Review of WIC Food Packages Improving Balance and Choice: Final Report (2017) / Chapter Skim
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1 Introduction and the Process for Revising the WIC Food Packages
1 Introduction and the Process for Revising the WIC Food Packages
Pages 17-50
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From page 17... ...
. The foods offered by WIC are referred to as the WIC food packages.
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WIC participants may also benefit from one or several of these programs. The committee was tasked with evaluation of the WIC food packages exclusively.
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. This introductory chapter provides an overview of the WIC services and food packages, as well as examining the committee's task and the process for determining what changes to the food packages might be appropriate.
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If a State agency chooses this option, it may issue one can of powder infant formula in the container size that provides closest to 104 reconstituted fluid ounces to partially breastfed infants on a case-by case basis. Breastfed infants who are provided this option are considered partially (mostly)
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From page 21... ...
Two years later, Congress passed the Healthy Meals for Healthy Americans Act, which requires that state WIC agencies spend $21 for each pregnant and breastfeeding woman in support of breastfeeding promotion. Both WIC and non-WIC breastfeeding promotion and support activities appear to play a critical role in the improvement of breastfeeding initiation, duration, and exclusivity among WIC participants according to the committee's review of 15 interventional and 3 cross-sectional studies (see Anderson et al., 2005, 2007; Bonuck et al., 2005; Hayes et al., 2008; Meehan et al., 2008; Hopkinson and Konefal Gallagher, 2009; Petrova et al., 2009; Sandy et al., 2009; Bunik et al., 2010; Olson et al., 2010; Pugh et al., 2010; Kandiah, 2011; Whaley et al., 2012; Chapman et al., 2013; Haider et al., 2014; Hildebrand et al., 2014; Howell et al., 2014; Reeder et al., 2014; NASEM, 2016)
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From page 22... ...
The Current WIC Food Packages The WIC program provides seven types of food packages, as shown in Table 1-1. These packages (numbered I through VII)
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Substitutions Allowed Within the WIC Food Packages An important change that has been implemented in the current WIC food packages is the ability to substitute foods within many of the food categories. These substitutions allow for more variety and more cultural sensitivity in foods provided by the packages.
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FP II–FF & FP I–BF/FF & III BF/FF FP I–FF & III–FF III–FF A: 0 to 1 montha,b FP II–BF/FF & III FP I–BF FP II–BF A: 0 through 3 months 6 through 11 B: 1 through 3 months BF/FF 0 through 6 through Foods B: 4 through 5 months months C: 4 through 5 months 6 through 11 months 5 months 11 months WIC A: FNB = 806 fl oz, FNB = 624 fl oz, A: 104 fl oz FNB = 312 fl oz, -- -- formulac,d,e,f MMA = 823 fl oz, MMA = 630 fl reconstituted powder MMA = 315 fl oz, reconstituted liquid oz, reconstituted reconstituted liquid concentrate or 832 fl liquid concentrate B: FNB = 364 fl oz, concentrate or 338 fl oz RTF or 870 fl oz or 643 fl oz MMA = 388 fl oz, oz RTF or 384 fl oz reconstituted powder RTF or 696 fl reconstituted liquid reconstituted powder oz reconstituted concentrate or 384 fl B: FNB = 884 fl oz, powder oz RTF or 435 fl oz MMA = 896 fl oz, reconstituted powder reconstituted liquid concentrate or 913 fl C: FNB = 442 fl oz, oz RTF or 960 fl oz MMA = 460 fl oz, reconstituted powder reconstituted liquid concentrate or 474 fl oz RTF or 522 fl oz reconstituted powder
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From page 25... ...
Only infant formula may be issued for infants in food packages I and II. d The full nutrition benefit is defined as the minimum amount of reconstituted fluid ounces of liquid concentrate infant formula as specified for each infant food package category and feeding variation (e.g., food package IA -- fully formula fed)
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From page 26... ...
b Food package VI is issued to two categories of WIC participants: Nonbreastfeeding postpartum women and breastfeeding postpartum women whose infants receive more than the maximum infant formula allowances, as appropriate for the age of the infant. c Food package VII is issued to four categories of WIC participants: Fully breastfeeding women whose infants do not receive formula from the WIC Program; women pregnant with two or more fetuses; women partially (mostly)
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From page 27... ...
(No more than a total of 4 qt of milk may be substituted for a combination of cheese, yogurt, or tofu for children in Food Package IV.) Additional amounts of tofu may be substituted, up to the maximum allowance for fluid milk for lactose intolerance or other reasons, as established by state agency policy.
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From page 28... ...
However, when individually tailoring food packages V or VII for nutritional reasons (e.g., food allergy, underweight, participant preference) , state agencies have the option to authorize the following substitutions: 1 lb dry and 64 oz canned beans/peas (and no peanut butter)
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From page 29... ...
