Public Health Nutrition

Social, economic, political and environmental determinants

Is participation in food and income assistance programmes associated with obesity in California adults? Results from a state-wide survey

Cindy W Leunga1a2 c1 and Eduardo Villamora1a2a3a4

a1 Department of Nutrition, Harvard School of Public Health, Boston, 665 Huntington Avenue, Boston, MA 02115, USA

a2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

a3 Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA

a4 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA


Objective Public assistance programmes may increase risk of obesity among adults. The current study assessed whether participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program), Supplemental Security Income (SSI) or California Work Opportunities and Responsibilities to Kids (CalWorks) was associated with obesity, independent of socio-economic status and food insecurity.

Design A cross-sectional analysis of the 2007 Adult California Health Interview Survey. Outcome measures included BMI and obesity. Distribution of BMI and prevalence of obesity were compared by participation in each programme, using weighted linear and binomial regression models in which BMI or obesity was the outcome, respectively, and programme participation was the predictor.

Setting A population survey of various health measures.

Subjects Non-institutionalized adults (n 7741) whose household income was ≤130 % of the federal poverty level.

Results The prevalence of obesity was 27·4 %. After adjusting for sociodemographic characteristics, food insecurity and participation in other programmes, the prevalence of obesity was 30 % higher in SNAP participants (95 % CI 6 %, 59 %; P = 0·01) than in non-participants. This association was more pronounced among men than women. SSI participation was related to an adjusted 50 % higher prevalence of obesity (95 % CI 27 %, 77 %; P < 0·0001) compared with no participation. SNAP and SSI participants also reported higher soda consumption than non-participants of any programme. CalWorks participation was not associated with obesity after multivariable adjustment.

Conclusions Participation in SNAP or SSI was associated with obesity independent of food insecurity or socio-economic status. The suggestion that these associations may be mediated by dietary quality warrants further investigation among low-income populations.

(Received January 07 2010)

(Accepted June 02 2010)

(Online publication August 12 2010)


c1 Corresponding author: Email