ELIMINATING OBESITY, LIVING LONGER AND BETTER
Authors:
Chula Diogo, Family Medicine Resident (1);
Jimenez Antoni, Family Doctor (1)
Mendoça Hugo, Nurse (1)
Gomes Vitor, Nurse (1)
Guerreiro Joana, Nurse (1)
Oliveira Carla, Psychologist (1)
Roque Ana Rita, Nutritionist (2)
Raúl José, Physical Education Teacher (2)


1 Odemira Primary Care Unit (UCSP) – Unidade Local de Saúde do Litoral Alentejano (ULSLA), Portugal
2 Munícipio de Odemira, Litoral Alentejano, Portugal


Background:
Obesity was declared by the World Health Organization as one of the 21st century pandemics. In Portugal, about 53% of the population are overweight (BMI > 27 kg/m²), and around 1.5 million are obese (1).

Approach:
At a more local scale, Odemira (Alentejo), is estimated that 24.3% of the population aged ≥18 years is obese(2). Moreover, among patients registered at Odemira UCSP, between the ages of 40 and 64, there were in 2023, 1,175 people (12.2% of this population)(3), with obesity and either Hypertension or Diabetes Mellitus.
In response to this scenario, ULSLA EPE (UCSP Odemira), in partnership with Municipio de Odemira, launched an integrated municipal primary prevention program for individuals with obesity and high cardiovascular disease risk (CVD), named Living More, Living Better. The program aims to reduce CVD risk, promote healthy behaviors, and empower individuals to effectively manage their health/disease.
People between 40 to 64 years old with obesity and another CVD risk factor – Diabetes Mellitus, Hypertension, and/or Dyslipidemia – were identified and recruted by their health team.
Exclusion criteria include: pregnancy, uncontrolled psychiatric illness or conditions that prevent moderate-intensity physical exercise.
A multidisciplinary team composed by a doctor, nurse, nutritionist, psychologist and physical education teacher was assembled to follow the patients.
A closed group of 10 people received personalized care over 12 months, with periodic biometric, analytical, and psychological evaluations by the multidisciplinary team every 3 months. Participants received weekly personalized physical training from a physical education teacher and weekly/biweekly dietary consultations with a nutritionist. Monthly educational/capacity-building sessions were held in a mutual aid group format.

Results:
Regarding the first group of the project, we could observe that half of the participants moved from obesity to overweight. All increased their HDL levels and reduced baseline systolic blood pressure, resulting in a reduced CVD risk. All improved their aerobic endurance.

Implications:
Health should increasingly occupy a central place in the territorial and community policies of each municipality, as community development is limited without health.
Multidisciplinary Integrated municipal/primary care programs seem to be an answer to instill in participants the responsibility for change. With appropriate and personalized professional support we can involve, empower, and equippe populations to adopt healthier lifestyles.

References:
1 Direcção Geral de Saúde (www.dgs.pt)
2 www.atlasmunicipiossaudaveis.pt
3 Functional Unit Information and Monitoring Module (MIM@UF)

Background: The +AGIL Barcelona program is an evidence-based, real-world, multidomain, and multidisciplinary initiative aimed at promoting healthy aging by enhancing older adults’ intrinsic capacity through a coordinated approach involving primary care, geriatrics and community resources. It aligns with the WHO’s ICOPE guidelines, emphasizing functional independence and an active lifestyle. Co-designed with healthcare professionals and end-users, the program bridges the gap between research findings and real-world practice. Initially implemented at one Primary Care Center (PCC), it showed significant improvements in physical function at three months, sustained at 6 months - even among individuals with cognitive decline. Building on its success, +AGIL is scaled to three PCCs with varied socio-demographic profiles, optimizing local resources to create a sustainable, person-centered care model.
Approach: The implementation follows a stepped-wedge, cluster-randomized design, integrating a complex intervention into routine care. Each PCC begins with a baseline control period during which the +AGIL model is co-designed to fit local contexts. Participatory co-creation methodologies, including focus groups and technical sessions, are guided by Participatory Action Research (PAR) principles and actively engaged stakeholders – healthcare professionals, community agents and older adults.
To ensure governance and share learning, a motor group oversees the global coordination and strategic decisions, while local implementation groups adapt and manage the program's day-to-day operations. Continuous evaluation identifies barriers and tailors solutions to diverse socio-economic contexts, ensuring seamless integration into routine clinical practice.
Results: Preliminary findings indicate high acceptance of the +AGIL Barcelona across PCCs, with improved coordination between healthcare and community resources. The co-creation process yields practical tools, including a desk prism for healthcare professionals, a foldable physical activity guide, and informational brochures for participants and community agents. These tools have strengthened community engagement and empowered stakeholders to support program delivery actively.
Implications: The +AGIL Barcelona program exemplifies key pillars of integrated care: a) Person centered-care, co-design approach prioritizes individual autonomy, aligning interventions with participants’ needs and preferences; b) coordinated care, the program fosters collaboration between healthcare providers and community agents to deliver accessible, continuous care that supports aging in place; c) system-based approach, levering existing healthcare and community assets, the program demonstrates system integration and resources optimization.

