Challenges for Implementing Integrated Obesity Management in Municipal Health Plans of Mato Grosso do Sul (Brazil): A Qualitative Study

Background and Aims: Despite the growing burden of obesity-related noncommunicable diseases, little is known about how obesity is incorporated into local health-planning instruments. Therefore, this study examined the presence and structure of actions and goals related to obesity management in the municipal health plans (MHPs) of the state of Mato Grosso do Sul, Brazil. Methods: We conducted an exploratory qualitative documentary analysis of 78 MHPs, guided by Bardin's content analysis framework and two regulatory instruments: State Technical Note No. 5/2017 and Ministry of Health Ordinance No. 424/2013 on obesity management. These documents defined four planning stages: situational analysis, problem prioritization, objectives/goals, and budget forecasting. Text segments that mentioned "obesity" or related terms were extracted and analyzed in the IRaMuTeQ software applying correspondence factor analysis, descending hierarchical classification, and similarity analysis. Results: Among the 78 MHPs (covering 98.7% of all municipalities in Mato Grosso do Sul), 52% mentioned obesity or related terms. However, obesity was rarely prioritized as a strategic health problem. In most plans, situational diagnoses were not translated into measurable goals or structured actions, and none included a dedicated budget allocation. Childhood obesity was seldom explicitly addressed, and primary care actions were described in generic preventive terms rather than as integrated care pathways. Textual analysis using IRaMuTeQ revealed that "obesity" occupied a peripheral position in planning discourse, reinforcing its limited institutional centrality. Only two municipalities' plans demonstrated coherent alignment across all four planning stages, underscoring a systemic weakness in incorporating obesity into local health management. Conclusions: These findings indicate not merely an omission, but a structural weakness in local health governance regarding obesity management. The absence of prioritization, measurable targets, and financial planning undermines the implementation of national obesity policies at the municipal level and contributes to fragmented care within the primary health-care network. Strengthening technical planning capacity, integrating epidemiological evidence into strategic goal-setting, and ensuring explicit budget allocation are essential to advancing comprehensive and equitable obesity management within Brazil's Unified Health System.