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1
Introduction and Background
Since the inception of the Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) in 1974, the primary nutritional problems of low-income women, infants, and
children have changed from concerns about undernutrition to concerns about consumption of
excessive food energy 1 and obesity. Yet, with the exception of the food package for exclusively
breastfeeding women, no substantial changes to the WIC food packages have occurred since the
WIC program was first begun. This report is the first step in developing recommendations for
revisions to the WIC food packages. It reviews the nutritional needs and assesses the dietary
adequacy of the WIC target population and proposes priority nutrients and food groups and
general nutrition recommendations for the WIC food packages.
This chapter reviews the reasons why a systematic evaluation and revision of the food
packages is timely. These reasons include profound changes since the inception of the WIC
program in (a) the population served by the program, (b) the food supply and the dietary patterns
of the WIC-eligible population, (c) the major health risks facing the WIC-eligible population,
and (d) the dietary guidance and recommendations and the science underlying those
recommendations.
THE WIC PROGRAM
The WIC program is a nutrition education and food assistance program for low-income
individuals with at least one nutritional risk factor for a poor health outcome during the critical
periods of growth and development during pregnancy, infancy, and early childhood. The
underlying premise for the WIC program is that substantial numbers of pregnant, postpartum and
breastfeeding women;2 infants;3 and children4 from households with insufficient income are at
1In this report the term "food energy" is used to refer to the metabolic energy that can be released from
utilization of the macronutrients in foods (protein, fat, and carbohydrate). The typical units for expressing food
energy are calories.
2 For the purposes of describing WIC participants above the ages of infants and children, the term `women' is
generally used; however, this category of participants includes both female adolescents and female adults, all of
reproductive age.
1-1
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1-2 PROPOSED CRITERIA FOR SELECTING THE WIC FOOD PACKAGES
special risk with respect to their physical and mental health by reason of inadequate nutrition
and/or health care (U.S. Congress, 7 C.F.R. § 246.1). The WIC program serves as an adjunct to
good health care during critical times of growth and development in order to prevent the
occurrence of both short- and long-term health problems. The WIC program helps meet the
special needs of these individuals by providing three main benefits: (1) supplemental food;
(2) nutrition education; and (3) referrals to health and social services.
Although all three types of benefits are central to the WIC program's mission to safeguard
the health of vulnerable subgroups and prevent adverse health outcomes, supplemental foods are
the distinctive benefit in the WIC program. About three-quarters of WIC funds are used to
provide supplemental foods. Supplemental foods are provided in food packages selected to
provide specific nutrients that appeared to be lacking in the diets of eligible WIC participants--
calcium, iron, vitamin A, vitamin C, and protein. Supplemental food is provided in the form of a
food instrument (usually either a voucher or check) that can be exchanged for specific foods in
participating grocery outlets.5 This food instrument lists the quantities of food items, sometimes
including brand names, that can be obtained. WIC food packages provide tailored selections of
foods from the following list: iron-fortified infant formulas, milk, cheese, eggs, iron-fortified
breakfast cereals (hot or cold) or infant cereals, fruit and vegetable juices, dried peas or beans,
and peanut butter. Carrots and canned tuna are also provide for some breastfeeding women (the
enhanced package). Tailoring of food packages at the local level with regard to the specific
nutritional needs of an individual may involve decreasing the amount of a food item below the
maximum allowance at the federal level. Nutritional standards have been set for some of the food
items allowed in the WIC food packages. Examples include the standard that juice produces
must be 100% fruit or vegetable juice and must contain a minimum quantity of vitamin C;
breakfast cereals must not exceed a maximum quantity of sugar. There are currently seven food
packages designed for WIC participants by categories: (1) infants from birth through three
months of age; (2) infants 4 through 11 months of age; (3) children and women with special
dietary needs; (4) children 1 through 4 years of age; (5) pregnant and breastfeeding women
(basic); (6) postpartum, non-breastfeeding women; and (7) exclusively breastfeeding women
(enhanced).
