National Academies Press: OpenBook

Planning a WIC Research Agenda: Workshop Summary (2011)

Chapter: 3 WIC and Obesity

« Previous: 2 WIC and Birth Outcomes
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

3
WIC and Obesity

The focus of this session, moderated by Patricia Crawford, was research on how the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could have an impact on behaviors that contribute to childhood obesity. The two presenters (Robert Whitaker and Elsie Taveras) identified possible behavioral intervention targets and discussed different aspects of suggested research methods. The discussant (Sara Benjamin Neelon) raised a number of questions about the selection of behavioral intervention targets. The session did not address research on efforts by WIC to address obesity.

RESEARCH PROPOSALS FOR OBESITY PREVENTION AMONG CHILDREN IN WIC

Presenter: Robert C. Whitaker


Whitaker covered four key research findings and their implications for future research. In addition, he mentioned structural constraints in WIC that limit potential research designs, and he proposed a research agenda and a potential staged research design.

Key Research Findings

Four research findings have implications for the WIC research agenda, Whitaker said. They are:

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
  1. Participation in WIC is not associated with obesity. Because of this, exposure to WIC alone is unlikely to either cause or protect against obesity, and body mass index (BMI) will not be a useful measure of a primary outcome (Hofferth and Curtin, 2005; Ploeg et al., 2008; Rose et al., 2006).

  2. The prevalence of obesity in WIC children no longer seems to be increasing. Because favorable secular trends are likely to continue among WIC and non-WIC children, careful attention must be given to the control condition when designing studies (Sharma et al., 2009).

  3. Within the WIC income range, higher income is associated with a greater rather than a lower prevalence of obesity. Thus qualitative studies are needed to examine the complex relationship between childhood obesity and household behaviors and resources (Anderson and Whitaker, 2010; Karp et al., 2005; Whitaker and Orzol, 2006).

  4. Successful prevention or treatment interventions in young children require parental involvement. Therefore, parents should be the primary targets of interventions to prevent childhood obesity (Epstein et al., 1994; Golan and Crow, 2004; Golan et al., 2006).

Structural Constraints

Because WIC currently has no waivers or wait lists, it is challenging to develop feasible random assignment designs. Interventions must work within WIC’s three core functions: the provision of the food package, nutrition education, and referrals.

Proposed Research Agenda

Whitaker’s research proposal is given below, followed by his criteria for selecting target behaviors.

Proposal

Develop and test the impact of a coordinated communication strategy among WIC, Head Start, and pediatricians on changing behaviors that help prevent obesity among children 12 to 60 months of age.

Target Behaviors

The target behaviors selected should meet three criteria, namely, that the behavior (1) has an effect on energy balance or weight, (2) is

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

BOX 3-1

Menu of Target Behaviors

  1. Decrease portion sizes.

  2. Increase the frequency of family meals.

  3. Limit sweetened beverages.

  4. Increase outdoor play time with parents.

  5. Decrease time spent watching television and on computers.

  6. Increase sleep duration.

unlikely to do harm, and (3) has a favorable effect on non-obesity outcomes, such as improving social well-being. The lack-of-harm criterion is especially important when the evidence of benefit is weak. The effect on outcomes other than obesity may provide the key to engaging parents and partners.

Whitaker’s menu for target behaviors appears in Box 3-1. According to Whitaker, behavior numbers 5 and 6 in this box, which have consistently been associated with a lower prevalence of obesity, also may lead to improvements in children’s moods and decreased aggressive behaviors—possible outcomes that may engage parents.

