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The impact of cash transfers to poor women in Colombia on BMI and obesity: prospective cohort study

International Journal of Obesity volume 36, pages 1209–1214 (2012)Cite this article

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Abstract

Introduction:

Prevalence of obesity is rising in Latin America and increasingly affecting socially disadvantaged groups, particularly women. Conditional cash transfers are recently established welfare interventions in the region. One, Familias en Accion, transfers ∼20% of average monthly income to women in Colombia's poorest families. Previous work has found that families buy more food as a result. We tested the hypothesis that participation in Familias would be associated with increasing body mass index (BMI) in participating women.

Methods:

Women from participating areas and control areas (matched on environmental and socioeconomic criteria) were surveyed in 2002 and 2006. Pregnant, breast-feeding or women aged <18 or with BMI <18.5 kg m−2 were excluded. The sample comprises 835 women from control and 1238 from treatment areas. Because some treatment areas started Familias shortly before baseline data collection, a dummy variable was created that identified exposure independent of time point or area. Follow-up was 61.5%. BMI was measured by trained personnel using standardized techniques. Overweight was defined as BMI ⩾25 kg m−2 and obesity as ⩾30 kg m−2. The effect of Familias was estimated using linear regression (or logistic regression for dichotomous outcomes) in a double-difference technique, controlling for several individual, household and area characteristics, including parity and baseline BMI, using robust standard-errors clustered at area-level in an intention-to-treat analysis.

Results:

At baseline, women's mean age was 33.3 years and mean BMI 25.3 kg m−2; 12.3% women were obese. After adjustment, exposure to Familias was significantly associated with increased BMI (β=0.25; 95% confidence interval (CI) 0.03, 0.47; P=0.03). Age (β=0.09; 95% CI 0.06, 0.13; P<0.001) and household wealth (β=0.78; 95% CI 0.41, 1.15; P<0.001) were also positively associated with BMI. Familias was also associated with increased odds of obesity (odds ratio (OR)=1.27; 95% CI 1.03, 1.57; P=0.03), as was age (OR=1.04; 95% CI 1.02, 1.06; P=0.001).

Conclusion:

Conditional cash transfers to poor women in Colombia are independently associated with increasing BMI and obesity risk. Although conditional cash transfers are generally regarded as popular and successful schemes, parallel interventions at individual, household and community level are needed to avoid unanticipated adverse outcomes.

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Acknowledgements

IF is funded by a Medical Research Council Fellowship, which mandates open access publishing (grant code G0701333). In 2001, a partnership between the Institute of Fiscal Studies (London, a research institute), Econometria (Bogotá, a research institute) and SEI (Bogotá, a company specializing in the design and collection of social surveys) was commissioned by the Colombian Government to evaluate Familias, after open tendering. IF is a public health and primary care physician who is researching the health impacts of Familias en Acción. SG and OA have published widely on other impacts associated with Familias and on health and development measures in Colombia. TC and MGM have published extensively on the social determinants of health and health inequity.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, University College London, London, UK

    I Forde & M G Marmot

  2. Cathy Marsh Centre for Census and Survey Research, University of Manchester, Manchester, UK

    T Chandola

  3. School of Government, Universidad de los Andes, Bogotá, Colombia

    S Garcia

  4. Department of Economics, University College London and Institute of Fiscal Studies, London, UK

    O Attanasio

Authors
  1. I Forde
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  2. T Chandola
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  3. S Garcia
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  4. M G Marmot
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  5. O Attanasio
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Corresponding author

Correspondence to I Forde.

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The authors declare no conflict of interest.

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Author contributions

IF planned the paper and wrote the first draft; IF, SG, TC, MGM and OA reviewed the paper and contributed equally to the final version. IF acts as guarantor.

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Forde, I., Chandola, T., Garcia, S. et al. The impact of cash transfers to poor women in Colombia on BMI and obesity: prospective cohort study. Int J Obes 36, 1209–1214 (2012). https://doi.org/10.1038/ijo.2011.234

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