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 over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a 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 post-partum 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 the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. 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.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE TO REVIEW WIC FOOD PACKAGES
• Reviewers
• Preface
• Summary
  • THE COMMITTEE'S APPROACH
  • KEY CONCLUSIONS
  • GUIDING PRINCIPLES AND FRAMEWORK FOR REVISION OF THE WIC FOOD PACKAGES
• 1. Introduction and Background
  • Organization of This Report
  • DEMOGRAPHIC SHIFTS AND TRENDS IN WIC PARTICIPATION
  • CHANGES TO PROGRAM ADMINISTRATION
  • CHANGES IN FOOD SYSTEMS, DIETARY PATTERNS, AND DIETARY GUIDANCE
  • REFERENCES
• 2. The WIC Participant Experience
  • ASSESSING PARTICIPANT ACCEPTANCE OF WIC FOODS
  • BARRIERS AND INCENTIVES TO WIC PARTICIPATION AND REDEMPTION
  • Barriers to Participation
  • Redemption Patterns and Barriers to Redemption
  • FACTORS AFFECTING ACCESS TO FOOD
  • ADMINISTRATION OF THE WIC FOOD PACKAGES
  • REFERENCES
• 3. Approach to the Task
  • WORKSHOPS
  • LITERATURE AND REPORT REVIEW
  • NUTRIENT AND FOOD INTAKE: EVALUATING ADEQUACY
  • NUTRIENT AND FOOD INTAKE IN THE WIC POPULATION
  • APPROACH TO DEVELOPMENT OF THE BASELINE FOOD PACKAGE: NUTRIENTS AND COST
  • SENSITIVITY ANALYSIS APPROACH
  • FOOD EXPENDITURE ANALYSIS
  • APPROACH TO THE REGULATORY IMPACT ANALYSIS
  • NATIONWIDE DISTRIBUTION AND COSTS OF FOOD
  • COMMITTEE WIC SITE VISITS AND SHOPPING EXPERIENCE
  • REFERENCES
• 4. Nutrient Intakes of WIC-Eligible Populations
  • LITERATURE AND REPORT FINDINGS: NUTRIENT INTAKES
  • NHANES ANALYSIS: NUTRIENT INTAKES
  • EVALUATION OF DIET QUALITY
  • CONSIDERATIONS FOR DATA INTERPRETATION
  • REFERENCES
• 5. Food Intake of WIC-Eligible Populations
  • LITERATURE AND REPORT FINDINGS: FOOD INTAKE OF WIC PARTICIPANTS
  • NHANES ANALYSIS: FOOD GROUP AND SUBGROUP INTAKES
  • EVALUATION OF DIET QUALITY
  • CONSIDERATIONS FOR DATA INTERPRETATION
  • REFERENCES
• 6. Nutrition-Related Health Risks in the WIC Population
  • INTRODUCTION
  • MATERNAL NUTRITION-RELATED HEALTH RISKS
  • NUTRITION-RELATED HEALTH RISKS IN INFANTS
  • NUTRITION-RELATED HEALTH RISKS IN CHILDREN
  • FOOD SAFETY CONSIDERATIONS
  • REFERENCES
• 7. Promotion, Motivation, and Support of Breastfeeding with the WIC Food Packages
  • BREASTFEEDING AND THE WIC PROGRAM
  • BENEFITS OF BREASTFEEDING
  • 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
  • REFERENCES
• 8. Meeting Diverse Dietary Needs and Preferences: Considerations for the WIC Food Packages
  • FOODS TO ADDRESS MEDICAL CONDITIONS
  • VARYING FOOD PREFERENCES AND PRACTICES
  • REFERENCES
• 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
  • CHOICE AND FLEXIBILITY
  • COST CONSIDERATIONS
  • PUBLIC COMMENTS
  • REFERENCES
• 10. Food Expenditure Analysis
  • DATA AND METHODS
  • RESULTS
  • SUMMARY AND LIMITATIONS
  • REFERENCES
• 11. Findings and Conclusions
  • FINDINGS
  • 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
  • REFERENCES
• APPENDIXES
  • Appendix A. Acronyms and Abbreviations
  • Appendix B. Glossary
  • Appendix C. Comparison of Institute of Medicine 2006 Recommendations and Regulatory Implementation
  • Appendix D. Composition of the WIC Food Packages
  • Appendix E. The U.S. Department of Agriculture's Food and Nutrition Service Funded Studies Describing the Effect of the 2009 WIC Food Package Changes
  • Appendix F. Changes in the WIC Food Packages and Program Participation: Methods
  • Appendix G. Literature Findings on Barriers and Incentives to WIC Participation and Redemption
  • Appendix H. Workshop Agendas
  • Appendix I. Evidence Review Strategy
  • Appendix J. Dietary Reference Intake Values and Nutrients and Foods Analyzed
  • Appendix K. Diet Quality Indexes
  • Appendix L. Household Food Expenditure Analysis
  • Appendix M. Regulatory Impact Analysis Approach
  • Appendix N. Committee Perceptions of the WIC Experience
  • Appendix O. Summary Results from the Diet Quality of American Young Children by WIC Participation Status
  • Appendix P. Nutrient Intake of WIC and WIC-Eligible Populations
  • Appendix Q. Food Intake of WIC and WIC-Eligible Populations
  • Appendix R. Summary of National Dataset Characteristics Applied in the Evaluation of Health Risks
  • Appendix S. Breastfeeding Literature Findings
  • Appendix T. Chronology of Statutes Pertaining to the Definition of WIC Supplemental Foods
  • Appendix U. Committee Biosketches

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.