Skip to main content

The Role of WIC in Obesity Prevention

Abstract

Purpose of Review

This paper seeks to answer the following two questions: (1) Is participation in the Supplemental Nutrition Program for Women, Infants and Children (WIC) associated with changes in obesity and overweight? and (2) What obesity prevention interventions in the WIC setting may be most effective for obesity prevention?

Recent Findings

The available evidence supports the conceptualization of the role of WIC in obesity prevention across the life course, with suggested impacts/influence on gestational weight gain during pregnancy, rapid infant weight gain during infancy, healthy lifestyle behavior during interconception, and prevalence of obesity during early childhood. Through the provision of nutrition education, breastfeeding support, and healthy foods and beverages, the WIC program has the potential to influence the mother’s nutritional knowledge and her and her child’s dietary intake and behaviors in a positive way.

Summary

Given the wide reach of the program and the high quality of height/weight measurements taken by the WIC program, WIC has the potential to capitalize upon the early critical periods of development to reduce the incidence of overweight and obesity in a substantial proportion of low-income women and children.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Oliveira V, Frazao E. The WIC program: background, trends and economic issues. 2015 ed. Economic Research Service: U.S. Department of Agriculture; 2015.

    Google Scholar 

  2. Oliveira V. The food assistance landscape: FY 2015 annual report. Economic information bulletin no. (EIB-150) 21 pp; March 2016. Available from: https://www.ers.usda.gov/publications/pub-details/?pubid=44062.

  3. Kennedy E, Gershoff S, Reed R, Austin J. Evaluation of the effect of WIC supplemental feeding on birth weight. Jada. 1982;80(3):220–7.

    CAS  Google Scholar 

  4. Kotelchuck M, Schwartz JB, Anderka MT, Finison IS. WIC participation and pregnancy outcomes: Massachusetts statewide evaluation project. Am J Public Health. 1984;74(10):1086–92.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Metcoff J, Costiloe P, Crosby WM, Dutta S, Sandstead HH, Milne D, et al. Effect of food supplementation (WIC) during pregnancy on birth weight. Am J Clin Nutr. 1985;41(5):933–47.

    CAS  PubMed  Google Scholar 

  6. Rush D, Sloan NL, Leighton J, ALvir JM, Horvitz DG, Seaver WB, et al. The national WIC evaluation: evaluation of the special supplemental food program for women, infants, and children. V. Longitudinal study of pregnant women. Am J Clin Nutr. 1988;48(2 Suppl):439–83.

    CAS  PubMed  Google Scholar 

  7. Kennedy E, Guthrie JF. Nutrition assistance programs: cause of solution to obesity. Curr Obes rep. 2016;5(2):176–83.

    Article  PubMed  Google Scholar 

  8. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(12):2284–91. doi:10.1001/jama.2016.6458.

    CAS  Article  PubMed  Google Scholar 

  9. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292–9. doi:10.1001/jama.2016.6361.

    CAS  Article  PubMed  Google Scholar 

  10. Centers for Disease Control and Prevention. Overweight and obesity [Internet]. Atlanta: US Department of Health and Human Services; 2015. Available from: http://www.cdc.gov/obesity/

    Google Scholar 

  11. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes rev. 2016;17(2):95–107.

    CAS  Article  PubMed  Google Scholar 

  12. Vahratian A. Prevalence of overweight and obesity among women of childbearing age: results from the 2002 National Survey of Family Growth. Matern Child Health J. 2009;13(2):268–73. doi:10.1007/s10995-008-0340-6.

    Article  PubMed  Google Scholar 

  13. Taveras EM. Childhood obesity risk and prevention: shining a lens on the first 1000 days. Chil Obes. 2016;12(3):159–61. doi:10.1089/chi.2016.0088.

    Article  Google Scholar 

  14. Commission on Ending Childhood Obesity. Report of the Commission on Ending Childhood Obesity [Internet]. Geneva: World Health Organization; 2016. Available from: www.who.int/end-childhood-obesity/en/

    Google Scholar 

  15. The impact of the first 1,000 days on childhood obesity [Internet]. Durham, NC: Robert Wood Johnson Foundation, Healthy Eating Research. 2016. Available from: http://healthyeatingresearch.org/wp-content/uploads/2016/03/her_1000_days_final-1.pdf.

  16. Power C, Parsons T. Overweight and obesity from a life course perspective. In: Kuh D, Hardy R, editors. A life course approach to women’s health. Oxford: Oxford University Press; 2002. p. 304–28.

    Chapter  Google Scholar 

  17. Redsell A, Weng S, Swift JA, Nathan D, Glazebook C. Validation, optimal threshold determination, and clinical utility of the infant risk of overweight checklist for early prevention of child overweight. Chil Obes. 2016;12(3):202–9.