Within federal regulatory maximum quantities, each WIC state agency is required to develop
food prescriptions that specify the types or brands of WIC foods and the quantities allowed. At
the local level, members of the professional staff assess each participant's nutritional needs and
food preferences, and prescribe an individually tailored food package that best fits the
participant's needs and circumstances.
3 For the purposes of describing WIC participants the term `infants' is used exclusively for individuals from
birth to the first birthday.
4 For the purposes of describing WIC participants the term `children' is used for individuals from the first
birthday to the fifth birthday (ages one year through four years). Five-year-olds are not eligible to participate in the
WIC program.
5 Two states currently have different distribution systems. Home delivery of the prescribed items is utilized in
Vermont. In Mississippi participants come to a designated site to pick up their food items rather than purchasing
through retail outlets.
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INTRODUCTION AND BACKGROUND 1-3
Current Definition of Supplemental Foods
In the federal regulations governing the WIC program, supplemental foods are defined as
those "foods containing nutrients determined to be beneficial for pregnant, breastfeeding, and
postpartum women, infants, and children" (U.S. Congress, 7 C.F.R. § 246.2).6 For all packages,
the WIC regulations state that the quantities and types of supplemental foods prescribed shall be
appropriate for the participant taking into consideration the participant's age and dietary needs
(FNS, 2003).
Historical Perspective on the WIC Food Package
The WIC program was launched at a time when a predominant concern was undernutrition in
low-income populations. The early legislation (U.S. Congress, Pub. L. No. 92-433, 1972; U.S.
Congress, Pub L. No. 94-105, 1975) directed the program to focus on calcium, iron, vitamin A,
vitamin C, and high-quality protein as target nutrients of concern in the WIC population. Later
reauthorization legislation (U.S. Congress, Pub. L. No. 95-627, 1978) was more general.
Supplementation was described as providing "nutrients determined by nutritional researchers to
be lacking in the diets of the targeted population." That law also stipulated that the fat, sugar, and
sodium content of WIC foods be appropriate. A WIC Food Package Advisory Panel, convened in
1978, recommended retaining calcium, iron, vitamin A, vitamin C, and high-quality protein as
the target nutrients. WIC food package regulations published in 1980 created six different
monthly packages that were consistent with Public Law 95-627 but continued to provide foods
that are nutrient-rich in calcium, iron, vitamin A, vitamin C, and high-quality protein. An
additional food package for exclusively breastfeeding women, including carrots and canned tuna,
was developed in 1992. States are given some flexibility, on a case by case basis, to substitute
more culturally appropriate foods if they are nutritionally equivalent and cost-neutral. However,
very few substitutions have been approved at the federal level.
Percentage of Target Dietary Needs Supplied by WIC Foods
The Committee found that there was no clear definition of the WIC food packages regarding
what percentage of a participant's dietary needs were to be supplied by the food package.
Although there are no published comparisons of the nutrients supplied in the WIC food packages
to current dietary reference values, some comparisons can be made. For example, the food
energy that could be provided by the maximum allowances of the food packages can range from
about one-third of energy needs for an active postpartum woman to over 100 percent of energy
needs for an 11-month-old girl (IOM, 2002a; FNS, 2003). Thus, although the goal of the WIC
program is to supplement the diet, rather than provide a complete diet, the extent to which that
goal can be realized varies among the categories of participants served.
Table 1-1 shows the percentage of Food Guide Pyramid servings supplied by the maximum
allowances in the current WIC food packages (GAO, 2002; USDA/DHHS, 1992). For all
categories, the WIC food packages provide more than 100 percent of recommended servings
6 Another statement of the definition of supplemental foods is written as "foods containing nutrients determined
by nutritional research to be lacking in the diets of pregnant, breastfeeding, and postpartum women, infants, and
children" [U.S. Congress, 42 U.S.C. § 1786(b)(14)]. This definition was amended in June, 2004 by addition of the
wording "and foods that promote the health of the population served by the program authorized by this section as
indicated by relevant nutrition science, public health concerns, and cultural eating patterns" (U.S. Congress, Pub L.
No. 108-265, 2004).
