Group Health Education in the Treatment of Obese Class III: a Challenge for Health Professionals

ABSTRACT Obesity has become a serious, global public health problem, with the number of people it affects reaching extreme numbers in recent years.In view of the increase in overweight and obese individuals in the municipality of Rio de Janeiro, the Municipal Health Department of Rio de Janeiro (SMSRJ), with the technical support of the Annes Dias Institute of Nutrition (INAD), implemented the first Obesity Reference Centre (CRO) in the district of Acari in July 2011.This service offers outpatient clinical treatment for class III obesity users (also known as morbid obesity), with individual consultations, as well as group visits. It also represents a specialized support service, contributing toward the increased capacity of Primary Health Care (PHC) teams to offer assistance to users with this profile through a cross-functional team composed of a physical education instructor, nurse, endocrinologist, nutritionist and psychologist.In this context, based on the experiences of the CRO, the objective of the study is to perform a literature review on the importance of group health education activities in the treatment of class III obese individuals and how health professionals have addressed this topic in publications of the last five years. Methodology This is an integrative literature review, according to the PICO strategy (participants, intervention, context and results), the data of which was collected between October and November 2018, in the Latin American Literature and Caribbean in Health Sciences (Lilacs), Web of Science, SciVerse Scopus, Pubmed databases and Nursing Databases (BDENF). Results Based on the analysis of the 11 articles selected in the study, three relevant themes were identified for discussion:network of users in treatment, primary health care and group activities in the treatment of class III obesity, implementation of specialized and qualified service to attend this group of users. Conclusion The evidence shows that the role of the health team in relation to the care of this user profile goes beyond guidelines and information and that the development and implementation of services and/or treatments for class III obesity are significant challenges and require qualified professionals to compose multidisciplinary teams acting in an interdisciplinary manner that make the user aware that he or she must take the lead role in their own treatment.And to this end, group health education activities are important tools to promote autonomy and share experiences in the search for health-related quality of life.摘要 肥胖已成为严峻的全球性公共卫生问题，近年来受其影响的人群规模已达到极高水平。鉴于里约热内卢市超重与肥胖人群数量持续增长，里约热内卢市卫生局（Municipal Health Department of Rio de Janeiro, SMSRJ）在阿内斯·迪亚斯营养研究所（Annes Dias Institute of Nutrition, INAD）的技术支持下，于2011年7月在阿卡里区设立了首个肥胖症诊疗参考中心（Obesity Reference Centre, CRO）。 该中心为Ⅲ级肥胖（亦称病态肥胖）患者提供门诊临床诊疗服务，涵盖个体咨询与团体随访。同时作为专项支持服务，它通过由体育教师、护士、内分泌科医师、营养师及心理学家组成的跨职能团队，提升了初级卫生保健（Primary Health Care, PHC）团队为该类人群提供服务的能力。 在此背景下，本研究基于肥胖症诊疗参考中心的实践经验，旨在开展一篇整合性文献综述，探讨团体健康教育活动在Ⅲ级肥胖患者治疗中的重要性，以及近五年卫生专业人员在相关出版物中对该主题的研究进展。 研究方法 本研究为整合性文献综述，采用PICO策略（研究对象、干预措施、研究场景与研究结果）进行研究设计，数据采集于2018年10月至11月，检索范围涵盖拉丁美洲与加勒比卫生科学文献数据库（Latin American Literature and Caribbean in Health Sciences, Lilacs）、科学网（Web of Science）、Scopus数据库（SciVerse Scopus）、PubMed数据库及护理数据库（Nursing Databases, BDENF）。 研究结果 通过对纳入研究的11篇文献进行分析，本研究确定了三个核心讨论主题：治疗过程中的患者社交网络、初级卫生保健与Ⅲ级肥胖治疗中的团体活动，以及为该人群提供专业化、高素质服务的实施路径。 结论 研究证据表明，卫生团队针对该类患者的照护职责不仅限于提供指导与健康信息；针对Ⅲ级肥胖的服务与治疗方案的开发与实施是一项重大挑战，需要由高素质专业人员组成跨学科团队开展协作，使患者明确自身需在治疗中发挥主导作用。为此，团体健康教育活动是提升患者自主性、分享健康相关生活质量改善经验的重要工具。