Obesity Trends Reversed in Children on Food Voucher Program

Pam Harrison

April 15, 2019

Obesity in young children between the ages of 2 and 4 years in the United States is declining thanks in part to changes made to the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) that improved the quality of foods parents could purchase with WIC food vouchers, new research shows. 

The WIC provides vouchers for foods and beverages to more than half of all US infants and one quarter of low-income pregnant and postpartum women and children under age 5 years.

"For obesity, prevention is key because obesity is very, very difficult to change once someone has it," senior author Erica Kenney, ScD, MPH, assistant professor of public health nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, told Medscape Medical News.

"So helping children form healthy eating habits and healthy relationships with food from an early age is a relatively lower cost, lower effort way to help prevent obesity and, much more importantly, the chronic diseases in adulthood like cancer, diabetes, and cardiovascular disease that can be associated with it," she added.

Madeleine I.G. Daepp, MSc, Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, and colleagues published their findings online April 2 in Pediatrics.

The goal of the study was to evaluate whether trends in obesity at both a national and state level among 2- to 4-year-old WIC participants changed after the WIC food package was revised in 2009.

The revised package provided extra cash allowances for fruits and vegetables, cut the previous juice allowance in half, required 2 to 4 year olds to consume only low-fat or skim milk, reduced the amount of cheese available for consumption, and required children to eat whole-grain rather than refined-grain products.

The data set included information from 49 states and involved anywhere from 2,253,471 children during 2000 to 3,152,137 children during 2012.

Prior to the changes, investigators estimated the prevalence of obesity among 2 to 4 year olds participating in WIC was increasing by 0.23 percentage points per year.

After the package revisions, the prevalence of obesity in the same cohort declined by 0.34 percentage points per year (post-2009 change in slope, -0.57 percentage points annually).

This meant that if the previous trend towards increasing childhood obesity had continued, "we'd expect that in 2014 the prevalence of obesity among WIC 2 to 4 year olds would have been greater than 16.5% [whereas] in reality it was about 14%," Kenney explained.

"As a very rough ballpark estimate, this is tens of thousands of more children who would have had obesity in 2014 had this trend continued," she added.

Fewer Total Calories

Families who participated in WIC purchased 11% fewer total calories after the 2009 package change compared with before.

Lower caloric intake drives obesity; therefore, the lower caloric intake likely influenced the observed annual decline in obesity prevalence among 2 to 4 year olds in WIC, Kenney speculated.

However, the fact that the new food package provides for more foods that help children feel full longer — and fewer foods and beverages that simply add empty calories without affecting satiety — "the food package also helped make it easier for people to keep from overeating without realizing it," she explained.

Asked what else policymakers might do to ensure the prevalence of childhood obesity continues to decline, Kenney suggested that WIC officials should try to keep more young children who are eligible for WIC in the program.

"A lot of 2 to 4 year olds who could benefit from WIC are not participating, so finding out why these children aren't participating and figuring out a way to help their families get in and stay in if they are eligible would be key," she said.

The Institute of Medicine has also convened a panel of experts to re-review the WIC food package to see if further changes can be made to take the observed benefits on childhood obesity further.

To be eligible for WIC, households must have an income 185% of the federal poverty level or lower or participate in several other federal aid programs and be at nutritional or medical risk.

According to the US Centers for Disease Control and Prevention, the prevalence of obesity among WIC participants in 2016 was 14.1% compared with 13.9% for all 2 to 5 year olds both in and out of the program.

The authors have reported no relevant financial relationships.

Pediatrics. Published online April 2, 2019. Abstract

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