Potential Staged Design

Whitaker proposed a multistage research design in which each stage informs the next (Box 3-2). The first four stages entail the development of

BOX 3-2

Potential Multistage Research Design

Development of the Communication Strategy

  1. Conduct formative qualitative research.

  2. Help messengers be healthy through staff wellness programs.

  3. Convene messengers to help them understand shared goals and challenges.

  4. Develop communication tools, and qualitatively assess both the messages and the medium with messengers and parents.

Testing of the Communication Strategy

  1. Pilot-test the communication strategy and the outcome measures.

  2. Conduct a controlled impact evaluation.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

a communications strategy, which is tested in the fifth and sixth stages. The first stage is the most important. It includes framing messages on behavioral targets and reconciling differences between the frames1 held by those delivering and those receiving the messages. A key part of the fourth stage is a qualitative assessment of how well both the messages and the medium resonate with the messengers and the parents.

The pilot test (stage 5) would focus on assessing the acceptability, feasibility, and fidelity of delivering the message. If the results of the pilot test are unfavorable, stage 6 would not go forward. If the results of the first five stages warrant a controlled evaluation of the impact of the communication strategy (stage 6), this stage would probably be conducted using a group- or community-randomized design that compares traditional WIC services with WIC services plus an enhanced coordinated communication strategy. The primary outcome should be the target behavior or behaviors. A process and cost evaluation would be an important element of the study in order to determine how to implement the intervention on a larger scale and then to sustain it.

Closing Comments

In closing, Whitaker emphasized that any interventions that are part of the research agenda should target behaviors rather than BMI, that the target behaviors must matter to the WIC partners and to the parents, and that qualitative research is more important and feasible than quantitative research in the WIC setting.

RESEARCH OPPORTUNITIES IN WIC FOR CHILDHOOD OBESITY

Presenter: Elsie M. Taveras2


Although the most recent statistics show that the prevalence of childhood obesity has reached a plateau, the prevalence is still high, and obesity is affecting even the nation’s youngest children. In 2007–2008, the prevalence of high weight for recumbent length among U.S. children from birth to 2 years of age was 9.5 percent (Ogden et al., 2010), where “high” is defined as weights at or above the 95th percentile of the Centers for Disease Control and Prevention (CDC) growth charts (Kuczmarski et al., 2000). The prevalence of obesity varied by racial and ethnic background,

1

The term frames refers to people’s perceptions and the meaning that people attribute to objects, events, and behaviors. Frames are likely to differ among WIC staff and WIC partners, such as pediatricians and parents.

2

Taveras’ participation was via conference call, with slides shown on site.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

BOX 3-3

Proposed Targets for Behavioral Counseling—Prenatal to Early Childhood

  • Gestational weight gain (Oken et al., 2006) and gestational diabetes

  • Maternal smoking during pregnancy (Oken et al., 2006)

  • Rapid infant weight gain (Taveras et al., 2009)

  • Breastfeeding promotion (Taveras et al., 2004)

  • Sleep duration and quality (Taveras et al., 2008)

  • Television viewing (Taveras et al., 2007) and television sets in bedroom

  • Improved responsiveness to infant hunger and satiety cues (Hodges et al., 2008)

  • Parental feeding practices, eating in the absence of hunger (Birch and Fisher, 1998; Birch et al., 2003; Taveras et al., 2006a)

  • Portion sizes (Fisher et al., 2008)

  • Fast food intake (Taveras et al., 2006b)

  • Sugar-sweetened beverages (James and Kerr, 2005; Wang et al., 2009)

  • Physical activity participation (Gooze et al., 2010; Strong et al., 2005; Tobias et al., 2010)

ranging from 8.7 for non-Hispanic white to 12.5 for Hispanic girls and boys (Ogden et al., 2010). Severe obesity (BMI ≥35 kg/m2) was especially high for Black and Hispanic boys and for Black girls 2 to 19 years of age (Wang et al., 2010).

Relevant Research Findings

Box 3-3 offers a list of proposed targets for behavioral counseling and key references that provide the basis for the inclusion of those targets on the list. Racial and ethnic differences are present in all the early life risk factors for childhood obesity, with children who belong to racial or ethnic minority groups being affected disproportionately. Clearly, prevention must start early, and preventive interventions should be based on the best available evidence for the highest risk populations. WIC fits well with the effort to prevent obesity because of the population groups covered, the structure for screening nutritional status, the nutrition education provided, and the referrals for needed health and social services.

