on data from the PMAQ. Of the 24,055 UBS analyzed, located in 4,845 different cities, only 7.6% had adequate structure for obesity management. Likewise, only 26.6% of the 114,615 users interviewed reported adequate access, and 27.8% of the UBS showed adequate service organization. Healthcare was considered as “good” or “very good” by 82.4% of users. These indicators varied according to geographic region, showing better results for the South and Southeast. Our results suggest that the country may still be at the initial stage of systematizing care with obesity, presenting significant disparities among regions.

Objective: Describing the consumption of ultra-processed foods (UPF) and their association with the nutritional profiles among users of a health promotion service in a Brazilian city.Design: Cross-sectional study.Setting: Public health promotion service of Primary Health Care in Belo Horizonte, Minas Gerais, Brazil.Participants: Totally, 3372 participants.Results: UPF were found to contribute to 27·7 % of the diet’s total energy. The highest consumption was associated with higher values for energy intake (1561·8v. 1331·8 kcal/d;P< 0·01), energy density (1·7v. 1·4 kcal/g;P< 0·01), total (32·5v. 27·3 %;P< 0·01) and trans-fats (2·1v. 1·2 %;P< 0·01) and Na (1001·6v. 758·9 mg/1000 kcal;P< 0·01) and with lower values for proteins (14·9v. 19·6 %;P< 0·01), mono-unsaturated fats (16·1v. 20·1 %;P= 0·02),n-3 (0·9v. 1·1 %;P< 0·01) and some vitamins and minerals when comparing individuals in the last quintile of energy contribution from UPF in relation to the first one. The prevalence rate of nutrient inadequacy aimed at preventing non-communicable diseases increased between 30 % and 100 % when compared with the values of the fifth to the first quintile of UPF consumption (P< 0·001). However, the participants had lower energy intake, energy density and Na and higher fibre consumption when compared to Brazilian population.Conclusions: Participants showed a high consumption of UPF, but also positive diet characteristics when compared with the national data. The results suggest the importance of health promotion services to promote healthy food and the need to include approaches to reduce UPF consumption.

Resumo Objetivou-se analisar espacialmente a distribuição de estabelecimentos de aquisição de alimentos para consumo imediato no entorno do Programa Academia da Saúde (PAS) de Belo Horizonte, Minas Gerais, Brasil, segundo Índice de Desenvolvimento Humano Municipal (IDHM). Estudo ecológico tendo o PAS como unidade de análise. Foram avaliados estabelecimentos de aquisição de alimentos para consumo imediato contidos em buffer circular com raio de 900 metros a partir das 77 unidades do PAS em funcionamento. Endereços e tipos de estabelecimento foram obtidos em lista pública e verificados em auditoria virtual. Mapas de Kernel temático foram elaborados. Identificou-se 3.050 estabelecimentos no entorno das unidades do PAS. Maiores densidades foram observadas na região Centro-sul da cidade e em áreas com IDHM alto e muito alto. Foi elevada a densidade de estabelecimentos comerciais de venda de alimentos para consumo imediato no entorno das unidades do PAS, sobretudo em áreas mais ricas. Os resultados podem subsidiar ações que visem fortalecer o PAS como promotor de ambientes alimentares saudáveis. Ademais, reforça a necessidade de políticas públicas equânimes de abastecimento e regulação visando promover o acesso à alimentação adequada e saudável para todos.