Representações sociais de sujeitos em situação de obesidade considerada grave : trajetórias de vida e Itinerários terapêuticos no Sistema Único de Saúde (SUS)

Abstract

The body and its forms can be understood and interpreted in different ways, depending on the interests that surround it and the historical period analyzed. It is through the body that one builds a relationship with the world. In contemporary times, the technological advance of medical science utters 'explanatory truths' about the 'normality' and the 'abnormality' of the body. This speech is widely legitimized by liberal capitalist culture, through the cultural industries of obesity and thinness, in the mass media. These vehicles pulverize the 'truths' for the society and, through that, they are transforming the corporal conception, idealizing it as an ideal of thinness and making it a symbol of health and beauty. The consequences of these 'truths' include the stigmatization of body shapes different from the hegemonic pattern, especially the obese body, deepening the thinness dichotomy as inclusion and obesity as exclusion. Given this scenario, the present research aimed to understand the process of constitution of the social representations of subjects in situations of obesity considered severe, in the face of their life trajectories and their therapeutic itineraries in the Unified Health System (SUS), in Brazil. Also, it aimed to analyze, from the perspective of these social representations, how hegemonic speech influences daily life and social relations of subjects. For that, through the qualitative approach, the Theory of Social Representations was used as a theoretical-methodological element. Twenty subjects in a situation of obesity, considered severe by the medical-scientific speech, were included in the Obesity and Bariatric Surgery Service of the Western Paraná University Hospital (SOCB-HUOP/UNIOESTE), in the municipality of Cascavel-PR. Throughout the interviews and focus group, it was possible to delineate the social representations of subjects in situations of obesity considered dangerous while marginalized by society: friends, relatives, co-workers, and some health professionals. By medical diagnosis of 'disease,' they blame themselves for their situation, their lack of conditions to follow the proposed treatments, in strictly medical terms. The most used word by them to describe their emotions is suffering - physical as well, but, above all, emotional. The internalization of this stigma anticipates discrimination, reducing to a great extent their self-esteem, hampering the quality of their social relations, and reinforcing their social isolation. The therapeutic itineraries covered were sometimes frustrating. The therapy used by professionals, mostly doctors, was not enough to cover the subject's integrality in all its biopsychosocial dimensions. There is a lack of health professionals in the SUS to create multidisciplinarity, and those who operate in the System have sometimes been considered unprepared, indifferent, and prejudiced. Because the municipality did not implement the Obesity Care Line, the obese subjects oscillated between the public, private, and charitable networks over months or even years. SOCB-HUOP/UNIOESTE has, to some extent, contributed to alleviate suffering through established horizontal relations with the multi-professional team. It is considered urgent to reflect on the legitimacy of hegemonic speeches, which significantly influence the lives of people in the situation of obesity.