New Institute of Medicine Report on the WIC Food Packages

WIC Food Package: Time for a Change, the final report of the Institute of Medicine Committee to Review the WIC Food Packages was issued on April 27^th. It offers a comprehensive set of recommendations for improving the WIC food packages.

The WIC program serves approximately 8 million women, infants and children each month. This important program provides nutrition education, referrals to health care and a nutritious package of foods. Research has shown that the WIC program helps to reduce low-birth weights, decrease the incidence of iron deficiency anemia in children, prevent overweight in children, and improve the growth of at-risk infants and children.

Since the food packages were last reviewed, there has been an explosion of research and recommendations related to nutrition and health. After an in-depth review of the current science and nutrition guidance and public comment letters, the Institute of Medicine (IOM) worked diligently to translate their findings into food package recommendations (within the limitation of cost neutrality which was part of their charge). We would have preferred, ideally, an analysis of what foods should be added without the constraints of having to reduce other foods dollar-for-dollar.

The IOM's recommendations are comprehensive and include important positive additions and choices for the WIC food package. Many of the positive changes are consistent with the recommendations made by FRAC and others in public comment letters and meetings as part of the review process, including adding fruits and vegetables, yogurt, tofu and soymilk to the food package, retaining strong nutritional standards and retaining the current types of foods, increasing participant choices and expanding cultural food choices in the package. The complexity and detail provided in the report will require further examination before FRAC can issue a full analysis of the recommendations. This is a preliminary overview of the highlights of the proposed food package changes.

New Foods are Added to the WIC Food Packages:
The types of foods offered in the WIC food packages have been increased by adding a fruit and vegetable category and by adding more high calcium food choices, including yogurt, soymilk and tofu.

The Proposed Food Packages Retain Strong Nutritional Standards for WIC Foods
Food package revisions protect the nutritional integrity of the WIC food packages by maintaining the current stringent nutrition standards for WIC foods. These standards include high requirements for iron in cereals and Vitamin C in fruit and vegetable juices, as well as limits on sugar and fat, including the prohibition of high sugar cereals and sweetened juice or milk.

Cultural Foods Options are Expanded in WIC Food Package
In order to increase the utility of the standard food package for WIC's diverse population, the Institute of Medicine recommends the addition of several new foods and options to maximize participant choice. Participants will be allowed to choose the types of fruits and vegetables, and tofu, soymilk and yogurt are new options for integrating cultural food choices.

Current Types of WIC Foods are Retained
All the types of food currently in the WIC food packages, including iron-fortified infant formula, infant cereal, milk, iron-fortified breakfast cereal, cheese, Vitamin C-rich fruit and vegetable juices, beans, peanut butter, eggs, and (for breastfeeding women) carrots and tuna fish, are retained because each type of food makes an important contribution to the nutritional content of the package. In addition, these foods are acceptable, practical, accessible and cost-efficient. However, the quantities of some of these foods are reduced in order to fund the additions.

Additional Changes to the WIC Packages:
The changes recommended for the infant food package, which include the addition of fruit and vegetable baby food and the reduction of infant formula for older infants, and the proposal for breastfeeding women, which includes significant enhancements to the women's food package but decreased infant formula options, are too intricate to be covered in detail in this summary. The implications will require further analysis.

As part of an effort to provide food package options that are more convenient and can be used by families with limited cooking facilities the IOM recommends an option for providing canned pre-cooked beans as a substitute for dried beans.

The IOM, in an effort to increase whole grain consumption, recommends the addition of a whole wheat bread and whole grains category and a complex whole grain requirement for cereals and bread that requires further analysis.

Reduces Amount of Some WIC Foods
Anticipating no new funding for improvements to the WIC food package, USDA, the sponsor of the food package study, specified that the Institute's recommendations must be cost neutral. Due to the cost constraints the Institute of Medicine was given, any addition to the food program had to be paid for by a reduction in another component of the food package. For this reason, the recommendations include cost saving reductions in the amounts of juice, milk, cheese, eggs and, in certain cases, infant formula provided through the WIC food package.

While clearly the WIC food packages need to be updated and will be able to do an even better job once the positive recommendations have been implemented, the current WIC food packages don't contribute to overweight and aren't substandard in any sense. The USDA Economic Research Service (ERS) reported in The WIC Program: Background, Trends, and Issues that a study by the Centers for Disease Control and Prevention concluded that WIC foods do not contribute to overweight. ERS concluded that, "In fact, WIC may have a positive effect on reducing overweight if participants substitute nutritious WIC foods for high-caloric-content foods in their usual diet."

A recently published analysis, Medicaid at Birth, WIC Take Up, and Children's Outcomes, showed that WIC is successfully preventing overweight in young children, which is likely to have implications for their future risk of contracting obesity-related diseases. The researchers concluded that this is an important measure of the success of the WIC program because of the importance of obesity as a public health threat, and because of the importance of establishing healthy eating habits early in life.

The Need to Pilot Test Revisions
The Chair of the IOM Committee to Review the WIC Food Packages made clear the committee's position on the need for pilots when she reiterated the report's recommendation in her written opening statement: "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." The Committee's distinguished panel of experts, having recommended many innovative changes, wants to be certain that these recommendations are implemented effectively, based on a complete understanding of the realities of WIC participants' lives, and operations at the local and state WIC agencies and farmers and food markets.

The California WIC Association, FRAC and others have been encouraging fruit and vegetable pilots for several years in order to be ready with the necessary information. FRAC's letter to USDA, recommending that the WIC food package be referred to the IOM for review and also recommended simultaneous fruit and vegetable pilots. In the 2004 WIC reauthorization Congress authorized ten WIC fruit and vegetable pilots.

Next Steps:
USDA, anxious to revise the WIC food package, requested a study from the Institute of Medicine, which it now has received. Congress, with a view to keeping the WIC food package revision process on track, included a provision in the 2004 WIC reauthorization requiring USDA to issue a final rule updating the WIC food package within 18 months of receiving the Institute of Medicine's final report. USDA will now evaluate the IOM recommendations and take the next steps in moving this process forward, which hopefully will be both expeditious and inclusive of the community of WIC stakeholders.

A copy of the report, WIC Food Packages: Time for a Change, can be purchased or viewed at the Institute of Medicine's website.

For additional information on WIC download FRAC's new publication WIC In the States: Thirty-One Years of Building a Healthier America.

For additional information or questions contact Geri Henchy at FRAC, (202) 986-2200 extension 3025 or ghenchy@frac.org