WIC FOOD PACKAGES
Proposed Framework for Revisions:
Kathleen M. Rasmussen, Marie E. Latulippe, and Ann L. Yaktine,
Committee to Review WIC Food Packages
Food and Nutrition Board
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
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NOTICE: This activity was supported by Grant No. AG-3198-D-14-0050_0001-005 from the U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organizations or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-38000-3
International Standard Book Number-10: 0-309-38000-6
Digital Object Identifier: 10.17226/21832
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC food packages: Proposed framework for revisions: Interim report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
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COMMITTEE TO REVIEW WIC FOOD PACKAGES
KATHLEEN M. RASMUSSEN (Chair), Nancy Schlegel Meinig Professor of Maternal and Child Nutrition, Division of Nutritional Sciences, Cornell University
SHANNON E. WHALEY (Vice Chair), Director of Research and Evaluation, Public Health Foundation Enterprises WIC Program
SUSAN S. BAKER, Professor and Co-chief, Digestive Diseases and Nutrition Center, Department of Pediatrics, Women and Children’s Hospital of Buffalo
MARIANNE P. BITLER, Professor, Department of Economics, University of California, Davis
PATSY M. BRANNON, Professor, Division of Nutritional Sciences, Cornell University
ALICIA L. CARRIQUIRY, Distinguished Professor, Department of Statistics, Iowa State University
DAVID E. DAVIS, Professor, Department of Economics, South Dakota State University
MARY KAY FOX, Senior Fellow, Mathematica Policy Research, Inc.
TAMERA J. HATFIELD, Assistant Professor, Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of California, Irvine
HELEN H. JENSEN, Professor of Economics and Head, Food and Nutrition Policy Division of Center for Agricultural and Rural Development, Iowa State University
RACHEL K. JOHNSON, Robert L. Bickford, Jr., Green and Gold Professor of Nutrition, Professor of Medicine, University of Vermont
ANGELA ODOMS-YOUNG, Assistant Professor, Department of Kinesiology and Nutrition, University of Illinois at Chicago
RAFAEL PÉREZ-ESCAMILLA, Professor of Epidemiology and Public Health, Director, Office of Public Health Practice, Director, Global Health Concentration, Yale School of Public Health
A. CATHARINE ROSS, Professor of Nutrition, Dorothy Foehr Huck Chair, Department of Nutritional Sciences, Pennsylvania State University
CHARLENE RUSSELL-TUCKER, Chief Operating Officer, Connecticut Department of Education
MEI CHUNG, Assistant Professor, Department of Public Health and Community Medicine, School of Medicine, Tufts University
GAIL G. HARRISON, Professor Emeritus, Department of Community Health Sciences, Center for Health Sciences, University of California, Los Angeles (through August 2015)
JOHN A. KIRLIN, Economist, U.S. Department of Agriculture, Economic Research Service
SUZANNE P. MURPHY, Researcher (Professor) Emeritus, University of Hawaii Cancer Center
MARIE E. LATULIPPE, Study Director
MEGHAN E. QUIRK, Program Officer
BERNICE CHU, Research Associate
ALICE VOROSMARTI, Research Associate
AMBAR SAEED, Senior Program Assistant
ANN L. YAKTINE, Director, Food and Nutrition Board
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
BARBARA ABRAMS, University of California, Berkeley
CARRIE ASSAR, U.S. Food and Drug Administration
LOREN BELL, Altarum Institute
ARTHUR W. BURGER, Burger, Carroll & Associates, Inc.
BARBARA DEVANEY, Mathematica Policy Research
JOHANNA DWYER, Tufts Medical Center
VICTOR FULGONI III, Nutrition Impact, LLC
CRAIG GUNDERSEN, University of Illinois
SANDRA HOFFMAN, U.S. Department of Agriculture, Economic Research Service
LUCIA KAISER, University of California, Davis
PHIL KAUFMAN, Altarum Institute
JANET KING, Children’s Hospital Oakland Research Institute
RON KLEINMAN, Massachusetts General Hospital for Children
JACOB A. KLERMAN, Abt Associates, Inc.
