Reducing Both Food Insecurity and Excess Body Weight in Costa Rican Women: A Cluster Randomized Trial

Abstract

The coexistence of food insecurity and excess body weight has been well documented in women. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these interventions might contribute to excess body weight, particularly in adult women. The purpose of this study was to develop, implement, and evaluate an intervention to simultaneously reduce food insecurity and body weight through alleviating discouragement-which women described as feeling sad, depressed, hopeless, and lacking drive to do important activities, such as finding a job or studying more-by increasing women's empowerment. This 2-armed cluster RCT was conducted from February to December 2017. Data were analyzed from January to July 2018. Participants were food-insecure women with excess body weight in the Central Canton of the province of Alajuela, Costa Rica. The intensive intervention arm consisted of activities at the individual (12 sessions lasting 2 hours each, 3 follow-up monthly sessions, and 1 closing session), household (1 workshop with the participants' household and community members and homework with family participation), and community (2 brochures and 1 workshop) levels. The nonintensive control arm consisted of 3 sessions about healthy lifestyles lasting 1 hour each. Outcome measures included BMI, waist circumference, and food insecurity. A total of 171 participants were enrolled (83 in intensive and 88 in nonintensive control arms). At 6 months, the intensive arm had greater decreases from baseline in BMI (-0.648, p=0.019), waist circumference (-2.21, p=0.002), and food insecurity (-1.35, p=0.009) compared with the nonintensive control arm. The intensive intervention was effective in simultaneously reducing food insecurity and excess body weight. Educational components should be added to interventions aimed to reduce food insecurity. This study is registered at www.clinicaltrials.gov NCT03492619.