Brazil’s MAPPS II Roundtable: Building a coordinated response to obesity prevention and care

A foundational theme throughout the roundtable was the urgent need to strengthen intersectoral obesity strategies and move towards a truly systemic approach. Brazil has internationally recognised policies but these have not translated into effective implementation on the ground. States and municipalities are the actors who implement policies formulated at the federal level, and without their effective involvement, guidelines do not reach the frontline.

There is a need for meaningful engagement with people living with obesity, ensuring their participation is not limited to one-off consultations and that their experiences inform the design, implementation, and monitoring of policies, research, and care pathways. It is also necessary to improve mechanisms for monitoring, and ensure the participation of states and municipalities in disseminating what is built in national forums.

“We can no longer treat obesity as an individual issue: it is a chronic, multifactorial and stigmatised disease that requires collective, cross-sectoral responses, sustainably funded within the public health system”

Fabio Trujilho, President of ABESO and FLASO and Board of Trustees member of WOF

"Brazil is a global benchmark in the fight against hunger. As a WHO-designated frontrunner   country for obesity control, we have the opportunity to bring together complementary perspectives within a comprehensive and integrated approach. Rather than framing prevention and treatment as competing priorities, we should recognize them as mutually reinforcing pillars of a truly person-centered strategy, capable of reducing both the prevalence and the incidence of obesity."

Guilherme Nafalski, Instituto Cordial, Brazilian Panel on Obesity Coordinator

Participants highlighted that food choices do not happen in isolation: people eat what is available in their territories, what they can access and what fits within the family budget. Whilst Brazil has demonstrated commitments to actions within the WHO Acceleration Plan to Stop Obesity, the food industry lobby is a real obstacle to the implementation of effective prevention strategies.

There is a need to accelerate progress in the regulation of food marketing (particularly marketing directed at children and adolescents) and implement fiscal measures to make healthier food more affordable. The promotion and valuing of Brazilian food cultures should be a strategy for promoting healthy eating, expanding access to healthy foods through family farming and community-based initiatives in underserved areas. Strengthening a rights-based narrative centres on sustainable food systems will also have a wider impact on food security, income generation, and environmental sustainability.

“The next step is to ensure these policies actually reach the population, expanding access to care and promoting healthier food environments and cities. For this, civil society's participation is crucial, both to boost policy improvements, incorporate the experience of people living with obesity and tackle the disproportionate influence of commercial interests that often hinder the advancement of essential regulatory measures, such as those for ultra-processed foods.”

Paula Johns, ACT Promoção da Saúde, Co-Founder and Director

The historical emphasis of the sector has been on the agenda of adequate and healthy eating, and therefore advances in prevention have preceded advances in the clinical treatment of obesity. There is a lack of investment in comprehensive treatment from the outset, access to obesity training for health professionals is limited, and there is no pharmacological treatment for obesity available through the SUS.

Attendees highlighted the need to establish structured integrated obesity care pathways between primary care, specialised care and reference centres, with multi- and inter-professional teams and effective referral and counter-referral mechanisms. It is important to increase the capacity of healthcare professionals at all levels of care to prevent, diagnose and treat obesity, including by addressing weight stigma and promoting person-centred approaches to care, and ensure adequate infrastructure (facilities, furniture, and equipment).

"The patient with obesity is resilient. The health professional is resilient. And those working in advocacy are even more resilient. But the numbers keep growing and care does not appear." 

Maria Edna de Melo

Stigma is structural, and present throughout society, affecting the prioritisation of obesity in public policy and strongly impacting treatment-seeking behaviour and experiences within health services. The SUS has made significant progress in addressing historically stigmatised conditions, but remains trapped in prejudice when it comes to obesity.

Experts called for the expansion of education and public awareness initiatives to help change public narratives around obesity, reduce prejudice and barriers to accessing care, and ultimately encourage the recognition of obesity as a chronic, complex and multifactorial condition.

“The SUS overcomes prejudice and that has results. With obesity, the SUS is stuck in prejudice”

Ericka Cuzziol, Lived Experience Advocate

Obesity disproportionately affects socially vulnerable populations, who face inadequate access to health care and policies which are technically sound but socially unviable. Populations such as indigenous people, quilombola communities, and residents of small inland towns remain invisible in information systems and, consequently, in public policies.

It is crucial to recognise structural factors, including racism, discrimination and other forms of social exclusion, as important considerations in obesity prevention and care.  There is a need to improve mechanisms to collect population data to identify at-risk populations and support local planning, using territorial diagnoses to identify local barriers and opportunities, including access to food, urban mobility, spaces for physical activity and adequacy of health service infrastructure. Participants advocated the strengthening of collaborative networks among professionals, managers, and communities as a means of sharing successful practices, reducing the isolation of frontline workers and building strategies adapted to local realities.

“Addressing obesity without tackling inequality is incomplete: populations in greater vulnerability face overlapping layers of exclusion in access to healthcare and public policies…The recommendations from this event must now be converted into concrete actions and public policies that reach those who need them most- with equity, active listening, and accountability”

Renata Couto, Desiderata, Executive Director