Food Stamps and Obesity

United States

Department of

Agriculture

Economic

Research

Service 

Economic

Information

Bulletin

Number 34

March 2008

What Do We Know?

Michele Ver Ploeg and Katherine Ralston
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Ver Ploeg, Michele

 Food stamps and obesity : what do we know?

 (Economic information bulletin ; no. 34)

 1. Food stamps—United States. 

 2. Poor—Nutrition—United States.

 3. Food supply. 

 4. Obesity—United States.

 5. Nutrition policy—United States. 

 I. Ralston, Katherine.

 II. United States. Dept. of Agriculture. Economic Research Service.

 III. Title.

HV696.F6

Photo credit: Elderly woman, Eyewire; Woman shopping, USDA/NAL; 

Man, Photodisc; Children, Corbis; EBT cards, USDA.
United States

Department

of Agriculture

www.ers.usda.gov

A Report from the Economic Research Service

Abstract

Results from reviewed studies indicate that for most participants in the Food Stamp 

Program—children, nonelderly men, and the elderly—use of food stamp benefi ts does 

not result in an increase in either Body Mass Index (BMI) or the likelihood of being 

overweight or obese. However, for nonelderly women, who account for 28 percent of 

the food stamp caseload, some evidence suggests that participation in the Food Stamp 

Program may increase BMI and the probability of obesity. Different results for age and 

sex subgroups remain unexplained. Further, because food stamp benefi ts are issued to 

households, not individuals, mixed results across age and sex subgroups make it diffi cult 

to target policy alternatives to address potential weight gain among some participants 

while not affecting others in the household. 

Key Words: Food Stamp Program, obesity, Body Mass Index. 

Acknowledgments

The authors thank the following individuals for reviewing the manuscript: Patricia 

Anderson, Dartmouth College; Charles Baum, Middle Tennessee State University; Ed 

Frongillo, University of South Carolina; and Steve Carlson, USDA, Food and Nutrition 

Service. Thanks also to Elise Golan and Mark Prell, both of USDA, Economic Research 

Service, for their thoughtful comments. 

Michele Ver Ploeg and Katherine Ralston

Food Stamps and Obesity

What Do We Know?

Economic

Information 

Bulletin

Number 34

March 2008
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Contents

Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

 Food Stamp Program Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Why Might Food Stamps Cause Weight Gain? . . . . . . . . . . . . . . . . . . . . 3

 Teasing Out Cause and Effect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

 Different Surveys, Different Measures . . . . . . . . . . . . . . . . . . . . . . . . . . 10

 Studies Reviewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Effect of Food Stamp Participation on Weight Status . . . . . . . . . . . . . . 15

 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

 Nonelderly Adult Women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

 Nonelderly Adult Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

 Elderly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

 Short-Term Versus Long-Term Participation. . . . . . . . . . . . . . . . . . . . . 17

Interpreting Differences Across Demographic Groups . . . . . . . . . . . . . 19

Interpreting Selection Bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Hypotheses Revisited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Recommended citation format for this publication:

Ver Ploeg, Michele, and Katherine Ralston. Food Stamps and Obesity: 

What Do We Know? EIB-34, U.S. Dept. of Agriculture, Economic 

Research Service. March 2008.
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Summary

The Food Stamp Program provides benefi ts for low-income individuals to 

purchase food at grocery stores. The program was begun in the 1960s and 

expanded in the 1970s at a time when a problem facing many Americans was 

underconsumption of food and nutrients. Today, however, the primary nutrition problem facing the U.S. population has shifted from too little intake to 

overconsumption and obesity, even among some low-income populations. 

What Is the Issue?

Past research fi nds that the Food Stamp Program increases food expenditures 

and stabilizes incomes of the poor. Yet, critics of the program have suggested 

that the program is too successful—that it has unintentionally contributed 

to higher rates of obesity among some low-income populations. Recently 

published studies that have explored the link between participation in the 

Food Stamp Program and body weight have come to varying conclusions. 

This report reviews the fi ndings of this emerging body of work and discusses 

policy implications. 

What Did the Study Find?

Results from the reviewed studies indicate that for the majority of program 

participants—children, nonelderly men, and the elderly—use of food stamp 

benefi ts does not increase either Body Mass Index (BMI) or the likelihood of 

being overweight or obese. For some subgroups, food stamp participation has 

a negative association with the probability of overweight. 

Nonelderly adult women, who account for 28 percent of the food stamp 

caseload, are the only group of food stamp recipients for whom multiple 

studies show a link between food stamp receipt and elevated BMI and 

obesity. According to these studies, food stamp participation over a 1- or 2-

year period increases the probability of a woman’s becoming obese by 2 to 

5 percentage points and may lead to a 0.5-point increase in BMI, or about 3 

pounds for a woman 5’4” to 5’6” tall. 

The length of time one participates in the Food Stamp Program may have 

an impact on obesity. The reviewed studies found that long-term participation among nonelderly women was linked to a higher probability of obesity 

by 4.5 to 10 percentage points. One study also found a smaller, but positive 

relationship between long-term food stamp participation and obesity for men. 

These results may suggest that small changes in BMI due to food stamp use 

accumulate over longer “spells” of participation. But enough is not known 

about the causal mechanisms of participation and weight gain to conclude 

that long-term use of food stamp benefi ts causes weight gain. Long-term food 

stamp participants are likely to be different from short- and medium-term 

participants in ways that one cannot observe. 

It is also unclear why food stamp participation may affect women, but not 

men or children. Factors that may account for this effect include differences 

in energy requirements, activity levels, or household allocation of resources. 
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Some evidence indicates that food stamp participation, food insecurity, and 

weight status are related. One study shows that weight change over a 2-year 

period among women who were persistently food insecure was less than that 

for women who were persistently food secure. But, food stamp participation 

roughly offset the smaller weight change for those who were persistently 

food insecure—a result consistent with the program’s serving as a nutritional 

buffer during diffi cult economic times. 

The reviewed studies were faced with separating and measuring two distinct 

relationships. On the one hand, food stamp participation may result in 

obesity. On the other hand, individuals who are heavier may be the very 

people who are more likely to apply for food stamps, because of larger appetites, for example. Causal attribution is a major challenge for these studies. 

Methodological and data weaknesses limit the ability of analysts to be certain 

that increased BMI and obesity risk are due to food stamp participation. 

Differential effects across sex and age groupings are also unexplained. 

The Food Stamp Program is a household-level program, and 89 percent 

of food stamp benefi ts go to households that contain a child, elderly adult, 

or nonelderly disabled adult. Devising program changes that are appropriately targeted to household members who may be at risk of gaining weight, 

without harming those who are not and who need the nutritional assistance, 

presents a diffi cult challenge. Policy changes that help improve overall diets 

of all household members may be more effective.

How Was the Study Conducted?

ERS reviewed studies that explored the link between food stamp participation and weight status. Particular attention was given to studies that used 

multivariate analysis, longitudinal data, and accounted for self-selection bias. 

Results are summarized by population subgroup: children (who make up the 

majority of food stamp participants), nonelderly adult women, nonelderly 

adult men, and the elderly. 
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Introduction

The Food Stamp Program, the Nation’s largest food and nutrition assistance 

program, was designed to provide low-income households with monthly 

benefi ts that can be used to purchase the food they need for good health. In 

2006, the program served about 27 million people at a cost of almost $32 

billion. In addition to providing these benefi ts, the program also helps stabilize the incomes of the poor and promote food expenditures. 

While the Food Stamp Program was founded to help undernourished households put food on the table, the primary nutrition problem facing the U.S. 

population has shifted from too little intake to overconsumption of calories 

and obesity. Nearly two-thirds of all Americans are overweight and nearly 

one-third are obese (Flegal et al., 2002), conditions that are risk factors for 

heart disease, diabetes, cancer, and other illnesses. The prevalence of overweight and obesity is even higher among some low-income populations, 

leading policymakers and researchers to question whether the Food Stamp 

Program might have been too successful in boosting food consumption so 

that participants eat too many calories and gain weight. 

The purpose of this report is to review and interpret what is known about the 

effect of food stamp participation on the weight status of those who receive 

program benefi ts. This review provides a snapshot of the results of studies 

of the effect of food stamp participation on body weight and is conducted at 

a time when adjustments to the Food Stamp Program to promote improved 

dietary health are currently under consideration by policymakers. Note 

that many of the reviewed studies in this body of literature are recently 

completed and that additional studies employing different data and methods 

are currently under way. The results of these studies and future efforts that 

expand upon them will further inform researchers and test the strength of the 

fi ndings in this report. 

