Public Assistance Program Participation and Overweight and Obesity Among Low-Income California Adults: A Repeated Cross-Sectional Analysis of the California Health Interview Survey, 2019–2024

Background Participation in public assistance programs may be associated with weight outcomes among low-income adults, but associations may differ by program type and sex. We examined associations of participation in the Supplemental Nutrition Assistance Program (SNAP), Supplemental Security Income (SSI), and California Work Opportunity and Responsibility to Kids (CalWORKs) with overweight and obesity among low-income California adults and evaluated differences by sex. Methods We analyzed 2019–2024 California Health Interview Survey (CHIS) data among adults with household income at or below 130% of the federal poverty level (n = 16,918). Survey-weighted binomial regression estimated adjusted prevalence ratios (APRs) for overweight (BMI 25.0–29.9 kg/m²) and obesity (BMI ≥ 30.0 kg/m²), adjusted for sociodemographic characteristics, smoking, insurance, and food insecurity, with sex-stratified models. Results SNAP participation was associated with higher obesity (APR = 1.23; 95% CI = 1.07–1.42) but not overweight; concentrated among females (APR = 1.37; 95% CI = 1.15–1.64) and non-significant among males. CalWORKs was associated with higher overweight (APR = 1.29; 95% CI = 1.10–1.59) but not obesity; significant among males (APR = 1.72; 95% CI = 1.14–2.59) but not females. SSI was not significantly associated with either outcome. Conclusions Associations varied by program type, outcome, and sex; further research is needed to elucidate underlying mechanisms and to inform policies that support healthy weight.