BARBARA J. PETERSON, Exponent
ALFRED SOMMER, Johns Hopkins Bloomberg School of Public Health
JANET TOOZE, Wake Forest School of Medicine
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Diane F. Birt, Iowa State University, and Elaine L. Larson, Columbia University Mailman School of Public Health. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Demographic Shifts and Trends in WIC Participation
Changes to Program Administration
Changes in Food Systems, Dietary Patterns, and Dietary Guidance
2 THE WIC PARTICIPANT EXPERIENCE
Assessing Participant Acceptance of WIC Foods
Barriers and Incentives to WIC Participation and Redemption
Factors Affecting Access to Food
Administration of the WIC Food Packages
Nutrient and Food Intake: Evaluating Adequacy
Nutrient and Food Intake in the WIC Population
Approach to the Development of the Baseline Food Package: Nutrients and Cost
Approach to the Regulatory Impact Analysis
Nationwide Distribution and Costs of Food
Committee WIC Site Visits and Shopping Experience
4 NUTRIENT INTAKES OF WIC-ELIGIBLE POPULATIONS
Literature and Report Findings: Nutrient Intakes
NHANES Analysis: Nutrient Intakes
Considerations for Data Interpretation
5 FOOD INTAKE OF WIC-ELIGIBLE POPULATIONS
Literature and Report Findings: Food Intake of WIC Participants
NHANES Analysis: Food Group and Subgroup Intakes
Considerations for Data Interpretation
6 NUTRITION-RELATED HEALTH RISKS IN THE WIC POPULATION
Maternal Nutrition-Related Health Risks
Nutrition-Related Health Risks in Infants
Nutrition-Related Health Risks in Children
7 PROMOTION, MOTIVATION, AND SUPPORT OF BREASTFEEDING WITH THE WIC FOOD PACKAGES
Breastfeeding and the WIC Program
Breastfeeding Trends in the United States and the WIC Population
Barriers, Motivators, and Incentives to Breastfeeding in the WIC Population
Breastfeeding Initiation, Duration, and Exclusivity: Influence of WIC Participation
8 MEETING DIVERSE DIETARY NEEDS AND PREFERENCES: CONSIDERATIONS FOR THE WIC FOOD PACKAGES
Foods to Address Medical Conditions
Varying Food Preferences and Practices
9 BACKGROUND AND APPROACH TO CONSIDERING FOOD PACKAGE OPTIONS
The Role of the WIC Food Packages
Dietary Guidance and Food Package Options
Foods Containing Functional Ingredients
Infant Formula: Functional Ingredients and the Market Landscape
Preliminary Nutrient and Food Group Priorities
Criteria for Review of the WIC Food Packages
Next Steps: Process for Phase II
Conclusions and Development of the Approach in Phase II
C Comparison of IOM 2006 Recommendations and Regulatory Implementation
D Composition of the WIC Food Packages
E USDA-FNS Funded Studies Describing the Effect of the 2009 WIC Food Package Changes
F Changes in the WIC Food Packages and Program Participation: Methods
G Literature Findings on Barriers and Incentives to WIC Participation and Redemption
J Dietary Reference Intake Values and Nutrients and Foods Analyzed
L Household Food Expenditure Analysis
M Regulatory Impact Analysis Approach
N Committee Perceptions of the WIC Experience
O Summary Results from the Diet Quality of American Young Children by WIC Participation Status
P Nutrient Intake of WIC and WIC-Eligible Populations
Q Food Intake of WIC and WIC-Eligible Populations
R Summary of National Dataset Characteristics Applied in the Evaluation of Health Risks
S Breastfeeding Literature Findings
T Chronology of Statutes Pertaining to the Definition of WIC Supplemental Foods
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve more than 8 million pregnant women, and mothers and their infants and young children. Today, the program serves more than one-quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and postpartum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population.
To assure the continued success of WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) re-evaluate the program’s food packages every 10 years to assure that they remain aligned with the goals of the Dietary Guidelines for Americans. In 2014, the USDA asked the Institute of Medicine (IOM) to undertake this reevaluation. This complex task included consideration of whether or not WIC participants should be permitted to purchase white potatoes with the cash value voucher (CVV), a part of the benefit package that provides access to fresh fruits and vegetables. In its first of three reports, published early in 2015, the Committee to Review WIC Food Packages (the committee) recommended that white potatoes be allowed as a WIC-eligible vegetable for purchase with the CVV. This, the second report of this series, provides a summary of the work of phase I of the study, and serves as the analytical underpinning for phase II in which the committee will report its final conclusions and recommendations (the third and final report).
In this report, the committee provides the findings and conclusions from its evidence gathering and data analyses. Finally, the report presents the committee’s criteria that lay the groundwork for phase II of the study, and offers a framework to guide development of the committee’s recommendations.
The work of the committee was greatly enhanced by the contributions of many individuals who participated in the study’s public activities. The committee is grateful to the speakers in its data-gathering workshops who gave valuable insights as well as their time to assist the committee with its task. The committee also thanks the members of the public who provided comments in open sessions or through the committee’s website. Lastly, the committee is indebted to the many WIC staff members who gave their time and expertise to help committee members better understand administration and participation in the WIC program.
The size of this report is testimony to the magnitude of the committee’s task. It exists thanks to the hard work of many individuals. Committee members volunteered many hours of their time to this work. Their collaborative spirit as well as careful thinking and writing are to be commended. The committee was supported in its work by two consultants. Suzanne Murphy provided critical insights based on her experience in leading the committee that produced the first major reevaluation of the WIC food packages, published in 2006. Her sage advice is much appreciated. Mei Chung led the development and execution of all of the committee’s literature reviews.
The committee would like to thank the staff of the Center for Agricultural and Rural Development (CARD) and the Department of Statistics at Iowa State University for their analysis of the data from the National Health and Nutrition Examination Survey (NHANES) and the National Household Food Acquisition and Purchase Survey. Committee members Alicia Carriquiry and Helen Jensen guided CARD’s work, which was carried out by Hocheol Jeon and David Osthus. John Kirlin of USDA-Economic Research Service reviewed the committee’s application of the Food Acquisition and Purchase Survey dataset to the study, and Kevin Dodd of the National Cancer Institute provided helpful guidance on analyses of NHANES.
To accomplish this task, numerous staff members at the National Academies of Sciences, Engineering, and Medicine supported the work of the committee. Marie Latulippe served as the project’s study director and provided leadership, creative ideas, and a calm spirit against tight deadlines. She was assisted by Meghan Quirk after March 2015. Bernice Chu assisted with literature reviews and data management, and Ambar Saeed dealt with administrative logistics. Leslie Pray assisted with report organization and editing, and Rebecca Morgan of the National Academies Library/Research
Center with fact-checking. Alice Vorosmarti assisted with literature reviews and other data-oriented tasks. Ann Yaktine, director of the Food and Nutrition Board, supervised the work of the staff and provided useful insights at many points in the committee’s deliberation. The committee owes them all a debt of gratitude for their hard work and professionalism.
Kathleen M. Rasmussen, Chair
Committee to Review WIC Food Packages
This volume is dedicated to Gail G. Harrison, Ph.D. (1943–2015) in recognition of her substantial contributions to the field of maternal and child nutrition and to the WIC program in particular. Gail’s vision and leadership led to substantive positive impacts on mothers and children in the United States and around the world.