Review of WIC Food Packages Proposed Framework for Revisions: Interim Report (2016) / Chapter Skim
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1 Introduction and Background
1 Introduction and Background
Pages 13-44
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at or below 185 percent of federal poverty guidelines or enrolled in Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program, or Medicaid; and (3) at nutritional risk (e.g., anemia, obesity, underweight, high-risk pregnancy)
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, the goals of the WIC program have evolved since its introduction. Today they include promoting and supporting successful long-term breastfeeding; providing WIC participants with a wider variety of foods, including fruits, vegetables, and whole grains; and providing WIC state agencies greater flexibility in prescribing food packages to accommodate cultural food preferences of WIC participants (USDA/ FNS, 2014a)
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See Appendix D for detail on composition of the WIC food packages.
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. The committee will first review and assess the nutritional status and food and nutritional needs of the WIC-eligible population and the impact of the 2009 regulation, finalized in 2014, to exclude white potatoes from WIC food packages against key recommendations of the 2010 Dietary Guidelines for Americans, on nutrient intake and indicators of diet quality; and changes in nutrient and food intake values and indices of diet quality if fresh white potatoes are included in the WIC benefit.
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An initial phase I letter report will include dietary and energy intake analyses, food in take analyses relative to the Dietary Guidelines for Americans, diet quality indices, and a sensitivity analysis to determine the impact of exclusion of white potatoes in WIC food packages on consumption of other foods and the ability of WIC partici pants to meet key recommendations of the Dietary Guidelines for Americans. The letter report will contain findings and recommendations for white potatoes that are consistent with the current Dietary Guidelines for Americans, consider the health and cultural needs of the WIC population, and can be administered effectively and efficiently nationwide and in a cost-effective manner.
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Organization of This Report In addition to introducing the charge to the committee and the rationale for this report, this first chapter considers demographic, administrative, and food system and dietary changes, including changes in national dietary guidance, that have occurred since the previous IOM committee proposed revisions to the WIC food packages (IOM, 2006)
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Specifically, the committee reviewed the role of the WIC food packages as intended by the USDA-FNS; applicability of the 2015 DGAC report recommendations to WIC food packages; the science of functional ingredients added to foods and infant formulas in the WIC food packages; the infant formula regulatory and market landscape; choice and flexibility within the food packages; and cost considerations. The approach to considering these other factors is described in Chapter 9.
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DEMOGRAPHIC SHIFTS AND TRENDS IN WIC PARTICIPATION In the 10 years since the last IOM review of the WIC food packages, the WIC population has changed in ways that reflect demographic changes across the United States. Although the U.S.
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SOURCE: USDA/FNS, 2015e. Figure 1-1, fixed 2011 2012 2013 2014 2015 FIGURE 1-2 National monthly participation in the WIC program, October 2011– February 2015.
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Finally, Medicaid, Supplemental Nutrition Assistance Program (SNAP) , and Temporary Assistance for Needy Families (TANF)
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. In fact, overall expenditures in USDA nutrition assistance programs decreased 5 percent between fiscal years 2013 and 2014.
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SOURCES: USDA/FNS, 2007a, 2013a. Figure 1-5a, fixed FIGURE 1-5b Distribution of ethnicity of WIC participants, 2006 and 2012.
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CHANGES TO PROGRAM ADMINISTRATION Implementation of the revised food packages in 2009 introduced not only new foods, but also the CVV,3 a new type of benefit with a specific dollar value for purchasing vegetables and fruits. States are now required to allow "split tender," meaning participants may pay the difference out-ofpocket (or with SNAP benefits)
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Changes in Program Costs Any changes to the food packages to be recommended by the committee during phase II of this study are required to be cost neutral so the current average food package cost (with adjustments for inflation) can be maintained.
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Major cost savings are made available to the WIC program through the infant formula rebate system. WIC state agencies are required to award infant formula rebate contracts competitively and grant winning infant formula manufacturers exclusive rights to provide formula to WIC participants in exchange for substantial discounts on infant formula and sometimes food (USDA/ERS, 2013)
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Changes in Food Systems Since the publication of the 2006 IOM report, national focus on the impact of food production and consumption on environmental sustainability and long-term food security has increased. The 2015 DGAC report devoted two of seven chapters of the report to food environment and food sustainability and found consistent evidence that plant-based diets are associated with lower environmental impact (USDA/HHS, 2015)
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. Changes in the 2015 DGAC report relevant to the WIC food packages are summarized below.