    Article  Google Scholar 

  18. Gorog K, Pattenden S, Antova T, Niciu E, Rudnai P, Scholtens S, et al. Maternal smoking during pregnancy and childhood obesity: results from the CESAR study. Matern Child Health J. 2011;15(7):985–92. doi:10.1007/s10995-009-0543-5.

    Article  PubMed  Google Scholar 

  19. Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014;14:1267. doi:10.1186/1471-2458-14-1267.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Olson CM, Strawdenman MS, Dennison BA. Maternal weight gain during pregnancy and child weight at age 3 years. Matern Child Health J. 2009;13(6):839–46.

    Article  PubMed  Google Scholar 

  21. Gillman MW, Rifas-Shinman S, Berkey CS, Field AE, Colditz GA. Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics. 2003;111(3):e221–6.

    Article  PubMed  Google Scholar 

  22. Mathai S, Derraik JG, Cutfield WS, Dalziel SR, Harding JE, Biggs J, et al. Increased adiposity in adults born preterm and their children. PLoS One. 2013;8(11):e81840. doi:10.1371/journal.pone.0081840.

    Article  PubMed  PubMed Central  Google Scholar 

  23. United States Department of Agriculture. Food and Nutrition Service. WIC. WIC food packages—-maximum monthly allowances [Internet]. (updated 2016 Nov 18). Available from: https://www.fns.usda.gov/wic/wic-food-packages-maximum-monthly-allowances.

  24. States Department of Agriculture. Food and Nutrition Service. Value enhanced nutrition education (VENA) in WIC: the first step in quality nutrition services [Internet]. 2006 Apr. Available from: https://wicworks.fns.usda.gov/wicworks/Learning_Center/VENA/VENA_Guidance.pdf.

  25. WIC. 2016 NWA WIC research needs to support an effective and efficient WIC program [Internet]. 2016. Available from: https://s3.amazonaws.com/aws.upl/nwica.org/2016nwawicresearchneedsassessment.pdf.

  26. Dablea D, Crume T. Maternal environment and the transgenerational cycle of obesity and diabetes. Diabetes. 2011;60(7):1849–55.

    Article  Google Scholar 

  27. Fingar KR, Lod SH, Dove MS, Gradziel P, Curtis MP. Reassessing the association between WIC and birth outcomes using fetuses-at-risk approach. Matern Child Health J. 2016;16:1–11.

    Google Scholar 

  28. Koleilat M, Kim LP, Whaley SE. Focusing on excessive gestational weight gain through education. Lecture presented at; 2015; National WIC Association 2015 Annual Education & Networking Conference & Exhibits.

  29. Kim LP, Koleilat M, Whaley SE. A qualitative study to examine perceptions and barriers to appropriate gestational weight gain among participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program. J Pregnancy. 2016; doi:10.1155/2016/4569742.

  30. National Academies of Sciences, Engineering and Medicine. Healthy weight gain during pregnancy [Internet]. 2016. (updated 2015 Aug 19). Available from: http://nationalacademies.org/HMD/About-HMD/Leadership-Staff/HMD-Staff-Leadership-Boards/Food-and-Nutrition-Board/HealthyPregnancy.

  31. Koleilat M, Whaley SE. Trends and predictors of excessive gestational weight gain among Hispanic WIC participants in Southern California. Matern Child Health J. 2013;17(8):1399–404.

    Article  PubMed  Google Scholar 

  32. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21th century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. doi:10.1016/S0140-6736(15)01024-7.

    Article  PubMed  Google Scholar 

  33. Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type II diabetes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(S467):30–7. doi:10.1111/apa.13133.

    CAS  Article  PubMed  Google Scholar 

  34. Whaley SE, Koleilat M, Leonard S, Whaley M. Breastfeeding is associated with reduced obesity in Hispanic 2–5-year-olds served by WIC. JNEB. under review/conditionally accepted.

  35. Pérez-Escamilla R, Kac G. Childhood obesity prevention: a life-course framework. Int J Obes Suppl. 2013;3(Suppl 1):S3–5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pérez-Escamilla, R. Is breastfeeding protective against childhood obesity? Discussion paper. NAM [Internet]. 2016. Available from: https://nam.edu/wp-content/uploads/2016/08/Can-Breastfeeding-Protect-Against-Childhood-Obesity.pdf

  37. United States Department of Agriculture. Food and Nutrition Service. WIC. Breastfeeding is a priority in the WIC program [Internet]. (updated 2016 Oct 27). Available from: https://www.fns.usda.gov/wic/breastfeeding-priority-wic-program.