The program’s sustainability and adaptability showcase a model of collaborative leadership and continuous improvement. Its flexible design translates scientific evidence into real-world clinical applications, bridging the gap between research and practice.
A unique strength of +AGIL Barcelona lies in its bottom-up development: healthcare teams at each PCC lead the design and solutions, ensuring contextual relevance and alignment with existing workflows. This approach enhances sustainability, supports integration into daily clinical operations, and fosters long-term engagement.
Through its replicable and scalable model, +AGIL Barcelona addresses the complex challenges of an aging society, paving the way for inclusive, person-centered, and sustainable healthcare solutions for older populations.

Background

The + Agil, a multicomponent program to maintain intrinsic capacity or reverse frailty of community dwelling older adults, has shown effectiveness and is being successfully implemented in three primary care areas (PCA) in Barcelona. As a side project of +AGIL we explored the importance of urban indicators in the neighborhood areas of the PCAs in relation to older people mobility with the final aim of informing urban policies.

Approach

The project was conducted by a team of urban designers, health care professionals and epidemiologists and followed a participatory design with users in four steps: 1. Literature search; 2. Focus groups with users of the +Agil Program (frail or prefrail older adults 65 years old or more) living in the three PCAs, and health care professionals (family physicians, nurses and physical therapists); 3. Surveys and personal interviews, and 4; A world cafe.
From the 57 urban indicators identified in the literature 12 were selected in the focus groups with professionals and users. We created three questionnaires (one for each PCA). First, we asked the users to mark on a map their route from home to the PCA center and then, we asked the users about the importance (1-10 scale) of the indicators for their routes selection. Data and itineraries were digitalized using QGIS software to create heatmaps showing the most frequented routes and the presence of the evaluated indicators. Finaly, 5 users of each Primary Health Care center (15) participated in a world caffe. The team of urban designers showed their conclusions and altogether we discussed them in a structured way through three different activities.

Results

The following variables were evaluated: pedestrian pathways, sidewalk width, street slope, ramps and stairs, benches and seats, trees and green areas, noise, illumination, public transport stops, speed of traffic, bicycles or scooters, parked cars. In general, older people valued negatively characteristics that represented a risk, such as the presence of bicycles and scooters, and positively the presence of benches and trees/green spaces
Some items were considered less relevant, for example, the presence of parked cars or illumination, while others were considered important only in the areas where they were problematic. For example, the presence of ramps and stairs and the slope of the street in one of the areas in which most streets have a high slope.
There were other items that emerged from the discussions: safety was one of the main worries for older people, who expressed concerns about the separation of pedestrian spaces from other uses, such as bicycles and scooters, or the occupation of sidewalks (even wide ones) by terraces. Also for safety reasons, more crowded streets with higher levels of noise and traffic were preferred to quiet narrow pedestrian streets.

Implications

The study poses some contradictions to the modern urban models in which Barcelona is a referent. Ongoing projects of urban pacification should take into account the opinions and preferences of older citizens, in order to adapt the urban environment to their needs, especially related with safety.

Background
We are an interdisciplinary team from ULSA and our project arose from the identification of a need to improve the coordination of care on the part of hospital care - Infectious Diseases Service that admits patients diagnosed with TB and Primary Health Care - the CDP (Pneumological Diagnostic Center) that monitors patients diagnosed with TB and their relatives in an outpatient clinic - Access for TB patients to primary/differentiated healthcare (without wasting time). This project is based on the pillars: Health needs of the population and local context, carried out based on the four-step management methodology - PDCA (PLAN - DO - CHECK - ACT).

We started by measuring the current situation (baseline):
-TB patients followed at the CDP, when they needed hospitalization, were admitted through the Emergency Department, increasing waiting time and risk of contagion.​
-As for TB patients admitted to the hospital, cohabitants/family members were lost to screening, we found a lack of systematization in the teaching given to patients and family members and patients were discharged without scheduling an appointment.​

Approach
Improvement objectives, indicators, solutions and monitoring plan for 6 months:
-Improve the circuit for patients diagnosed with TB, referred from the CDP to hospital care, increasing the number of direct admissions to 100%, without the need to go to the emergency department.
-Improve the identification and referral circuit of cohabitants for screening of patients admitted to hospital care, providing an increase in screenings carried out.
-That all patients admitted with a diagnosis of TB demonstrate knowledge about the disease until discharge.
-That all patients admitted with a diagnosis of TB, at the time of hospital discharge, have their first nursing appointment scheduled at the CDP within 72 hours.​

Strategies used: creation of a direct communication channel (telephone and email), preparation of protocols, systematization of procedures, use of Guidelines, information leaflets, definition of roles and existence of a case manager and team training. An action plan was defined using regular monitoring strategies.

Results
In 6 months:
-All patients referred by the CDP for hospital care were admitted directly to the Infectious Diseases service.
-All patients hospitalized with a diagnosis of TB, at the time of discharge, had a nursing appointment at the CDP scheduled in less than 72 hours.​
-All patients admitted with a diagnosis of TB and lack of knowledge about the disease showed an increase in knowledge at the time of discharge.
-All people living with TB patients identified during hospitalization and referred to the CDP undergo screening.​
-This project included 12 hospitalized patients and 18 cohabitants who were screened. 10 positive cohabitants were identified, people who started treatment early, interrupting the transmission of the disease.

Implications
The path was one of growth and learning, understanding that there are several fundamental strategies for the successful implementation of a project, namely the importance of listening to the people to whom we direct our projects and care and always working towards continuous improvement.​
This project resulted in health gains for the patient, family and community.