Now Reading: Neighborhoods, Obesity, and Diabetes – A Randomized Social Experiment

Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment

As compared with the control group, the group with a randomly assigned opportunity to use a voucher to move to a neighborhood with a lower poverty rate had lower prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more, representing relative reductions of 13.0%, 19.1%, and 21.6%, respectively. The magnitudes of the associations with health were larger still for participants who moved with a voucher that was restricted to use in a low-poverty area than they were for the intention-to-treat estimates for all participants who received the restricted voucher and are consistent with the effect sizes reported in previous observational studies.3 Because we generated estimates for several BMI cutoff points, our estimates for the associations between program participation and extreme obesity may be marginally significant.

Is moving to a different neighborhood as powerful or more powerful an intervention than health care, health education, apps, reminders, games and other individually-directed behavior change strategies people are talking about with obesity? It seems to have an impact.

What an interesting study – randomizing families (via incentive vouchers) to either move to a neighborhood with a low poverty rate, a neighborhood of their choice, or no intervention, between 1994 and 1998, with a 10-12 year follow-up. How often does that happen.

Not every family offered the voucher to move actually moved, and the analysis takes this into account (via intention-to-treat). It appears to my eyes that all families that did move (low poverty or move-where-you-want) went to neighborhoods that were less-poor and higher education levels, and there was an association with the impact on their health (weight, HbA1c).

Interestingly, at interview, none of the study groups reported having better access to non-emergency room health care, so that part of their neighborhood experience didn’t change, while their health experience did.

I recommend looking at Tables 2-3 – I can’t reproduce here to respect copyright, but the article is open access.

This is all related to research on the impact of location (see: Now Reading: Place, not race: disparities dissipate when blacks and whites live under similar conditions ) combined with modern tools to assess what’s happening in locations (see: Pioneering Idea: Your Patient’s Community Health Needs Assessment on the Desktop – Robert Wood Johnson Foundation)

I think this is a well done study. I am in the habit of reviewing disclosures – the study itself wasn’t funded by pharmaceutical, device, or food manufacturers, however authors of this publication or their institution(s) have received funding from those sources.

Ted Eytan, MD