  38. United States Department of Agriculture. Food and Nutrition Service .WIC. Loving Support Award Program at WIC [Internet]. (updated 2016 Oct 14). Available from: https://www.fns.usda.gov/wic/loving-support-award-excellence-program.

  39. WIC infant and toddler feeding practices study 2: infant year report (Internet). 2017. (updated 2017 Jan 12). Available from: https://www.fns.usda.gov/wic/wic-infant-and-toddler-feeding-practices-study-2-infant-year-report.

  40. Metallinos-Katsaras E, Brown L, Colchamiro R. Maternal WIC participation improves breastfeeding rates: a statewide analysis of WIC participants. Matern Child Health J. 2015;19:136–43.

    CAS  Article  PubMed  Google Scholar 

  41. Tenfelde S, Finnegan L, Hill PD. Predictors of breastfeeding exclusivity in a WIC sample. J Obstet Gynecol Neonatal Nurs. 2011;40:179–89.

    Article  PubMed  Google Scholar 

  42. Joyce T, Racine A, Yunzal-Butler C. Reassessing the WIC effect: evidence from the pregnancy nutrition surveillance system. J Policy Anal Manage. 2008;27(2):277–303.

    Article  PubMed  Google Scholar 

  43. United States Department of Agriculture. WIC. Breastfeeding policy and guidance [Internet]. 2016. Available from: https://www.fns.usda.gov/sites/default/files/wic/WIC-Breastfeeding-Policy-and-Guidance.pdf.

  44. United States Department of Agriculture. Food and Nutrition Service. WIC Works. WIC program nutrition education guidance [Internet]. 2016. Available from: https://wicworks.fns.usda.gov/wicworks/Learning_Center/ntredguidance.pdf.

  45. United States Department of Agriculture. WIC education study: phase I report [Internet]. 2016 (updated 2016 Jun 22). Available from: https://www.fns.usda.gov/wic-nutrition-education-study-phase-i-report.

  46. Arizona Department of Health Services Bureau of Nutrition and Physical Activity Research and Development. WIC needs assessment [Internet]. 2013 (updated 2013 Feb 22). Available from: http://azdhs.gov/documents/prevention/azwic/wic-needs-assessment-02-22-13.pdf.

  47. California WIC association. WIC nutrition education supports behavior change [Internet]. 2010 (updated 2010 Mar) Available from: https://www.phfewic.org/Projects/files/NWA_NEFPI_Brief2010.FINAL.pdf.

  48. Lockner DW, Kibbe D, Marley SC, Trowbridge F. Get healthy together: a program to improve counseling for childhood obesity in community based WIC clinics. J Health Care Poor Underserved. 2014;25:771–86.

    Article  PubMed  Google Scholar 

  49. Ritchie LD, Whaley SE, Spector P, Gomez J, Crawford PB. Favorable impact of nutrition education on California WIC families. J Nutr Educ Behav. 2010;42(3 suppl):S2–S10.

    Article  PubMed  Google Scholar 

  50. Crawford PB, Gosliner W, Strode P, Samuels SE, Burnett C, Craypo L, et al. Walking the talk: fit WIC wellness programs improve self-efficacy in pediatric obesity prevention counseling. Am J Public Health. 2004;94(9):1480–5.

    Article  PubMed  PubMed Central  Google Scholar 

  51. United States Department of Agriculture. Food and Nutrition Service. Fit WIC. Programs to prevent childhood overweight in your community: final report summary [Internet]. 2005. Available from: https://www.fns.usda.gov/sites/default/files/fitwic.pdf.

  52. Deehy K, Hoger FS, Kallio J, et al. Participant-centered education: building a new WIC nutrition education model. J Nutr Educ Behav. 2010;42(3 suppl):S39–46.

    Article  PubMed  Google Scholar 

  53. Isbell MG, Seth JG, Atwood RD, Ray TC. A client-centered nutrition education model: lessons learned from Texas WIC. J Nutr Educ Behav. 2014;46:54–61.

    Article  PubMed  Google Scholar 

  54. Au LE, Whaley SE, Gurzo K, Meza M, Ritchie LD. If you build it they will come: satisfaction of WIC participants with online and traditional in-person nutrition education. J Nutr Educ Behav. 2016;48(5):336–42.

    Article  PubMed  Google Scholar 

  55. Institute of Medicine. WIC food packages: time for change. Washington, DC: The National Academies Press; 2005.

    Google Scholar 

  56. US Department of Agriculture Food and Nutrition Service. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): revisions in the WIC food packages; final rule. Washington, DC: US Government Printing Office; 2014.

