**1. Introduction**

In Brazil, the tendency of obesity in contexts marked by poverty and inequalities were studied [1–5]. Such analyzes may be valuable contributions to the deepening and understanding of the phenomenon of obesity in these segments, because they reveal the complex network of interrelationships that operate in this multifaceted dynamics of a more comprehensive and relational approach [5]. Explanations for obesity among the poor in Brazil are therefore interrelated with a number of important structural, economic, social and cultural transformations verified in the last that profoundly altered the relationship between Brazilians and food, body and health. In general terms, it can be said that these changes are linked to the emergence of obesogenic environments, that is, social, economic and cultural trends that stimulate the population to overeating and poor physical activity [5, 6].

Limitations of economic and social order also promoted inequalities in accessing the main means of intervention in the problem. Inequalities in access to healthy food and recreational public spaces have accentuated health inequalities, especially with in relation to the problem of obesity among the poor in Brazil. Thus, the limited choice of lifestyles that favor health and well-being promote marked inequalities in the daily life of these segments. Yet, income ratio does not seem to be the only factor or the most consistent to explain the phenomenon of obesity among the poor. Cultural conceptions related to food, body, health, work and living conditions permeate the dynamic [5, 6].

At the same time, the poor have been targeted by the market for unhealthy products, contributing to the growth profile of obesity. Companies that produce consumer goods, including processed and ultraprocessed foods, soft drinks and sugary drinks, among others, have been able to change behaviors and lifestyles, contributing to the increase of excess weight and its comorbidities in different groups, including those with lower income [7, 8]. This imposes protectionist measures of the Brazilian government aimed at regulating unhealthy products and expanding the supply of products and services that promote health and quality of life of the most socially vulnerable segments [7, 8]. Thus, the proposal of a resolute public intervention of the Brazilian government to intervene in this public health problem becomes an emergency [5, 7, 8].

In this light, we believe that it is opportune to deepen the theoretical discussions around the subject and to advance in proposing more consistent intervention initiatives in the control of obesity. In this sense, this study contributes to this debate by listing the main obstacles and opportunities for coping with obesity in poor women living in the historic city of Diamantina, located in the southeastern region of Brazil called Vale do Jequitinhonha, Minas Gerais. For that, we investigated the dietary practices aligned to the life context of obese women and holders of the conditional cash transfer program, Bolsa Família, of the municipality.

## **2. Methodology**

The proposal was to carry out a single interpretive case study within the health promotion approach [9]. The choice from the perspective of health promotion relies fundamentally on valuing the context in which subjects interact socially. This perspective reflects, in part, the recognition that most health practices are oriented by social space and seeks to expand increasingly the study of socio-technical networks and spaces of social interaction to subsidize the planning, implementation and the evaluation of initiatives in the sector. Such an approach may, according to some authors, create valuable opportunities for the strengthening of current health promotion actions, especially for coping with contemporary social phenomena, including the dynamic obesity among poor women [10–12], a reflexive effort on the dynamics of female obesity in poverty from the perspective of health promotion.

In this direction, this study sought an approximation with the life context of holders of the Bolsa Família government program, from the urban and rural areas of the historic city of Diamantina, Minas Gerais, Brazil, in order to understand the dynamics that permeate the phenomenon of obesity in this group, in particular. Fieldwork totaled 24 interviews and 3 focus groups. The criteria for the selection of the group included: (1) the family registered with a local Family Health Strategy team; (2) the family registered in the Bolsa Família government program and (3) the diagnosis of obesity in at least one of its members. All these combined information allowed the selection of socially vulnerable families, using criteria beyond the purely normative dimension, incorporating elements related to the general conditions of life and well-being of families [13–15].

The instrument for data collection followed two previously established roadmaps. The first script was used to conduct the in-depth interviews—"semistructured interview script," which contained information such as socioeconomic; consumption and food practices; work and leisure activities; and the conditional income transfer program Bolsa Família. For the focus groups, the "script of debates" was used that addressed the themes of food, the body and aspects related to the

**83**

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

**3. Results and discussion**

Bolsa Família program. In the data treatment, the content analysis proposed by Bardin [16] was used. The data were compiled in five main thematic axes: (1) food routine; (2) perceptions and conceptions of body; (3) perceptions about the Bolsa Família program (PBF); (4) physical and leisure activity and (5) living conditions. In this chapter, in particular, we will address issues related to coping with obesity in the group. It is worth pointing out that in this investigation, the ethical principles

From 24 interviews conducted in the domiciles and 3 focus groups conducted in a primary health care unit, it was verified that obesity was present in women [18]. The coexistence of obesity with several chronic diseases, being the most prevalent—diabetes mellitus, hypertension, dyslipidemias and bone diseases was also observed. Regarding the age range of our research universe, age of women presented range from 14 to 56 years. In the analysis of the combined social indicators, which aimed to discriminate women subjected to conditions of social vulnerability, it was observed that low schooling was present in the group. And some women were considered to be functional illiterates. In fact, educational inequalities have been related to the occurrence of obesity in women. In general, the lower the schooling, the greater the frequency of obesity in the group [19, 20]. This profile is related to lower job opportunities, lower wages and protection [21]. Thus, the holders were inserted in occupations of work of little prestige exercising activities of day laborers, domestic workers, nannies, artisans, among others. The low qualifications of the occupations performed by these women were also reflected in low income: the

