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



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