Appendix T
Chronology of Statutes Pertaining to the Definition of WIC Supplemental Foods
September 26, 1972: Public Law No. 92-433. The term “supplemental foods” is defined in the original Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) statute, Child Nutrition Act, as amended.
§ 17(f)(3): “Supplemental foods” shall mean those foods containing nutrients known to be lacking in the diets of populations at nutritional risks and, in particular, those foods and food products, containing high-quality protein, iron, calcium, vitamin A, and vitamin C. Such term may also include (at the discretion of the Secretary) any food product commercially formulated preparation specifically designed for infants.
July 11, 1973: In what appears to be the first WIC rule (Fed Reg p. 18447):
§ 246.2(v): “Supplemental food” means any food authorized to be made available under the WIC program.
October 7, 1975: Public Law No. 94-105. Child Nutrition Act § 17(f)(3) is amended to include a new, final sentence:
The contents of the food package shall be made available in such a manner as to provide flexibility, taking into account medical and nutritional objectives and cultural eating patterns.
January 12, 1976: Interim “Revision, Reorganization, and Republication” (Fed Reg p. 1743) reads:
§ 246.2(t): “Supplemental foods” means the foods authorized by FNS in this part to be made available under the WIC program.
January 9, 1979: Proposed Rule, to comply with section 3 of Public Law No. 95-627 § 3 (beginning Fed Reg p. 2114) deletes the definition of supplemental foods (no explanation is provided for this change):
§ 246.2 (no “letter” designation): “Supplemental foods” [Reserved].
July 27, 1979: Final Rule, to comply with Public Law No. 95-627 § 3 (beginning Fed Reg p. 44422):
§ 246.2 (no “letter” designation): “Supplemental foods” [Reserved].
July 8, 1983: Proposed Rule (beginning on Fed Reg p. 31502) issued to “reduce the regulatory burden on State and local agencies.” It states:
A definition of “supplemental foods” was reserved in the 1979 regulations because of the pending issuance of the proposed food package regulations. A definition consistent with the legislative definition and past regulatory definitions is proposed in this rulemaking.
§ 246.2 (no “letter” designation): “Supplemental foods” means those foods containing nutrients determined to be beneficial for pregnant, breastfeeding, and postpartum women, infants, and children, as prescribed by the Secretary in section 246.10.
November 10, 1989: Public Law No. 101-147. Child Nutrition and WIC Reauthorization Act of 1989 continues the statutory emphasis on providing nutrients for which WIC participants are most vulnerable to deficiencies and adds concern regarding nutrient density and how to effectively provide the priority nutrients.
June 30, 2004: Public Law No. 108-265. Child Nutrition and WIC Reauthorization Act of 2004 continues the statutory emphasis on nutrients that are lacking. It also adds language about foods to the definition, still at (b)(14), and adds material to (f)(11) without altering the sentences inserted in 1978. The new (b)(14) reads:
(b)(14): “Supplemental foods” means those foods containing nutrients determined by nutritional research to be lacking in the diets of pregnant, breastfeeding, and postpartum women, infants, and children, and those 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, as prescribed by the Secretary. State agencies may, with the approval of the Secretary, substitute different foods providing the nutritional equivalent of foods prescribed by the Secretary, to allow for different cultural eating patterns.
Child Nutrition Act § 17, includes the following relevant provisions in a paragraph primarily addressing state operations:
“(f)(11) SUPPLEMENTAL FOODS—
(A) IN GENERAL—The Secretary shall prescribe by regulation the supplemental foods to be made available in the program under this section.
(B) APPROPRIATE CONTENT—To the degree possible, the Secretary shall assure that the fat, sugar, and salt content of the prescribed foods is appropriate.”
