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ROLE OF PRIMARY HEALTH CARE IN THE MANAGEMENT AND
CONTROL OF OBESITY
Matheus Siega Nepomuceno1
Letícia Lima Silva de Abreu2
Fernandez Fonseca Almeida3
Edila Alves Moraes Nogueira4
Rafaela Barros Pinheiro5
Kênia Alencar Fróes6
Carolliny Pimenta Faria Galvão7
Silvânia Paiva Santos Rocha8
Ana Caroline Pereira Costa9
Flávia Ferreira Santana10
Valdira Vieira de Oliveira11
Marlete Scremin12
Rita de Cássia Caldeira Santos Goes13
Andreia Correia14
1 Integrated Colleges of Northern Paraná
2 Montes Claros State University
3 Montes Claros State University
4 University Center of Northern Minas Gerais
5 Pitágoras University Center
6 Montes Claros State University
7 Montes Claros State University
8 Montes Claros State University
9 University Center of Northern Minas Gerais
10 Paulista University
11 Montes Claros State University
12 University of the Joinville Region.
13 Integrated Colleges of Northern Paraná
14 Integrated Colleges of Northern Paraná
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Sueli Antunes Aquino Cardoso Gonçalves15
Natália Gonçalves Ribeiro16
Leandro Felipe Antunes da Silva17
Abstract: The aim was to describe the role of primary health care in the attention to and control of
obesity. An integrative literature review study was conducted. The descriptor obesity and primary care
was used to search the databases Scientic Electronic Library Online, Latin American and Caribbean
Health Sciences Literature, and Virtual Health Library; books and manuals from the Ministry of
Health regarding the subject of study were also considered. The approach to obese patients is often
permeated by stigma, over-medicalization, and excessive screenings not based on evidence. Three
main practices were identied as strategies for caring for obese patients in primary health care,
which are: not prescribing weight-loss medications in isolation without a robust therapeutic program
including diet, physical activity, and behavioral change; not prescribing weight-loss medications for
individuals with mild obesity without comorbidities; and not failing to perform evaluation and follow-
up with a multidisciplinary team, including a nutritionist and psychologist, for obese individuals.
Signicant practices have been identied that can be carried out by professionals during the care of
users with obesity, which can reverse the logic of excessive screening, requests for additional tests,
overmedicalization, and stigmatization.
Keywords: obesity; comprehensiveness of care; primary health care.
15 Santo Agostinho College
16 University Center of Northern Minas Gerais
17 Faculty of Health and Humanities Ibituruna
INTRODUCTION
Obesity is a global problem. It is estimated that more than 600 million adults are obese (GBD,
2017). In Brazil, obesity prevalence increased by more than 60% between 2006 and 2018, rising from
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11.8% to 19.8% (BRASIL, 2019). Beyond its health consequences, obesity has a signicant economic
impact on individuals, families, countries, and healthcare systems. (GBD, 2017; González et al., 2017).
Several countries around the world have high-level evidence recommendations regarding
therapeutic care for overweight and obese individuals. One study aimed to write and evaluate the
quality of clinical guidelines for the treatment of obesity in adults in different countries. It identied
20 guidelines: nine from Europe, six from North America, three from Latin America, one from Asia,
and one from Oceania (Reis; Passos; Santos, 2018).
However, the proper practice of nutritional therapies in primary and secondary care services
that lead to satisfactory results remains incipient in different countries and contexts (Menezes et al.,
2020). In Brazil, from the perspective of the health system and its guidelines, primary health care
units (PHCUs) are fundamental spaces for addressing the challenges of obesity care. The primary
health care (PHC) approach to obesity should include (but not be limited to) health promotion, food
and nutritional surveillance, health education, and medical and interdisciplinary care (BRASIL, 2014;
Beaglehole et al., 2008). Obesity care in Brazilian PHCs is a challenge and requires intersectoral
actions, which must be continuously carried out by multidisciplinary teams (BRASIL, 2014).
Primary Health Care Units (UBS) are the preferred entry points to the Brazilian Unied
Health System (SUS) and should coordinate the health care provided. In this scenario, care is mainly
centered on the Family Health Strategy (ESF). The provision of prevention and care actions for
people with obesity has been identied as one of the greatest health challenges for Brazil and other
countries. The causes of obesity encompass a complex series of genetic, individual/behavioral, and
environmental factors, in which the main element for the increase in the prevalence of obesity in
populations is the increasingly obesogenic environment (Swinburn et al., 2019a), characterized as one
that hinders the adoption and maintenance of healthy eating habits and the regular practice of physical
activity (Swinburn et al., 2019b).In this context, the present study sought to understand the role of
primary health care in the care and control of obesity.
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MATERIALS AND METHODS
A theoretical-reective study was conducted based on the concepts of health education
and health promotion; that is, it proposes to consider the different dimensions that constitute it. To
this end, Therrien’s (2014) proposition was adopted. Regarding the pillars that constitute a research
phenomenon: ontology, epistemology, and methodology.
The study was conducted by identifying the theme, guiding question, and research objective;
establishing subject descriptors and databases, as well as inclusion and exclusion criteria; dening the
information to be extracted and evaluating the included studies; and subsequently, interpreting the
results and presenting the review and synthesis of knowledge.
The research was conducted in the second half of 2025 using the guiding question: What is
the role of primary care?in the care and control of obesityThe following descriptors were used: obesity;
comprehensiveness of care and primary health care, with the aid of Boolean operators to assist and
rene the search for studies for analysis. The secondary databases used for the search were:Scientic
Electronic Library Online (SCIELO), Catalog of Theses and Dissertations of the Coordination for
the Improvement of Higher Education Personnel (CAPES) Commission, in addition to websites of
agencies related to the subject of study.
