UCLA

Obesity is a worldwide epidemic. While numerous obesity prevention efforts have been implemented around the world for different age groups and at different settings (i.e. school, home, community), most of these have shown short-term, moderate results if at all. Identifying successful obesity prevention strategies, therefore, remains critical. Food assistance programs (FAPs), originally designed to prevent hunger among the poor, have the potential to work as venues for obesity prevention interventions since they reach low-income populations with high rates of chronic disease. The goal of this dissertation was to examine the association between FAP participation, both in the U.S. and Peru.

For the first paper in this dissertation (Chapter 2), I assessed the individual and neighborhood-level predictors of participation in the Supplemental Nutrition Assistance Program (SNAP) among adults in LA County. Using data from wave 1 of the Los Angeles Family and Neighborhood Survey (L.A. FANS) and multilevel analyses in which people were nested in census tracts, I found that the best single predictor of SNAP participation was participation in the Temporary Assistance for Needy Families (TANF) program. Age was negatively associated with SNAP participation and Hispanics and people who cohabitated with their partners but were not married were more likely to participate in SNAP when compared to non-Hispanic Whites and people who were married, respectively. In addition, people who lived in neighborhoods with higher rates of social cohesion were less likely to participate in SNAP.

For the second paper (Chapter 3), I investigated if SNAP participation was associated with obesity among adults in LA County and if mental health was a mediator and the neighborhood food environment a moderator in the association between SNAP participation and BMI.

Again using L.A. FANS data, I found that SNAP participation was associated with BMI: an additional year of SNAP participation was associated with an increase in BMI of 0.14-0.19 Kg/m2. I also found that mental health partially and significantly mediated the association between SNAP participation and BMI. On the other hand, the neighborhood food environment, operationalized as the density (count per square mile) of unhealthy food outlets, was not a significant moderator in the association between SNAP participation and BMI.

For the third and final paper (Chapter 4) I analyzed data from Peruvian nationally representative cross-sectional surveys (2003-2010) to investigate if FAP participation was associated with overweight (including obesity) among women and preschool-aged children. For the country as a whole and all the years of study, FAP participation was not significantly associated with overweight among women and was negatively and significantly associated with overweight among children. When stratified by area of residence, FAP participation was associated with increased overweight for women who lived in Lima, the capital of Peru. For children, FAP participation was associated with lower overweight for all sub-groups except for children living in Lima.

Results from these three studies indicate that FAP participation is a potential risk factor for adult obesity, both in the U.S. and in Peru. Efforts should be made to better understand the mechanisms linking FAP participation and obesity. In the U.S., having a poor mental health seems to be one link associating SNAP participation and obesity. In Peru, on the other hand, the high caloric content as well as the high leakage rates seen in most FAPs could be reasons why FAP participants have higher overweight rates than their counterparts. Regardless of the reasons, FAP reform is warranted and the high rates of obesity experienced by FAP recipients should be taken into account when re-defining FAP benefits.