TABLE T-1 2015 DGAC Food Groups, Definitions, and Example Foods
| Food Group | Definition and Unit | Examples of 1 Serving Equivalent* |
|---|---|---|
| Fruits | Total intact fruits (whole or cut) and fruit juices (c-eq) | 1 c raw or cooked fruit; 1 c fruit juice |
| Vegetables | Total dark green, red and orange, starchy, and other vegetables; excludes legumes (c-eq) | 1 c raw or cooked vegetables |
| Dark green vegetables | Dark green vegetables (c-eq) | 1 c raw or cooked dark green vegetables |
| Red/Orange vegetables | Total red and orange vegetables (tomatoes and tomato products + other red and orange vegetables) (c-eq) | 1 c raw or cooked red/orange vegetables |
| Dry beans and peas | Beans and peas (legumes) computed as vegetables (c-eq) | 175 g cooked beans; 175 g cooked peas |
| Starchy vegetables | Total starchy vegetables (white potatoes + other starchy vegetables) (c-eq) | 155 g boiled or canned potatoes; 245 g cooked, frozen, or canned pumpkin |
| Other vegetables | Other vegetables not in the vegetable components listed above (c-eq) | 100 g raw cauliflower; 80 g raw eggplant |
| Grains | Total whole and refined grains (oz-eq) | 1/2 c cooked rice, pasta; 1 slice bread |
| Whole grains | Grains defined as whole grains and contain the entire grain kernel—the bran, germ, and endosperm (oz-eq) | 1/2 c cooked whole grain rice, pasta; 1 slice whole grain bread |
| Protein foods | Total meat, poultry, organ meat, cured meat, seafood, eggs, soy, and nuts and seeds; excludes legumes (oz-eq) | 1 egg |
| Meat, poultry, eggs | Total meat, poultry, organ meat, and cured meat (oz-eq) | 28.35 g cooked, lean meat or poultry |
| Seafood | Seafood (finfish, shellfish, and other seafood) (oz-eq) | 28.35 g cooked fish or shellfish |
| Nuts, seeds, soy | Peanuts, tree nuts, and seeds; excludes coconut; soy products, excluding calcium-fortified soy milk (soy milk), and mature soybeans (oz-eq) | 1/2 oz nuts; 1/2 oz seeds; 1 Tbsp peanut butter; 1/4 c roasted soybeans |
| Dairy | Total milk, yogurt, cheese, and whey. For some foods, the total dairy values could be higher than the sum of D_MILK, D_YOGURT, and D_CHEESE because the Miscellaneous Dairy component composed of whey is not included in FPED as a separate variable (c-eq) | 1 c milk; 1–2 oz cheese |
| Food Group | Definition and Unit | Examples of 1 Serving Equivalent* |
|---|---|---|
| Oils | Fats naturally present in nuts, seeds, and seafood; unhydrogenated vegetable oils, except palm oil, palm kernel oil, and coconut oil; fat present in avocado and olives above the allowable amount; 50 percent of fat present in stick and tub margarines and margarine spreads (grams) | 1.5 g per 100 g in olives and avocados; 100 g per 100 g in vegetable oil; 60 g per 100 g in tub margarine |
| Solid fats | Fats naturally present in meat, poultry, eggs, and dairy (lard, tallow, and butter); fully or partially hydrogenated oils; shortening; palm, palm kernel, and coconut oils; fats naturally present in coconut meat and cocoa butter; and 50 percent of fat present in stick and tub margarines and margarine spreads (grams) | 100 g per 100 g in coconut or palm oil; 81.1 g of 100 g in butter |
| Added sugars | Foods defined as added sugars: honey, corn syrup, white sugar, brown sugar, fructose (tsp-eq) | 1 tsp-eq of added sugars = 4 g of added sugars such as honey, corn syrup |
NOTES: c-eq = cup equivalents; DGAC = Dietary Guidelines Advisory Committee; FPED = Food Patterns Equivalent Database; oz-eq = ounce equivalents; Tbsp = tablespoon; tsp-eq = tsp equivalents.
* As indicated in the Food Patterns Serving Equivalent Database documentation (USDA/ARS, 2014).
SOURCES: USDA/HHS, 2015; serving sizes from USDA/ARS, 2014.
TABLE T-2 Food Package Modifications Suggested by Public Comment: Selected Themes
| Proposed Modification | Rationale Provided |
|---|---|
| CVV: | |
|
Mandate that states offer both fresh and some form of processed fruit and vegetable in the CVV |
There is no nutritional loss in other forms Would reduce confusion for participants with family members whose CVV does allow the purchase of other forms |
|
Longer shelf life |
|
| Milk: | |
|
Allow purchase of 2% or whole milk |
Literature shows no difference between 1% and 2% milk in childhood weight gain |
|
Reduce the amount of milk alternatives and increase the CVV or cheese/yogurt |
WIC gives too much milk; if more than one family member on WIC, gallons of milk would not fit standard refrigerator |
|
Allow almond, rice, or coconut milk to accommodate allergies |
Some participants have both milk and soy allergies |
| Whole grains: | |
|
Offer more whole grain options (e.g., whole grain pasta, rolls) |
Increase flexibility |
|
Increase whole grain bread sizes to 24–26 ounces per month |
Difficult to find certain sizes; would likely be cost neutral as stores charge the same for 16 ounce versus 26 ounce loaves |
|
Include enriched pasta. Permit flexibility of whole grain pasta package sizes up to 16 ounces |
Increase flexibility |
| Canned fish: | |
|
Offer pregnant women canned seafood |
DGA recommends more fish |
|
Add canned wild Alaskan salmon |
Comments regarding nutritional value and supporting local economy in Alaska |
|
Offer tuna as an option for children |
|
| Cereal: | |
|
Increase options for hot cereals (e.g. single packages) |
Participants would like more options |
|
Decrease amount of cereal/number of sugary cereals |
Highly processed increases blood sugar levels |
| Yogurt: | |
|
Allow all fat levels of yogurt for all participants |
