July 12, 2018
This interview was originally published by The State of Obesity on July 9, 2019.
In June 2019, the Journal of the American Medical Association (JAMA) published a new study, “Changes in Obesity Among US Children Aged 2 Through 4 Years Enrolled in WIC During 2010 – 2016.” The study examined trends in overweight and obesity among 2- to 4-year-olds who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including analyzing data about race and ethnicity, sex and age. The study shows that the obesity rate among children in WIC decreased significantly between 2010 and 2016, and that rates declined among children in all racial and ethnic groups.
We asked Georgia Machell, PhD, Senior Director, Research & Program Operations for the National WIC Association, and Jim Weill, J.D., President of Food Research & Action Center (FRAC), for their insights about the new data.
Before we dive into the study itself, we’d like to understand from both of you why you believe that WIC matters. Can you tell us why you think it’s an important federal nutrition assistance program?
Georgia: WIC helps grow healthy, happy babies, and supports moms to have healthy pregnancies. WIC services, like nutrition counseling, breastfeeding support, and healthcare referrals, are critical to establishing healthy, long-term eating habits and behaviors to get children pre-school ready. Participation in WIC saves money. Recent research shows how $1 invested in WIC saves about $2.48 in medical, educational, and productivity costs. WIC is a great investment in our children.
Jim: WIC is one of the best investments the nation makes in women’s and children’s well-being. Research shows that numerous health benefits are associated with WIC participation. The research shows that WIC reduces food insecurity and improves diets, improves birth outcomes, produces better academic outcomes for children, and increases access to regular health care.
How many children and families participate in WIC?
Georgia: Nearly 7 million women, infants, and children rely on WIC every year, and today, it serves nearly half of the infants born in our country, many of whom are at a higher risk for obesity because of where they live or how much money their family makes. Despite WIC’s value add for families, WIC participation has been falling since 2010. Only around 55% of all eligible families currently participate in WIC. The reasons for WIC caseload decline and low coverage rates are complex and well documented. They include record low fertility and birthrates, an improving economy, a conflicted political environment, public shaming, immigration restrictions, and some pain points in the WIC participant experience.
Through a number of journey mapping exercises in 2014, the National WIC Association identified two main areas where pain points exist – in the WIC certification process and in the shopping experience in the grocery store. The good news is that WIC is an extremely innovative program, and state and local agencies have responded to shrinking caseloads by being creative, developing strategies to improve the WIC participant experience and addressing misconceptions about the program.
Jim: Georgia is right that far too many children and women who are eligible for WIC are missing out. FRAC released a report last month showing that WIC participation has dropped significantly in recent years. We also reported on barriers that keep families from participating, such as misconceptions about eligibility, language and cultural barriers, lack of knowledge about the program, transportation costs, loss of time away from work (creating job risk and lost wages) to apply and participate in WIC, and difficulty redeeming benefits (limited selection of WIC foods available and embarrassing check-out experiences). Given what we know about the impact of WIC on the health of families and children, we must do more to help people who are eligible to enroll. This is especially true for children ages 1-5, who have lower participation rates than eligible women and infants. We hope that the JAMA study of obesity for 2-4 year olds will give extra impetus to reaching more eligible children.
Can you talk more about the impact of WIC, specifically what the study published in JAMA found?
Georgia: The study shows that obesity rates among young children who participate in WIC have continued to decline overall, from 15.9% in 2010 to 13.9% in 2016. The researchers found that rates declined among all races and ethnicities, including Black and Hispanic children, whose obesity rates are typically higher than average. All of these declines were statistically significant.
Does the study share any possible reasons for the decline in obesity rates?
Jim: The Centers for Disease Control and Prevention could not definitively determine the reasons for the decline, but suggested that some may be local, state and national initiatives, as well as the recent updates to the WIC food package. Those updates made the foods and beverages available in the food packages more nutritious. In turn, research shows that these changes have led to favorable improvements in dietary intake, breastfeeding outcomes, and obesity rates, as well as healthier options being stocked in stores.
What are the major takeaways for childhood obesity prevention advocates?
Georgia: This analysis provides the latest strong evidence that WIC is an effective program for preventing and reducing childhood obesity–an epidemic that continues to threaten the health of our nation’s children from a young age. Research shows that children who are overweight or obese as preschoolers are five times more likely to be overweight or obese as adults, so preventing obesity in early childhood is critical.
Jim: The first takeaway is that we are making progress. The second is that we should pay special attention to the results for children of color. This report has the hopeful finding that obesity rates are declining among Black and Hispanic children who participate in WIC. Obesity and related chronic diseases, such as heart disease and type 2 diabetes, disproportionately affect families of color and these inequities have persisted for decades. WIC can help address obesity and narrow these disparities. If we can reduce the barriers that keep eligible families from enrolling, we will help even more children have the opportunity to grow up healthy.
How does the National WIC Association plan to use the data to protect and strengthen WIC?
Georgia: The study gives us even more evidence about the critical impact of WIC and how it benefits both women and children. But we’re not yet done. If we want to see obesity rates continue to decline, we must continue to strengthen the program. This study is a great advocacy tool to help the National WIC Association make the case with policy makers for expanding and enhancing effective nutrition services for pregnant women, postpartum women, and young children. We are excited to use these findings as part of our WIC advocacy strategy.
Likewise, how does FRAC plan to use the data?
Jim: This study provides additional evidence that the WIC program is working to reduce childhood obesity, which is a top priority for many advocates and national, state and local policy makers. These findings create another opportunity to engage leaders in conversations about the impact of WIC and the benefits of helping more families enroll, which is critical as we continue to recommend strategies for reducing barriers to eligibility, improving the WIC clinic experience and modernizing the program. The combination of evidence of greater health gains and identification of strategies for boosting participation provides new opportunities for advocates and other WIC champions.
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