title: The impact of cash transfers to poor women in Colombia on BMI and obesity: prospective cohort study.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK. i.forde@ucl.ac.uk
authors.forename: I
authors.initials: I
authors.lastname: Forde
authors.forename: T
authors.initials: T
authors.lastname: Chandola
authors.forename: S
authors.initials: S
authors.lastname: Garcia
authors.forename: M G
authors.initials: MG
authors.lastname: Marmot
authors.forename: O
authors.initials: O
authors.lastname: Attanasio
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D005380:Financing, Government; D006078:Government Programs; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D011203:Poverty / Q000706:statistics & numerical data; D015995:Prevalence; D015397:Program Evaluation; D011446:Prospective Studies; D012946:Social Welfare