Neighborhood affects obesity and diabetes

January 01, 0001

Neighborhood affects obesity and diabetes

This study by US authors uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which at least 40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where less than 10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, they measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA1c).

They found: "As part of our long-term survey, we obtained data on body-mass index (BMI) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points, 3.38 percentage points, and 4.31 percentage points, respectively. The differences between the group receiving traditional vouchers and the control group were not significant."

The authors concluded: "The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health."

Living in a better neighborhood decreases the risk of extreme obesity, but we don’t know exactly why.

For the full abstract, click here.

N Eng J Med 365:1509-1519, 20 October 2011 © 2011 to the Massachusetts Medical Society
Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment. Jens Ludwig, Lisa Sanbonmatsu, Lisa Gennetian, et al. Correspondence to Dr. Ludwig: jludwig@uchicago.edu

Category: T. Endocrine/Metabolic/Nutritional, Z. Social Problems. Keywords: social experiment, obesity, diabetes, housing, neighborhood, vouchers, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 8 November 2011

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