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Review of WIC Food Packages: Improving Balance and Choice: Final Report (2017)

Chapter: Appendix C: WIC Food Package Regulation

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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
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TABLE C-1 Comparison of IOM 2006 Recommendations and USDA and State Implementation Specific to Meeting Dietary Guidance

2006 IOM Report USDA Action
Major Proposed Changes Specific Recommendation Federal Regulationa State Option
Include fruits and vegetables for all individuals ages 6 months and older Provide a CVV for fruit and vegetable purchases, $8 for children and $10 for women; allow fresh and processed; allow jarred infant vegetables and fruits to infants ages 6 to 12 months. One lb of fresh bananas may replace 8 oz of infant food Provide a CVV of $8 for children; $10 for women; vegetables and fruits may be fresh or processed with no added sugars or fats; vendors must stock at least 2 fruits and 2 vegetables; jarred vegetables and fruits for infants ages 6 to 12 months, may substitute ½ of jars with a CVV for infants ages 9 to 11 months States must allow fresh and may allow processed; may restrict packagingb; may allow farmer’s markets to accept vouchers; for infants ages 9 to 11 months, substitution of a portion of jarred infant food vegetables and fruits with a CVV ($8 for fully BF; $4 for others) by individual assessment; states may allow the substitution of bananas for infant food as specified in the IOM (2006) report
Include more whole grain products Allow only whole grain breakfast cerealsc Allow whole grain bread with other possible whole grain substitutions At least ½ of all breakfast cereal on each state agency’s authorized food list must have whole grain as the primary ingredient by weight and meet labeling requirements for making a health claim as a “whole grain food with moderate fat content” States may select authorized cereals
Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Allow whole grain bread, brown rice, bulgur, oats, whole-grain barley, soft corn or whole wheat tortillas, and whole wheat macaroni (pasta) products States may select authorized breads and substitutions
Reduce amounts of saturated fat for participants ages 2 years and older (thereby reducing cholesterol and total fat provided) Reduce amounts of milk

Permit whole milk for children ages 1 to 2 years; for others milk must be 2% milkfat or less Reduce quantity of cheese

Reduce quantity of eggsd
Reduce amounts of milk

Permit whole milk between ages 1 and 2 years only; for others milk must be nonfat or 1% only Reduce cheese and limit substitution rate

Reduce quantity of eggs
No option to increase milk amounts

States may issue fat-reduced milks to infants 1 year of age if weight is a concern No option to increase substitution of cheese for milk

No option for eggs
Provide more flexibility for WIC state agencies and more variety and choice for WIC participants In grain category, allow soft corn or whole wheat tortillas, brown rice, oats, bulgur, and barley, as bread substitutes; allow soy beverage, tofu, and yogurt as milk substitutes; allow canned beans; allow tuna, salmon, sardines, and mackerel Whole grain tortillas (corn or wheat), brown rice, oats, bulgur, barley, and whole wheat macaroni (pasta) products may be substituted for bread; tofu may be substituted for milk; 1 qt yogurt may be substituted for 1qt milk; dried or canned beans; tuna, salmon, sardines, and mackerel permitted as fish options States must provide bread, milk, dry or canned beans, and at least 2 fish options; additional substitutions at state option

States may offer various substitutions in the whole grains category
Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
2006 IOM Report USDA Action
Major Proposed Changes Specific Recommendation Federal Regulationa State Option
Promote and support breastfeeding, especially full breastfeeding Provide a $10 CVV for all women Provide a $10 CVV for all women No option to change the CVV amount
Reduce formula to partially breastfed infants No routine issuance of formula to partially breastfed infants States may tailor amounts of formula up to the maximum allowance
Infant formula not provided in the first month to breastfeeding infants Infant formula may be provided to breastfed infants in the first month, but this should not be standardized No routine issuance in the first month to breastfeeding mothers, or may provide 1 can of powdered infant formula in the first month
Fully breastfed infants receive jarred infant food meats in addition to greater amounts of jarred infant food vegetables and fruits Individual needs should be assessed and the food quantities issued accordingly Assess individual needs to tailor packages
Additional quantities of milk, eggs, and cheese; also fish, for fully breastfeeding mothers Additional quantities of milk, eggs, and cheese; also fish, for fully breastfeeding mothers No option
Address developmental needs of infants and young children Slightly increase formula amounts for fully formula-fed infants ages 4 to 5 months Fully formula fed infants ages 4 to 5 months received a slightly increased amount of infant formula No option
Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Reduce formula amounts for infants ages 6 to 11 months; infant foods provided only at 6 months of age or older (and exclusion of juice) Reduced maximum amounts of formula; no infant foods provided from 0 to less than 6 months of age No option
Jarred infant food and fresh bananas for infants From 9 months to less than 1 year, half of jarred foods may be substituted with fresh vegetables and fruitse; for infants ages 6 months to less than 1 year, fresh bananas may be substituted for a limited amount of jarred infant food fruit State option to allow the infant fruit and vegetable substitutions
Address obesity concerns Slightly decrease total food energy provided by the packages after age 4 months (except for fully breastfed infants) including reduced milk, cheese, eggs, and juice Milk, cheese, eggs, and juice quantities were reduced overall No option
Limit sugars in jarred infant food, processed vegetables and fruits, breakfast cereals and whole grains Limits placed on added or total sugars content of jarred infant foods, processed vegetables and fruit, breakfast cereals, and yogurt States may further reduce total sugars limits

