**4. The multiple challenges to intervene in overweight in the local context**

With regard to coping with obesity, it was possible to verify two fundamental questions that were recurrent in the women's testimony. Thus, for the group to intervene in overweight, it is meant following the medical guidelines. This issue reveals the incorporation of medical and media discourse operating in the group. For women, it was therefore necessary to have "discipline"; "Self-control" ("doing physical activity," "walking," "exercise," "sport," "swimming," "walking," "if you can, gym," "diet," "To do the right thing," "to close the mouth," "to control the mouth," "to stop eating," "to force") to intervene in the problem of being overweight.

For the group, facing the excess weight was still, to have greater access to health professionals (nutritionists), for them, to obtain "some recommendations"; "tips"; "guidance"; "have a follow up". In this regard, they consider it possible to control the problem. Although advances have been noted with the inclusion of nutritionists in the Family Health Support Centers (NASF) since 2008, the insertion of this professional is still insufficient. In this sense, it is necessary to increase the number of these professionals within the scope of the Unified Health System [29].

In the analysis of all the empirical material, we verified the interweaving of multiple dimensions operating in the dynamics of obesity in the group. Thus, it was possible to identify the main obstacles, as well as some possibilities to face the problem among the women interviewed. In this direction, we find that at the macro level, the historical social debt the State of Minas Gerais and the federal public power has with the Jequitinhonha/MG Valley region must be considered.

**85**

*Social Inequalities, Poverty and Obesity DOI: http://dx.doi.org/10.5772/intechopen.80987*

problem of female obesity [5].

For decades, this region has presented high levels of social inequality and poverty [30]. The Vale do Jequitinhonha/MG therefore lacks a broad scope of integrated public policies to minimize the perverse effects of scarce public investments in the region [31]. Thus, inequalities in work opportunities, income, health, education, infrastructure and leisure are observed [5]. In this context of adversity, the Bolsa Família program represents an extremely positive public intervention for the families interviewed, while minimizing the effects of poverty. However, the program proved to be an insufficient public measure to transform the extremely precarious context in which these women and their families live. Poverty and social inequities in this region are therefore of a macrostructural order and it must be acknowledged

that there is still a considerable gap for the local development of the Valley.

Also in the field of public interventions, we verified advances in actions directed to health and care of women with primary health care and the Reference Center for Social Assistance (CRAS). However, they need to be expanded and intensified. In this way, we consider the proposal of an articulated network of integral support for women, which includes: (1) health actions (mainly in the postpartum and puerperium periods, moments in which women signaled beyond weight gain, symptoms depressive disorders); (2) adequate provision of day-care centers and public schools; (3) psychological support and social assistance to poor families experiencing multiple conflicts, including the use of alcohol and drugs; (4) implementation of specific social programs directed to family arrangements headed by women with minor children and other dependents; (5) institutionalization of spaces for listening and dialog for the problematization of social practices; (6) a reduced working day considering the multiple social roles assumed by women that lead to stress situations [32], as measures that, in our view, are more appropriate to overcome the

In addition, women's social rights need to be guaranteed. In particular, the of citizenship by feeding one of the most perverse aspects of poverty in the group. Actions that promote the democratization of the means of production and consumption of food; the promotion of local food marketing and consumption directly from the producer; agroecology; the dynamization of community gardens in neighborhoods; the increased participation of women in food production and marketing through existing government initiatives, such as the Food Acquisition Program (PAA) [33], are fundamental public strategies to promote food security and nutritional security of the group [5, 34, 35]. The lack of local public actions aimed at increasing the supply and access to healthy food has been an impediment to the consumption of these items in

In our view, facing obesity in the group imposes, in this way, public actions of intervention of the State contextualized the local reality. That is, it involves broader and more integrated public measures that consider the network of interdependence that operates in the dynamics of overweight among poor women in the region. The challenge is to consider local specificities and recognize the vulnerabilities and potentialities of social contexts. It must be considered, above all, that individual choices, whether in food or leisure, are fundamentally social choices, as this study found. That is, individual choices interact with the social context and involve broader dimensions such as production, supply, access, availability, income, context, community participation and local culture. In this direction, the study carried out in a low income social context in France revealed the positive effect of a health promotion intervention on the reduction of obesity with the participation and mobilization of all local community—merchants, residents' association, users of health services health professionals and educators, public authorities and the participants themselves, who were invited to propose recreational and intervention activities. The proposal of intervention to promote a healthy lifestyle was structured in three fundamental axes:

the daily lives of Brazilians, according to a national study [36].