Food Stamp Program Background

The Food Stamp Program furnishes participants with Electronic Benefi t 

Transfer (EBT) cards that can be used at supermarkets and grocery stores, 

convenience stores, and other food retailers to purchase foods to be prepared 

at home. The program is an entitlement program available to all U.S. households that meet eligibility requirements pertaining to income, assets, work, 

and immigration status. Eligibility and benefi ts are based on household 

size, household assets, and gross and net income. The average benefi t level 

in 2007 was $96 per person and $215 per household each month (Oliveira, 

2007). 

The Food Stamp Program serves a diverse population. The largest group 

of participants is children, who accounted for almost 50 percent of caseloads in 2006 (USDA, 2007). Over the same period, working-age women 

made up 28 percent of the caseloads, working-age men made up 13 percent, 

and the elderly age 60 and older made up 8 percent. Just over a third of all 

households that receive food stamps are single-adult households with children (34 percent). Of all food stamp benefi ts issued, most go to households 

that contain a child, an elderly adult, or a nonelderly disabled person (89 
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percent of all benefi ts). Although gross income eligibility for the program 

includes those households with incomes up to 130 percent of the Federal 

poverty guidelines, the majority of food stamp households had gross monthly 

incomes below the poverty line (88 percent). The median length of time that 

participants received food stamps was 6 to 8 months during the 1990s (Cody 

et al., 2005). The program affects about half of Americans at some point in 

their lives: 49 percent of children and 51 percent of adults age 20-65 receive 

food stamps at some point (Rank and Hirschle, 2003).
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Why Might Food Stamps Cause Weight Gain?

If food stamp participation does cause weight gain and, more severely, overweight and obesity,1 then participants may not have become overweight 

or obese if they had not participated in the program (or if they received a 

smaller benefi t). Two hypotheses attempt to explain how food stamp benefi ts 

could contribute to weight gain that may lead to obesity: (1) food stamps 

encourage benefi ciaries to spend more money on food than they otherwise 

would and to consume more calories as a result; and (2) food stamp participation is linked to a cycle of deprivation followed by abundance and binge 

eating, which results in weight gain over time. 

The fi rst hypothesis implies that food stamp benefi ts, while having the 

intended effect of reducing undernourishment or underweight for at least 

some participants, also may be pushing a portion of participants into overweight or obesity. Citing evidence that offering benefi ts as cash induces 

smaller increases in food spending than offering coupons that can only be 

spent on food (Fox et al., 2004, pp. 45-47), Besharov (2002) suggests food 

stamp benefi ts should be delivered as cash to combat obesity among program 

participants. 

This hypothesis is intuitively appealing and is backed with some empirical 

evidence on food spending from cash-out experiments. These experiments, 

which randomly assigned some food stamp participants to receive an equal 

1Body Mass Index (BMI), a measure 

of weight adjusted for height, is used 

to classify individuals as overweight 

or obese. BMI-for-age percentiles are 

used to classify children as at-risk of 

overweight or overweight (see box, 

“Defi nitions of Body Mass Index and 

Weight Status”).

Defi nitions of Body Mass Index and Weight Status

Body Mass Index (BMI) is calculated as an individual’s weight in kilograms divided by the square of his or her height in meters. For adults, 

numerical thresholds of BMI distinguish healthy weight from underweight, overweight, and obesity. For children and adolescents, sexspecifi c BMI-for-age thresholds, using the 2000 Centers for Disease 

Control and Prevention growth charts, distinguish healthy weight from 

underweight, at risk of overweight, and overweight. 

Adults

Underweight = BMI below 18.5

Healthy weight = BMI at or above 18.5 but below 25

Overweight = BMI at or above 25 but below 30

Obese = BMI at or above 30

Children (age 2 to 19)

Underweight = Below the 5th percentile of BMI-for-age 

Healthy weight = At or above the 5th percentile but below the 85th 

 percentile of BMI-for-age

At risk of overweight = At or above the 85th percentile but below the

 95th percentile of BMI-for-age

Overweight = At or above the 95th percentile of BMI-for-age
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level of benefi ts as cash, showed that for every dollar, food expenditures 

from food stamp benefi ts were $0.18 to $0.28 greater than food expenditures 

from cash (Fraker et al., 1995). Nonexperimental data show greater differences—marginal propensities of spending on food ranging from $0.17 to 

$0.47 for every dollar of food stamp benefi ts, compared with $0.05 to $0.13 

for every dollar of cash (Fraker, 1990). Note that these estimates refer to 

greater food expenditures from food stamps, which would be consistent 

either with greater quantities consumed or with better quality and greater 

variety of food, or both. The implicit assumption in the argument that food 

stamp benefi ts may be linked to obesity is that the greater expenditures lead 

to greater calories consumed. 

The hypothesis that food stamp benefi ts encourage participants to consume 

more food than they otherwise would and to gain weight is also theoretically intuitive. The effect is like a pure income effect in economic theory—if 

someone is given more resources, he or she will use those resources to 

purchase more food and more of other goods. If benefi ts are lowered, the 

individual will spend less on food and other goods. An increase (decrease) 

in spending on food would result regardless of whether the benefi t came in 

the form of cash or a food stamp benefi t, although the size of the increase 

(decrease) would not be the same because of different marginal propensities 

to spend on food from food stamps and from cash. 

But just because food stamp participants spend more on food does not mean 

that the additional spending leads to overconsumption and obesity. It is 

possible that food stamp benefi ts allow people to choose a different bundle 

of foods than they otherwise would. For example, participants could shift 

spending toward relatively more expensive foods that were previously out 

of reach (e.g., fresh meats versus canned beans or fresh fruits and vegetables 

instead of canned items). Or, since food stamps can only be redeemed for 

food in grocery stores, participation in the program may shift a household’s 

food spending toward foods prepared and consumed at home, as opposed to 

food away from home. In either case, an increase in food expenditures may 

not necessarily lead to overconsumption of calories or a poorer diet that then 

leads to overweight or obesity; rather, it could lead to a more healthful diet, 

which then leads to a healthier body weight. 

Some evidence indicates that the types of foods that food stamp participants 

are choosing may serve to meet their caloric needs but may not include 

more healthful foods. Wilde et al. (2000) found that food stamp participants consumed more meat and more added sugars and total fats, but the 

same amount of fruits, vegetables, grains, and dairy than nonparticipants. 

Further, in an analysis of data from food stamp cash-out experiments in 

San Diego and Alabama, Whitmore (2002) found that households that were 

constrained by the food stamp benefi t level spent less on nondairy beverages 

(primarily soda and juice) when they received their benefi ts as cash instead 

of food stamps.2 Those who were not constrained by the benefi t (i.e., their 

food spending was at least as much as the food stamp benefi t) did not shift 

consumption.

The second hypothesis posits that the administrative practice of distributing 

food stamps only once a month results in alternate periods of under- and 

overconsumption, a pattern dubbed the “food stamp cycle,” which may result 

2For a constrained household, the 

amount of benefi ts received is worth 

more than what the household usually 

spends on food in a month, and thus, 

the household is constrained to spend 

more of its budget on food than it 

would if it received the benefi ts as cash. 

Whitmore (2002) estimates that between 20 and 30 percent of food stamp 

recipients are “constrained.”
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in weight gain (Townsend et al., 2001). Households consume food every 

day but purchase food less regularly—every few days for some households, 

every few weeks for others. Some households make a large monthly shopping trip and smaller shopping trips during the rest of the month. Food stamp 

participants might spend all or most of their food stamps soon after receiving 

them, but they may spread out the actual consumption of these foods over 

the month—purchased foods can be stored for use later in the month. But 

it is possible that food stamp participants run out of food to consume (and 

benefi ts with which to purchase more food) near the end of the month. As 

food becomes scarce and food intake is restricted, a person may lose weight. 

Then, when food is abundant, the individual may overeat. This distorted 

pattern of consumption with its periods of binge eating gradually can lead to 

increased weight (Brownell et al., 1986; Coscina and Dixon, 1983; Franklin 

et al., 1948; Keys et al., 1950; Kochan et al., 1997; Lavery and Loewy, 1993; 

Polivy et al., 1994). In addition to an individual “overshooting” in food 

consumption, his or her metabolism may slow in response to periods of lower 

calorie intake (Manore et al., 1991), which could exacerbate the effects of 

higher average consumption of calories. Consumption cycles may lead some 

individuals to become more comfortable with extra weight as a perceived 

cushion against food insecurity. 

The food stamp cycle hypothesis of weight gain has not been explicitly 

tested, although some related evidence is consistent with the hypothesis. 

Evidence suggests that food security status is associated with weight and 

weight gain, particularly for those who were in households with marginal 

and low food security (but not those in households with very low food security) (Townsend, 2001; Wilde and Peterman, 2006). However, the direction of the relationship—whether food insecurity leads to weight gain or 

whether heavier individuals are more likely to be food insecure—is not clear. 

