Correctional Institutions as Obesogenic Environments: a Multi-level Exploration of Determinants that Influence Inmates’ Weight Outcomes During Incarceration in Canadian Federal Penitentiaries

Abstract

Background: Since inmates in Canada are excluded from household statistics, very little information is known about obesity prevalence or associated risks in this vulnerable population. This is a problem since obesity rates are high in Canada, and obesity is considered a public health crisis. Furthermore, the burden of obesity is disproportionately carried by low-income, vulnerable and marginalized populations (such as inmates). The goal of this study was to determine weight changes during incarceration in Canadian federal penitentiaries, and to determine which factors were influential at the socio-demographic, behavioral, institutional and policy level.

Methods: This study was a retrospective cohort study that used a quantitative approach. The setting for this study was 12 correctional institutions in Ontario, New Brunswick and Nova Scotia (or the “Atlantic region”). Administrative data were collected from 1420 inmates, with 754 of these participants also participating in a face to face interview to gather additional data on self-reported behavioral determinants and measured anthropometric data. Eligibility criteria for inmates to participate were: a recorded admission weight in their medical chart, housed in their current institution for at least 6 months, not acutely or terminally ill (and requiring hospitalization), and not pregnant or in a wheelchair.

Results: We found that almost three quarters of inmates (73%) gained weight during incarceration. Obesity rates increased by 71%, going from 26.6% to 45.4%. The observed weight gain was associated with the tobacco ban (macrosystem level), the use of commissary store (or “canteen”) (at the microsystem level), and many determinants at the individual level (physical activity, diet, smoking status). The observed weight gain was also significantly associated with age, ethnicity, length of incarceration, duration of total sentence and region. It was however not associated with the national menu, food service/feeding system, sleep, screen time, mental health status or psychotropic medication use. Some inmates who gained excessive weight also developed obesity related illnesses.

Interpretation: The observed weight gain was deemed to be unhealthy, since obesity rates increased significantly (and the proportion of inmates with normal weight decreased). These findings have potential repercussions on inmate health, since the observed weight gain was associated with the development of obesity related illnesses. Lastly, many of the factors associated with the observed weight gain were modifiable, which means it is possible to intervene to manage weight gain during incarceration.