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1-4 PROPOSED CRITERIA FOR SELECTING THE WIC FOOD PACKAGES
TABLE 1-1 Percentage of the Minimum Recommended Servings from the Food Guide
Pyramid Supplied by the Current Maximum Allowances for the WIC Food Packages by
Category of Participant
Participant Category Grains Vegetables Fruit Meat and Meat
(juice) Dairy Alternatives
Pregnant or lactating
women 13% 0% 50% 123% 27-28%
Breastfeeding women,
enhanced 13% 9% 60% 137% 50%
Postpartum women 20% 0% 50% 160% 24%
Children, 2 through 3 years 30% 0% 115% 160% 46-49%
Children, 4 years 20% 0% 75% 160% 32-34%
SOURCE: GAO, 2002; USDA/DHHS, 1992.
from the dairy group. For the dairy group the recommended number of servings is two servings
per day for children and women 19 years and older and three servings per day for adolescents;
this is equivalent to 16 to 24 oz of milk per day. Yet the maximum allowance for the dairy group
is equivalent to 25 to 30 oz per day. For children ages 2 through 3 years, the package also
provides more than 100 percent of the recommended servings of fruit, as juice only.
THE WIC POPULATION HAS CHANGED SINCE THE INCEPTION
OF THE WIC PROGRAM
Over the past several decades, the WIC program has expanded considerably and the
population the program serves has changed in important ways. The WIC program has been one
of the fastest growing food and nutrition assistance programs (see Figure 1-1). In fiscal year
1974, the WIC program served an average of 88,000 women, infants, and children per month.
During 2003, the WIC program served an average of 7.6 million women, infants, and children
per month at a cost of $4.5 billion for the fiscal year. Currently, about one half of all U.S. infants
and one quarter of children 1 through 4 years of age receive WIC benefits. Children make up just
over one-half of the total caseload (Figure 1-2, data for 2002).
The program's growth has been disproportionately in the western states, which accounted for
13 percent of total WIC participants in 1988 and 24 percent in 1998. California alone accounted
for 16.7 percent of WIC participants in 2003. This regional shift is reflected in the ethnic
composition of the WIC population, with Hispanics constituting a growing proportion. Hispanics
constituted 38.1 percent of the WIC caseload in 2002, up from 21 percent in 1988. Asians and
Pacific Islanders have become a substantial part of the WIC population in several states over the
same time period. There is substantial variability among geographic areas, even within states,
with some programs serving much more ethnically diverse populations than others.
The proportion of women participating in the WIC program who are in the work force has
increased since 1974. By 1998, about 25 percent of the women who were certified or who
certified a child for the WIC program were employed (Cole et al., 2001). Data from the Bureau
of Labor Statistics show that work activity has increased recently in low-income households with
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INTRODUCTION AND BACKGROUND 1-5
8
tsn s 6
ipa
ion
rtic ill 4
Pa M
tal
To 2
0
1974 1979 1984 1989 1994 1999 2004
FIGURE 1-1 Annual Number of Participants in the WIC Program Constructed from
Monthly Averages of Participants, Fiscal Years 1974-2004.
SOURCE: FNS, 2004a (USDA website). FY 2002 is the latest complete data. Data for FY 2003
(12 months) and FY 2004 (February alone) may be incomplete.
Women (24.2%)
Infants (25.7%)
Children (50.1%)
FIGURE 1-2 The WIC Population by Participant Category, 2002
SOURCE: Bartlett et al., 2003; FNS, 2004d (USDA website). FY 2002 is the
latest complete dataset.
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1-6 PROPOSED CRITERIA FOR SELECTING THE WIC FOOD PACKAGES
children. Between 1990 and 1999, the proportion of children in families with income below the
poverty level who lived with both parents with at least one parent employed full-time increased
from 44 to 52 percent (GAO, 2001). The proportion of poor children living in families with a
single mother employed full-time doubled, from 9 to 18 percent (GAO, 2001).
