REVIEW OF WIC FOOD PACKAGES

Improving Balance
and Choice

Final Report

Committee to Review WIC Food Packages

Food and Nutrition Board

Health and Medicine Division

A Report of

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Grant No. AG-3198-D-14-0050_0001-005 from the U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

The National Academy of Sciences was established in 1863 by an act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine.

Proceedings chronicle the presentations and discussions at a workshop, symposium, or other convening event. The statements and opinions contained in proceedings are those of the participants and have not been endorsed by other participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine.

COMMITTEE TO REVIEW WIC FOOD PACKAGES

KATHLEEN M. RASMUSSEN (Chair), Nancy Schlegel Meinig Professor of Maternal and Child Nutrition, Division of Nutritional Sciences, Cornell University

SHANNON E. WHALEY (Vice Chair), Director of Research and Evaluation, Public Health Foundation Enterprises WIC Program

SUSAN S. BAKER, Professor and Co-Chief, Digestive Diseases and Nutrition Center, Department of Pediatrics, Women and Children’s Hospital of Buffalo

MARIANNE P. BITLER, Professor, Department of Economics, University of California, Davis

PATSY M. BRANNON, Professor, Division of Nutritional Sciences, Cornell University

ALICIA L. CARRIQUIRY, Distinguished Professor, Department of Statistics, Iowa State University

DAVID E. DAVIS, Professor, Department of Economics, South Dakota State University

MARY KAY FOX, Senior Fellow, Mathematica Policy Research, Inc.

TAMERA J. HATFIELD, Associate Professor, Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of California, Irvine

HELEN H. JENSEN, Professor of Economics and Head, Food and Nutrition Policy Research of the Center for Agricultural and Rural Development, Iowa State University

RACHEL K. JOHNSON, Robert L. Bickford, Jr., Green and Gold Professor of Nutrition, Professor of Medicine, University of Vermont

ANGELA ODOMS-YOUNG, Associate Professor, Department of Kinesiology and Nutrition, University of Illinois at Chicago

RAFAEL PÉREZ-ESCAMILLA, Professor of Epidemiology and Public Health, Director, Office of Public Health Practice, Director, Global Health Concentration, Yale School of Public Health

A. CATHARINE ROSS, Professor of Nutrition, Dorothy Foehr Huck Chair, Department of Nutritional Sciences, Pennsylvania State University

CHARLENE RUSSELL-TUCKER, Chief Operating Officer, Connecticut Department of Education

Consultants

MEI CHUNG, Assistant Professor, Department of Public Health and Community Medicine, School of Medicine, Tufts University

ROSE GLADSTEIN, Consultant, R Gladstein Consulting LLC

HOECHEL JEON, Post-doctoral Research Associate, Center for Agricultural and Rural Development, Iowa State University

JOHN A. KIRLIN, Economist, U.S. Department of Agriculture, Economic Research Service

DAVID LEVIN, Economist, U.S. Department of Agriculture, Economic Research Service

SUZANNE P. MURPHY, Researcher (Professor) Emeritus, University of Hawaii Cancer Center

MIYOUNG OH, Post-doctoral Research Associate, Center for Agricultural and Rural Development, Iowa State University

Health and Medicine Division Staff

MARIE E. LATULIPPE, Study Director

MEGHAN E. QUIRK, Program Officer

BERNICE CHU, Research Associate

ALICE VOROSMARTI, Research Associate

AMBAR SAEED, Senior Program Assistant

ANN L. YAKTINE, Director, Food and Nutrition Board

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

LOREN BELL, Altarum Institute

RONETTE BRIEFEL, Mathematica Policy Research

JULIE A. CASWELL, University of Massachusetts at Amherst

SUSAN J. CROCKETT, University of Minnesota

STEPHEN R. DANIELS, University of Colorado School of Medicine

WILLIAM DIETZ, George Washington University

LUCIA KAISER, University of California, Davis

JACOB A. KLERMAN, Abt Associates, Inc.

