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. In this third report, the committee provides its final analyses, recommendations, and the supporting rationale.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE TO REVIEW WIC FOOD PACKAGES
• Reviewers
• Preface
• Summary
  • THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN
  • THE REVISED FOOD PACKAGES
  • COST EVALUATION OF THE REVISED FOOD PACKAGES
  • THE REVISED FOOD PACKAGES MEET SPECIFIED CRITERIA
  • RECOMMENDATIONS FOR IMPLEMENTATION AND RESEARCH
  • KEY MESSAGES FROM THE COMMITTEE FOR USDA AND FOR THE NEXT WIC REVIEW COMMITTEE
• 1. Introduction and the Process for Revising the WIC Food Packages
  • OVERVIEW OF THE WIC PROGRAM
  • THE COMMITTEE'S TASK
  • THE PROCESS FOR REVISING THE WIC FOOD PACKAGES
  • SUMMARY AND ORGANIZATION OF THIS REPORT
  • REFERENCES
• 2. The WIC Program: Changes Since the Last Review and Continuing Challenges
  • ADAPTATION TO THE WIC FOOD PACKAGE CHANGES PROPOSED IN 2006
  • CHANGES IN THE WIC-PARTICIPATING POPULATION
  • WIC PROGRAM COSTS OVER TIME
  • RELEVANT CHANGES IN THE ENVIRONMENT SINCE 2006: DIETARY PATTERNS, THE FOOD SUPPLY, AND DIETARY GUIDANCE
  • THE WIC PARTICIPANT EXPERIENCE TODAY
  • KEY FINDINGS AND CONCLUSIONS
  • REFERENCES
• 3. Alignment of the Current Food Packages with Dietary Guidance, Special Dietary Needs, and Cultural Eating Practices or Food Preferences
  • ALIGNMENT OF THE FOOD PACKAGES WITH DIETARY GUIDANCE FOR INDIVIDUALS AGES 2 YEARS AND OLDER
  • ALIGNMENT OF THE FOOD PACKAGES WITH DIETARY GUIDANCE FOR INDIVIDUALS LESS THAN 2 YEARS OF AGE
  • ALIGNMENT WITH THE DIETARY REFERENCE INTAKES
  • FORMS AND COMPOSITION OF FOODS PROVIDED IN THE FOOD PACKAGES AND ALIGNMENT WITH DIETARY GUIDANCE
  • ALIGNMENT OF THE FOOD PACKAGES WITH SPECIAL DIETARY NEEDS AND PREFERENCES
  • FINDINGS AND CONCLUSIONS: POTENTIAL AREAS FOR FOOD PACKAGE MODIFICATIONS
  • REFERENCES
• 4. Nutrient and Food Group Intakes of WIC Participants
  • LITERATURE AND REPORT REVIEW RELATED TO THE WIC POPULATION AND WIC PARTICIPANTS' NUTRIENT AND FOOD GROUP INTAKES
  • ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY DATA: NUTRIENT ADEQUACY
  • ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY DATA: FOOD GROUP INTAKES COMPARED TO RECOMMENDATIONS
  • QUALITY OF WIC PARTICIPANTS' DIETS
  • CONSIDERATIONS FOR INTERPRETATION OF FINDINGS FROM THE LITERATURE AND THE COMMITTEE'S ANALYSES
  • SUMMARY OF FINDINGS
  • REFERENCES
• 5. Nutrient and Food Group Priorities for the WIC Food Packages
  • IDENTIFYING NUTRIENT PRIORITIES
  • IDENTIFYING FOOD GROUP PRIORITIES
  • IDENTIFYING POTENTIAL ACTIONS FOR FOOD PACKAGE REVISIONS
  • RESULTS FROM USE OF THE DECISION TREE
  • SUMMARY
  • REFERENCES
• 6. The Revised Food Packages
  • THE COMMITTEE'S OVERARCHING STRATEGY
  • THE REVISED FOOD PACKAGES FOR WOMEN AND CHILDREN
  • ADDITIONAL SUBSTITUTION OPTIONS FOR VEGANS OR VEGETARIANS AND FOR ALLERGIES OR INTOLERANCES
  • SUMMARY OF RECOMMENDED CHANGES TO THE AMOUNTS AND TYPES OF FOOD AND SUBSTITUTION OPTIONS IN THE WIC FOOD PACKAGES FOR WOMEN AND CHILDREN
