Introduction
Governments around the world are seeking to address the increasing prevalence of obesity and hypertension. Our objective was to evaluate the effect of an incentive-based development program (Oportunidades, formerly Progresa) on body mass index (BMI), blood pressure, and self-reported health.

Methods
An intervention group of low-income (below the 20th percentile nationally), rural, Mexican adults (aged 30–65 years) (n = 5280) received program benefits (cash transfers contingent on positive changes in health behavior such as regular health checkups) for 3.5 to 5.0 years. They were compared with a newly recruited control group of adults (n = 1063) who had not yet begun receiving benefits. Analyses were adjusted for almost 50 social and economic covariates.

Results
Age- and sex-adjusted BMI was lower in adults from intervention communities than in those from control communities (26.57 kg/m² vs 27.16 kg/m², P < .001), as was the prevalence of obesity (20.28% vs 25.31%, P < .001) and overweight (59.24% vs 63.04%, P = .03); these results were attenuated after covariates were included. Adults in intervention communities had a lower combined prevalence of uncontrolled hypertension (33.80% vs 34.52%, P = .008) when adjusting for all covariates. Mean systolic (β = –2.60, P < .001) and diastolic (β = –2.84, P < .001) blood pressures were significantly lower in the intervention communities after all covariates were included, and self-reported health outcomes were better.

Conclusions
Participation in Oportunidades, a large-scale cash-transfer program, was associated with lower prevalence of obesity and hypertension and better self-reported health in adults in rural Mexico.