THE FOOD SUPPLY AND DIETARY PATTERNS HAVE CHANGED
SINCE THE INCEPTION OF THE WIC PROGRAM
Increased Variety in the Food Supply
The number of food products in U.S. food retail outlets has increased approximately 60
percent since 1990. Between 1997 and 2001 an average of 10,513 new food products were
introduced into the market each year (Food Institute, 2002). Many of these were existing
products that were repackaged/relabeled or simple line extensions; the introduction of some of
these products some was heavily advertised. Recent new food products include consistent-weight
packages of fresh fruits and vegetables that were formerly purchased as bulk, random-weight
items. Even though many of the new products fail to stay on the shelves for more than two years,
there has been a steady increase in the total number of products available. Each product is
referred to as a stock-keeping unit (SKU) by food manufacturers and vendors. The average
number of SKU's in a typical supermarket has increased from 20,000 in 1990 to over 32,000 in
2002 (Food Institute, 2002).
The variety of foods available has increased with a number of new products introduced as the
result of global sourcing of fresh fruits and vegetables. A wider variety of fresh produce is now
available year-around at reasonable prices and in many more locations. Variety in the forms of
food products also has increased due to changes in lifestyles and a preference for very
individualized types of foods. For example, consumers with particular health interests are
selecting foods fortified with particular nutrients such as calcium in orange juice or iron in
oatmeal. Variety also has increased due to the increase in "store brands." Supermarkets are
differentiating themselves from competition and building store loyalty through expansion of their
own brands. The percentage of SKU's in a typical supermarket that are store-brand products rose
from 18.6 percent in 1995 to 20.7 percent in 2001 (Food Institute, 2002). These store-brand
products are priced between 15 and 50 percent lower than national branded products of similar
quality (Food Institute, 2002).
Changes in Food Consumption
The percentage of personal disposable income spent for food from retail stores has fallen
over the last several decades. The average American household spent 7.8 percent of their
disposable income on food eaten at home in 2001, compared to over 10 percent in 1970 (BLS,
2003). Despite this trend, households in the lowest income quintile, which would include most
WIC households, spend 25 percent of their disposable income for food at home (Blisard, 2001).
Research by USDA on food spending by households reveals that low-income households
economize using their food dollars. Despite often facing higher food item prices, they tend to
spend less per pound for nearly all food groups by purchasing lower cost items within the food
groups (Kaufman et al., 1997).
Food consumption trends are available for women regarding the consumption of 12
categories of food between 1977 and 1995 (see Table 1-2). The trends in mean dietary intakes
for women 20 years of age and older reveal substantial increases in beverages (114 percent for
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INTRODUCTION AND BACKGROUND 1-7
TABLE 1-2 Trends and Changes in Food Consumption from Selected Food Groups: Mean
Intakes for Women 20 Years and Older
Mean Intake (grams per day) % change,
1997-1978
to
Food Group 1977-1978 1989-1991 1994-1995 1994-1995
Grain products 177 234 255 44%
Vegetables 205 187 189 -8%
Fruits 142 150 156 10%
Milk and milk products 203 206 202 -0.5%
Meat, poultry, and fish 184 167 168 -9%
Eggs 24 16 16 -33%
Legumes 18 17 19 6 %
Fats and oils 13 16 16 23%
Sugars and sweets 17 17 19 12%
Beverages (nonalcoholic) 698 753 854 22%
Fruit drinks and ades 29 46 58 100%
Carbonated soft drinks 137 238 293 114%
NOTE: An ade in a sweetened drink made from water and fruit juice.
SOURCE: NFCS 1977-1978, CSFII 1989-1991, CSFII 1994-1995 (Enns et al., 1997).
carbonated beverages), grain products (44 percent), and sugars and sweets (22 percent) (Enns et
al., 1997). Intake of eggs decreased the most for women (33 percent) (Enns et al., 1997). Similar
trend data were available for children ages 6 through 11 years (Enns et al., 2000). No trend data
of this type were available for children in age ranges eligible for the WIC program.