THE COMMITTEE'S TASK In response to a request from Congress, USDA-FNS charged the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine's11 current Committee to Review the WIC Food Packages to conduct a two-phase evaluation of the WIC food packages and 9 In states issuing electronic benefit transfer (EBT)
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30 REVIEW OF WIC FOOD PACKAGES TABLE 1-4 Substitutions Allowed by WIC State Agencies, Fiscal Year 2015 All WIC State Agencies Percent of WIC Number of Percent of Participants Covered Authorized Forms Agencies Agencies by This Optiona Milk and milk substitutes Soy beverages 82 95 99.9 Tofu 54 63 72.7 Nonfat, 1%, and 2% milkb 61 71 69.1 Nonfat and 1% milkb 22 26 28.8 Cheese Low sodium 22 26 48.3 Fat free 16 19 37.1 Low cholesterol 11 13 18.3 Peanut butter Low sodium 25 29 45.3 Low sugar 17 20 34.4 Reduced fat 17 20 15.6 Beans and peasc Canned beans 73 85 84.9 Whole grainsd Brown rice 83 97 99.8 Tortillas 77 90 99.6 Oats 66 77 85.9 Bulgur and/or barley 22 26 22.8 Whole wheat pasta 25 29 29.7 Canned fishe Any tuna 86 100 100 Any salmon 80 93 97.7 Sardines 54 63 45.7 Any mackerel 20 23 6.9 Forms of vegetables and fruits Frozen 70 81 85.5 Canned 51 59 63.4 Dried 5 6 16.5
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This, the final report, includes any relevant updates to the interim report as well as the final recommendations for changes to 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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From page 33... ...
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-participating population, and can be administered effectively and efficiently nationwide and in a cost-effective manner.
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Although the committee acknowledges that WIC participants prepare WIC foods in various ways (e.g., some WIC participants add saturated fats, added sugars, and sodium to foods included in their WIC packages) , the committee was not asked to consider how WIC participants modify WIC foods before consumption.
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Comments provided are available in the public access file for this study.14 Conducting a Comprehensive Literature and Report Review The committee was tasked with conducting a comprehensive literature review to gather evidence to support its final recommendations.15 In collaboration with HMD staff and committee consultants, draft key research questions were developed based on the statement of task, literature review questions developed for the letter report (IOM, 2015) , and other topics outlined by USDA-FNS for committee consideration.
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Determining WIC Food Package Food, Nutrient, and Cost Profiles The food group and nutrient contributions and costs of the current food packages served as the baseline from which to evaluate food package changes. Details of the food group and nutrient contributions of the current food packages, along with a comparison to dietary intake recommendations, are presented in Chapter 3.
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The final criteria, presented in Box 1-4, reflect the committee's priorities, first, to meet the goals of the WIC program; second, to respond to the requirement that the WIC food packages be aligned with the DGA; and third, to provide a package that is acceptable to participants and feasible to implement at every level. In this section, the rationale supporting each criterion is described.
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The committee decided that, because WIC participants (other than formula-fed infants in the first 6 months of life) , consume foods and beverages not supplied by the WIC food packages that meet some portion of their nutrient needs, the supplementation target (i.e., proportion of requirement)
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Criterion 3: Aligning with the Most Recent Dietary Guidelines for Americans The packages contribute to an overall dietary pattern that is consistent with the DGA for individuals 2 years of age and older. Rationale A goal of the final recommendations is to ensure that WIC food packages are consistent with the DGA.
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Criterion 6: Acceptability, Availability, and Perceived Value The foods in the packages are readily acceptable, commonly consumed, widely available, take into account cultural eating patterns and food preferences, and provide incentives for families to participate in the WIC program. Rationale Consumption of WIC foods may be influenced by the acceptability, preferences for, or availability of foods that are issued in the food packages.
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, and other preferences. Perceived value Participation in WIC and redemption and consumption of WIC foods may be somewhat dependent upon the perceived value of the food packages (as an incentive)
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Rationale The WIC program is administered by USDA-FNS and numerous state and local agencies. As specified in the task, the proposed changes should not unduly add to the administrative burden of these agencies.17 Likewise, changes should not unduly add to WIC vendor burden, given that the ease of WIC program administration is closely linked to the ability of WIC-authorized vendors to provide WIC foods.
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NOTES: The dotted line indicates components of the process that iterate until the criteria for food package revisions are met (see criteria 1 through 7 presented above)
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Variations from Cost-Neutral Although the committee was tasked with ensuring overall cost-neutrality for recommended changes to the WIC food packages, it was also asked to offer prioritized recommendations in the event that USDA-FNS's WIC funding is either above or below the cost-neutral level. These priorities appear in Chapter 11.
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From page 45... ...
. In contrast to nutrients, food group intakes are assessed using the DGA food patterns, which are designed to ensure that the nutrient requirements of nearly all (97.5 percent)
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From page 46... ...
The chapter contents are as detailed below: Chapter 2 -- Changes Since the Last Review and Continuing Challenges Chapter 3 -- Alignment of the Current Food Packages with Dietary Guidance, Special Dietary Needs, and Cultural Eating Practices or Food Preferences Chapter 4 -- Nutrient and Food Group Intakes of WIC Participants Chapter 5 -- Nutrient and Food Group Priorities for the Food Packages Chapter 6 -- The Revised Food Packages Chapter 7 -- Evaluation of Cost Chapter 8 -- Sensitivity Analysis Chapter 9 -- How the Revised Food Packages Meet the Criteria Specified Chapter 10 -- The Regulatory Impact Analysis (Abridged) Chapter 11 -- Recommendations for Implementation and Research
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From page 47... ...
2012. Updated US Department of Agriculture food patterns meet goals of the 2010 dietary guidelines.
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From page 48... ...
2015. Review of WIC food packages: An evaluation of white potatoes in the cash value voucher: Letter report.
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From page 49... ...
: Revisions in the WIC food packages; final rule.
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