Research on the household food choices of marginally and low food secure 

households indicates that these households tend to reduce the quality and 

variety of their diets in order to avoid a reduction in the amount of food they 

eat (Nord and Prell, 2007). Evidence also suggests that the frequency of food 

shopping, the types of stores visited (i.e., supermarket vs. nonsupermarket), 

and spending on food vary over the food stamp benefi t month (Wilde et 

al., 2000). Some food stamp participants also reduce their food consumption toward the end of the monthly benefi t cycle, although the mean effect 

is small and not as large as the reduction in food spending at the end of the 

month (Shapiro, 2005; Wilde and Ranney, 2000). 

Both of these hypothesized mechanisms may play roles in the weight status 

of food stamp recipients. This study examines the evidence for each. The 

assessment may benefi t program designers because if program participation is found to contribute to obesity, policies to reduce such effects will 

need to address the mechanisms linking participation with weight status. 

For example, if monthly issuance of benefi ts is the root problem behind 

obesity, the most effective policy response may be to issue the benefi ts 

more frequently because the boom-and-bust cycle could exist regardless of 

whether the benefi t is cash or a food stamp EBT. 
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Teasing Out Cause and Effect

Assessing causal relations between food stamp participation and body 

weight is diffi cult because researchers have not conducted experiments that 

compare the body weight outcomes of some participants who are randomly 

assigned to receive program benefi ts with those of others who are assigned 

to a comparison program (or lack of program). Researchers must instead rely 

on nonexperimental methods that try to determine the counterfactual—that 

is, what would have happened if no one received food stamp benefi ts or if an 

alternative program to food stamps was implemented. A simple comparison 

of food stamp participants to eligible nonparticipants is an obvious starting 

point, but such a comparison may be problematic. Those who choose to 

participate in the Food Stamp Program may have different characteristics 

than those who are eligible but choose not to participate. Very poor individuals, for example, may be more likely to participate than individuals who are 

less poor but still eligible. This is consistent with the observation that households that participate in the Food Stamp Program receive almost twice as 

much in food stamp benefi ts as the amount that nonparticipating but eligible 

households would have received had they decided to participate (Downer, 

2005).3 Other differences between participants and nonparticipants also may 

affect the comparison.

While most studies try to control for as many differences between participants and nonparticipants as possible, it is likely that important differences 

are not observed. If these differences are related to body weight, then estimated effects of food stamp participation could be biased. This bias is called 

selection bias because individuals self-select into the Food Stamp Program. 

Linz et al. (2005) note that poverty is associated with higher risk of obesity 

among some population groups (e.g., White women) but lower risk of obesity 

among other groups (African-American and Hispanic men), suggesting that 

selection bias can be positive or negative in the case of food stamp participation and obesity. Accounting properly for selection bias can reveal a higher 

or lower risk of obesity than estimates that do not account for such bias. 

Several of the early studies of the relationship between food stamp participation and body weight used cross-sectional data (observations of many 

individuals for a single point in time) and multivariate regression analysis 

to control for as many other factors that might be related to weight (see box, 

“Studies Linked by Type of Methodology”). While these studies are useful 

for understanding broad trends and highlighting possible relationships for 

further exploration, they do not account for potential selection bias and only 

observe individuals at a point in time, so they are limited in drawing causal 

conclusions. 

As the studies have evolved, more sophisticated methods and data have been 

applied. Recent studies used an array of statistical techniques to address 

selection bias, including instrumental variable models, simultaneous selection models, difference-in-difference models, fi xed- and random-effects 

models, and hazard analysis to control for selection bias and/or to try to 

decipher causal mechanisms. Both cross-sectional data and longitudinal data 

(multiple observations on the same individuals over time) have been used 

in these studies. While a complete review of these techniques is beyond the 

scope of this report, a brief overview is provided.

3Households with fewer resources are 

eligible for larger food stamp benefi ts. 
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Longitudinal data enable researchers to explore the dynamics of food 

stamp participation and body weight. Such data are especially important 

because body weight is the accumulation of past behaviors with respect to 

diet and exercise and because food stamp participation itself is a dynamic 

process. Observing study participants’ behaviors for a longer time period 

and observing changes in behaviors can better explain current weight. For 

example, Jones and Frongillo (2006) examine the relationship between 

changes in food insecurity status, changes in food stamp participation, and 

changes in body weight, controlling for as many other intermediating factors 

as possible. Hazard model analysis of the probability of becoming obese 

conditioning on current and past observable characteristics (including current 

Studies Listed by Type of Methodology*

Studies that account for selection bias and use longitudinal data:

Baum (2007) – instrumental variables and fi xed effects.

Gibson (2004 & 2003) – fi xed effects.

Meyerhoefer & Pylypchuk (2008) – discrete factor random effects and instrumental variables.

Studies that account for selection bias and use cross-sectional data: 

Chen et al. (2005) – simultaneous bivariate probit.

Hofferth & Curtin (2005) – instrumental variables.

Kaushal (2007) – difference-in-difference with repeated cross-sections of data.

Studies that use longitudinal data and dynamic models (examine changes in weight status associated with changes in food stamp participation) but do not account for selection bias:

 Baum (2007) – survival models of probability of becoming obese; models of the transition to and from 

obesity status over a 2-year time period.

Kim & Frongillo (2007) – multivariate regression of change in food stamp participation and in food 

security status on change in BMI.

Jones and Frongillo (2007) – weight change over 2 years regressed on baseline characteristics; weight 

change over 2 years regressed on changes in other characteristics and baseline characteristics.

Cross-sectional data studies:

Bhattacharya & Currie (2000) – multivariate analysis of the likelihood of having BMI above the 85th 

percentile for young adults.

Boumtje et al. (2005) – multinomial regression on probability of healthy weight, at risk of overweight, 

and overweight .

Gibson (2001) – multivariate logistic regression on probability a youth is obese.

Jones et al. (2003) – multivariate logistic regression on probability of at risk of overweight.

Townsend (2001) – multivariate logistic regression on probability of overweight among women.

Ver Ploeg et al. (2007) – multiple cross-sections of data and multivariate regression to predict BMI, 

probability of overweight, and obesity.

*Some studies use multiple methods and, thus, are listed more than once.
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and past food stamp participation) also gives a dynamic perspective to understanding the mechanisms behind food stamp participation, food security, and 

body weight (Baum, 2007). 

Longitudinal data aid in studying these types of transitions. Still, other 

factors that have not been controlled for are changing and driving changes 

in body weight and in food stamp participation (see Frongillo, 2003). Thus, 

researchers also employ methods to correct for any bias due to those unobserved changes along with longitudinal data. “Fixed-effects modeling” 

essentially models the change in body weight corresponding to a change in 

program participation status while controlling for “fi xed” or time-invariant 

characteristics of each individual (both observed and unobserved) (Gibson, 

2003 & 2004; Baum, 2007). Fixed-effects models control for unobserved 

time-invariant characteristics at the individual level but not for unobserved 

time-varying characteristics. Food security status is a time-varying unobserved variable that was not controlled for in most of the studies that used 

fi xed-effects models. 

Other studies have accounted for selection bias by identifying observable 

characteristics that predict food stamp participation (or eligibility) but are not 

correlated with body weight or changes in body weight using instrumental 

variable models (with cross-sectional or longitudinal data), simultaneous 

selection models, or difference-in-difference approaches. 

Instrumental variable estimates predict food stamp participation and then use 

those data to explain BMI or weight status. This approach relies heavily on 

fi nding information that can predict food stamp participation but which is 

not correlated with unobserved characteristics that might also be correlated 

with weight. Diagnostic tests can reveal the suitability of the instruments, 

but if the chosen instruments are found to be not suitable, then it will remain 

unclear as to whether selection bias is not a problem or if the right instruments to account for the bias have not been found. 

Chen et al. (2005) used a simultaneous selection model and cross-sectional 

data to model the decision to participate in the Food Stamp Program simultaneously with body weight, allowing for unobserved determinants of both 

outcomes to be correlated. Estimation of this model relies heavily on assumptions about the distribution of the errors, and the maximum likelihood estimation of the parameters is sensitive to misspecifi cation error (Chen et al., 

2005; Vella, 1998). The models estimated by Chen et al. (2005) use variables 

to identify food stamp participation (specifi cally, employment status and 

region) and test the sensitivity of their fi ndings, but these variables have been 

found to predict body weight and obesity in other studies (Cawley, 2004; 

Averett and Korenman, 1996; Meyerhoefer & Pylypchuk, 2008). 

