Higher risk of adult obesity linked to extra cash from government program

| 22 October 2008

While a poverty-alleviation program launched by the Mexican government has led to improved health and cognition outcomes in children, a new study by Berkeley researchers says that the cash component of the program has a downside for adults.

The program, called Oportunidades, provides money to impoverished families on the condition that they participate in health-promoting activities, such as getting annual health checkups and attending nutrition- and hygiene-education seminars. This is in contrast to traditional welfare programs that provide cash to families based solely upon their income or where they live.

The study published this week in the Journal of Nutrition found that adults in households that received more cash from the program were more likely to be overweight or obese, and have higher blood pressure, than those who had received less money over time.

“It’s a controversial finding because it suggests that adults are not necessarily spending the money wisely for themselves,” says Lia Fernald, assistant professor of public-health nutrition and lead author of the study. “It’s not clear why the cash is having this effect, but it could be because people who suddenly have more cash are able to buy more high-calorie soft drinks, alcohol, or snacks that they couldn’t afford before, though we did not analyze how the money was spent in our study. This result could also reflect trends in the developing world, particularly in rapidly changing economies, of increased availability of foods high in fat and sugar in place of healthier cereals, fruits, and vegetables.”

The surprising study results come on the heels of an earlier paper authored by the same Berkeley researchers, which showed that, overall, the conditional cash-transfer program was linked to better health outcomes among adults.

The researchers noted that the earlier paper compared adults who had been enrolled in Oportunidades for three-and-one-half to five years with newly enrolled adults who had not yet received any program benefits. In the new study, the authors wanted specifically to examine the role played by money accumulated through the program.

The Mexican government randomly selected communities eligible to enroll when the program first launched a decade ago and allowed the remaining communities to enroll 18 months later. Households that enrolled first thus received more money cumulatively than ones enrolled later.

The study linked people’s receipt of greater amounts of cash with higher body-mass index, higher diastolic blood pressure, and a higher prevalence of overweight and moderate-to-severe obesity in adults. In their analysis, the study authors controlled for other factors that could have influenced the results, such as length of time enrolled in the program, age, gender, and education level.

The researchers noted that the initial and central aim of the Oportunidades program was to improve health and development outcomes for children, a goal that the program has largely achieved. The impact of the program’s components on adult health, however, has been a matter of debate.

“It’s not unusual for adults to make better health and nutrition decisions for their kids than they do for themselves,” adds Fernald. “It’s also possible that healthier foods and beverages are not available in the rural and impoverished regions where the Oportunidades program operates, and so adults may not have adequate access to sufficient resources for the whole family.”

The researchers noticed that those enrolled in the program for the longest period — five years — had slightly better health outcomes than those enrolled for only three-and-one-half years.

Combined with the results from the earlier study showing that adults in the program had lower blood pressure and lower body-mass index, the new findings suggest that the program’s non-cash interventions — screening for chronic diseases and educational classes — seem to be counteracting the negative effects of extra income.

Launched in 1997, Oportunidades serves more than 5 million Mexican families and has been replicated in more than 20 developing countries. In 2007, New York City established the first conditional cash program in the United States that was modeled after Oportunidades.

“Our data suggest that if cash is given to adults unconditionally, with no health-education or -promotion component to balance it out, it could cause an increase in obesity and hypertension for adults,” says Fernald. “What this study shows is that a strong focus on health education and prevention is a really critical part of any cash-transfer or welfare program targeting adults.”