Proposed Research Agenda

Taveras proposed the following study: Develop and test the impact of coordinated surveillance and communication strategies among

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
  1. WIC providers and obstetricians on promoting healthful behaviors during pregnancy to prevent childhood obesity and improve maternal health; and

  2. WIC providers, home visitation programs, child care providers, and pediatricians on changing behaviors to help prevent excess weight gain among infants from birth to 12 months.

The targets of intervention during pregnancy would be maternal prepregnancy BMI, excessive gestational weight gain, maternal smoking, and gestational diabetes. The interventions would occur mainly during the inter-pregnancy interval. Taveras called for improving the surveillance of obesity-related risk factors; coordinated referrals and communication strategies; and improvements in parents’ ability to handle infant feeding, sleep, and media exposure. A very important communication goal would be to counter the myth that the pregnant woman needs to “eat for two.”

The targets of intervention during infancy would be excessive infant weight gain; breastfeeding initiation, continuation, and exclusivity; responsive feeding; portion sizes of bottles and solid food containers; outdoor physical activity; limiting television viewing and televisions in bedrooms; and improving sleep quality and duration. Taveras called for improved surveillance of infant weight gain using the CDC growth charts in combination with the identification of children at high risk of rapid growth and coordinated communication strategies to counter the myth that “bigger is better.” Other possible tactics involve education and support that would be directed mainly toward feeding practices and the promotion of physical activity and healthful sleep.

Possible Methodology for Impact Evaluation

Taveras supported the multistage design approach presented by Whitaker and focused on two possible evaluation methods: quasi-experiments and cluster-randomized controlled trials.

Quasi-Experiments

Quasi-experiments, as described by Gortmaker (2004), can have all the attributes of a randomized controlled trial, including pretest and posttest data. The key difference is the lack of random assignment to intervention and control groups. The success of the method depends on appropriate selection of the control sample (e.g., through propensity matching; see Chapter 10). Quasi-experiments make it possible to study programs and policies that are innovative, expensive, and difficult to implement.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Cluster-Randomized Controlled Trials

Cluster-randomized controlled trials are studies in which groups (clusters) are randomized rather than individuals. This method is useful when the intervention is applied to an entire group. Because of the randomization, such trials have better internal validity than quasi-experimental studies. They also allow the study of interventions that cannot be directed toward selected individuals. However, the design and analysis of cluster-randomized controlled trials are complex, the required sample sizes are large, the cost is high, and the long time it takes to obtain study results may preclude rapid evaluations of innovations.

Concluding Comments

Taveras said that WIC can play a substantial role in efforts to prevent childhood obesity during pregnancy, infancy, and early childhood—especially when WIC works in collaboration with partners such as obstetricians, home visitation programs, child care providers, and pediatricians. She concluded that those determining the research agenda should consider innovative study designs and methods as a way of overcoming the barriers to wide-scale intervention testing in WIC.

RESPONSE

Discussant: Sara Benjamin Neelon

Questions Triggered by the Obesity Session Presentations

Benjamin Neelon asked all those present to consider the presentations by Whitaker and Taveras and think about four questions, and she provided her own responses, as follows:

  1. What is WIC already doing and already doing well to prevent childhood obesity?

    Response: Screening and measuring growth, addressing competing issues within families.

  2. What can WIC do to include more obesity prevention within its current structure?

    Response: Target various family members and caregivers, not just the mother.

  3. Are there missed opportunities for obesity prevention within WIC?

    Response: Reaching women during interconceptional periods, engaging fathers and partners.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
  1. Where does obesity prevention rank among other behavioral targets within WIC? How would you prioritize obesity prevention when you consider other health concerns?

    Response: None provided.