A difference-in-difference approach with multiple cross-sections of data 

has also been used to study the effect of food stamp participation on body 

weight. Kaushal (2007) used differences in food stamp eligibility rules for 

immigrants across States and over time to compare BMI and obesity among 

foreign-born individuals with low education levels. The 1996 Personal 

Responsibility and Work Opportunity Reconciliation Act excluded some 

immigrants from eligibility for the Food Stamp Program, but some States 

enacted “substitute” programs for immigrants. To account for selection bias, 
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Kaushal compared the body weights of foreign-born individuals in States 

with substitute programs with those of individuals in States without substitute 

programs. Eligibility for the program among immigrants is assumed to be 

randomly distributed across States and across time (or at least it is not correlated with body weight). Thus, the selection into the Food Stamp Program is 

random among immigrants. 

Two studies used both instrumental variable estimators and longitudinal data 

to study the effects of food stamp participation on weight (Meyerhoefer and 

Pylypchuk, 2008; Baum, 2007). Meyerhoefer and Pylypchuk used a discrete 

random factor model with Medical Expenditures Panel Survey data to relate 

food stamp participation to obesity. They also used instrumental variables to 

predict food stamp participation. In addition to using the hazard model and 

fi xed-effect analysis discussed earlier, Baum also used instrumental variable 

estimates of food stamp participation on BMI and obesity.

 Most of the studies reviewed assume that food stamp participation causes 

weight gain. But it is plausible that the causation may be reversed—that is, 

obesity may raise the need for food stamps (e.g., heavier individuals have 

larger appetites and need more calories per day to maintain their weight) or 

obesity may hurt the economic chances of individuals and increase the probability they will be eligible to receive food stamps. It is also possible that 

some other factor is causing both weight gain and food stamp participation. 

Some evidence shows that obese women, especially White women, have 

lower incomes than healthy weight women (Averett and Korenman, 1996). 

The lower incomes of obese women are primarily due to lower probabilities 

of marriage and lower spousal incomes when they do marry, and, secondarily, to lower wages of obese women themselves. Interestingly, Averett and 

Korenman found that among men, underweight rather than obesity can have 

a negative effect on wages and marriage probabilities. Cawley (2004) fi nds 

that weight lowers the wages of White women (but not Hispanic or Black 

women); body weight that is two standard deviations greater than the mean 

leads to wages that are 7 percent lower, which is equivalent to the wage 

effect of 1 more year of schooling. Given these differences in income and 

wages for heavier women, all else equal, excess weight may be correlated 

with women’s eligibility for the Food Stamp Program. 

Also, there may be feedback effects between overweight/obesity and food 

stamp participation. For example, those with greater BMIs need to consume 

more calories than those with lower BMIs just to maintain their current 

weight. Thus, those who are overweight/obese may have greater food needs 

(and perhaps are more likely to be food insecure), and are more likely to 

receive food stamps than those with lower BMIs. Or, food insecurity may 

be driving both weight gain and the need for food stamps (Frongillo, 2003). 

That is, food insecurity may change the amount and type of foods eaten in 

ways that could lead to weight gain, and food stamp participation may be 

an indicator of food insecurity. It is also possible that psychological factors 

(e.g., depression) associated with low income, lower marital prospects, food 

insecurity, or food stamp participation may be tempered by consuming more 

food—especially foods that give the most enjoyment (like cookies or potato 

chips—not spinach or bananas).
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Different Surveys, Different Measures

In addition to differing techniques used to account for selection bias, the 

studies and the data sets reviewed also differ in inclusion, measurement, and 

response quality of key variables, such as participation in food and nutrition 

assistance programs, food intake, weight and height, food security status, and 

physical activity. 

Different surveys provide different measures of food stamp participation. 

Some only record whether the individual or household received benefi ts, 

whereas others record the amount of assistance received and the length of 

time benefi ts were received. Some provide information on current benefi t 

receipt, and others provide information on receipt over the past year or at 

anytime in the past year. Data on the amount of benefi ts received and the 

length of time they were received provide more information about the “intensity” of program participation (one might expect that if food stamp participation affects body weight, those who receive more benefi ts or receive benefi ts 

for longer periods of time may be more affected). This information, however, 

is harder to collect, and, because respondents are asked to recall more 

detailed information, the measurements are prone to error. 

With the exception of data compiled in the National Health and Nutrition 

Examination Survey (NHANES), all of the other data sets used in the 

reviewed studies contain only self-reported height and weight to compute 

BMI. However, weight is known to be underreported and height is known to 

be overreported. This potential data weakness will be a problem only if food 

stamp participants are more likely than nonparticipants to overreport height 

and underreport weight. While this relationship has not been adequately 

tested, Kuchler and Variyam (2003) did fi nd that overweight food stamp 

participants were more likely to report their weight as “healthy” than overweight nonparticipants. Further, most of the studies reviewed make an adjustment for reporting bias (see Cawley, 2000). 

Some of the studies focused on changes in BMI associated with food stamp 

participation, while others focused on overweight or obesity status—whether 

the individual’s BMI is high enough to classify the individual as overweight or obese. Some studies examined both measures (see tables 1 and 2). 

Increases in BMI do not translate into obesity for individuals who are underweight to begin with or for those who are far enough from the cutoff that 

designates obesity status (or overweight status). Thus, interpretation of the 

studies requires a clear focus on what outcome was measured and modeled. 

Jolliffe (2004) used a continuous measure of overweight status that captured 

not only whether an individual was overweight or obese but also by how 

much (i.e., overweight or obesity “depth” and “severity” measures). These 

measures are less sensitive to errors in height and weight measurement. They 

also produce different rankings for overweight and obesity status of different 

ethnic groups than the discrete measure. The depth and severity measure 

have not been applied to models of food stamp participation and obesity, 

however. 

Most of the studies of the relationship between food stamp participation and 

body weight do not control for physical activity (the exceptions are Jones and 

Frongillo, 2006; Kim and Frongillo, 2007; and Townsend et al., 2001). Even 
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Table 1

Studies of the effect of food stamp participation on children’s weight: data, methods, and 

results by methodology

 Authors Population studied Data set used Methods Results

Account for selection bias and use longitudinal data (fi xed effects)

 Gibson (2004)† Children 12-16 NLSY 1979 Multivariate logistic regression Not signifi cant for girls or boys 

 child sample with child & family fi xed effects. age 12-18;

 BMI, prob(at risk of overweight) Girls age 5-11: FSP ↑ P(Owgt);

 & Prob(overweight) examined. long-term FSP ↑ P(Owgt) 

 even more (5 years of FSP ↑

 P(Owgt) by 42.8%)

 Boys age 5-11: FSP ↓ P(Owgt);

 long-term FSP ↓ P(Owgt)

 even more (5 years of FSP ↓

 P(Owgt) by 28.8%)

Account for selection bias and use cross-sectional data (instrumental variables predicting food stamp participation)

 Hofferth & Children 6-12 PSID – Child Regress predicted FSP benefi t Not signifi cant for boys or 

 Curtin (2005) † Development amount on BMI & probability girls

 Supplement of overweight.

Cross-sectional data but do not account for selection bias

 Bhattacharya & Children 12-16 NHANES 1988-94 Multivariate logistic regression Not signifi cant for girls or boys

 Currie (2000) of probability of obesity. 

 Boumtje et al. Children age 5-18 CSFII 1994-96 & Multinomial logit for probability Not signifi cant for girls or boys 

 (2005) 1998 of at risk of overweight, & 

 overweight relative to healthy 

 weight.

 Gibson (2001) Children age 12-16 NLSY 1997 Multivariate logistic regression Not signifi cant for boys or 

 of the probability of obesity. girls

 Jones et al. Children age 5-12 in PSID – Child Multivariate logistic regression Boys: Not signifi cant

 (2003) households Development of prob(at risk of overweight). Girls: 

 <185% FPL Supplement Participation in FS, NSLP, or Food secure: ↓ risk of 

 NSBP for food secure & overweight

 insecure. Food insecure: ↓ risk of 

 overweight 

 Ver Ploeg et al. Children age 5-19 NHANES data: Multiple cross-sections No consistent pattern in 

 (2007) 1976-80, 1988-94, comparing FSP to eligible association between FSP and

 1999-2002 nonparticipants & higher- BMI, at risk of overweight, or 

 income nonparticipants overweight 

 over time. 

† Study received at least partial funding through the Food and Nutrition Research Program of USDA, Economic Research Service. 

