WASHINGTON - A new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine proposes updated revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to better align with the Dietary Guidelines for Americans and promote and support breast-feeding. The committee that carried out the study and wrote the report recommended cost-neutral changes that include adding fish; increasing the amount of whole grains; and increasing vegetables and fruits as a trade-off for decreasing juice, milk, legumes, peanut butter, infant vegetables and fruits, and infant meats. It also recommended allowing women to receive the quantity of formula needed to support any level of breast-feeding. The proposed changes will save approximately $220 million programwide from 2018 to 2022.
A program of the U.S. Department of Agriculture's Food and Nutrition Service, WIC is one of the largest nutrition programs in the U.S., providing not only access to specific foods but also nutrition education and health and social service referrals for low-income infants; children up to age 5; and women who are pregnant, breast-feeding, or postpartum. In 2015, the program served approximately 8 million women, infants, and children - which included a little more than half the infants and 30 percent of children ages 1 to 5 years in the U.S. - at a cost of about $6.2 billion. WIC food "packages" allow participants to obtain foods that provide specific nutrients for pregnancy, growth, and development. Foods offered through WIC must align with the current Dietary Guidelines for Americans, which are revised every five years, and an evaluation of the WIC food packages is congressionally mandated to occur every 10 years. This report serves as the next required review since the 2006 Institute of Medicine report WIC Food Packages: A Time for Change.
"Our report leaves most aspects of the current food packages unchanged, but a few foods have been added or amounts adjusted to enhance their quality for participants," said Kathleen Rasmussen, chair of the committee and the Nancy Schlegel Meinig Professor of Maternal and Child Nutrition, Cornell University, Ithaca, N.Y. "The proposed revisions provide better adherence to the Dietary Guidelines for Americans, are more consistent with the standards of other nutrition assistance programs, and increase flexibility and choice for participants. These changes build upon the revisions made to the food packages in 2009, so we anticipate they will not be difficult to implement."
One of the committee's overall recommendations was to increase the value of the voucher that participants receive to purchase vegetables and fruits in order to help improve consumption of these food groups and meet potassium and fiber requirements, which are often lacking. The committee recommended increases in the vouchers ranging from $4 to $24 per month, depending on the participant. To support cultural eating patterns, other food preferences, and special dietary needs, it also recommended offering additional options for the WIC food categories - including substitution of a voucher in place of juice, different forms and varieties of vegetables and fruits, both canned and dried legumes, and a range of options and sizes for grains and yogurt. A substitution of legumes for peanut butter or for eggs should be allowed for individuals who have a peanut allergy or are following a vegan diet, respectively.
The committee also examined nutritional and cost trade-offs to ensure cost-neutrality for the new packages. Foods currently provided in lower amounts or consumed less adequately - such as whole grains, vegetables, and fruits - were increased in the recommended new packages. The committee also proposed adding fish to the packages, because fish is a recommended food in the Dietary Guidelines for Americans and seafood consumption is often below the recommended levels. Most foods that already provided at least 100 percent of the recommended intake of several nutrients and food groups were proposed to be reduced - such as juice, dairy, peanut butter, legumes, and infant foods.
To promote and encourage any level of breast-feeding - especially among women who find exclusive breast-feeding incompatible with other constraints in their lives but are interested in and can be successful with partial breast-feeding - the committee proposed enhancing the food packages for both partially and exclusively breast-feeding women, allowing women to receive the quantity of formula needed to support any level of breast-feeding. This improves upon the 2009 packages that were designed to encourage exclusive breast-feeding by allowing very limited issuance of infant formula to breast-feeding women in the first 30 days after an infant's birth. Although the intention of this policy was to support breast-feeding in the immediate postpartum period, women essentially had to choose between either receiving no formula from WIC or receiving the maximum amount of formula provided to non-breast-feeding mothers. Evidence suggested that many women who might have wanted to begin breast-feeding, but were not confident of success, chose the latter option.
The committee also examined current food specifications and considered modifications to improve the potential for food packages to meet the nutritional needs of participants or improve alignment with dietary guidance while still ensuring availability. It called for modified specifications for some WIC foods to improve their alignment with dietary guidance on the intake of whole grains, added sugars, and some specific nutrients. For example, the committee recommended that all breakfast cereals meet the whole grain-rich criteria, all bread be 100 percent whole wheat, yogurt contain no more than 30 grams of total sugars per 8 ounces, soy beverage contain no more than 12 grams of total sugars per 8 ounces, and only unflavored milk be permitted.
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The study was sponsored by the Food and Nutrition Service of the U.S. Department of Agriculture. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. The National Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit http://national-academies.org. A roster follows.
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Download Report
Infographic of Timeline of WIC Program
Report Highlights
Summary of Report's Recommendations
Public Briefing Power Point Slides
Table 6-1
Table 6-2
Appendix N - Comparison of Current and Revised Food Packages
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Copies of Review of WIC Food Packages: Improving Balance and Choice: Final Report are available from the National Academies Press at http://www.nap.edu or by calling 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE
Health and Medicine Division
Food and Nutrition Board
Committee to Review WIC Food Packages
Kathleen M. Rasmussen, Sc.D., (chair)
Nancy Schlegel Meinig Professor of Maternal and Child Nutrition
Division of Nutritional Sciences
Cornell University
Ithaca, N.Y.
Shannon E. Whaley, Ph.D. (vice chair)
Director of Research and Evaluation
Public Health Foundation Enterprises WIC Program
Irwindale, Calif.
Susan S. Baker, Ph.D., M.D.
Professor and Co-Chief
Digestive Diseases and Nutrition Center
Department of Pediatrics
Women and Children's Hospital of Buffalo
Buffalo, N.Y.
Marianne P. Bitler, Ph.D.
Professor
Department of Economics
University of California
Davis,
Patsy M. Brannon, Ph.D., R.D.
Professor
Division of Nutritional Sciences
Cornell University
Ithaca, N.Y.
Alicia L. Carriquiry, Ph.D.1
Distinguished Professor
Department of Statistics
Iowa State University
Ames
David E. Davis, Ph.D.
Professor
Department of Economics
South Dakota State University
Brookings
Mary Kay Fox, M.Ed.
Senior Fellow
Mathematica Policy Research Inc.
Cambridge, Mass.
Tamera J. Hatfield, M.D., Ph.D.
Associate Professor
Obstetrics and Gynecology
Division of Maternal and Fetal Medicine
University of California
Irvine
Helen H. Jensen, Ph.D.
Professor of Economics and Head
Food and Nutrition Policy Division
Center for Agricultural and Rural Development
Iowa State University
Ames
Rachel K. Johnson, M.P.H., Ph.D., R.D.
Robert L. Bickford Jr. Green and Gold Professor of Nutrition, and
Professor of Medicine
University of Vermont
Burlington
Angela Odoms-Young, Ph.D.
Assistant Professor
Department of Kinesiology and Nutrition
University of Illinois
Chicago
Rafael Perez-Escamilla, Ph.D.
Professor of Epidemiology and Public Health and Director
Office of Public Health Practice, and
Director, Global Health Concentration
Yale School of Public Health
Yale University
New Haven, Conn.
A. Catharine Ross, Ph.D.2
Professor of Nutrition and Dorothy Foehr Huck Chair
Department of Nutritional Sciences
Pennsylvania State University
University Park
Charlene Russell-Tucker, M.S.M., R.D.
Chief Operating Officer
Connecticut Department of Education
Middletown
STAFF
Marie E. Latulippe Study Director
1Member, National Academy of Medicine
2Member, National Academy of Sciences