As per family arrangements, we can characterize them as "couple with children"

With regard to consumer goods in all households where the families were interviewed, there was a television, stove and refrigerator. The microcomputer was present in 30% of households, however, only 10% had access to the internet. Still according to PNAD, in Brazil, there are 77 million people connected to the internet. In recent years, the number of internet users has grown by 14.7% [24]. However, among the poor, the expansion seems to occur more slowly. For Tilly [15], this is one of the mechanisms for maintaining social inequalities in the daily lives of the poor within contemporary societies—"digitized," "connected" and "computerized." Low internet access in these segments limits opportunities and the majority of households did not use fixed-line telephony, but all of them used mobile telephony (cellular telephone). Mobile telephony appears to be replacing the landline telephony, according to the 2010 Census [22]. With regard to access to public services, we can now see the absence, at times the deficit of basic sanitation, garbage collection and transportation. For local health services, the biggest complaints were related to the reduced number of doctors and the enormous difficulties encountered in making appointments and examinations. In this study, it was found that the mean number of children found was relatively similar to the results obtained in the 2010 Census [22]. Each women had, on average, 2–4 children. It has been observed that parity has been a potential predictor for the development of obesity in women, as the studies reveal [5, 20]. We also observed the presence of grandchildren under 5 years of age in these families. This profile increases the degree of dependence and fragility of these arrangements.

and "single parent" (those headed by women, without spouses and with children). According to data from the 2010 Census [22], this is one of the new trends in Brazilian family dynamics. Official statistics indicate that, in fact, there is an

unequal position in the family income of single-parent households [23].

contained in the Declaration of Helsinki were fulfilled [17].

average wage found was one to two monthly minimum wages.

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

*Psychology of Health - Biopsychosocial Approach*

problem becomes an emergency [5, 7, 8].

**2. Methodology**

cash transfer program, Bolsa Família, of the municipality.

tions of life and well-being of families [13–15].

consistent to explain the phenomenon of obesity among the poor. Cultural conceptions related to food, body, health, work and living conditions permeate the dynamic [5, 6]. At the same time, the poor have been targeted by the market for unhealthy products, contributing to the growth profile of obesity. Companies that produce consumer goods, including processed and ultraprocessed foods, soft drinks and sugary drinks, among others, have been able to change behaviors and lifestyles, contributing to the increase of excess weight and its comorbidities in different groups, including those with lower income [7, 8]. This imposes protectionist measures of the Brazilian government aimed at regulating unhealthy products and expanding the supply of products and services that promote health and quality of life of the most socially vulnerable segments [7, 8]. Thus, the proposal of a resolute public intervention of the Brazilian government to intervene in this public health

In this light, we believe that it is opportune to deepen the theoretical discussions around the subject and to advance in proposing more consistent intervention initiatives in the control of obesity. In this sense, this study contributes to this debate by listing the main obstacles and opportunities for coping with obesity in poor women living in the historic city of Diamantina, located in the southeastern region of Brazil called Vale do Jequitinhonha, Minas Gerais. For that, we investigated the dietary practices aligned to the life context of obese women and holders of the conditional

The proposal was to carry out a single interpretive case study within the health promotion approach [9]. The choice from the perspective of health promotion relies fundamentally on valuing the context in which subjects interact socially. This perspective reflects, in part, the recognition that most health practices are oriented by social space and seeks to expand increasingly the study of socio-technical

networks and spaces of social interaction to subsidize the planning, implementation and the evaluation of initiatives in the sector. Such an approach may, according to some authors, create valuable opportunities for the strengthening of current health promotion actions, especially for coping with contemporary social phenomena, including the dynamic obesity among poor women [10–12], a reflexive effort on the dynamics of female obesity in poverty from the perspective of health promotion. In this direction, this study sought an approximation with the life context of holders of the Bolsa Família government program, from the urban and rural areas of the historic city of Diamantina, Minas Gerais, Brazil, in order to understand the dynamics that permeate the phenomenon of obesity in this group, in particular. Fieldwork totaled 24 interviews and 3 focus groups. The criteria for the selection of the group included: (1) the family registered with a local Family Health Strategy team; (2) the family registered in the Bolsa Família government program and (3) the diagnosis of obesity in at least one of its members. All these combined information allowed the selection of socially vulnerable families, using criteria beyond the purely normative dimension, incorporating elements related to the general condi-

The instrument for data collection followed two previously established roadmaps. The first script was used to conduct the in-depth interviews—"semistructured interview script," which contained information such as socioeconomic; consumption and food practices; work and leisure activities; and the conditional income transfer program Bolsa Família. For the focus groups, the "script of debates" was used that addressed the themes of food, the body and aspects related to the

**82**

Bolsa Família program. In the data treatment, the content analysis proposed by Bardin [16] was used. The data were compiled in five main thematic axes: (1) food routine; (2) perceptions and conceptions of body; (3) perceptions about the Bolsa Família program (PBF); (4) physical and leisure activity and (5) living conditions. In this chapter, in particular, we will address issues related to coping with obesity in the group. It is worth pointing out that in this investigation, the ethical principles contained in the Declaration of Helsinki were fulfilled [17].