Benjamin Neelon also asked attendees to consider behavioral targets according to three different considerations: (1) those that have the greatest effect on obesity prevention, (2) those that WIC is in a good position to address, and (3) those that are or should be integral to the mission of WIC. Some behavioral targets may move WIC nutritionists beyond their training and comfort zone. With these points in mind, Benjamin Neelon highlighted those behavioral intervention targets that she considered to be more promising—that is, the ones for which WIC could have a greater impact (see bolded items in Box 3-4).

Concluding Comments

According to Benjamin Neelon, WIC can play a substantial role in obesity prevention, although it cannot provide the entire answer. WIC needs to engage collaborative partners. Target behaviors must matter to partners and caregivers and must extend beyond weight and obesity. The research design should compare WIC to an enhanced form of WIC. Most importantly, a combination of qualitative and quantitative formative processes and impact evaluation will be needed to assess the effectiveness of new measures.

BOX 3-4

Behavioral Intervention Targetsa

Pregnancy

Infancy

Early Childhood

Excess weight gain

Excess weight gain

Sweetened beverages

Smoking

Breastfeeding

Family meals

Pre-pregnancy BMI

Portion sizes

Portion sizes

Gestational diabetes

Responsive feeding

Play/physical activity

 

Play/physical activity

Screen time

 

TV viewing/TV bedroom

Sleep quality/duration

 

Sleep quality/duration

 

  

aBold font indicates the targets for which WIC could have a greater impact.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

GROUP DISCUSSION

Moderator: Patricia B. Crawford


The following topics were addressed during the discussion period:

  • Methods: Considerable evidence shows that quasi-experimental designs such as regression discontinuity and propensity scoring place large demands on the sample size, often requiring sample sizes much larger than those needed for randomized controlled trials (RCTs). When RCTs are feasible, they may be relatively simple and straightforward.

  • Healthy Habits for Life kits and the Around Food Insecurity program: These products of a partnership between the National WIC Association and the Sesame Workshop include evaluation components, and they tie in with suggestions for behavior change made during this session.

  • Efforts to encourage appropriate infant feeding (exclusive, long-term breastfeeding): These efforts tie together behaviors related to maternal health (postpartum fat loss) and infant health.

  • The screening component of WIC: (1) The use of the new World Health Organization growth charts results in identifying overweight children earlier than with the CDC growth charts. (2) Crowded living conditions can lead to positive responses to questions such as, “Is there a TV in the room in which your child sleeps?”

  • Formative research related to obesity prevention: This approach has value for 1-year-old children as well as for the older ones.

SUMMARY OF SUGGESTED RESEARCH TOPICS

The research proposals made during this session focused on developing and testing strategies to change behaviors linked with excess weight among infants and young children. Emphasis was placed on collaboration with a range of partners. The method proposed here would involve a multistage research design that would be used to identify target behaviors that matter to partners and caregivers and that extend beyond weight and obesity. The design would also help determine effective ways to address those behaviors. Both qualitative and quantitative research designs will be needed.

REFERENCES

Anderson, S. E., and R. C. Whitaker. 2010. Household routines and obesity in US preschool-aged children. Pediatrics 125(3):420–428.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

Birch, L. L., and J. O. Fisher. 1998. Development of eating behaviors among children and adolescents. Pediatrics 101(3 II Suppl.):539–549.

Birch, L. L., J. O. Fisher, and K. K. Davison. 2003. Learning to overeat: Maternal use of restrictive feeding practices promotes girls’ eating in the absence of hunger. American Journal of Clinical Nutrition 78(2):215–220.

Epstein, L. H., A. Valoski, R. R. Wing, and J. McCurley. 1994. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology 13(5):373–383.

Fisher, J. O., N. F. Butte, P. M. Mendoza, T. A. Wilson, E. A. Hodges, K. C. Reidy, and D. Deming. 2008. Overestimation of infant and toddler energy intake by 24-h recall compared with weighed food records. American Journal of Clinical Nutrition 88(2):407–415.

Golan, M., and S. Crow. 2004. Parents are key players in the prevention and treatment of weight-related problems. Nutrition Reviews 62(1):39–50.