Key to data set abbreviations:

CSFII – Continuing Survey of Food Intake by Individuals

NLSY – National Longitudinal Survey of Youth

NHANES – National Health and Nutrition Examination Survey

PSID – Panel Study of Income Dynamics

Source: USDA, ERS. 
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Table 2

Studies of the effect of food stamp participation (FSP) on adult weight: data, methods, and results 

by methodology

Study Population studied Data set used Methods Results 

Account for selection bias and use longitudinal data

 Baum (2007)† Men & women age NLSY 1985-2000 OLS; IV estimates for FSP; Women: 

 20-28 in 1985 fi xed effects; hazard OLS: 2-5 percentage point ↑

 analysis; lagged receipt in obesity

 of FS benefi ts – long-term vs. Fixed effects: ↑ in BMI & 

 short-term participation; obesity

 examined BMI & IV: Not different from OLS

 Prob(obesity) as outcomes. Hazard: ↑ in BMI & obesity

 Lag FSP: long-term use ↑ 

 BMI & obesity; short- &

 medium-term do not

 Men: 

 OLS: Not signifi cant

 Fixed effects: food stamp 

 benefi t amount ↑ BMI

 IV: Not different from OLS

 Hazard: Not signifi cant

 Lag FSP: long-term use ↑ 

 BMI & obesity; short- & 

 medium-term do not

 Gibson (2003) † Men & women age NLSY 1985-1996 Fixed effects; examined Women: 

 20-28 in 1985 long-term FSP; Prob(obese) Fixed effects: FSP ↑ obesity 

 was outcome examined. 2 percentage points, or 9.1%;

 Long-term FSP ↑ 20.5%

 Men:

 Not signifi cant for short- or

 long-term

 Meyerhoefer & Men & women MEPS 2000-03 Discrete factor model for Women: 

 Pylypchuk age 18-64 random effects w/ IV 6.7% increase in obesity

 (2008) estimates for FSP & Men:

 longitudinal data Not signifi cant

 Prob(normal, overweight or

 obese) weight status examined. 

 Chen et al. (2005) Men & women age CSFII 1994-96 Bivariate probit to predict Women: 

 15+ in households FSP and BMI & Prob(obese). ↑ BMI 3.6 points; 33% obesity 

 w/ income<130% 

 of poverty line Men: 

 Not signifi cant

 Kaushal (2007) † Men & women age NHIS 1992- Difference-in-difference Women: 

 21-54, foreign born 2001 & comparing BMI of foreign born Not signifi cant for either 

 & low education CPS 1994-2002 in States with substitute Food D-in-D or IV estimates 

 Stamp Programs to BMI of those Men:

 in States without substitute Not signifi cant for D-in-D or IV

 programs. IV estimates 

 using State substitute programs 

 to predict FSP.

 continued...
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Table 2 (Cont.)

Studies of the effect of food stamp participation on adult weight: data, methods, and results by methodology

Study Population studied Data set used Methods Results 

Longitudinal data and dynamic models

 Jones & Frongillo Women age 18-74 PSID 1999 & 2001 Lagged FSP & food Lagged and dynamic results are 

 (2006) † security status on change in similar—no effect of change in 

 weight; change in FSP & food security status, but 

 food security status on persistently food insecure lost 

 change in weight weight; FSP had no effect for 

 food secure in both time periods 

 & for those who change food 

 security status; for persistently

 food insecure, FSP offset weight 

 change 

 Kim & Frongillo Men and women AHEAD & HRS Examined current, lagged & Results similar for men & 

 (2007) age 54+ (AHEAD) 4 waves of each changes in food insecurity women. Food insecure FSP less

 & age 71+ (HRS) from 1995-2002 status & food stamp likely to be overweight than

 participation on BMI & nonparticipants. Interactions 

 overweight status. between food insecurity & FSP

 not signifi cant.

Cross-sectional studies without accounting for selection bias

 Townsend et al. Men & women CSFII 1994-96 Prob(overweight) as function Women: Food insecurity & 

 (2001) † age 20+ of FSP & food insecurity. FSP ↑ obese

 Men: Not signifi cant

 Ver Ploeg et al. Men & women Multiple cross- Multivariate regression Women: Differences in early

 (2007) age 20+ sections of comparing BMI and years between FSP & non-

 NHANES Prob(overweight & participants not present in

 1976-80, 1988-94, obese) of FSP to recent years. 

 1999-2002 eligible nonparticipants Men: Few differences for FSP

 & nonparticipants over time 

† Indicates the study received at least partial funding through the Food and Nutrition Research Program of USDA, Economic 

Research Service. 

Key to data set abbreviations:

AHEAD – Asset and Health Dynamics Among the Oldest Old

CPS – Current Population Survey

CSFII – Continuing Survey of Food Intake by Individuals

HRS – Health and Retirement Survey

NHIS – National Health Interview Survey

NLSY – National Longitudinal Survey of Youth

MEPS – Medical Expenditure Panel Survey

NHANES – National Health and Nutrition Examination Survey

PSID – Panel Study of Income Dynamic

Source: USDA, ERS.
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those that control for exercise and activity rely on imprecise, self-reported 

measures. Ignoring or inadequately controlling for physical activity would 

distort results of these analyses if food stamp participants have different 

physical activity patterns than similar nonparticipants against whom they are 

compared. But this is untested. Physical activity differences across gender 

and across the income spectrum, particularly related to occupation and types 

of work, could explain differential patterns of weight—for example, if lowincome men are more likely to work in physically demanding jobs than highincome men. 

Studies Reviewed

Despite these limitations, the body of literature examining the effect of food 

stamp participation on weight has grown. This ERS review summarizes the 

state of knowledge at this point in time, and there is certainly room for more 

research on the topic. In drawing conclusions from the available literature, 

greater emphasis was placed on studies that account for selection bias. 

Note that a panel of experts formed by USDA’s Food and Nutrition Service 

(FNS) studied the effect of all food and nutrition assistance programs and 

poverty on obesity (Linz et al., 2005).4 This panel concluded that poverty 

and obesity are associated for some populations, but that there is an inconsistent association between food and nutrition assistance program participation 

and obesity and no evidence to support a causal relationship between the 

programs and obesity. This review builds upon the FNS study and benefi ts 

from the recent publication of additional studies that have exploited longitudinal data and applied different statistical techniques to account for selection bias. ERS reviewed 15 studies. Table 1 lists the methods, data used, 

and results for studies of children. Table 2 presents the studies, methods, 

data, and results for adults. The studies of adults use a greater variety of data 

sets and methods than those that focus on children. Further, only two of the 

studies of children account for selection bias (Gibson, 2004; Hofferth and 

Curtin, 2005), compared with fi ve of the studies of adults. 

This review discusses statistically signifi cant results that show that food 

stamp participants have different BMIs or are more or less likely to be 

obese than similar nonparticipants with at least 90 percent confi dence. The 

review notes the size of these effects (positive or negative and magnitude). 

Statistically insignifi cant results may still provide evidence that food stamp 

participation affects weight; however, the effect is just not very important or 

the statistical power for detecting an effect is too low. 

For results concerning the probability of obesity, it is important to be clear 

about the magnitude of reported changes because the probability of obesity 

is itself a fraction, measured in percent. Specifi cally, fi ndings and summaries 

in the literature may report the percent increase in obesity associated with 

food stamps, a measure that differs from the percentage point increase in 

obesity. For example, if the base probability of obesity were 20 percent, then 

an increase of 2 percentage points from 20 to 22 percent translates into a 10-

percent increase (2 percent relative to 20 percent). This 10-percent increase 

is not the same as a 10-percentage-point increase in obesity, which would be 

from 20 percent to 30 percent. Caution is warranted whenever reading and 

interpreting statistical fi ndings involving percentage points and percentages. 

4Many food stamp participants receive 

benefi ts from other food and nutrition 

assistance programs, such as the Special Supplemental Nutrition Program 

for Women, Infants, and Children, and 

the National School Lunch and School 

Breakfast Programs. This review 

considers only the relationship between 

food stamp participation and body 

weight. Jones et al. (2003) considered 

participation in all four programs for 

children, and Hofferth and Curtin 

(2005) considered participation in food 

stamps and the two school feeding 

programs. 
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Effect of Food Stamp Participation on 

Weight Status

Children

Children account for about half of all food stamp participants, and among all 

participants, the long-term consequences of overweight and obesity for children are greater in terms of both the possibility of current and future weightrelated health problems and the pecuniary costs of treating those health 

problems. Most studies that address the link between food stamp participation and weight for children examine only schoolage children and separately 

analyze adolescent children (age 12-18) and pre-adolescent children (age 

5-12) (see table 1). Studies of children age 2-4 focus on participation in the 

Special Supplemental Nutrition Program for Women, Infants, and Children 

(WIC) rather than on participation in the Food Stamp Program.5 

Food stamp participation does not seem to be related to BMI or the probability of overweight for adolescent children. None of the studies reviewed 

found a link between food stamp participation and body weight for boys or 

girls between ages 12 and 18. 

For children age 5-12, the studies show mixed results. Most studies found 

no signifi cant relationship between food stamp participation and weight. 

