Efeitos do brainspotting no tratamento da obesidade em adolescentes: uma abordagem quali-quantitativa
Data
2023-12-12
Autores
Azevedo, Débora Candido de 
Orientadores
Konstantyner, Tulio
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: estimar os efeitos do Brainspotting (BSP) como intervenção terapêutica na saúde de adolescentes com obesidade e na compreensão do modo como eles percebem e cuidam do corpo-próprio. Métodos: ensaio clínico randomizado com 20 adolescentes com obesidade (escore-Z do Índice de Massa Corporal para idade (IMC/I) maior que 2) com período de acompanhamento de 11 meses. A intervenção testada foi a terapia de BSP associada à intervenção padrão para o tratamento da obesidade (apoio médico, nutricional e psicológico). Foram medidas as dimensões corporais dos adolescentes (peso, estatura, circunferência abdominal, do braço e da panturrilha) antes e após a intervenção que se caracterizou por seis sessões de 60 a 90 minutos com intervalo em torno de 15 dias. As análises estatísticas foram realizadas com base na estratégia por protocolo. As medianas foram comparadas com o teste de Mann-Whitney e as prevalências com o teste do Qui-quadrado. O poder do teste das associações foi identificado por meio do cálculo post-hoc. Posteriormente, entrevistas individuais abertas, face a face, foram realizadas para ouvir como o adolescente percebia e cuidava do corpo-próprio antes e após a intervenção. Estes dados foram analisados de modo qualitativo com abordagem fenomenológica descritiva e interpretados à luz da filosofia husserliana sobre o corpo-vivente, da percepção conforme a proposta de Maurice Merleau-Ponty e do conceito de cuidado desenvolvido a partir da hermenêutica de Martin Heidegger. Resultados: Após a intervenção, houve redução do escore-Z do IMC/I em 90% dos participantes do grupo intervenção (GI) e 60% do grupo controle (GC), porém sem diferença estatisticamente significante entre os grupos (p=0,121). O poder estatístico desta associação foi de 33,1% (erro tipo II: 66,9%). Não houve diferenças nas comparações entre grupos entre as reduções das circunferências abdominal, do braço e da panturrilha. No aspecto qualitativo, ao retomar à pergunta norteadora após a intervenção, “como o adolescente percebe seu corpo e como cuida dele desde antes do tratamento até agora?”, as respectivas interpretações e reduções fenomenológicas sucessivas se apresentaram em cinco categorias de Ideias Abrangentes: percepção do corpo, modos de cuidado, modos de sentir, movimento de mudança rumo à liberdade e abertura ao futuro. Conclusões: Os resultados da análise quantitativa não confirmaram a hipótese de que a intervenção com BSP, integrada ao tratamento padrão da obesidade, produza efeito na redução do IMC de adolescentes. No entanto, o poder do estudo foi relativamente baixo para identificar diferenças. Contudo, as análises qualitativas mostraram o alto benefício trazido pelo tratamento a partir da narrativa dos adolescentes, que desvelaram uma grande modificação da autopercepção corporal, novos e melhores modos de cuidar do corpo e da saúde, maior sentimento de bem-estar, a realização de um movimento em direção à liberdade de si mesmo, revelando abertura para o outro e para o mundo com novas perspectivas futuras.
