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In the first randomized trial of its kind, researchers provided women living in high-poverty areas with vouchers and counseling so they could move into better neighborhoods. After 10 years of living in the new areas, those women were 19% less likely to be morbidly obese, and 22% less likely to have developed type 2 diabetes compared to the control group that stayed in high-poverty neighborhoods.
"Investments outside the health care system can be really important complements to spending within the health care system," noted study author Jens Ludwig, the McCormick Foundation Professor of Social Service Administration, Law and Public Policy at the University of Chicago.
"The effects in our paper seem to be roughly comparable to the best practice lifestyle and medication interventions. That's pretty striking," he said. "The initial aim of the study was to help families be safer, but it turns out there's an effect on these really important health outcomes that's in the ballpark of lifestyle and medical interventions."
Results of the study are published in the Oct. 20 issue of the New England Journal of Medicine.
From 1994 through 1998, the study authors recruited 4,498 women with children living in public housing in high-poverty areas. The study was called Moving to Opportunity, and its aim was to see if moving the women and their children from high-poverty areas to lower-poverty areas could improve their lives. The study volunteers came from five U.S. cities: Baltimore, Boston, Chicago, Los Angeles and New York.
The women were assigned to one of three groups based on the results of a random lottery: one group received housing vouchers that were only redeemable if they moved to an area with less than 10% of people living in poverty, and they received counseling on moving; another group received housing vouchers with no restrictions; and the final group received no intervention.
In 2008 through 2010, the researchers collected follow-up information, including measurements of height, weight and blood samples to test for diabetes.
During the follow-up period, 17% of the women in the control group were morbidly obese, which means a body mass index of 40 or above. Among the women who moved to lower-poverty areas, that rate was 14.4%, which is 19% lower than the control group, according to the study. Women who received traditional housing vouchers had a morbid obesity rate of 15.4%.
The rate of diabetes was 16.3% in the women who moved to lower-poverty areas, 20.6% in the traditional housing voucher group and 20% in the control group.
Ludwig said this study wasn't designed to identify the specific factors that might have contributed to the drop in obesity and diabetes rates after moving to lower-poverty areas, but that there are four major factors that likely contributed. One is access to better foods. In higher-poverty areas, there are often no grocery stores, only small corner stores. Another is the ability to exercise in safer neighborhoods. Access to better health care may also play a role, said Ludwig. And, reduced psychological stress because of moving to a safer neighborhood may also help, he said.
"This was a good study looking at a very complicated problem. And, they showed that the neighborhood may be a very important component in controlling obesity and diabetes," said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.
And, he added, the change wasn't an expensive one to implement.
Ludwig said that counseling was really the only additional cost of the study, as the women were already living in public housing. And, he noted, it's estimated that caring for one person with diabetes costs about $5,000 per year, so the savings from such a program could end up being quite significant.
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