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

Chapter: Appendix M: Behavioral Approaches in WIC as a Potential Action

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Suggested Citation:"Appendix M: Behavioral Approaches in WIC as a Potential Action." 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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Appendix M

Behavioral Approaches in WIC as a Potential Action

The decision tree in Chapter 5, Figure 5-1, includes behavioral approaches as a possible option for addressing low consumption of nutrients or food groups. Behavioral approaches may overcome some challenges that prevent individuals from making the choice that best aligns with the Dietary Guidelines for Americans (DGA). These approaches to reducing cognitive load (the amount of information that must be processed at one time) have been demonstrated to improve individual food choice behavior.

Consumers frequently behave in ways (e.g., make decisions about foods) that contradict standard assumptions of economic theory (Just and Payne, 2009). Individuals often exhibit biases, a prime example being loss aversion (Kahneman and Tversky, 1984), when making choices. Loss aversion refers to the tendency to treat losses differently than gains, that is, people will pay less for an object they do not already have compared to what they will accept to give that object up. People also exhibit a tendency to remain within the status quo, even if choosing an alternative action seems clearly better. The implication for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is that there may be ways to frame food package choices to influence participant decisions, for example to make the breastfeeding package the status quo or “default” choice, or alternatively, to make it clear that when one chooses the partial or nonbreastfeeding package, the mother receives less food. There is evidence to suggest that, when individuals select new goods, they tend to focus on utilitarian characteristics (functional features of a good; an example for food is “healthful”). However, when individuals decide what to give up, they focus instead on hedonic characteristics (experiential features of a

Suggested Citation:"Appendix M: Behavioral Approaches in WIC as a Potential Action." 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.
×

good; an example for food is taste) (Dhar and Wertenbroch, 2000; USDA/ERS, 2007). Thus, individuals might be willing to consider healthfulness when adding foods to their diet, but be less willing to give up a food that is perceived as tasting good. In the context of WIC, an example would be a greater willingness to add low-fat yogurt compared to giving up higher-fat milk. The U.S. Department of Agriculture’s Economic Research Service (USDA-ERS) also reviewed research showing that specific cues (i.e., appearance, brand, name, price, and information) can influence product choices, which may be relevant for the labeling of food items (USDA/ERS, 2007).

Additionally, there is considerable evidence from the field of behavioral economics that the present time is valued more than future time and that individuals respond differently when asked what they would trade “now” for $10 provided in 2 weeks compared to what they would trade 1 month from now for $10 provided in 6 weeks (Loewenstein, 1988).1 In the context of this decision being faced by a new WIC woman participant, the trade-off would be what the participant might receive now compared to the value of what would be received later. The choice now is the value of 806 fluid ounces of formula right away and less food in her package compared to the value of the breastfeeding package now (extra food in the package for the mother and nothing for the infant). The option (choice) later in the period of 6 to 12 months from now is the relatively lower value of the formula package but no benefits for the mother compared to the value of the breastfeeding package (maternal food and some additional food [meats] for the infant). The participant might be inclined to select the breastfeeding package at higher rates than if she had made the decision at some point before the baby was born, over both choices that occur in the future. Recommitment has been suggested as a strategy to address this tendency, or present bias. In the WIC program, periodic WIC office visits and breastfeeding peer counseling offer participants continuing opportunity for (re)commitment.

Although the field of behavioral economics is relatively new, there is evidence from intervention studies that indicates that incentives can induce behavior change. For example, the Health Incentives Pilot study conducted in Massachusetts provided Supplemental Nutrition Assistance Program recipients with an additional benefit of 30 cents for every dollar spent on specific vegetables and fruits. Participants who received the benefits consumed 26 percent more of the targeted vegetables and fruits compared to the group that did not receive the extra benefit (USDA/FNS, 2014). A number of other behavioral economics studies of potential relevance to

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1 There is a body of literature that suggests food assistance recipients consume more of their allotment right around the time the benefits are disbursed (e.g., Wilde and Ranney, 2000). One explanation for this is that recipients have a high personal discount rate and value the present much more than the future.

Suggested Citation:"Appendix M: Behavioral Approaches in WIC as a Potential Action." 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.
×

WIC are currently under way, funded through the Behavioral Economics Research Center at Duke University (BECR, 2016). Outcomes of this and future work may yield practically applicable strategies for improving WIC participant redemption and intake of foods provided in the food packages.

REFERENCES

BECR (Behavioral Economics Research Center at Duke University). 2016. Funded 2015 WIC white papers. https://becr.sanford.duke.edu/funding/wic (accessed August 30, 2016).

Dhar, R., and K. Wertenbroch. 2000. Consumer choice between hedonic and utilitarian goods. Journal of Marketing Research 37(1):60–71.

Just, D. R., and C. R. Payne. 2009. Obesity: Can behavioral economics help? Annals of Behavioral Medicine 38(Suppl 1):S47–S55.

Kahneman, D., and A. Tversky. 1984. Choices, values, and frames. American Psychologist 39(4):341–350.

Loewenstein, G. F. 1988. Frames of mind in intertemporal choice. Management Science 34(2):200–214.

USDA/ERS (U.S. Department of Agriculture/Economic Research Service). 2007. Could behavioral economics help improve diet quality for nutrition assistance program participants? Washington, DC: USDA/ERS. http://ben.cornell.edu/pdfs/USDA-BeEcon.pdf (accessed December 21, 2016).

USDA/FNS (U.S. Department of Agriculture/Food and Nutrition Service). 2014. Evaluation of the healthy incentives pilot (HIP): Final report. http://www.fns.usda.gov/sites/default/files/HIP-Final.pdf (accessed December 21, 2016).

Wilde, P. E., and C. K. Ranney. 2000. The monthly food stamp cycle: Shopping frequency and food intake decisions in an endogenous switching regression framework. American Journal of Agricultural Economics 82(1):200–213.

Suggested Citation:"Appendix M: Behavioral Approaches in WIC as a Potential Action." 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 M: Behavioral Approaches in WIC as a Potential Action." 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 M: Behavioral Approaches in WIC as a Potential Action." 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 M: Behavioral Approaches in WIC as a Potential Action." 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 691
Suggested Citation:"Appendix M: Behavioral Approaches in WIC as a Potential Action." 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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