Golan, M., V. Kaufman, and D. R. Shahar. 2006. Childhood obesity treatment: Targeting parents exclusively v. parents and children. British Journal of Nutrition 95(5):1008–1015.

Gooze, R. A., C. C. Hughes, D. M. Finkelstein, and R. C. Whitaker. 2010. Reaching staff, parents, and community partners to prevent childhood obesity in Head Start, 2008. Preventing Chronic Disease 7(3):A54.

Gortmaker, S. L. 2004. Scenario 2: Prevention of childhood obesity. Paper presented at the May 4–5, 2004, Workshop on Research Designs for Complex, Multi-level Health Interventions and Programs, Bethesda, MD. http://obssr.od.nih.gov/news_and_events/conferences_and_workshops/FY_2004/complex_interventions.aspx#dates (accessed September 7, 2010).

Hodges, E. A., S. O. Hughes, J. Hopkinson, and J. O. Fisher. 2008. Maternal decisions about the initiation and termination of infant feeding. Appetite 50(2-3):333–339.

Hofferth, S. L., and S. Curtin. 2005. Poverty, food programs, and childhood obesity. Journal of Policy Analysis and Management 24(4):703–726.

James, J., and D. Kerr. 2005. Prevention of childhood obesity by reducing soft drinks. International Journal of Obesity 29(Suppl. 2):S54–S57.

Karp, R. J., C. Cheng, and A. F. Meyers. 2005. The appearance of discretionary income: Influence on the prevalence of under- and over-nutrition. International Journal of Health Inequities 4:10.

Kuczmarski, R. J., C. L. Ogden, L. M. Grummer-Strawn, K. M. Flegal, S. S. Guo, R. Wei, Z. Mei, L. R. Curtin, A. F. Roche, and C. L. Johnson. 2000. CDC growth charts: United States. Advance Data from Vital and Health Statistics 314:1–27. http://www.cdc.gov/nchs/data/ad/ad314.pdf (accessed September 24, 2010).

Ogden, C. L., M. D. Carroll, L. R. Curtin, M. M. Lamb, and K. M. Flegal. 2010. Prevalence of high body mass index in US children and adolescents, 2007–2008. Journal of the American Medical Association 303(3):242–249.

Oken, E., Y. Ning, S. L. Rifas-Shiman, J. S. Radesky, J. W. Rich-Edwards, and M. W. Gillman. 2006. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstetrics and Gynecology 108(5):1200–1207.

Ploeg, M. V., L. Mancino, B. H. Lin, and J. Guthrie. 2008. US food assistance programs and trends in children’s weight. International Journal of Pediatric Obesity 3(1):22–30.

Rose, D., J. N. Bodor, and M. Chilton. 2006. Has the WIC incentive to formula-feed led to an increase in overweight children? Journal of Nutrition 136(4):1086–1090.

Sharma, A. J., L. M. Grummer-Strawn, K. Dalenius, D. Galuska, M. Anandappa, E. Borland, H. Mackintosh, and R. Smith. 2009. Obesity prevalence among low-income, preschool-aged children—United States, 1998–2008. Morbidity and Mortality Weekly Report 58(28):769–773.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

Strong, W. B., R. M. Malina, C. J. Blimkie, S. R. Daniels, R. K. Dishman, B. Gutin, A. C. Hergenroeder, A. Must, P. A. Nixon, J. M. Pivarnik, T. Rowland, S. Trost, and F. Trudeau. 2005. Evidence based physical activity for school-age youth. Journal of Pediatrics 146(6):732–737.

Taveras, E. M., K. S. Scanlon, L. Birch, S. L. Rifas-Shiman, J. W. Rich-Edwards, and M. W. Gillman. 2004. Association of breastfeeding with maternal control of infant feeding at age 1 year. Pediatrics 114(5):e577–e583.