#### *Social Inequalities, Poverty and Obesity DOI: http://dx.doi.org/10.5772/intechopen.80987*

*Psychology of Health - Biopsychosocial Approach*

to the domestic and intimate world of the house.

poverty in the city.

According to the National Survey of Household Sample—PNAD [24], the presence of children in the homes is an indicator of vulnerability in the poorer arrangements, especially those headed by women, because they have less provider in the household. Still according to PNAD [24], in this profile, there is an overrepresentation of providers by color or race—black or brown, in addition to low level of education of the reference person. Studies have shown the relationship between gender, color/race, socioeconomic position and obesity [19, 25–27]. This was the profile of the families interviewed in this study. It should also be noted that the city of Diamantina/MG has few public day care centers. For this reason, it was found that many women, especially older women, took care of the smaller grandchildren so their daughters could work. This is a very problematic issue in overcoming

Regarding the leisure activities carried out by the women in these rare moments (in which they said they were "idle"), the following were mentioned: (1) manual or non-profit activities ("I'll sew, I'll weave"; "I like to sew some things like that for others and fix clothes"; "I usually take care of the flowerbeds"); (2) family with children and grandchildren ("I play with the boys"; "when I'm late I'll talk to my daughter"; "I play with my grandchildren because I like to play ball with them, I take them to walk on the court"); (3) physical rest ("I lie on the couch"; "I take a nap"; "I sleep a little"). And especially (4) watching television ("when I have a little time to watch television I like"; "I lie down and watch television"; "I'm going to watch television, watch a movie"). The frequency of watching television has been associated with obesity among women [27]. Watching television seemed be the most commonly used by the group, because it is economical, safe and available. In addition, according to Da Matta [28], everything that refers to the use, care and recovery of the body, and which as a consequence implies rest and renewal is linked

**4. The multiple challenges to intervene in overweight in the local context**

With regard to coping with obesity, it was possible to verify two fundamental questions that were recurrent in the women's testimony. Thus, for the group to intervene in overweight, it is meant following the medical guidelines. This issue reveals the incorporation of medical and media discourse operating in the group. For women, it was therefore necessary to have "discipline"; "Self-control" ("doing physical activity," "walking," "exercise," "sport," "swimming," "walking," "if you can, gym," "diet," "To do the right thing," "to close the mouth," "to control the mouth," "to stop eating," "to force") to intervene in the problem of being

For the group, facing the excess weight was still, to have greater access to health professionals (nutritionists), for them, to obtain "some recommendations"; "tips"; "guidance"; "have a follow up". In this regard, they consider it possible to control the problem. Although advances have been noted with the inclusion of nutritionists in the Family Health Support Centers (NASF) since 2008, the insertion of this professional is still insufficient. In this sense, it is necessary to increase the number of

In the analysis of all the empirical material, we verified the interweaving of multiple dimensions operating in the dynamics of obesity in the group. Thus, it was possible to identify the main obstacles, as well as some possibilities to face the problem among the women interviewed. In this direction, we find that at the macro level, the historical social debt the State of Minas Gerais and the federal public power has with the Jequitinhonha/MG Valley region must be considered.

these professionals within the scope of the Unified Health System [29].

**84**

overweight.