However, two studies are of note because they did fi nd links—although in 

opposite directions. Gibson (2004) found that for young girls, additional 

years of food stamp participation led to greater probability of overweight; for 

boys, however, additional years of food stamp participation were associated 

with lower probability of overweight. Jones et al. (2003) examined the effect 

of food stamp participation by food security status. This study found no 

signifi cant relationship between food stamp participation and the probability 

of at-risk of overweight for boys regardless of their food security status. For 

girls, the study found that food stamp participation had a negative effect on 

risk of overweight regardless of food security status. 

The mixed results for young girls could be due to the different approaches 

of the studies. Jones et al. (2003) used 1 year of data and only observed food 

stamp participation and at-risk of overweight and overweight status for one 

time period and did not control for selection bias. The study did, however, 

investigate the interactive effects of food security status and food stamp 

participation on weight. Further, it controlled for participation in other food 

and nutrition assistance programs (National School Lunch and Breakfast 

Programs). Gibson (2004) does account for time-invariant family and individual characteristics that may be correlated with food stamp participation 

and overweight status. It fi nds that the positive effect of food stamp participation on the probability of overweight becomes both stronger statistically 

and larger when controls for time-invariant family or individual characteristics are included; however, it is diffi cult to reconcile these results with 

the results for young boys and for older children, which show that when 

time-invariant family and individual characteristics are controlled for, the 

relationship between food stamp participation and overweight status either 

becomes negative (i.e., food stamp participation is associated with lower risk 

of overweight) or becomes statistically insignifi cant. Further, when both age 

5BMI-for-age is not defi ned for 

children under age 2.
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groups are analyzed together, the fi xed-effects estimates show no relationship 

between food stamp participation and the probability of overweight. 

In general, therefore, the evidence for adolescents seems to indicate that food 

stamp participation is not linked with body weight, while the evidence for 

younger schoolage children is mixed. 

Nonelderly Adult Women

Several studies of the effect of food stamp participation on nonelderly adult 

women, who make up 28 percent of all food stamp participants, show that 

food stamp participation increases BMI and the probability of obesity. Other 

studies fi nd no effect and/or point to specifi c segments of the population for 

whom the effect is larger or nonexistent (see table 2). Baum (2007), Gibson 

(2003), and Meyerhoefer & Pylypchuk (2008) each use longitudinal data and 

attempt to control for unobserved characteristics that increase a woman’s 

propensity to be a food stamp participant. Results from these three studies 

indicate that current food stamp participation increases the probability that 

a woman is obese by a range of 2-5 percentage points over a period of 1-2 

years.6 These changes in the probability of obesity of 2-5 percentage points 

translate to an increase in the probability of obesity ranging from 5 to 21 

percent. Using a single period of cross-sectional data, Chen et al. (2005) fi nd 

a much larger effect of food stamp participation on obesity—a 33-percent 

increase. Unlike the other three studies, this study uses cross-sectional data 

with only one measurement of weight and food stamp participation for each 

sampled individual.7 Further, the study uses weak information to identify 

food stamp participation and strong assumptions about the distribution of 

unexplained variance to estimate the impact of food stamp participation on 

weight. 

Baum (2007), Kaushal (2007), and Jones and Frongillo (2006) also study 

the link between food stamp participation and body weight using continuous 

measures of body weight—BMI or just weight unadjusted for height. Baum 

fi nds that food stamp participation is associated with a 0.5-point increase in 

BMI for women. For women between 5’4” and 5’6” tall, this effect would 

translate into about a 3-pound difference. Kaushal fi nds that food stamp 

participation does not lead to increases in BMI for foreign-born women (the 

population studied). Jones and Frongillo examine the increase in body weight 

after 2 years for women who change food security and food stamp participation status over those years. They fi nd that food stamp participation is not 

a signifi cant factor in weight change for women who are persistently food 

secure or who changed food security status over the 2-year period. Women 

who were persistently food insecure had signifi cantly smaller changes in 

body weight than other women when food stamp participation was not 

controlled. But, among these persistently food insecure women, food stamp 

participation offset the lower weight change associated with being persistently food secure—increasing weight change by almost 8 kg, or about 17 

pounds. Thus, it appears that food stamp participation has a moderating 

effect on weight change among persistently food insecure women. 

Both Baum (2007) and Gibson (2003) examine the effect of long-term participation in the Food Stamp Program on the probability of obesity. Gibson 

fi nds that women receiving food stamp benefi ts for all 5 years of the study’s 

6Gibson (2003) and Baum (2007) use 

yearly data for part of the study period, 

but biennial data for other years. 

Meyerhoefer and Pylypchuk (2008) use 

biennial data.

7The use of a single period of crosssectional data also means that more of 

the sample of food stamp participants 

are long-term participants, which may 

explain the larger estimated impact 

discussed later in this report. 
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data span are 4.5 percentage points (or 20.5 percent) more likely to be obese. 

Baum fi nds a larger effect—long-term participants (those who have received 

food stamp benefi ts for at least 24 months) have an increased probability of 

obesity of 10 percentage points (or about a 50-percent increase in obesity). 

Nonelderly Adult Men

Nonelderly men age 20-59 account for 13.4 percent of all food stamp 

participants. With one exception, none of the studies found a signifi cant 

link between concurrent food stamp participation and BMI, overweight, or 

obesity status for men (see table 2). Baum (2007) found that food stamp 

participation was positively related to BMI for men in fi xed-effects estimates; 

however, these results did not show a signifi cant link between food stamp 

participation and the probability of overweight or obesity. Thus, the positive 

effect on BMI was not large enough to shift more men into the categories of 

greater health risk, or the shift in BMI was an improvement among underweight men. The ordinary least squares (OLS) and hazard model estimates 

from Baum (2007) do not show any effects of food stamp participation on 

BMI, overweight, or obesity for men. 

The evidence with respect to long-term participation in the Food Stamp 

Program and men’s weight is mixed. Gibson (2003) fi nds no signifi cant 

effect of long-term participation (up to 5 consecutive years) on BMI or 

the probability of obesity. Baum (2007) fi nds that long-term participation (received benefi ts for all 24 months in between observation periods) 

increases BMI and the probability of obesity for men, but short- and 

medium-term participation does not, nor do multiple spells of participation. 

Elderly 

Elderly food stamp participants (age 60 and older) make up 8 percent of 

all food stamp participants. Only two studies have examined the relationship between food stamp participation and weight among the elderly. Kim 

and Frongillo (2007) examined weight and participation in food and nutrition assistance programs in the context of food insecurity for elderly individuals. They found some evidence that among food-insecure elders, those 

who participated in food and nutrition assistance programs were less likely 

to be overweight than those who did not participate. An earlier descriptive 

study (Fox and Cole, 2004) compared the prevalence of obesity among food 

stamp participants with that of income-eligible nonparticipants by age group, 

without accounting for other factors that could infl uence obesity. It found 

that for women age 60-69, food stamp participants were more likely to be 

obese. The differences did not hold for women age 70 and older. Elderly men 

receiving food stamps were not more likely to be obese than nonparticipants 

of the same age group. 

Short-Term Versus Long-Term Participation

Most of the studies summarized in the previous sections used current food 

stamp participation as the measure of food stamp participation. The outcome 

measures were either current measures of weight status (BMI, overweight, or 

obese) or the change in weight status over a period of 1-2 years. The “effect” 

of food stamps was then modeled as the effect of current participation on 

current weight or on a change in weight over the same length of time. 
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Most “spells” of food stamp participation (the number of consecutive months 

an individual receives food stamps) do not last very long—the median 

spell length of newly enrolled food stamp participants was 6-8 months in 

the 1990s (Cody et al., 2005). Given this short time frame, it should not be 

surprising that food stamp participation has little impact on BMI and obesity; 

however, some individuals have much longer spells of participation. Some 

low-income households cycle on and off the Food Stamp Program, making 

the weight effects of any one spell an underestimate of the overall potential 

weight effect of the program. 

Three studies examined the effects of long-term participation in the Food 

Stamp Program on BMI (Baum, 2007; and Gibson, 2004 and 2003). Gibson 

(2003) found that for women, long-term participation was linked with even 

greater probability of obesity relative to otherwise similar women who did 

not receive food stamp benefi ts. The same study did not fi nd a long-term 

effect for men. Baum (2007) found that long-term (but not medium-term, 

short-term, or multiple spells of) participation increases the probability of 

obesity among men, but that the effect is much larger for women. For children, Gibson (2003) fi nds that long-term food stamp participation is associated with a sizable increase in the probability of overweight for young girls 

(5 years of food stamp participation increases the probability of overweight 

among girls by 42.8 percent), but that long-term food stamp participation 

greatly reduces the probability of overweight among young boys (5 years of 

participation lowers the probability of overweight 28.8 percent). 