BARBARA PETERSEN, Exponent

KAREN E. PETERSON, University of Michigan

LORRENE RITCHIE, University of California Division of Agriculture and Natural Resources

JUDITH S. STERN, University of California, Davis

JANET AUSTIN TOOZE, Wake Forest Baptist Medical Center

KENNETH W. WACHTER, University of California, Berkeley

JAMES P. ZILIAK, University of Kentucky

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Diane F. Birt, Iowa State University, and Elaine L. Larson, Columbia University Mailman School of Public Health. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Contents

This page intentionally left blank.

The revised food packages were constrained to be cost neutral with the current food packages, which means that any increases in the costs of components of the packages or allowed substitutions had to be balanced by corresponding decreases in costs elsewhere. This required the committee to be creative in responding to its charge to align the packages with the DGA. When making these revisions, the committee considered the supplemental nature of the WIC program and used a systematic approach. The committee was able to make changes to the packages that improve their alignment with the DGA and, thus, the dietary balance of the packages. The committee was able to improve the number of substitution options included in the packages and, thus, the choices available to participants to meet their cultural and personal preferences. The revised packages increase the cash value voucher for all participants, although the amounts differ by food package, and include fish in nearly all food packages. In addition, the committee provided enhanced support for breastfeeding, both exclusive and partial breastfeeding, along with greater flexibility for breastfeeding in the first 30 days after delivery.

This report is the first review of the WIC food packages to contain a regulatory impact analysis. This may permit USDA to move more rapidly to implement the changes proposed. These changes build on administrative actions taken in response to the IOM’s 2006 Time for a Change report for further ease of implementation. It is noteworthy that the regulatory impact analysis not only shows that the revisions to the food packages should be cost neutral when implemented but also that they are projected to provide substantial cost savings over time, savings that could be used to make further nutritional improvements to the food packages.

The work of the committee was greatly enhanced by the contributions of many individuals who participated in the study’s public activities. The committee is grateful to the speakers in its data-gathering workshops who gave valuable insights as well as their time to assist the committee with its task. The committee also thanks the members of the public who provided comments in open sessions or through the committee’s website. Lastly, the committee is indebted to the many WIC staff members who gave their time and expertise to help committee members better understand administration of and participation in the WIC program.

The size of this report is testimony to the magnitude of the committee’s task. It exists thanks to the hard work of many individuals. Committee members volunteered many hours of their time to this work. Their collaborative spirit as well as careful thinking and writing are to be commended. The committee was supported in its work by several consultants. Suzanne Murphy provided critical insights based on her experience in leading the committee that produced the first major reevaluation of the WIC food packages, published in 2006. Her sage advice is much appreciated. Mei Chung

led the development and execution of all of the committee’s literature reviews. Rose Gladstein assisted with the regulatory impact analysis.

The committee would like to thank the staff of the Center for Agricultural and Rural Development (CARD) and the Department of Statistics at Iowa State University for their analysis of the data from the National Health and Nutrition Examination Survey (NHANES) and National Household Food Acquisition and Purchase Survey. Committee members Helen Jensen and Alicia Carriquiry guided the CARD’s work, which was carried out by David Osthus, Miyoung Oh, and Hocheol Jeon. John A. Kirlin and David Levin of USDA’s Economic Research Service reviewed the committee’s application of the FoodAPS and IRI datasets to the study, and Kevin Dodd and Susan Krebs-Smith of the National Cancer Institute provided helpful guidance on analyses of NHANES.

To accomplish this task numerous staff members at the National Academies of Sciences, Engineering, and Medicine supported the work of the committee. Marie Latulippe served as the project’s study director and provided leadership, creative ideas, and an optimistic and calm spirit against tight deadlines. She was assisted by Meghan Quirk after March 2015, who led the regulatory impact analysis. Bernice Chu assisted with literature reviews and data management, and Ambar Saeed dealt with administrative logistics. Leslie Pray assisted with report organization and editing, and Rebecca Morgan of the National Academies Library/Research Center with fact checking. Alice Vorosmarti assisted with literature reviews and other data-oriented tasks. Naisi Zhao assisted the committee from January to April 2016 as a Mirzayan Fellow. Ann Yaktine, director of the Food and Nutrition Board, supervised the work of the staff and provided useful insights at many points in the committee’s deliberation. The committee owes them all a debt of gratitude for their hard work and professionalism.

Kathleen M. Rasmussen, Chair
Committee to Review WIC Food Packages

This page intentionally left blank.