For decades, this region has presented high levels of social inequality and poverty [30]. The Vale do Jequitinhonha/MG therefore lacks a broad scope of integrated public policies to minimize the perverse effects of scarce public investments in the region [31]. Thus, inequalities in work opportunities, income, health, education, infrastructure and leisure are observed [5]. In this context of adversity, the Bolsa Família program represents an extremely positive public intervention for the families interviewed, while minimizing the effects of poverty. However, the program proved to be an insufficient public measure to transform the extremely precarious context in which these women and their families live. Poverty and social inequities in this region are therefore of a macrostructural order and it must be acknowledged that there is still a considerable gap for the local development of the Valley.

Also in the field of public interventions, we verified advances in actions directed to health and care of women with primary health care and the Reference Center for Social Assistance (CRAS). However, they need to be expanded and intensified. In this way, we consider the proposal of an articulated network of integral support for women, which includes: (1) health actions (mainly in the postpartum and puerperium periods, moments in which women signaled beyond weight gain, symptoms depressive disorders); (2) adequate provision of day-care centers and public schools; (3) psychological support and social assistance to poor families experiencing multiple conflicts, including the use of alcohol and drugs; (4) implementation of specific social programs directed to family arrangements headed by women with minor children and other dependents; (5) institutionalization of spaces for listening and dialog for the problematization of social practices; (6) a reduced working day considering the multiple social roles assumed by women that lead to stress situations [32], as measures that, in our view, are more appropriate to overcome the problem of female obesity [5].

In addition, women's social rights need to be guaranteed. In particular, the of citizenship by feeding one of the most perverse aspects of poverty in the group. Actions that promote the democratization of the means of production and consumption of food; the promotion of local food marketing and consumption directly from the producer; agroecology; the dynamization of community gardens in neighborhoods; the increased participation of women in food production and marketing through existing government initiatives, such as the Food Acquisition Program (PAA) [33], are fundamental public strategies to promote food security and nutritional security of the group [5, 34, 35]. The lack of local public actions aimed at increasing the supply and access to healthy food has been an impediment to the consumption of these items in the daily lives of Brazilians, according to a national study [36].

In our view, facing obesity in the group imposes, in this way, public actions of intervention of the State contextualized the local reality. That is, it involves broader and more integrated public measures that consider the network of interdependence that operates in the dynamics of overweight among poor women in the region. The challenge is to consider local specificities and recognize the vulnerabilities and potentialities of social contexts. It must be considered, above all, that individual choices, whether in food or leisure, are fundamentally social choices, as this study found. That is, individual choices interact with the social context and involve broader dimensions such as production, supply, access, availability, income, context, community participation and local culture. In this direction, the study carried out in a low income social context in France revealed the positive effect of a health promotion intervention on the reduction of obesity with the participation and mobilization of all local community—merchants, residents' association, users of health services health professionals and educators, public authorities and the participants themselves, who were invited to propose recreational and intervention activities. The proposal of intervention to promote a healthy lifestyle was structured in three fundamental axes:

(1) strengthening the individual; (2) strengthening the community and (3) improved living conditions at the local level and proved to be extremely successful [37].

In Brazil, intervention initiatives in these social contexts are still scarce. Although advances have been observed in the theoretical field with the publication of official documents in the perspective of health promotion [34, 35], there is an urgent need to build public initiatives in these territories. In our view, such measures are fundamental to find more feasible and decisive strategies for the success of intervention initiatives on obesity among poor women.