A cross-section of food stamp participants at a given point in time will 

always include more long-term participants because these participants accumulate as a larger portion of all participants. For example, Cody et al. (2005) 

found that among a cross-section of food stamp participants in March 1996 

(not just new entrants), the median spell length was between 2 and 4.5 years. 

Studies based on a single cross-section of data will necessarily include more 

long-term food stamp participants. This may at least partially explain why 

Chen et al. (2005), which uses only a single cross-section of data, found 

much larger effects of food stamp participation on obesity among women. 

Long-term food stamp participants (however defi ned) are a subset of all food 

stamp participants and are likely to have different characteristics than other 

participants in ways other than weight status. Long termers are most likely 

the poorest participants and the least likely to be able to support themselves 

from earnings. Cody et al. (2005) found that the elderly and single mothers 

were two subgroups of new food stamp participants who had longer median 

spell lengths in the program (15 and 11 months, respectively). 

Small but positive effects of current food stamp participation on BMI for 

women may accumulate over longer spells of food stamp participation or 

over shorter, but repeated spells, and result in substantial total effects on BMI 

over time. Or, if the causal mechanisms underlying weight gain for women 

are related to the food stamp cycle, then prolonged use of the food stamps 

could result in long-term weight gain. Or, the weight gain itself may increase 

the need for food stamps if a heavier woman needs to eat more calories just 

to maintain her weight or if her economic need for food stamp benefi ts is 

increased because of reduced wages and marriage opportunities associated 

with heavier women—associations that have been documented in previous 

studies. 
19

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Interpreting Differences Across 

Demographic Groups

The literature does not thoroughly examine the factors that account for 

different results by sex. The study results show almost no effects of food 

stamp participation on men or boys, while several studies fi nd that food 

stamp participation increases weight for women and young girls, although 

the results for young girls are not as consistent. Several factors may help 

account for the differences between adult men and adult women. Chen et 

al. (2005) suggest that differences in caloric requirements between men and 

women may account for differences in the effects of the program on weight 

because food stamp benefi t levels do not differ by the sex of recipients. 

Devaney et al. (2005) found that average energy requirements for men participating in the Food Stamp Program are higher than those for women participants, although the ranges for requirements for each group overlap. This 

study did not consider activity levels that affect caloric need; accounting for 

this factor would accentuate this difference if male food stamp recipients are 

more likely to have higher physical activity levels (e.g., from jobs requiring 

more physical exertion) than women recipients. Consumption trends reveal 

that male food stamp participants consume fewer calories than higher income 

male nonparticipants for most age groups. In contrast, female participants 

consume more calories than higher income women in the younger age 

groups—particularly for adolescent and young women (fi g. 1). 

Food stamps are targeted toward households, not individuals, and, thus, 

the benefi ts are part of the process of household allocation decisions for 

food expenditures and consumption (e.g., allocation of the food portion of 

a household’s resources to individual household members, such as children). Differences in household structure and household allocation of food 

3.5

3.0

2.5

2.0

1.5

1.0

.5

0

Males, by age Females, by age

1-3 4-8 9-13 14-18 19-30 31-50 51-70 71 1-3 4-8 9-13 14-18 19-30 31-50 51-70 71

Thousands of calories consumed per day

Food stamp participants

Income-eligible nonparticipants

Higher income nonparticipants

Figure 1

Caloric intake by age, sex, and food stamp participation

Source: USDA, ERS using Fox and Cole (2004), based on NHANES 1988-94.
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resources could result in sex differentials in consumption and body weight. 

Women are more likely to have children in their households than men, and 

the presence of children could have an impact on how food resources are 

allocated and eventually on consumption and body weight. For example, 

boom-and-bust cycles of consumption due to the monthly allocation of food 

stamp benefi ts may lead to weight gain. In poor households with scarce food 

resources, adults may shield their children by reducing their own food intake, 

and allocate more of the food resources to their children. Food security 

studies show empirical results that are consistent with this behavior (Nord 

et al., 2007). If this type of allocation affects women more than men, since 

women are more likely to have children in their households, then the periods 

of reduced intake linked with the monthly issuance of food stamp benefi ts 

(the food stamp cycle hypothesis) may affect women’s weight more than 

men’s. It is also possible that in households with both men and women, food 

stamp benefi ts are a part of the household budget that women are more likely 

to control than men, so women may buy more of the foods they prefer or that 

the children prefer than what their spouses or partners prefer. 

Perhaps women use food consumption to cope with the hardships of poverty 

or depression whereas men have other means of coping. Some evidence 

shows that the relationship between BMI and depression differs for men and 

for women (Dragan and Akhtar-Danesh, 2007). 

Selection bias that is not entirely controlled for could also be driving the 

differences in results by sex. For example, the stigma of receiving food 

stamps is likely to be greater for men than for women. Men are still viewed 

as the “providers” for families, and a man who relies upon food stamps is 

probably stigmatized more than a woman who relies on food stamps. Women 

are also more likely to live in households with children than men, and the 

stigma from participation is probably less for households that contain children since participation may be for the benefi t of the children. If the stigma 

for men is greater than the stigma for women, it could be that only those men 

who are the worst off fi nancially (with the most unmet food need) participate 

in the Food Stamp Program, while women participants include women who 

are not as bad off (have less unmet food needs and are more likely to be overweight). If that is the case, then giving both groups more resources for food 

may give enough food to avoid undernourishment to men who participate, 

but may give some women enough food to push them into overconsumption 

and weight gain. 

If long-term participation in food stamps is linked to weight gain, then differences in spell lengths of food stamp participation for males and females 

may help account for the differences in the estimated effects of participation on weight status for men and women. Estimates of the length of time 

that participants receive benefi ts have been conducted only at the household 

level, but these estimates show that households headed by single mothers had 

much longer median spell lengths than all food stamp households (15 months 

versus about 7 months). 

The mixed results for young boys and girls are harder to explain. One study 

fi nds that food stamp participation reduces the risk of overweight among 

boys but increases the risk of overweight among girls. Why would food 

stamp participation make young boys less likely to be overweight but young 
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girls more likely to be overweight, and have no effect on older children of 

either sex? Perhaps young boys’ and girls’ food consumption and activity 

levels are different so that the amount of food provided through food stamp 

participation is too much for girls but just right for boys. One might expect 

differences in consumption between teenage boys and girls—USDA’s 

Thrifty Food Plan is derived by incorporating differences in consumption 

between boys and girls age 12 and older—but not for younger children, 

where the research shows differential effects of food stamp participation on 

weight. 

Even with a plausible explanation as to why food stamp participation would 

have a different effect on young boys than on young girls and on women 

and men, the policy implications may be disconcerting because it would be 

impractical from an administrative standpoint (and inequitable) to tie benefi t 

levels to sex, or more generally, to caloric requirements. 

Although most studies controlled for race and ethnicity and the fi xed-effect 

estimates controlled for those time-invariant characteristics and others, two 

studies in particular provided specifi c information on how the effects of 

food stamp participation on women’s weight may vary across race/ethnicity. 

Kaushal (2007) examined the effect of food stamp participation on the BMI 

of foreign-born women (which could include people of many different 

ethnicities but likely comprises mostly Mexican and other Latin American 

immigrants). Kaushal found no effect of food stamp participation on weight 

for the foreign-born population. In a study using repeated cross-sections of 

data to examine the association between food stamp participation and BMI 

over time, Ver Ploeg et al. (2007) found that non-Hispanic Black women 

who received food stamps had similar BMIs to eligible nonparticipants and 

some higher income nonparticipants over time (from 1976 to 2002). Greater 

differences between food stamp participants and eligible nonparticipants 

were found among non-Hispanic White women, but the latest cross-section 

of data used in this study (covering 1999-2002) showed no differences 

between food stamp participants, eligible nonparticipants, and low/moderate 

income nonparticipants for non-Hispanic White women. Thus, some 

evidence points to possible differential effects by race/ethnicity, although 

mechanisms to account for these effects have not been hypothesized or 

tested. 
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Interpreting Selection Bias

A key methodological question in deciphering the relationship between 

use of food stamps and weight gain is whether unobserved characteristics 

correlated with both food stamp participation and weight might bias results 

of simple multivariate regression models. Both Meyerhoefer and Pylypchuk 

(2008) and Gibson (2003) fi nd that accounting for unobserved time-invariant 

individual characteristics reduces the size of coeffi cient estimates of food 

stamp participation on the probability of obesity. In other words, accounting 

for individual characteristics reduces the size of the association of food stamp 

participation on obesity, whereas not accounting for them upwardly biases 

the estimated effect. Interestingly, Baum (2007) fi nds the same effect for 

women, but the opposite for men—that is, once time-invariant individual 

characteristics are controlled for, the estimated effect of food stamp participation increases in size for men (and becomes statistically signifi cant). Taken 

together, these results suggest that women with higher proclivities for obesity 

are more likely to participate in the Food Stamp Program, while men with 

lower proclivities for obesity are more likely to participate. 
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Hypotheses Revisited

What does this body of work reveal about the causal mechanisms between 

food stamp participation and weight gain? A few of the studies provide material to draw upon, although none give a clear answer to this question. 

