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Children Increase Fruit and Vegetable Consumption Following 2009 Changes to the WIC Food Package in New York State

Changing the WIC Food Package in Response to the US Childhood Obesity Epidemic

Childhood overweight is highly prevalent in the United States with more than one quarter (26.7%) of children as young as 2-5-years-old already overweight or obese (BMI >85th percentile)1. In 2005, in response to the childhood obesity epidemic, the Institute of Medicine (IOM) report WIC Food Packages: Time for a Change recommended a change to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which reaches nearly half of all infants born in the United States and serves approximately nine million low-income pregnant and postpartum women, infants, and children below age fi ve per months2. The change was to reduce the elements of the food package that contribute to overweight and obesity without compromising key nutrients/micronutrients often absent in the diet3. In response, the US Department of Agriculture (USDA) mandated changes to WIC food packages in all states. WIC programs also were encouraged to offer educational programs focused on increasing physical activity and reducing screen time for children and their families in addition to WIC’s core nutrition education function.

Adding Fruits, Vegetables, and Whole Grains to the WIC Food Package

On 5 January 2009, New York (NYS) was the fi rst state to implement these revisions. For the fi rst time, food packages were required to include fruits, vegetables, and whole grains. Children were eligible for modest $6 fruit/vegetable vouchers/month. For children 2-4 years of age, low nonfat milk (1%) replaced whole milk. At the same time, NYS introduced the WIC Healthy Lifestyle Initiative. This multifaceted, comprehensive program incorporated breastfeeding peer counseling and client-centered counseling which provide education to WIC participants on how to help their families eat healthier, increase physical activity, and reduce screen time from birth. The Healthy Lifestyle Initiative grew out of programs that have been progressively implemented by NYS WIC since 1997 as part of the statewide initiative for childhood obesity prevention4,5.

Using the Automated New York State WIC Database to Compare Fruit and Vegetable Consumption and Weight Before and After Before and After Changing the Food Package

This study was undertaken as part of a comprehensive evaluation of the innovative NYS WIC program obesity prevention policies and implementation of the new WIC food package. Using cross-sectional data abstracted from the NYS WIC administrative data system (WICSIS), more than 3.5 million records were analyzed at six month intervals from July-December 2008 (pre-implementation of the new WIC food package) through July-December 2011. Behavioral data in WICSIS were obtained from parent interview by WIC staff at mandatory certifi cation and recertifi cation visits. Approximately 500,000 infants and children through age four years were enrolled in the program in each six month interval. Prevalence proportions for behaviors and BMI were calculated. Statistical tests were not calculated because biannual WIC data represented a census of all children who participated in WIC. The objective of the study was to examine trends over time in prevalence of: infant feeding practices; daily consumption of fruits, vegetables, whole grains, and low-/non-fat milk; screen time; and obesity in children 1-4 years of age.

Increases in Healthy Eating Behaviors Including Fruit, Vegetable and Whole Grain Consumption and Decreases in Weight Following Changes to the WIC Food Package

Comparing July-December in 2008 and 2011, increases in prevalence proportions were observed in: daily fruit (87.0 to 91.6%), vegetable (78.1 to 80.8%), and whole grain consumption (59.0 to 64.4%) by children aged 1-4 years; breastfeeding initiation (72.2 to 77.5%); delaying introduction of solid foods until after four months of age (90.1 to 93.8%); and switches from whole milk to low-/ non-fat milk by children aged 2-4 years (66.4 to 69.4%). In one year old children, the proportion > 95th percentile weight-for-recumbent length decreased from 15.1 to 14.2%; the proportion of children 2-4-years-old with BMI > 95th percentile decreased from 14.6 to 14.2%.

Making Small, Revenue Neutral Changes to a Program that Reaches Nearly Half of All Infants in the US May Have a Measurable Impact on Behavior

These findings demonstrate that, within the context of the NYS Healthy Lifestyle Initiative, positive changes in dietary intake and reductions in obesity followed implementation of the USDA mandated revisions to the WIC food package for the hundreds of thousands of young children participating in the NYS WIC program. While our findings are limited to NYS, they suggest that WIC has enormous potential to positively infl uence nutrition and diet, both now and in the future6, through revenue neutral changes to a nutritional program that reaches one-half of all children born in in the U.S. A national focus on evidence-based, population-level obesity prevention programs such as WIC that target children from the earliest ages may be key to combating the obesity epidemic in the US7.

Based on: Chiasson MA, Findley SE, Sekhobo JP, Scheinmann R, Edmunds LS, Faly AS, McLeod NJ. Changing WIC changes what children eat. Obesity (Silver Spring). 2013 Jul;21(7):1423-9. doi: 10.1002/oby.20295. Epub 2013 May 22. PMID: 23703806

  1. Ogden CL,et al. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. Jama. 2012 Feb 1;307(5):483-90.
  2. Frequently Asked Questions about WIC. Food & Nutrition Service; Available from: http://www.fns.usda.gov/wic/faqs/faq.htm, accessed November 11, 2013.
  3. WIC Food Packages: Time for a Change. Washington, DC: Institute of Medicine April 2005.
  4. Davison KK, et al. Feasibility of increasing childhood outdoor play and decreasing television viewing through a family-based intervention in WIC, New York State, 2007-2008. Prev Chronic Dis. 2011 May;8(3):A54.
  5. Sekhobo JP et al. Evidence of the adoption and implementation of a statewide childhood obesity prevention initiative in the New York State WIC Program: the NY Fit WIC process evaluation. Health Educ Res. 2012 Apr;27(2):281-91.
  6. Craigie AM, et al. Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas. 2011 Nov;70(3):266-84.
  7. Trust for America’s Health and the Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America’s Future — 2012: Available from: http://healthyamericans.org/assets/fi les/2012_f_as_in_fat_FINAL%20ES%209-22-12.pdf.
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