THE REAL-WORLD TRAJECTORY OF OBESITY IN THE UNIFIED HEALTH SYSTEM (SUS) OF BRAZIL (2022-2025)
Author(s)
JULIO CESAR B. OLIVEIRA, MD1, Daniela Mayumi Rocha, PhD2.
1MD, Precision Data, São Paulo, Brazil, 2Precision Data, São Paulo, Brazil.
1MD, Precision Data, São Paulo, Brazil, 2Precision Data, São Paulo, Brazil.
OBJECTIVES: Obesity prevalence continues to rise worldwide, including in Brazil, yet real-world evidence on how BMI evolves within publicly funded health systems remains limited. The SUS addresses obesity across care levels, from primary prevention to bariatric surgery, with no pharmacotherapy in the public formulary. This study aimed to understand obesity trajectories in the SUS, whether patients improve, stabilize, or worsen under specialized care, and how outcomes differ across Brazilian territories.
METHODS: A nationwide cohort was built through deterministic record linkage of outpatient (SIA/APAC) and inpatient (SIH) DataSUS databases (2022-2025) using the Nexus framework, structured under the OMOP Common Data Model. Patients with baseline BMI ≥25 kg/m², ≥2 valid anthropometric measurements, and ≥12-month follow-up were included. BMI was classified into five categories (<25 kg/m², overweight, class I, II, III obesity). The outcome was BMI class transition from baseline to last measurement (regressed, maintained, or progressed) stratified by baseline class, and state.
RESULTS: Among 1,742,495 patients (median follow-up 2.83 years; 12 measurements/patient), 59.5% were female and 48.5% aged ≥60 years. Only 16.7% regressed at least one BMI class, while 74.8% maintained and 8.5% progressed—meaning 83.3% did not improve despite specialized care. Regression increased with baseline severity (13.5% overweight to 25.2% class III); all class III patients who regressed (n=16,615) reached class II or below. State-level regression ranged from 5.0% (Espírito Santo) to 29.0% (Minas Gerais) — a nearly sixfold variation not explained by baseline patient severity, pointing to health-system factors as main drivers of territorial disparities.
CONCLUSIONS: A substantial majority of patients maintained or worsened their BMI class despite specialized care, revealing that current strategies effectively reach only a minority. Unexplained between-state differences, independent of patient severity, reveal structural inequities in obesity care. These results call for broader action, including prevention, multidisciplinary programs, and expanded therapeutic options within the SUS.
METHODS: A nationwide cohort was built through deterministic record linkage of outpatient (SIA/APAC) and inpatient (SIH) DataSUS databases (2022-2025) using the Nexus framework, structured under the OMOP Common Data Model. Patients with baseline BMI ≥25 kg/m², ≥2 valid anthropometric measurements, and ≥12-month follow-up were included. BMI was classified into five categories (<25 kg/m², overweight, class I, II, III obesity). The outcome was BMI class transition from baseline to last measurement (regressed, maintained, or progressed) stratified by baseline class, and state.
RESULTS: Among 1,742,495 patients (median follow-up 2.83 years; 12 measurements/patient), 59.5% were female and 48.5% aged ≥60 years. Only 16.7% regressed at least one BMI class, while 74.8% maintained and 8.5% progressed—meaning 83.3% did not improve despite specialized care. Regression increased with baseline severity (13.5% overweight to 25.2% class III); all class III patients who regressed (n=16,615) reached class II or below. State-level regression ranged from 5.0% (Espírito Santo) to 29.0% (Minas Gerais) — a nearly sixfold variation not explained by baseline patient severity, pointing to health-system factors as main drivers of territorial disparities.
CONCLUSIONS: A substantial majority of patients maintained or worsened their BMI class despite specialized care, revealing that current strategies effectively reach only a minority. Unexplained between-state differences, independent of patient severity, reveal structural inequities in obesity care. These results call for broader action, including prevention, multidisciplinary programs, and expanded therapeutic options within the SUS.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD120
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)