Taveras, E. M., S. L. Rifas-Shiman, K. S. Scanlon, L. M. Grummer-Strawn, B. Sherry, and M. W. Gillman. 2006a. To what extent is the protective effect of breastfeeding on future overweight explained by decreased maternal feeding restriction? Pediatrics 118(6): 2341–2348.

Taveras, E. M., T. J. Sandora, M. C. Shih, D. Ross-Degnan, D. A. Goldmann, and M. W. Gillman. 2006b. The association of television and video viewing with fast food intake by preschool-age children. Obesity 14(11):2034–2041.

Taveras, E. M., A. E. Field, C. S. Berkey, S. L. Rifas-Shiman, A. L. Frazier, G. A. Colditz, and M. W. Gillman. 2007. Longitudinal relationship between television viewing and leisure-time physical activity during adolescence. Pediatrics 119(2):e314–e319.

Taveras, E. M., S. L. Rifas-Shiman, E. Oken, E. P. Gunderson, and M. W. Gillman. 2008. Short sleep duration in infancy and risk of childhood overweight. Archives of Pediatrics and Adolescent Medicine 162(4):305–311.

Taveras, E. M., S. L. Rifas-Shiman, M. B. Belfort, K. P. Kleinman, E. Oken, and M. W. Gillman. 2009. Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics 123(4):1177–1183.

Tobias, D. K., C. Zhang, R. M. van Dam, K. Bowers, and F. B. Hu. 2010. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: A meta-analysis. Diabetes Care. (Electronically published September 27, 2010).

Wang, Y. C., D. S. Ludwig, et al. 2009. Impact of change in sweetened caloric beverage consumption on energy intake among children and adolescents. Archives of Pediatrics and Adolescent Medicine 163(4):336–343.

Wang, Y. C., S. L. Gortmaker, and E. M. Taveras. 2010. Trends and racial/ethnic disparities in severe obesity among US children and adolescents, 1976–2006. International Journal of Pediatric Obesity. (Electronically published March 18, 2010).

Whitaker, R. C., and S. M. Orzol. 2006. Obesity among US urban preschool children: Relationships to race, ethnicity, and socioeconomic status. Archives of Pediatrics and Adolescent Medicine 160(6):578–584.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

This page intentionally left blank.

Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 25
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 26
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 27
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 28
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 29
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 30
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 31
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 32
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 33
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 34
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 35
Suggested Citation:"3 WIC and Obesity." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 36
Next: 4 Research Needed to Improve Breastfeeding Protection, Promotion, and Support Within WIC »
Planning a WIC Research Agenda: Workshop Summary Get This Book
×
Buy Paperback | $55.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The time has come to initiate a new program of research on the Supplemental Nutrition Program for Women, Infants, and Children (commonly referred to as WIC). WIC is the third largest food assistance program administered by the U.S. Department of Agriculture (USDA). The program's scope is large, serving approximately 9.3 million low-income women, infants, and children at nutritional risk. Through federal grants to states, participants receive three types of benefits: 1) a supplemental food package tailored to specific age groups for infants and children; 2) nutrition education, including breastfeeding support; and 3) referrals to health services and social services. To cover program costs for fiscal year (FY) 2010, Congress appropriated $7.252 billion. Congress also appropriated $15 million for research related to the program for FY 2010.

The timing of the funding for WIC research is propitious. In October 2009, USDA issued regulations that made substantial revisions to the WIC food package. These revisions are the first major change in the food package since the program's inception in 1972. Over the intervening years WIC has expanded greatly, Medicaid coverage has increased, large changes have occurred in the racial and ethnic backgrounds and socioeconomic status of WIC participants as well as in public health services, and obesity rates have increased substantially among the general population.

To guide its planning for the use of the $15 million allocated for WIC research, the Food and Nutrition Service of USDA asked the Institute of Medicine to conduct a two-day public workshop on emerging research needs for WIC. As requested, the workshop included presentations and discussions to illuminate issues related to future WIC research issues, methodological challenges, and solutions. The workshop also planned for a program of research to determine the effects of WIC on maternal and child health outcomes.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!