## **5. The possible possibilities of coping with obesity**

In this study, we found that although some of the interviewed women were not "perceived" as obese, they "felt" the enormous discomfort from the symptoms of being overweight. For this reason, they worried excessively about the negative repercussions of obesity on their health and well-being. The external and internal social pressures suffered by obese women, especially those related to the damage to physical health, lead, some of them, to seek a weight reduction program [38]. This fact may contribute to the group's adherence to actions in primary health care. Under the SUS, the close partnership between the Family Health Teams (ESFs) and the Family Health Support Centers (NASFs) may also favor the creation of legitimate spaces for listening, reflection and questioning of social practices that are reproduced in the daily routine of the group for a better performance of the teams. The articulation along with the Bolsa Família program would allow the strengthening, expansion, consolidation and empowerment of intervention actions on obesity among poor women, promoting the universalization of care. In this aspect, it is necessary to expand the actions of nutritional and nutritional surveillance of the holders in order to carry out the diagnosis of obesity more quickly and the referral to the integral care with more efficiency. In the FHS, the creation of operating groups for obese women, dynamics and interdisciplinary support are presented as feasible strategies in the daily practice of primary health care. In this way, to refine the articulation of primary health care programs within the FHS and NASF with the Bolsa Família Program and the Health Academy Program for us seems to be a very timely initiative to control obesity in these groups, especially with the participation and the involvement of the community [37].

For the area of health promotion, intersectoral partnerships that raise the issue of obesity in poverty as a priority of government should be encouraged. The articulation of the public sector, with institutions of education, vocational training and social support, among others, can generate more favorable opportunities of intervention to the problem in the territory. More than that, partnerships can promote institutional investments in the region to revitalize the economy. The strengthening of cooperatives and residents' associations that disseminate culture, tourism, cooking and regional handicrafts is a concrete opportunity to promote socioeconomic development. Fundamentally, these actions are presented as more feasible possibilities favoring new "doors of exit of poverty" for this population [5, 34, 35].

In the urban environment, the inclusion of public spaces for culture and leisure, expansion of the retail food trade, job offer and professional qualification, income and digital inclusion would be measures with a positive impact on the control of obesity. Partnerships with local retailers to promote healthier rebates for these groups are measures that can undoubtedly favor interventions in obesity [37]. In rural areas, the state must promote agrarian reform and a secure, productive and equitable food system. That is, a model of agro-ecological family production increases access to a nutritious and quality diet in these populations. Agroecology

**87**

**Author details**

**6. Conclusion**

Vanessa Alves Ferreira1

\* and Rosana Magalhães2

2 Department of Social Sciences, ENSP, FIOCRUZ/Rio de Janeiro, Brazil

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Department of Nutrition, UFMG/Minas Gerais, Brazil

about the subject of female obesity in poverty in Brazil.

\*Address all correspondence to: vanessa.nutr@gmail.com

provided the original work is properly cited.

*Social Inequalities, Poverty and Obesity DOI: http://dx.doi.org/10.5772/intechopen.80987*

combines traditional knowledge with technological innovations that help to address problems linked to productivity in the countryside, socially restructuring the farming community and family farming. These actions revitalize the traditional and cultural reproduction conditions of these groups in their typical forms of production and life and allow the population to settle in the interior, avoiding migratory processes commonly observed in poor populations [21]. Finally, the encouragement of research, teaching and extension projects within the theme of female obesity should be encouraged as well as the exchange of experiences in the academic and professional fields. The exchange of knowledge can be useful in recognizing suc-

cessful strategies and initiatives by enriching this debate in the country.

This work allowed to understand the dynamics of social interactions that operated in the obese body profile of the poor women, from the Bolsa Família government program. And, in this way, the challenges to coping with obesity are recognized. In our view, research that proposes to incorporate relational theoreticalmethodological approaches, using the perspective of health promotion, become fundamental for the proposition of intervention initiatives more resolutive. Thus, we believe that this study could stimulate new research and contribute to the debate *Social Inequalities, Poverty and Obesity DOI: http://dx.doi.org/10.5772/intechopen.80987*

combines traditional knowledge with technological innovations that help to address problems linked to productivity in the countryside, socially restructuring the farming community and family farming. These actions revitalize the traditional and cultural reproduction conditions of these groups in their typical forms of production and life and allow the population to settle in the interior, avoiding migratory processes commonly observed in poor populations [21]. Finally, the encouragement of research, teaching and extension projects within the theme of female obesity should be encouraged as well as the exchange of experiences in the academic and professional fields. The exchange of knowledge can be useful in recognizing successful strategies and initiatives by enriching this debate in the country.
