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Obesity and diabetes reduced when move to better neighborhood – or better UV – Oct 2011

Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment

Jens Ludwig, Ph.D. jludwig at uchicago.ed, Lisa Sanbonmatsu, Ph.D., Lisa Gennetian, Ph.D., Emma Adam, Ph.D., Greg J. Duncan, Ph.D., Lawrence F. Katz, Ph.D., Ronald C. Kessler, Ph.D., Jeffrey R. Kling, Ph.D., Stacy Tessler Lindau, M.D., Robert C. Whitaker, M.D., M.P.H., and Thomas W. McDade, Ph.D.
N Engl J Med 2011; 365:1509-1519October 20, 2011

BACKGROUND The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes.

METHODS 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 ?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 <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, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA1c).

RESULTS As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) 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 (95% confidence interval CI, ?8.54 to ?0.69), 3.38 percentage points (95% CI, ?6.39 to ?0.36), and 4.31 percentage points (95% CI, ?7.82 to ?0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant.

CONCLUSIONS 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. (Funded by HUD and others.)

PDF is attached at bottom of page

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Looks like a very good study, but the diseases involved make us wonder about vitamin D. . .

The health improvement might have been because increased vitamin D when they moved out of the poverty neighborhood

  1. Less haze ==> increased UV ==> vitamin D ==> reduces both Obesity and Diabetes
  2. Less likely to feel safe being outside (going for a walk, etc) in poverty neighborhood
  3. Less likely to have grass to mow, garden to tend, house to fix in poverty neighborhood

Points about the study

  • Seems unlikely that they would have changed their food consumption much as they did not get any more money for food in the new location
  • Appears that the study excluded families which were not headed by women (exclusion: "106 Were not headed by women")
    • This makes it even more likely that the person (women) went outdoors more - no man to do the outdoor chores
  • 91% had dark skin - and it is known that the vast majority of people with dark skin are vitamin D deficient
  • We suspect that at least a one of the reasons that half of the women did not elect to move was that they did not feel up to the outdoor work involved

It would be nice to have a new study go thru the data with the above in mind

  • The study may have kept the blood samples for the diabetes analysis, which could be used to look at the vitamin D levels
  • The census track information may be able to be used to determine change in haze due to moving
  • The housing information may indicate the percentage of women who transferred into homes

See also VitaminDWiki

On the Web

Attached files

ID Name Comment Uploaded Size Downloads
826 Obesity, diabetes and where you live - 2011.pdf admin 20 Oct, 2011 03:19 615.72 Kb 803
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