THE HEALTH RISKS OF THE WIC-ELIGIBLE POPULATION HAVE
CHANGED SINCE THE INCEPTION OF THE WIC PROGRAM
Since the inception of the WIC program, there have been fundamental changes in the
predominant health and nutrition risks faced by the WIC-eligible population, and in the context
of these risks. Several problems that were high on the list of public health problems in the 1970s
have receded. Access to health care for WIC participants is now better than in the early years of
the program (Fox et al., 2003); at present more than 80 percent of WIC participants report some
kind of health care insurance, primarily Medicaid or employer-sponsored insurance (Cole et al.,
2001). Further, there is evidence that the Medicaid-enrolled children who participate in the WIC
program have greater use of all health services, including preventive services and effective care
of common illnesses, than the Medicaid-enrolled children who are not WIC participants
(Buescher et al., 2003). The situation with regard to breastfeeding7 has improved since the early
days of the WIC program, with more than two-thirds of mothers initiating breastfeeding
presently. However, average duration remains short, and WIC participants remain somewhat less
7In the WIC program, a mother is considered to be breastfeeding as long as breastfeeding occurs at least once
per day.
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1-8 PROPOSED CRITERIA FOR SELECTING THE WIC FOOD PACKAGES
likely to breastfeed their babies than other mothers (Abbott Laboratories, 2002, 2003). Diets
have improved in many respects, and nutrients for which intakes often appeared to be low in the
1970s (vitamins A and C, and calcium) are less problematic, particularly for children. Iron
deficiency has declined considerably, probably at least partly as a positive effect of the WIC
program (Sherry et al., 2001), but remains a problem to be actively addressed, with prevalence
hovering 2 to 5 percentage points above the 2010 national health objectives (CDC, 2002). Infants
in the WIC program (Kahn et al., 2002) and low-income postpartum women (Bodnar et al.,
2002) have been demonstrated to be particularly at risk.
At the same time, new risks have emerged. By far the most dramatic of these is the rapidly
increasing prevalence of overweight and obesity in adults, adolescents, and children, with the
attendant health risks. Excess body fat and physical inactivity are associated with the
development of hypertension, dyslipidemia, type 2 diabetes, coronary heart disease,
osteoarthritis, respiratory ailments, sleep problems, certain cancers (e.g., breast cancer), and all-
cause mortality. The negative health effects and economic costs associated with excess body fat
and physical inactivity are second only to smoking, and likely to overtake tobacco as the leading
cause of death from modifiable behavioral factors in the near future (Mokdad et al., 2004).
While there is no firm evidence that the WIC participant population is any more prone to
overweight than non-WIC populations (CDC, 1996), neither are they protected. The number of
overweight and obese women in the U.S. has risen substantially, with age-adjusted prevalence
increasing approximately 30 percent between 1960 and 1994 (Kuzmarski et al., 1994). In 1994
28 and 27 percent of women aged 25 years and older were overweight and obese, respectively
(Flegal et al., 1998). Over the same period the percentage overweight among women of
childbearing ages (20 through 39 years) almost doubled (Kuzmarski et al., 1994; Flegal et al.,
1998). Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000
indicated that 28 percent of non-pregnant women aged 20 through 39 years are obese (Flegal et
al., 2002). More recent data from NHANES 2001-2002 indicates that the prevalence of obesity
among these women remains high at 29 percent (Hedley et al., 2004).
Overweight and obesity are prevalent among minority groups, except for Asian-Americans.
Data from the most recent NHANES multistage probability sampling (1999-2002) estimate the
overall prevalence of overweight and obesity at 70 and 47 percent for non-Hispanic black
women, 62 and 31 percent for Mexican-American women, and 55 and 25 percent for non-
Hispanic white women (Hedley et al., 2004). Of particular concern is the prevalence of Class 3
obesity (body mass index > 40), which affects 15 percent of non-Hispanic black women ages 20
and over, a prevalence nearly double that (7.9 percent) reported in the 1988-1994 NHANES
(Flegal, et al, 2002). However, women of low socioeconomic status disproportionately bear the
burden of obesity and overweight regardless of race or ethnicity. Among individuals with less
than a high school education the prevalence is roughly twice that of college graduates (Mokdad
et al., 1999).