The inclusion criteria were: publications addressing the analyzed theme, available online
and with full text, in Portuguese, English, or Spanish, without a publication time limit. The exclusion
criteria were: duplicate publications and works published solely in conference proceedings.
After analyzing the data from the selection and reading of the retrieved publications,
thematic content analysis was conducted, according to Minayo, which is performed through three
interdependent phases: pre-analysis, exploration of the material, and interpretation of the results
(Minayo, 2014).
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DISCUSSION
Obesity, a chronic, complex, and multifactorial disease, has reached epidemic proportions
globally, representing one of the greatest public health challenges of the 21st century. Its impact
transcends increased morbidity and mortality, burdening health systems and compromising quality of
life. Given this complexity, effectively tackling obesity requires a strategic and coordinated approach,
and it is in this context that Primary Health Care (PHC) assumes a central and irreplaceable role in
the care and control of this condition (Ralston et al., 2018).
The primary health care model, characterized by being the rst point of contact,
longitudinality, comprehensiveness, and coordination of care, offers the ideal environment for
implementing interventions that address the entire spectrum of disease: from universal prevention
to the management of established cases, including early detection and coordination with specialized
levels of care (Lopes et al., 2021).
The role of primary health care (PHC) begins before clinical diagnosis; the longitudinality and
the bond established between health teams and the community allow PHC to be primarily responsible
for promoting healthy lifestyle habits and for the primary prevention of excessive weight gain.
This includes educational actions on adequate nutrition, regular physical activity, and awareness of
environmental and social risk factors (social determinants of health) that inuence obesity (Semlitsch
et al., 2019).
Prevention interventions in primary health care are ideally community-based and family-
oriented, integrating into individuals’ routines and considering the cultural and socioeconomic
particularities of each territory. Primary health care has the necessary reach to inuence local policies
and health-promoting environments (schools, workplaces, public spaces), acting on the macro-
determinants of health (Bonilla et al., 2016).
Primary health care (PHC) is the gateway to the system and, consequently, the most
appropriate place for population screening. Regular measurement of weight, height, and abdominal
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circumference, and calculation of Body Mass Index (BMI), are simple and effective tools that allow
for the early identication of individuals at risk or already with established obesity (Höfelmann;
Braga, 2023).
The initial clinical management of obesity is also a fundamental responsibility of primary
health care (PHC). Treatment in primary care focuses on intensive behavioral changes, involving
individualized counseling on diet and exercise. The multidisciplinary PHC team (physicians, nurses,
nutritionists, physical educators, community health workers) is essential to offer a holistic care plan
that addresses not only the biological aspects but also the psychological and social aspects of diet
and lifestyle. The approach in PHC should be marked by empathy and the ght against the stigma of
obesity, promoting adherence and maintenance of long-term treatment (Schwenke et al., 2020).
Obesity often coexists with other chronic conditions, such as type 2 diabetes mellitus,
hypertension, and dyslipidemia, forming what is known as metabolic syndrome. Primary health care
(PHC) is the ideal level of care for the integrated management of these comorbidities. Therefore, obesity
treatment in PHC is not isolated, but rather part of a comprehensive care plan for the individual’s
overall health (Jesus et al., 2022).
For more complex cases, such as severe obesity (BMI greater than or equal to 40 kg/m²
or greater than or equal to 35 kg/m² with comorbidities) or treatment failure at the primary level,
primary health care (PHC) plays a crucial role in coordinating care with secondary and tertiary
care. This includes timely referral to specialists (endocrinologists, psychologists/psychiatrists) and,
when indicated, to bariatric surgery. Pre- and post-operative follow-up of bariatric surgery is also a
responsibility of PHC, ensuring nutritional follow-up, supplementation, and monitoring of long-term
complications (NCD, 2024).
Expanding and improving the approach to overweight individuals in primary healthcare
services impacts cost reduction for the Brazilian Unied Health System (SUS), as it decreases
hospitalizations for conditions sensitive to primary care, especially chronic diseases. The preparedness
and competence of healthcare teams in managing obesity also reduce referrals to specialized care,
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resulting in fewer complications and shorter waiting times for treatment (Oliveira et al., 2023).
Despite its central role, primary health care faces challenges in addressing obesity, including
time constraints in consultations, a lack of specic training for teams in nutritional and behavioral
counseling, and a scarcity of resources for managing complex cases (such as access to anti-obesity
medications or structured exercise programs). Overcoming these obstacles requires investment in
continuing education for professionals, strengthening multidisciplinary teams, and integrating
evidence-based clinical protocols. (Migowski; Costa, 2024).
CONCLUSION
The approach to obese patients is often permeated by stigma, overmedication, and excessive
screening not based on evidence. Three main approaches were identied as strategies for serving obese
patients in primary health care: not prescribing weight-loss medications in isolation without a robust
therapeutic program including diet, physical activity, and behavioral change; not prescribing weight-
loss medications to individuals with mild obesity without comorbidities; and ensuring that obese
individuals receive multidisciplinary assessment and follow-up with a nutritionist and psychologist.
Primary Health Care is the key link in any effective obesity control strategy. Its ability to act
preventively, detect obesity early, provide initial clinical management of comorbidities, and coordinate
care with other levels of care makes it the cornerstone for transforming the trajectory of this disease.
Success in combating obesity intrinsically depends on strengthening and valuing Primary Health
Care as a robust, accessible, and patient-centered system.
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