Concerns that the restriction for only whole milk yogurt for 1-year-olds is challenging at the retail levels (limited yogurt availability in some stores; yogurt not labelled as whole milk) |
|
Reduce the allowed sugar content of yogurt to align with DGA |
Specification of < 40 grams of total sugar is too generous given that many popular yogurts contain lower levels. Manufacturers are working to lower sugar contents |
| Proposed Modification | Rationale Provided |
|---|---|
| Cheese: | |
|
Allow cheese for pregnant and postpartum women |
Cheese can be tolerated better than milk for lactose intolerant |
| Peanut Butter/Legumes: | |
|
Make canned beans an option |
“If participants can get peanut butter with added sugar and salt, canned beans should be an option.” |
|
Decrease amount of peanut butter, consider limiting additives allowed for peanut butters including hydrogenated oils and sweeteners added as “seasoning,” allow natural nut butters |
Packages have too much peanut butter (1 comment) |
|
Many participants with peanut allergy |
|
| Eggs: | |
|
Increase egg allowance |
Eggs are an important protein source for growing toddlers and pregnant moms |
|
Cholesterol is important for central nervous system development |
|
| Juice: | |
|
Increase CVV and remove or reduce juice |
Participants ask for more fruits and vegetables in place of juice Minimal nutrition |
|
Allow partial or full replacement of the juice benefit with CVV |
|
|
Dental dangers |
|
|
Mixed message of juice being a health food since provided by WIC |
|
|
Request by recipients |
|
|
Referred to as liquid candy |
|
| Infant foods: | |
|
Offer additional forms of fruits/vegetables with infant CVV |
Would reduce confusion among participants and allows more shelf-stable fruits/vegetables for families in rural areas |
|
Add meat for formula-fed infants; do not add meat |
Majority of families do not choose infant meats |
|
Flexibility for infants 6–12 months to use fresh fruits and vegetables instead of jarred foods |
Families can make their own baby foods |
|
Reduce the amount of baby foods to exclusively breastfed infants |
Excessive amounts of baby foods increase risk of abuse |
|
Consider additional complementary foods for infants age 9–11 months as they are transitioning to soft table foods such as regular breakfast cereal |
Infant cereal and infant fruits and vegetables provided by WIC are inappropriate texture for this age group |
| Proposed Modification | Rationale Provided |
|---|---|
| Special diets and other: | |
|
Expand substitutions for food allergies and vegetarians |
Currently no vegan WIC substitutions for egg and fish categories. DGA recommends increased consumption of plant foods. |
|
Offer vegan substitutions in the eggs/fish categories |
Vegetarians might be at risk for protein, iron, vitamin B12, zinc, calcium, and vitamin D deficiencies |
|
Continue to allow organic foods and Farmers’ Market Nutrition Program benefits |
Organic foods are perceived by some participants to be of improved safety or nutritional quality compared to conventionally produced foods |
|
Expand organic food options at the state level |
|
| Administration: | |
|
Consider a flexible range of package sizes that allow practical and cost-effective implementation |
16-ounce size of bread and 16-ounce whole wheat pasta are difficult to obtain, vegetable juices not available in 48 ounce sizes Often difficult for staff to explain allowable items and difficult for participants to find items at store Simplify shopping experience, eliminate need for cost containment (participants will be elastic consumers), reduce vendor fraud Rebate model is unsustainable and some argue it violates the World Health Organization code Increasing range of childhood obesity. The best estimates for the energy content of breastmilk is in a somewhat lower range than earlier studies, between 62–63 and 65–71 kcal per mL. Current recommendation is at odds with AAP and European guidelines |
|
Consider practical application of recommendations |
|
|
Incentivize breastfeeding by increasing the dollar amount of CVV for fully breastfeeding women above postpartum, pregnant, and partially breastfeeding |
|
|
Support breastfeeding through prenatal education, not food package incentives |
|
|
Allow option for frozen foods |
|
|
Round to next dollar amount instead of rounding down; allow flexibility to go above the maximum benefit when state funds allow |
|
|
Provide CVVs instead of specific foods for all food groups |
|
|
Revisit cost containment of formula |
|
|
Do not place the 67 kcal per 100 mL minimum energy requirement on standard infant formula but allow for the regulatory range of 63 to 71 kcal per 100 mL |
|
|
Redefine “fully breastfed” |
Definition of “fully breastfed” is not helpful |
NOTES: AAP = American Academy of Pediatrics; CVV = cash value voucher; DGA = Dietary Guidelines for Americans. This table summarizes only the public comments relevant to the task, or very commonly submitted. All public comments are accessible through the National Academies Public Access File. Email: paro@nas.edu.
REFERENCES
IOM (Institute of Medicine). 2006. WIC food packages: Time for a change. Washington, DC: The National Academies Press.
USDA/ARS (U.S. Department of Agriculture/Agricultural Research Service). 2014. Food patterns equivalents database 2011–2012: Methodology and user guide. Beltsville, MD: USDA/ARS. http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/fped/FPED_1112.pdf (accessed August 31, 2015).