The prevalence of overweight for children in the U.S. also has steadily risen over the last
several decades. Data from the most recent NHANES national survey (1999-2000) indicate that
the prevalence of overweight was 13 percent in children ages 6 through 11 years as compared to
4 percent in 1965 (Ogden et al., 2002). In children ages 2 through 5 years, 10 percent were
overweight. A 1998 survey of children participating in the WIC program found that 13 percent of
these children were overweight (Cole, 2001). Overweight children and adolescents are at
increased risk for overweight in adulthood (Ogden et al., 2003). Childhood overweight has been
linked to adverse health outcomes including elevated blood pressure, hyperinsulinemia, glucose
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INTRODUCTION AND BACKGROUND 1-9
intolerance, type 2 diabetes, dyslipidemia, and other early risks for chronic disease, as well as to
psychosocial problems including depression, social isolation, and low self-esteem (Dietz, 1998b;
Must and Strauss, 1999). A recent analysis of NHANES data from 1971 to 2000 indicates that
the extent of overweight (i.e., the degree of overweight among those who are overweight) has
increased even more rapidly than the prevalence of overweight among U.S. children and
adolescents (Jolliffe, 2004).
DIETARY GUIDANCE AND RECOMMENDATIONS HAVE
CHANGED SINCE THE INCEPTION OF THE WIC PROGRAM
New Nutrient Recommendations
Over the past decade, knowledge of nutrient requirements has increased substantially,
resulting in a set of new dietary reference values called the Dietary Reference Intakes (DRIs)
(IOM, 1997, 1998, 2000b, 2001, 2002a, 2004). The DRIs replace the 1989 Recommended
Dietary Allowances (RDAs) as nutrient reference values for the U.S. population (NRC, 1989b).
Based on the new DRIs, many of the recommendations for individual intakes (RDAs) have
changed substantially since the WIC food packages were originally formulated. Although basic
concepts of nutrition have not changed, there has been a substantial increase in knowledge of
specific concepts such as bioavailability, nutrient-nutrient interactions, and the distribution of
dietary intake across subgroups of the population. In addition, the DRIs include appropriate
standards to use in determining whether diets are nutritionally adequate without being excessive.
The DRIs differ from the old RDAs in several respects: (1) they consider reduction in the risk of
chronic disease, rather than merely the absence of signs of deficiency; (2) for most nutrients,
both RDA and Estimated Average Requirement (EAR) values are given--the EAR makes it
possible to estimate the prevalence of inadequacy within a population; (3) Tolerable Upper
Intake Levels (ULs) have been set to aid in evaluation of the risk of adverse effects from excess
consumption; (4) appropriate ranges of macronutrient densities are given as Acceptable
Macronutrient Distribution Ranges (AMDRs); and (5) when data are available, reference values
are provided for other food components.
New Food Intake Recommendations
New guidance on food intakes also is available. At the time the WIC program was
established, there was no systematic process for the development and revision of science-based
dietary guidance for the U.S. population. Nutrition education tools such as the "Four Food
Groups" focused on eating enough of various types of foods to assure nutrient adequacy. The
original selection of foods for the WIC food packages was based on food consumption data that
indicated that calcium, iron, vitamin A, and vitamin C were the nutrients most likely to be low in
the diets of low-income women and young children. Understanding of the necessity for adequate
high-quality protein in periods of rapid growth and development provided the basis for inclusion
of protein as a priority nutrient. The specific foods selected for the food packages were good
sources of the nutrients listed above, available, generally acceptable, and reasonable in cost.
As deficiency diseases became less common, scientific research into the relationships
between various dietary components and chronic diseases expanded. In 1977, the U.S. Senate
Select Committee on Nutrition and Human Needs published dietary goals for the U.S., which for
the first time set forth dietary guidance that included a focus on the total diet and
recommendations for minimizing risk of chronic disease and for ensuring nutritional adequacy
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1-10 PROPOSED CRITERIA FOR SELECTING THE WIC FOOD PACKAGES
(U.S. Senate, 1977). There was a great deal of controversy over these goals, not only because of
the lack of agreement among scientists on many of the issues but also surrounding the process
for arriving at the goals (McMurry, 2003). A period of intense activity culminated in a 1979
Surgeon General's Report on Health Promotion and Disease Prevention (DHEW/PHS, 1979).
