Doenças associadas à obesidade custam meio bilhão de reais por ano ao SUS
Pesquisa revela o gasto para atender patologias relacionadas ao excesso de peso. Ministério da Saúde lança linha de cuidados para prevenção e tratamento do sobrepeso e obesidadeDa Redação
O ministro da Saúde, Alexandre Padilha, assinou nesta terça-feira (19) portaria que cria a Linha de Cuidados Prioritários do Sobrepeso e da Obesidade no Sistema Único de Saúde (SUS). Dados do Ministério da Saúde revelam que o SUS gasta anualmente R$ 488 milhões com o tratamento de doenças associadas à obesidade. A nova linha define como será o cuidado, desde a orientação e apoio à mudança de hábitos até os critérios rigorosos para a realização da cirurgia bariátrica, último recurso para atingir a perda de peso.
A obesidade é um fator de risco para a saúde e tem forte relação com altos níveis de gordura e açúcar no sangue, excesso de colesterol e casos de pré-diabetes. “Este é o momento de o Brasil agir em todas as áreas, prevenção e tratamento, atuando com todas as faixas etárias e classes sociais, com um esforço pra quem tem obesidade grave”, ressaltou o ministro, durante a apresentação da pesquisa da Universidade de Brasília (UnB), que rastreou os gastos com obesidade no SUS.
Os custos com o tratamento da obesidade grave atingem hoje R$ 116 milhões, outro dado importante apontado pela pesquisa. Foram analisados dados de internação e de atendimento de média e alta complexidade relacionados ao tratamento da obesidade e de outras 26 doenças relacionadas (ver tabela no fim do texto), entre elas isquemias do coração, cânceres e diabetes.
Levantamentos mostram que o excesso de peso e a obesidade têm crescido no Brasil. De acordo com a pesquisa Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), realizada em 2011 pelo Ministério da Saúde, a proporção de pessoas acima do peso no Brasil avançou de 42,7%, em 2006, para 48,5%, em 2011. No mesmo período, o percentual de obesos subiu de 11,4% para 15,8%.
Padilha destacou que a obesidade está mais presente na população com renda menor que três salários mínimos e com menos de oito anos de estudo.
LINHA DE CUIDADO – A portaria prevê atividades desde a Atenção Básica para o cuidado do excesso de peso e outros fatores de risco que estão associados ao sobrepeso e à obesidade até o atendimento em serviços especializados. A atenção básica vai proporcionar diferentes tipos de tratamentos e acompanhamentos ao usuário, o que inclui também atendimento psicológico.
“Precisamos cuidar da qualidade de vida, oferecer novos caminhos, como alimentação adequada e atividade física. Se as pessoas com obesidade grave ficar no estado de obesidade, ela já terá melhor qualidade de saúde, poderá reconstruir seus hábitos de vida com uma situação diferente”, afirmou o ministro, explicando que o atendimento será de acordo com a realidade de cada pessoa.
A pessoa com sobrepeso (IMC igual ou superior a 25) poderá ser encaminhada a um polo da Academia da Saúde para realização de atividades físicas e a um Núcleo de Apoio à Saúde da Família (NASF) para receber orientações para uma alimentação saudável e balanceada. Atualmente, 82,1% dos 1.888 NASFs contam com nutricionistas, 85,7% com psicólogo e 61,6% com professores de educação física. Toda a evolução do tratamento será acompanhada por uma das 37 mil Unidades Básicas de Saúde (UBS), presentes em todos os municípios brasileiros.
O Programa Academia da Saúde é a principal estratégia para induzir o aumento da prática da atividade física na população. Até agora, já foram repassados R$ 114 milhões, de um total de investimento previsto de R$ 390 milhões. A iniciativa prevê a implantação de polos com infraestrutura, equipamentos e profissionais qualificados para a orientação de práticas corporais, atividades físicas e lazer. Atualmente, há mais de 2,8 mil polos habilitados para a construção em todo o país e outros 155 projetos pré-existentes que foram adaptados e custeados pelo Ministério da saúde.
CIRURGIA BARIÁTRICA – A nova portaria do Ministério da Saúde também reduz de 18 para 16 anos a idade mínima para realizar o procedimento, em casos em que há risco ao paciente. A iniciativa foi tomada com base em estudos que apontam o aumento crescente da obesidade entre os adolescentes, como a Pesquisa de Orçamento Familiar de 2009 (POF). A POF verificou que na faixa de 10 a 19 anos o percentual de 21,7% dos brasileiros apresenta excesso de peso – em 1970, este índice estava em 3,7%. A avaliação clínica nos jovens entre 16 e 18 anos deverá constar no prontuário e deve incluir: a análise da idade óssea e avaliação criteriosa do risco-benefício, realizada por equipe multiprofissional com participação de dois profissionais médicos especialistas na área.
A idade máxima, que até então era de 65 anos, também foi alterada. Com a portaria, o que determinará para o indivíduo se submeter à cirurgia não será a idade, e sim a avaliação clínica (risco-beneficio), podendo ultrapassar o limite atualmente estabelecido.
O documento também prevê incremento no valor pago em cinco exames ambulatoriais pré-operatórios – os aumentos serão de 100% a 277%. A portaria prevê ainda reajuste médio em 20% das técnicas de cirurgia bariátrica na tabela do SUS. Além do incremento financeiro,o SUS passa a autorizar a realização da técnica Gastrectomia Vertical em Manga (Sleeve), totalizando a cobertura de quatros técnicas de cirurgia bariátrica. Também há novidade na cirurgia plástica reparadora pós-operatória. O SUS dará cobertura para mais uma cirurgia plástica reconstrutiva, a dermolipectomia abdominal circunferencial pós-gastroplastia, totalizando cinco tipos de cirurgias.
AÇÕES EM DESENVOLVIMENTO – Para frear a obesidade e o sedentarismo, que são fatores de risco importantes para doenças crônicas, e promover hábitos de vida mais saudáveis, o Ministério da Saúde prevê uma série de iniciativas no Plano de Ação para Enfrentamento das Doenças Crônicas Não Transmissíveis (DCNT), por meio de parcerias com o setor privado e outras pastas do governo. Lançado em agosto de 2011, o plano tem por meta reduzir em 2% ao ano a taxa de mortalidade prematura causada por DCNT até 2022.
O ministério investe também em ações preventivas para evitar a obesidade em crianças e adolescentes, como o Programa Saúde na Escola (PSE), que este ano está aberto a todos os municípios e passa a atender creches e pré-escolas. Para 2013, está previsto o investimento de R$ 175 milhões. Outra medida é a parceria do ministério com Federação Nacional de Escolas Particulares para distribuição de 18 mil Manuais das Cantinas Escolares Saudáveis como incentivo a lanches menos calóricos e mais nutritivos.
Para melhorar a dieta dos brasileiros e qualidade de vida, o Ministério da Saúde firmou um acordo com a indústria alimentícia que prevê a redução gradual do teor de sódio em 16 categorias de alimentos. A previsão é de que, até 2020, estejam fora das prateleiras mais de 20 mil toneladas de sódio.
A autora da pesquisa apresentada nesta terça-feira, Michele Lessa, destacou a resposta do Ministério da Saúde à questão ao criar a linha para prevenção e tratamento da obesidade: “A partir de dados epidemiológicos disponibilizados pelo próprio ministério, foi possível fazer a associação da obesidade com outras doenças para analisar o valor gasto no SUS com o tratamento da obesidade”.
Lista de doenças relacionadas à obesidade:
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