  • THE REVISED FOOD PACKAGES FOR WOMEN AND INFANTS
  • FOOD PACKAGE III
  • OTHER SPECIAL CASES
  • SPECIFICATIONS FOR WIC-ELIGIBLE FOODS
  • SUMMARY
  • REFERENCES
• 7. Evaluation of Cost
  • METHODS USED TO ESTIMATE COSTS
  • RESULTS AND DISCUSSION: PROGRAM COSTS
  • COMPARING COST INCENTIVES FOR BREASTFEEDING
  • SUMMARY
  • REFERENCES
• 8. Sensitivity Analysis for Food Package Nutrient, Food Group, and Cost Models
  • PURPOSE, GOALS, AND LIMITATIONS OF SENSITIVITY TESTING
  • METHODOLOGICAL APPROACH TO SENSITIVITY ANALYSIS
  • SENSTIVITY ANALYSIS RESULTS
  • SUMMARY
  • REFERENCES
• 9. How the Revised Food Packages Meet the Criteria Specified
  • CRITERION 1
  • CRITERION 2
  • CRITERION 3
  • CRITERION 4
  • CRITERION 5
  • CRITERION 6
  • CRITERION 7
  • SUMMARY
  • REFERENCES
• 10. The Regulatory Impact Analysis (Abridged)
  • KEY CONSIDERATIONS
  • SUMMARY OF PROPOSED CHANGES
  • COST
  • UNCERTAINTIES
  • ALTERNATIVES
  • MARKET ANALYSIS
  • SUMMARY
  • REFERENCES
• 11. Recommendations for Implementation and Research
  • RECOMMENDATIONS FOR IMPLEMENTATION OF THE REVISED FOOD PACKAGES
  • RESEARCH AND DATA COLLECTION RECOMMENDATIONS FOR EVALUATION OF THE WIC FOOD PACKAGES
  • PRIORITIES FOR FUNDING OUTSIDE COST-NEUTRALITY
  • MULTILEVEL APPROACHES TO IMPROVING CONSUMPTION OF WIC FOODS
  • CONSIDERATIONS FOR THE NEXT REVIEW
  • CONCLUDING REMARKS
  • REFERENCES
• APPENDIXES
  • Appendix A. Acronyms and Abbreviations
  • Appendix B. Glossary
  • Appendix C. WIC Food Package Regulation
  • Appendix D. Details of the Committee's Information-Gathering Strategies
  • Appendix E. SDA-Funded Studies of the 2009 Food Package Changes
  • Appendix F. Changes in the WIC Food Packages and Program Participation
  • Appendix G. Barriers to Participation and Redemption
  • Appendix H. Kosher and Halal Substitution Options
  • Appendix I. Complementary Feeding: Summary of Information Reviewed
  • Appendix J. Nutrient and Food Intake of WIC Subgroups: Analytical Methods and Results
  • Appendix K. Study Design Strategies for Reducing the Effects of Selection Bias in Studies Comparing WIC Participants to Others
  • Appendix L. Gap Analysis
  • Appendix M. Behavioral Approaches in WIC as a Potential Action
  • Appendix N. Comparison of Current and Revised Food Packages
  • Appendix O. Specific Nutrient Comparisons
  • Appendix P. Food Specification Detail
  • Appendix Q. Foods and Food Specifications That Were Reviewed, But Not Changed
  • Appendix R. Development of the Food Package Nutrient and Cost Profiles
  • Appendix S. Sensitivity Tests and Results
  • Appendix T. Amounts of Food Groups and Nutrients Provided by the Current, Compared to the Revised WIC Food Packages
  • Appendix U. The Regulatory Impact Analysis (Complete)
  • Appendix V. Committee Biosketches

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC food packages: Improving balance and choice: Final report. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/23655.