WASHINGTON — A new report from the Institute of Medicine of the National Academies proposes a number of changes to the WIC nutrition assistance program to encourage participants to consume more whole grains, fruits and vegetables. If implemented, these revisions would be the most substantial changes to the mix of foods offered through WIC since the supplemental nutrition program for low-income women, infants and children was launched in 1974.
The recommendations also are the first effort to apply the new Dietary Guidelines for Americans to a national food program.
"Because scientific knowledge about nutrition has greatly increased since the WIC program's inception, and the nutritional challenges facing families have altered significantly, it is definitely time for a change in the foods offered through WIC," said Suzanne P. Murphy, chair of the committee that wrote the report and research professor, Cancer Research Center of Hawaii, University of Hawaii, Honolulu. "We now know much more about the links between nutrition and chronic diseases, plus the nation is in the midst of an obesity epidemic.
"Our proposed revisions would bring the foods provided through WIC up to date with current nutritional science and make it easier for participants to improve their diets and health."
WIC — shorthand for the Special Supplemental Nutrition Program for Women, Infants, and Children — is one of the largest nutrition programs in the United States. In 2000, the WIC program served about half of all U.S. infants and about a quarter of children ages 1 through 4, along with many of their mothers.
The costs of providing supplemental food packages as well as nutrition education, breast-feeding support and other assistance to 7.6 million participants a month totaled $4.7 billion in 2003.
In many localities, food "packages" are actually itemized vouchers or checks that participants use to obtain specific foods at participating grocery outlets. The packages have remained largely unchanged since the U.S. Department of Agriculture initiated the program 30 years ago.
One of the most fundamental revisions proposed by the report is the inclusion of a wide choice of fruits and vegetables in the food packages for women and children. WIC participants should be given vouchers or coupons for fresh produce totaling $10 per month for each woman and $8 a month per child, the report recommends.
The amount corresponds to one to two servings of fruits and vegetables a day. When access to fresh produce is limited, WIC state agencies can specify that participating women may choose processed items, such as canned fruits and vegetables, in comparable amounts, the report said.
The expansion of the WIC food packages to include fresh produce applies a major recommendation of the new federal dietary guidelines, which call for people to eat more fruits and vegetables daily. The only fruits and vegetables currently provided through WIC are juice for all participants 4 months and older,and carrots for new mothers who breast-feed rather than formula-feed.
The committee also proposed that fruit and vegetable baby foods be added to the packages for infants 6 months and older. Baby food meats also should be added to the packages for infants 6 months and older who are primarily breast-fed to ensure that their iron and zinc needs are met.
Currently, the only semisolid foods offered through WIC are infant cereals, starting at 4 months. Cereal and other semisolid foods should not be part of the packages for infants until they reach 6 months, the age at which many medical and nutritional experts agree that almost all infants are developmentally ready for such foods, the report says.
The breakfast cereals that have been a key part of WIC food packages for women and children should be whole-grain varieties only, the report says. Some popular breakfast cereals are whole grain, but others do not provide whole grains' health benefits, such as protection against heart disease, the report says.
The food packages should also provide whole-grain bread or brown rice, among other options. These additions will help WIC participants meet the new dietary guidelines to get at least three servings of whole grains daily.
To help ensure that these changes are cost-neutral, the committee recommended reducing the amount of juice, eggs, cheese and milk offered through the program. These reductions are consistent with current dietary guidance, such as the American Academy of Pediatrics' recommendation that young children drink no more than 4 to 6 oz of fruit juice per day, and the American Heart Association's recommendation that people limit their intake of cholesterol, saturated fat and total fat.
To help participants reduce their saturated fat intakes, the WIC program should offer only milk that contains no more than 2% fat in the food packages for women and children over age 2, the report says. However, children up to 2 years old should receive whole milk because of their developmental need for dietary fat.
In addition, the committee recommended that the amount of cheese provided for most participants be reduced from a maximum of 4 lbs per month to no more than 1 lb monthly.
To promote the benefits of breast-feeding, the revised food packages for mother-infant pairs who rely on breast-feeding as the primary feeding method should contain greater amounts and a wider variety of foods to be more attractive, the report says. For example, the package for mothers who primarily breast-feed should include more milk, eggs, cheese and whole grains than the packages for women who formula-feed. The packages for older infants who are given no formula should contain twice the amount of baby food fruits and vegetables than the packages for older infants who receive formula.
The committee called for the WIC program to provide a broader variety of food options and allow more choices to take into account the wide range of dietary and cultural preferences among WIC participants. There should be few restrictions on participants' choices among fresh produce, the report says.
Yogurt should be permitted as a substitute for some of the milk for both women and children, and tofu and soy beverages should be allowed as alternatives to milk for women.
Overall, the proposed additions, deletions and substitutions would make it possible for the WIC program to provide a wider variety of foods without raising the total cost of the food packages, the committee concluded. The average monthly cost per participant currently is estimated to be about $35, which would be approximately the same for the revised packages if all the changes are made.
Recognizing that some of the proposed changes entail significant adjustments and could result in unanticipated effects, the committee recommended that they be tested first in pilot programs before being implemented nationwide. For example, if participants will not drink milk with less fat or eat whole-grain products, then the revised food packages for children and women may inadvertently result in less grain and milk consumption.
The study was sponsored by the U.S. Department of Agriculture. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.
Robert Earl, MPH, RD, Senior Director of Nutrition Policy for the Food Products Association, said the report underscored the importance of processed and packaged foods, but he stressed the need for a pilot program before widespread changes were made to the WIC.
"This report notes the convenience, availability, nutritional value and popularity of processed and packaged foods, and clearly makes the case that they are an integral part of government food assistance programs such as WIC," Dr. Earl said. "This report also urges that any adjustments to the WIC food packages be tested first in pilot programs, to ensure that there are no unintended consequences from such changes.
"F.P.A. strongly agrees with this recommendation for evaluation with WIC participants. Such testing is essential to prevent unanticipated effects, such as decreasing consumption of fruits and vegetables, grains or dairy products. Final changes to the WIC food packages must have a positive impact on the nutrition of WIC participants."