Association between food assistance program participation and overweight

Chaparro, M Pia; Bernabe-Ortiz, Antonio; Harrison, Gail G

doi:10.1590/S0034-8910.2014048005359

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Original Articles • Rev. Saúde Pública 48 (6) • Dec 2014 • https://doi.org/10.1590/S0034-8910.2014048005359 copy

Association between food assistance program participation and overweight

Associação entre participação em programa de assistência alimentar e sobrepeso

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level.

METHODS

A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year.

RESULTS

Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status.

CONCLUSIONS

Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.

Overweight, epidemiology; Nutrition Programs and Policies; Socioeconomic Factors

Program	Objective	Target population	Type of assistance	Eligibility assessment	Budget for 2012 (million $)^a
Glass of Milk [Vaso de Leche]	To improve the nutritional status and quality of life of the poor	First priority: children younger than 6 years and pregnant and lactating women. Second priority: children aged 7-13 years, older adults, and patients with tuberculosis	250 mL of fortified whole milk or an equivalent ready-to-drink product daily	Geographical, based on neighborhood socioeconomic status; within neighborhoods, beneficiaries are chosen at the discretion of mothers’ committees in charge of day-to-day operations	145
Community Kitchen Program [Comedores Populares]	To improve access to food for impoverished families by feeding vulnerable groups at high nutritional risk	People living in poverty and extreme poverty in periurban and rural areas	Low cost lunches (subsidized by the government)	Geographical, based on neighborhood socioeconomic status; within neighborhoods, beneficiaries are chosen at the discretion of mothers’ committees in charge of day-to-day operations	46^b
Wawawasi [now called Cuna Mas]	To provide comprehensive child care for children living in poverty	Children 6-36 months of age who live in poverty	Child care plus 2 meals per day	Geographical, based on neighborhood socioeconomic status	94
Programa de Alimentacion y Nutricion para el Paciente Ambulatorio con Tuberculosis y Familia (PANTBC)	To contribute to the integral recovery of tuberculosis ambulatory patients and their families	Patients with tuberculosis and their families	Monthly food basket comprising 13 kg of cereals, 2 kg of legumes, 1.7 kg of canned fish, and 1 liter of vegetable oil	Based on tuberculosis diagnosis; benefits distributed through hospitals or health posts	4

	2003-2006 (n = 43,390)	2008-2010 (n = 2,827)	p^a
	%	%	p^a
Age [years; mean (SE)]	30.3 (0.1)	27.6 (0.2)	< 0.0001
Education level			0.0820
Less than primary school	4.0	4.5
Primary school	28.6	23.1
Secondary school	45.3	47.2
More than secondary school	22.2	25.3
Family socioeconomic status			0.1416
0 poverty indicators	12.2	16.8
1 poverty indicator	25.8	25.4
≥ 2 poverty indicators	62.0	57.8
Urbanization status			< 0.0001
Urban	66.1	85.5
Rural	33.9	14.5
Weight status			< 0.0001
Overweight	31.0	31.2
Obese	11.8	16.4
FAP participation (yes)	33.3	29.9	0.1602

	Food assistance program participation		p^a

	No	Yes
Total	45.6	42.9	0.0567
Family socioeconomic status
0 poverty indicators	44.4	57.2	0.0428
1 poverty indicator	50.0	50.7	0.8241
≥ 2 poverty indicators	43.7	40.2	0.0308
Are of residence
Lima	48.0	52.9	0.1609
Rest of country	44.5	40.0	0.0031
Urbanization status
Urban	47.7	49.8	0.2816
Rural	37.0	33.3	0.0364

FAP participation (yes/no)	Whole sample		Lima only		Rest of country		Urban areas		Rural areas		2003-2006		2008-2010

	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI	PR	95% CI	PR	95%CI	PR	95%CI
0 poverty indicators
Crude	1.29	1.03;1.61	1.36	1.01;1.85	1.16	0.92;1.47	1.29	1.03;1.61	1.09	0.60;1.98	0.99	0.74;1.32	1.68	1.31;2.14
Adjusted^b	1.29	1.06;1.57	1.36 ^c	1.01;1.85	1.19	0.86;1.64	1.30	1.06;1.58	0.79	0.38;1.65	1.07	0.82;1.40	1.56 ^d	1.18;2.06
1 poverty indicator
Crude	1.01	0.90;1.15	1.09	0.87;1.36	0.96	0.84;1.10	1.01	0.89;1.15	1.06	0.71;1.58	1.07	0.94;1.21	0.95	0.75;1.20
Adjusted^b	1.03	0.92;1.15	1.08	0.88;1.32	0.99	0.87;1.12	1.02	0.91;1.15	0.98	0.71;1.36	1.06	0.94;1.18	0.97	0.79;1.20
≥ 2 poverty indicators
Crude	0.92	0.85;0.99	0.98	0.81;1.20	0.92	0.86;0.99	1.02	0.92;1.13	0.90	0.81;0.99	0.92	0.86;0.98	0.93	0.79;1.10
Adjusted^b	0.99	0.92;1.06	0.97	0.79;1.17	1.01	0.94;1.08	1.02	0.93;1.12	0.95	0.87;1.04	1.00	0.94;1.06	0.96	0.83;1.11

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[1] Correspondence
: M. Pia Chaparro. Center for Health Equity Studies – CHESS. Stockholm University and Karolinska Institutet. Sveavagen 160, Floor 5. 10691 Stockholm, Sweden. E-mail: pia.chaparro@chess.su.se