The report relied heavily on the findings of a panel of the American Society for Clinical
Nutrition that examined the association between dietary components and chronic disease (ASCN,
1979). Then in 1980, USDA/DHHS jointly issued the first edition of Dietary Guidelines for
Americans (USDA/DHHS, 1980). The purpose was to provide the public with authoritative,
consistent guidelines on diet and health.
Since 1980, the Dietary Guidelines have been revised every five years; the most recent
version was released in May 2000 (USDA/DHHS, 2000) and the 2005 revision is expected to be
available in preliminary form in time to inform the deliberations of the current Institute of
Medicine (IOM) Committee to Review the WIC Food Packages. Over time, the Dietary
Guidelines have evolved to incorporate the evidence that has developed about the relationships
between diet and chronic disease. The 2000 version of the Dietary Guidelines (USDA/DHHS,
2000) recommends a total dietary pattern that is largely plant-based, with emphasis on whole
grains, fruits and vegetables; limitation or moderation in consumption of fats, sugars, sodium,
and alcohol; food safety; and physical activity.
The Dietary Guidelines form the basis for widely-used nutrition education tools and dietary
evaluation processes. The Food Guide Pyramid, a nutrition education tool based on the Dietary
Guidelines, was first issued by USDA and DHHS in 1992. The Pyramid has become a widely
recognized representation of dietary guidance by the public. Currently, USDA is evaluating the
Food Guide Pyramid system to respond to new Dietary Reference Intakes, new Dietary
Guidelines, and current information on food consumption patterns and consumer perceptions and
understanding.
THE COMMITTEE'S TASK
In view of the substantial changes in the nutritional context for the WIC program since its
inception, the Food and Nutrition Service of USDA asked the Institute of Medicine to present a
proposal to conduct a review of the WIC food packages. The project was undertaken by the Food
and Nutrition Board in September 2003. The Committee to Review the WIC Food Packages was
formed to conduct the review and the statement of task for the project follows.
The committee's focus is the population served by the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC). Specific tasks for the committee are:
(Phase I) review nutritional needs using scientific data summarized in Dietary Reference Intake
reports (IOM, 1997, 1998, 2000b, 2001, 2002a, 2004), assess supplemental nutrition needs (by
comparing nutritional needs to recent dietary intake data for pertinent populations), and propose
priority nutrients and general nutrition recommendations for the WIC food packages; and
(Phase II) based on this assessment, recommend specific changes to the WIC food packages.
Recommendations are to be cost-neutral, efficient for nationwide distribution and vendor check-
out, non-burdensome to administration, and culturally suitable. The committee will also consider
the supplemental nature of the WIC program, burdens/incentives for eligible families, and the
role of WIC food packages in reinforcing nutrition education, breastfeeding, and chronic disease
prevention.
The remainder of this preliminary report presents the basis for the Committee's proposed
approach to designing WIC food packages during Phase I of the project. Chapter 2 identifies
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INTRODUCTION AND BACKGROUND 1-11
some of the challenges the Committee faces in designing an effective set of WIC food packages.
To assess supplemental nutrition needs, the Committee considered several types of evidence:
distributions of nutrient intakes for WIC populations were examined to identify the prevalence of
inadequate or excessive intakes (Chapter 3); published information on food intakes was
compared to dietary recommendations for the target populations (Chapter 4); and published
evidence of nutrient inadequacy for these populations, based on physiological or biochemical
evidence, was examined (Chapter 5). All of these sources of data have strengths and weaknesses,
so a combination was used to identify the nutrients and food groups of the most concern.
Although breastfed infants must be excluded from certain analyses because the data are limited
or lacking, breastfed infants were considered when feasible, primarily in the analyses described
in Chapter 5. Chapter 6 presents the Committee's preliminary synthesis of information related to
nutritional needs and to priority nutrients and food groups to be considered for the food package.
The proposed criteria and a general description of the process to be used in selecting the WIC
food packages during Phase II of the project are also presented.
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Representative terms from entire chapter:
food packages