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33.94 33.02 30.84 30.64 –7 Added sugars (tsp-eq) 14.83 15.80 15.24 15.37 –3 NOTES: c-eq = cup-equivalents; FP = food package; g-eq = gram-equivalents; oz-eq = ounce equivalents; tsp-eq = teaspoon-equivalents.
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Recommended intakes of dairy foods were slightly increased for two calorie levels. Compared to the 2010 DGA, the 2015 DGAC report included no changes to the recommended amounts from each of the major food groups or food subgroups, except for small changes to the subgroups of protein foods.
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Dry beans and peasb ½ ½ 1 ½ 1 ½ 3 2 (c-eq/wk) Starchy 1½ 2 2½ 3½ 2½ 3½ 6 6 (c-eq/wk)
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a Food patterns for the 2,200 kcal diet were applied to women in this report because this is equivalent to the mean Estimated Energy Expenditure (EER) calculated for women reporting WIC participation in NHANES 2005–2008.
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Iron was still considered a nutrient of public health concern for these women. Food Components to Reduce Both the 2010 DGA and 2015 DGAC report focus on limiting added sugars in the diet, and the 2015 DGAC report recommended limiting added sugars to no more than 10 percent of total calories.
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= nutrient of public health concern; nutrients of public health concern are those shortfall nutrients that are linked to adverse health outcomes.
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Given the WIC program objective to supplement participants' usual diets, it is useful to know the potential contribution of the WIC food packages to USDA-recommended food group intakes (USDA/HHS, 2015)
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For pregnant and partially breastfeeding women, the food packages provide approximately 57, 19, 98, 25, and 47 percent of the recommended intakes for those same food groups. 5 To evaluate the diets of all children 1 to less than 5 years of age in this report, the com mittee applied a weighted food pattern (a 1,000 kcal pattern weighted 1:3 with the average of 1,200- and 1,400-kcal patterns)
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38 REVIEW OF WIC FOOD PACKAGES TABLE 1-7 Percentage of the Recommended Servings from the 2015 USDA Food Patterns Supplied by the Current Maximum Allowances for the WIC Food Packages by Category of Participant Children FP IV: 1 to 4 Years USDA Food DGAC 1,300 WIC Food Pattern Units/ % of DGAC Kcal Food Category Group Day WIC Max Report Rec Patterna Total fruit Fruits c-eq 0.9 77 1.2 Juice, 100%c Fruit (juice c-eq 0.5 107 0.5 only) Fruitd Fruit, fresh c-eq 0.4 57 0.7 Total Total c-eq 0.5 36 1.4 vegetables vegetables Vegetablese c-eq 0.3 21 1.4 Dry legumes Dry beans and c-eq 0.3 353 0.1 peas Total dairy Dairy c-eq 2.1 90 2.4 Milkf c-eq 2.1 90 2.4 Cheeseg oz-eq 0.0 0 2.4 Total grains Grains oz-eq 2.3 55 4.1 Breakfast oz-eq 1.2 29 4.1 cereal Whole wheat breadh oz-eq 1.1 26 4.1 Total proteini Total protein oz-eq 1.9 60 3.1 foods Dry legumesj Dry beans and oz-eq 0.3 NR NR peas Peanut butterk Nuts, seeds, oz-eq 1.2 354 0.3 and soy Eggs Meat, poultry, oz-eq 0.4 19 2.1 eggs Fish Seafood oz-eq 0.0 0 0.6
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INTRODUCTION AND BACKGROUND 39 Women FP V: Pregnant and Partially BF, FP VI: Up to FP VII: Fully BF, Up to 1 Year PP 6 Months PP Up to 1 Year PP % of DGAC % of % of WIC DGAC 2,200 WIC DGAC WIC DGAC Maximum Report Kcal Food Max Report Rec Max Report Rec Allowance Rec Patternb 1.1 57 0.9 47 1.1 57 2.0 0.6 91 0.4 61 0.6 91 0.7 0.5 40 0.5 40 0.5 40 1.3 0.6 19 0.6 19 0.6 19 3.0 0.4 13 0.4 13 0.4 13 3.0 0.3 88 0.3 88 0.3 88 0.3 2.9 98 2.1 71 3.6*
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j Legumes were considered a protein substitution (in addition to a vegetable option) as it al ternates with peanut butter, another protein source, in the food packages.
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2015. Review of WIC Food Packages: An evaluation of white potatoes in the cash value voucher: Letter report.
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: Revisions in the WIC food packages; interim rule, 7 C.F.R.
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: Revisions in the WIC food packages; final rule, 7 C.F.R.
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