Meyerhoefer and Pylypchuk (2008) provide an informal test of the theory 

that higher marginal propensities to consume food out of food stamps are 

causing participants to gain weight. Using evidence from the cash-out experiments showing that only households with multiple adults had higher marginal 

propensities to consume food out of food stamps while single adult households did not (Breunig and Dasgupta, 2005), Meyerhoefer and Pylypchuk 

conducted separate estimates of the effect of food stamp participation on the 

probability of obesity for women in single-adult households and compare 

them with women in multiple adult households. If greater marginal propensities to consume food acquired through the use of food stamps are driving 

the weight gain among women, then the effects of the use of food stamps 

would be expected to be greater for women in multiple-adult households; 

however, this test fi nds that the effect of food stamp participation on obesity 

is larger for women in single-adult households than in multiple-adult households (2.8 percentage points). Thus, initial evidence does not support the idea 

that obesity is a byproduct of food stamp benefi ts enabling participants to 

consume more food than they otherwise would. This analysis suggests that 

cashing out food stamp benefi ts to reduce overconsumption of food may not 

have the intended effect on body weight. 

If the level of food stamp benefi ts are too high for some participants and 

enable them to gain weight, then one would expect that the value of food 

stamp benefi ts received (per food needs for a given family size) would be 

positively related to BMI and the probabilities of overweight and obesity. 

While none of the studies use a benefi t-relative-to-need measure of food 

stamp participation, some of the studies use the amount of food stamp 

benefi ts received (or a prediction of that amount) instead of or in addition to 

a dichotomous measure of food stamp participation.8 The results of studies 

that include measures of the food stamp benefi t level show either similar 

results as those that use a dichotomous variable or a weaker link between 

food stamp participation and body weight. Jones and Frongillo (2006) use 

the total amount of food stamp benefi ts received over the study time period 

as their control for food stamp participation and fi nd a relationship for only 

those women who are persistently food insecure (see results explained 

earlier). Two studies used both a continuous and a dichotomous measure 

of food stamp participation (Baum, 2007; Gibson, 2003). The fi xed-effects 

models estimated in Baum (2007) show no relationship between food stamp 

participation and BMI or obesity for women when benefi t levels are used to 

measure food stamp participation. However, for men, the amount of food 

stamp benefi ts is positively related to BMI (but not obesity) and is marginally signifi cant. The OLS estimates from Baum (2007) using the food stamp 

benefi t amount are consistent with results when a dichotomous measure of 

food stamp participation is used. In contrast to fi ndings using a dichotomous 

measure of food stamp participation, Gibson (2003) fi nds no relationship 

between the benefi t amount and obesity for women. 

8Most studies do control for some 

measure of family or household size.
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Two studies examine the interplay between food security, food stamp participation, and weight, although neither tests the food stamp cycle hypothesis. 

Jones and Frongillo (2006) fi nd that among the persistently food insecure, 

food stamp participation offsets most of the smaller change in weight 

(compared with those who were persistently food secure). 9 Food stamp 

participation offsets about 5-8 kg of the 7 kg difference in weight change 

between those persistently food secure and those persistently food insecure. 

The study does fi nd that those who change food security status (become 

food secure or food insecure) had greater weight change than those who 

were persistently food secure. It also fi nds a positive association between 

food stamp participation and weight change for those who are persistently 

food secure, although the statistical signifi cance of this association varies 

across model specifi cations. Although Jones et al. (2003) did not examine 

the dynamics of food security, food stamp participation, and weight, the 

results of this study support the fi nding that food stamp participation had a 

moderating effect for low income girls who were food insecure. The results 

of these studies cannot be interpreted as evidence that the food stamp cycle is 

the cause of increased obesity among women; however, it is clear that some 

factor associated with persistent food insecurity and food stamp participation 

may be affecting weight status for women, or that some unobserved factor is 

driving the results (Jones and Frongillo, 2006). 

9Changes in food security and food 

stamp participation in this study are 

measured over the course of a year—

not on a monthly basis, which would 

be required to examine the food stamp 

cycle hypothesis
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Conclusions 

Results from the reviewed studies indicate that, for the majority of participants, food stamp benefi ts do not have an impact on overweight or obesity. 

Even taking the results of studies that fi nd a consistent link, the effect of 

short-term food stamp participation on overall obesity levels is, at most, 

very small. For example, say that researchers observe 100 individuals who 

receive food stamp benefi ts in a given month and then observe the recipients’ 

BMIs over the next year or two. If all of these recipients were nonelderly 

women, one would expect that BMIs after 2 years would reveal that between 

two and fi ve of the women would be obese due to food stamp participation. 

But nonelderly women make up only 28 percent of all food stamp participants. Thus, of the 100 participants, the number that would be observed as 

becoming obese after food stamp participation would be lower—between 0.6 

and 1.4 individuals (28 percent of 2 to 5). Thus, of 100 people who received 

food stamps in a given month, it could be expected that about 1 participant 

would be obese due to food stamp participation and 99 would not change 

their weight status (i.e., due to food stamp participation). 

Using the results of his study and assuming that the Food Stamp Program has 

a causal relationship to obesity (at least for some participants), Baum (2007) 

estimated the impact of the Food Stamp Program on the overall increase in 

obesity in the United States. The study found that overall, the Food Stamp 

Program has had a negligible effect on obesity in the United States—use of 

food stamps may account for 0.5 percent of the increase in obesity among 

adults since the mid-1970s. Results from Chang and Lauderdale (2005) and 

Ver Ploeg et al. (2007) show that differences across income groups in BMI 

and overweight and obesity are also diminishing. It is clear that factors other 

than the Food Stamp Program play a larger role in explaining the obesity 

epidemic. 

Two reviewed studies found that long-term participation in the Food Stamp 

Program may have a larger impact on BMI and obesity for women (Gibson, 

2003; Baum, 2007). Further research could explore why effects are different 

for long-term participants or why long-term participation has a different 

effect on weight status than short- and medium-term participation. 

Not enough is known about the causal mechanisms of food stamp participation and weight gain among some participants—particularly nonelderly 

women—but not other participants to make policy recommendations. The 

Food Stamp Program serves a diverse population, and any change in policy 

or administration will need to consider that some participants may be helped 

by the changes while others may be hurt. For example, reducing the overall 

benefi t level may have the intended effect of lowering weight gain for some 

participants but may have the unintended effect of adding hardship for others. 

Further, because adult women are the only group for which a link between 

participation and body weight may exist, any policy solutions would have to 

consider the differential effect across age and sex. Nonetheless, with some 

caution, this report discusses the implications of these fi ndings for policy 

alternatives. 
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The analysis conducted in reviewed studies suggests that the “cash out” 

solution to reducing obesity may only change the consumption of a group of 

women for whom the program has less of an impact on weight—women in 

multiple-adult households. Further, cashing out food stamps may not solve 

the problem of cyclical consumption, and reducing benefi t levels could make 

the problem worse for some participants. Evidence from Jones and Frongillo 

(2006) suggests that food stamp participation infl uences weight change of 

the persistently food insecure but does not affect women who change their 

food security status or who are persistently food secure. This study provides 

some evidence that food insecurity and food stamp participation have an 

interactive effect on weight for women. The study did not attempt to pinpoint 

how changes in food security status within a monthly food stamp benefi t 

cycle repeated over time may affect weight (any such study would run into 

severe data limitations). Thus, it is not known whether boom-and-bust food 

consumption patterns tied to monthly benefi t issuance are driving weight 

gain among women. If the boom-and-bust pattern does contribute to obesity, 

possible policy solutions include either increasing the frequency of benefi t 

payment (to biweekly or weekly) or even increasing the benefi t amount, 

which could, paradoxically, help reduce obesity by reducing the number of 

hungry days at the end of the payment cycle. 

Some alterations to the Food Stamp Program have been suggested to improve 

the overall diets of food stamp participants and to combat obesity. Proposed 

changes include restricting the types of foods that can be purchased with food 

stamps, offering bonuses or vouchers for buying healthful foods, such as 

fruits and vegetables, and expanding Food Stamp Nutrition Education. Such 

policies, if effective, could benefi t recipients at risk for development of overweight and obesity without adversely affecting recipients who depend more 

heavily on food stamps to meet their food needs. However, the effectiveness 

of such policies is untested, and some initial examination of the potential 

effects of these policies raises doubts that they may substantially change food 

expenditure and consumption behaviors (Guthrie et al., 2007). 
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