NOTES: BF = breastfeeding or breastfed; CVV = cash value voucher; lb = pound; oz = ounce; qt = quart or quarts.

a Federal regulation information is from the Final Rule issued March 4, 2014. See the documentation for the minimum requirements and specifications for foods including sugar limits and Standards of Identity.

b States may not selectively choose the vegetable and fruit varieties allowable, but may restrict packaging type and packaging sizes. Types may be restricted if vendor or participant confusion is anticipated.

c At least 51 percent of the grain in the product was required to be whole grain.

d The primary reason for reducing the quantity of eggs was to maintain cost-neutrality; fat and cholesterol reduction was a secondary result.

e Partially breastfed or fully formula-fed infants may receive a $4 CVV plus 64 ounces of infant food vegetables and fruits; fully breastfed infants may receive an $8 CVV plus 128 ounces of infant food vegetables and fruits.

SOURCES: IOM, 2006; USDA/FNS, 2014a.

Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

TABLE C-2 Timeline for Implementation of the Most Recent WIC Food Package Changes

Deadline for Implementation Action of State Agencies Source
1992 FP VII was created to encourage breastfeeding, added two new items: carrots and canned tuna, along with increased amounts of juice, cheese, legumes and peanut butter for women who exclusively breastfeed their infants WIC Program: Background, Trends, and Economic Issues (USDA/ERS, 2015)
October 1, 2009 New WIC food packages effective February 4, 2008 (CVV for vegetables and fruits, added whole grains, reduced amount of juice, milk, cheese and eggs, allowed greater substitution of foods), must be implemented by August 5, 2009, according to the Interim Rule, later changed to October 1, 2009, to align with the federal fiscal year WIC Interim Rule (USDA/FNS, 2007); WIC Program: Background, Trends, and Economic Issues (USDA/ERS, 2015)
June 2, 2014 CVV must increase for children from $6 to $8 WIC Final Rule (USDA/FNS, 2014a)
October 1, 2014 State agencies may issue authorized soy-based beverages or tofu to children who receive FP IV based on the determination of a competent professional authority WIC Final Rule (USDA/FNS, 2014a)
October 1, 2014 States must require only low-fat (1%) or nonfat milks for children over age 2 and women in FP IV through VII WIC Policy Memorandum 2014-6 (USDA/FNS, 2014b)
April 1, 2015 Split tender CVV must be implemented WIC Final Rule (USDA/FNS, 2014a)
April 1, 2015* States may authorize yogurt for children and women in FP III through VII WIC Final Rule (USDA/FNS, 2014a)
July 1, 2015 States are required to include white potatoes to be eligible for purchase with CVV 15 days after the date of enactment (December 31, 2014), all implementations including education and new product lists completed by July 1, 2015 WIC Policy Memorandum 2015-3 (USDA/FNS, 2015a)
October 1, 2015 CVV for women must increase from $10 to $11 WIC Policy Memorandum 2015-4 (USDA/FNS, 2015b)

NOTES: CVV = cash value voucher; FP = food package.

* Effective date.

Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

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 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 (Federal Register 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” (Federal Register 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 Federal Register 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 Federal Register p. 44422):

§ 246.2 (no “letter” designation): “Supplemental foods” [Reserved].

July 8, 1983: Proposed Rule (beginning on Federal Register p. 31502) issued to “reduce the regulatory burden on State and local agencies.” It states:

Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

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.”

Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

REFERENCES

IOM (Institute of Medicine). 2006. WIC food packages: Time for a change. Washington, DC: The National Academies Press.

USDA/ERS (U.S. Department of Agriculture/Economic Research Service). 2015. The WIC program: Background, trends, and economic issues, 2015 edition. Washington, DC: USDA/ERS. http://www.ers.usda.gov/media/1760725/eib134.pdf (accessed April 13, 2016).

USDA/FNS (U.S. Department of Agriculture/Food and Nutrition Service). 2007. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC food packages; interim rule, 7 C.F.R. § 246.

USDA/FNS. 2014a. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC food packages; final rule, 7 C.F.R. § 246.

USDA/FNS. 2014b. WIC policy memorandum #2014-6: Final WIC food package rule: Implementation of low-fat (1 percent) and nonfat milks provision. Alexandria, VA: USDA/FNS.

USDA/FNS. 2015a. WIC policy memorandum #2015-3 to WIC state agency directors: Eligibility of white potatoes for purchase with the cash-value voucher. Alexandria, VA: USDA/FNS.

USDA/FNS. 2015b. WIC policy memorandum #2015-4 to WIC state agency directors: Increase in the cash value voucher for pregnant, postpartum, and breastfeeding women. Alexandria, VA: USDA/FNS.

Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Page 491
Suggested Citation:"Appendix C: WIC Food Package Regulation." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population.

To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. In this third report, the committee provides its final analyses, recommendations, and the supporting rationale.

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