Food Stamp Program participation but not food insecurity is associated with higher adult BMI in Massachusetts residents living in low-income neighbourhoods

Objective: Food-insecure populations employ multiple strategies to ensure adequate household food supplies. These strategies may increase the risk of overweight and obesity. However, existing literature reports conflicting associations between these strategies and BMI. The objective of the present study was to examine whether food insecurity and strategies for managing food insecurity are associated with BMI in adults. Design, setting and subjects: In 2005, RTI International and Project Bread conducted a representative survey of 435 adult residents of low-income census tracts in Massachusetts. Food insecurity was assessed using the US Department of Agriculture's eighteen-item Household Food Security Module. Results: The prevalence of overweight and obesity was 51% and 25%, respectively. After adjusting for age, sex, sociodemographic characteristics and food insecurity, both participation in the Food Stamp Program (FSP) and participation in any federal nutrition programme 12 months prior to the survey were each associated with an approximate 3.0 kg/m(2) higher adult BMI. In the subset of current FSP participants (n 77), participation for >= 6 months was associated with an 11.3 kg/m(2) lower BMI compared with participation for < 6 months. Respondents who consumed fast foods in the previous month had a mean BMI that was 2.4 kg/m(2) higher than those who did not. Food insecurity was not associated with BMI after adjustment for sociodemographic characteristics and FSP participation. Conclusions: Participation in federal nutrition programmes and consumption of fast food were each associated with higher adult BMI independent of food insecurity and other sociodemographic factors. However, prolonged participation in the FSP was associated with lower BMI.