Objective: To estimate the effects of BSP as a therapeutic intervention on the health of adolescents with obesity and on their understanding on how they perceive and care for their own bodies. Methods: A randomized clinical trial involving 20 adolescents with obesity (Body Mass Index for age (BMI/A) Z-score greater than 2) with an 11-month follow-up period. The tested intervention consisted of BSP therapy combined with standard intervention for obesity treatment (medical, nutritional, and psychological support). Adolescent’s body dimensions (weight, height, waist circumference, arm circumference, and calf circumference) were measured before and after the intervention, which consisted of six sessions of 60 to 90 minutes with an interval of around 15 days. Statistical analyses were based on the per-protocol strategy. Medians were compared using the Mann-Whitney test and prevalences using the Chi-square test. The power of the association test was identified through post-hoc calculation. Subsequently, individual open face-to-face interviews were conducted to explore how adolescents perceived and cared for their own bodies before and after the intervention. These data were qualitatively reviewed considering a descriptive phenomenological approach and interpreted in light of Husserlian philosophy on the living body, on the perception as proposed by Maurice Merleau-Ponty, and the concept of care developed from Martin Heidegger's hermeneutics. Results: After the intervention, 90% of the participants in the intervention group (IG) and 60% in the control group (CG) presented a reduction in BMI/A Z-scores. However, no statistically significant difference was observed between the groups (p=0.121). Nonetheless, the statistical power of the test was 33.1%, indicating a Type II error (Beta) of 66.9%. There were no differences in group comparisons between reductions in abdominal, arm and calf circumferences. Qualitatively, once addressed the guiding question after the intervention, which is, "how do adolescents perceive and care for their bodies from before treatment until now," interpretations and successive phenomenological reductions were presented in five categories of Comprehensive Ideas: body perception, ways of caring, ways of feeling, the movement of change toward self-liberation, and openness to the future. Conclusions: The results of the quantitative analysis did not confirm the hypothesis that the intervention with BSP, integrated into standard obesity treatment, produces an effect in reducing the BMI of adolescents. However, the power of the study was relatively low to identify differences. Furthermore, qualitative analyses indicate the substantial benefits brought about by the treatment, as revealed through the narratives of the participants who demonstrated a significant shift in self-perception of their bodies, new and improved ways of caring for their bodies and health, a greater sense of well-being, a movement toward self-liberation, and an openness to others and the world with new future perspectives.
Objective: To estimate the effects of BSP as a therapeutic intervention on the health of adolescents with obesity and on their understanding on how they perceive and care for their own bodies. Methods: A randomized clinical trial involving 20 adolescents with obesity (Body Mass Index for age (BMI/A) Z-score greater than 2) with an 11-month follow-up period. The tested intervention consisted of BSP therapy combined with standard intervention for obesity treatment (medical, nutritional, and psychological support). Adolescent’s body dimensions (weight, height, waist circumference, arm circumference, and calf circumference) were measured before and after the intervention, which consisted of six sessions of 60 to 90 minutes with an interval of around 15 days. Statistical analyses were based on the per-protocol strategy. Medians were compared using the Mann-Whitney test and prevalences using the Chi-square test. The power of the association test was identified through post-hoc calculation. Subsequently, individual open face-to-face interviews were conducted to explore how adolescents perceived and cared for their own bodies before and after the intervention. These data were qualitatively reviewed considering a descriptive phenomenological approach and interpreted in light of Husserlian philosophy on the living body, on the perception as proposed by Maurice Merleau-Ponty, and the concept of care developed from Martin Heidegger's hermeneutics. Results: After the intervention, 90% of the participants in the intervention group (IG) and 60% in the control group (CG) presented a reduction in BMI/A Z-scores. However, no statistically significant difference was observed between the groups (p=0.121). Nonetheless, the statistical power of the test was 33.1%, indicating a Type II error (Beta) of 66.9%. There were no differences in group comparisons between reductions in abdominal, arm and calf circumferences. Qualitatively, once addressed the guiding question after the intervention, which is, "how do adolescents perceive and care for their bodies from before treatment until now," interpretations and successive phenomenological reductions were presented in five categories of Comprehensive Ideas: body perception, ways of caring, ways of feeling, the movement of change toward self-liberation, and openness to the future. Conclusions: The results of the quantitative analysis did not confirm the hypothesis that the intervention with BSP, integrated into standard obesity treatment, produces an effect in reducing the BMI of adolescents. However, the power of the study was relatively low to identify differences. Furthermore, qualitative analyses indicate the substantial benefits brought about by the treatment, as revealed through the narratives of the participants who demonstrated a significant shift in self-perception of their bodies, new and improved ways of caring for their bodies and health, a greater sense of well-being, a movement toward self-liberation, and an openness to others and the world with new future perspectives.
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Citação
AZEVEDO, Débora Candido de. Efeitos do brainspotting no tratamento da obesidade em adolescentes: uma abordagem quali-quantitativa. 2023. 156f. Tese (Doutorado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2023.