    Google Scholar 

  57. Hillier A, McLaughlin J, Cannuscio CC, Chilton M, Krasny S, Karpyn A. The impact of WIC food package changes on access to healthful food in 2 low-income urban neighborhoods. J Nutr Educ Behav. 2012;44(3):210–6.

    Article  PubMed  Google Scholar 

  58. O’Malley K, Luckett BG, Dunaway LF, Bodor JN, Rose D. Use of a new availability index to evaluate the effect of policy changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the food environment in New Orleans. Public Health Nutr. 2015;18(01):25–32.

    Article  PubMed  Google Scholar 

  59. Gleason S, Morgan R, Bell L, Pooler J. Impact of the revised WIC food package on small WIC vendors: insight from a four-state evaluation. Alexandria: Altarum Institute; 2011.

    Google Scholar 

  60. Andreyeva T, Luedicke J, Middleton AE, Long MW, Schwartz MB. Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods. J Acad Nutr Diet. 2014;112(6):850–8.

    Article  Google Scholar 

  61. Havens EK, Martin KS, Yan J, Dauser-Forrest D, Ferris AM. Food nutrition program changes and healthy food availability. Am J Prev med. 2012;43(4):419–22.

    Article  PubMed  Google Scholar 

  62. Rose D, O’Malley K, Dunaway LF, Bodor JN. The influence of the WIC food package changes on the retail food environment in New Orleans. J Nutr Educ Behav. 2014;46(3):S38–44.

    Article  PubMed  Google Scholar 

  63. Zenk SN, Powell LM, Odoms-Young AM, Krauss R, Fitzgibbon ML, Block D, et al. Impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policy on fruit and vegetable prices. J Acad Nutr Diet. 2014;114(2):288–96.

    Article  PubMed  Google Scholar 

  64. Zenk SN, Odoms-Young A, Powell LM, Campbell RT, Block D, Chavez N, et al. Fruit and vegetable availability and selection: federal food package revisions, 2009. Am J Prev med. 2012;43(4):423–8.

    Article  PubMed  Google Scholar 

  65. Andreyeva T, Middleton AE, Long MW, Luedicke J, Schwartz MB. Food retailer practices, attitudes and beliefs about the supply of healthy foods. Public Health Nutr. 2011;14(6):1024–32.

    Article  PubMed  Google Scholar 

  66. Ayala GX, Laska MN, Zenk SN, Tester J, Rose D, Odoms-Young A, et al. Stocking characteristics and perceived increases in sales among small food store managers/owners associated with the introduction of new food products approved by the Special Supplemental Nutrition Program for Women, Infants, and Children. Public Health Nutr. 2012;15(9):1771–9.

    Article  PubMed  Google Scholar 

  67. Gittelsohn J, Laska MN, Andreyeva T, Foster G, Rose D, Tester J, et al. Small retail perspectives of the 2009 Women, Infants, and Children program food package changes. Am J Health Behav. 2012;36(5):655–65.

    Article  PubMed  PubMed Central  Google Scholar 

  68. •• Tester JM, Leung CW, Crawford PB. Revised WIC food package and children’s diet quality. Pediatrics. 2016;137(5). This publication is important because it documents evidence of an association between the WIC food package revisions and higher diet quality for WIC-enrolled children based on analyses of data from a nationally representative sample.

  69. Whaley SE, Ritchie LD, Spector P, Gomez J. Revised WIC food package improves diets of WIC families. J Nutr Educ Behav. 2012;44(3):204–9.

    Article  PubMed  Google Scholar 

  70. Ishdorj A, Capps O. The effect of revised WIC food packages on Native American children. Am J Agric Econ. 2013;95(5):1266–72.

    Article  Google Scholar 

  71. Chiasson MA, Findley SE, Sekhobo JP, et al. Changing WIC changes what children eat. Obesity. 2013;21(7):1423–9.

    CAS  Article  PubMed  Google Scholar 

  72. Kong A, Odoms-Young A, Schiffer LA, Kim Y, Berbaum ML, Porter SJ, et al. The 18-month impact of Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions on diets of recipient families. Am J of Prev med. 2014;46(6):543–51.

    Article  Google Scholar 

  73. Odoms-Young AM, Kong A, Schiffer LA, et al. Evaluating the initial impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on dietary intake and home food availability in African-American and Hispanic families. Public Health Nutr. 2014;17(01):83–93.

    Article  PubMed  Google Scholar 

  74. •• Chiasson MA, Scheinmann R, Hartel D, McLeod N, Sekhobo J, Edmunds LS, et al. Predictors of obesity in a cohort of children enrolled in WIC as infants and retained to 3 years of age. J Community Health. 2016;41(1):127–33. This article reports results from the only study that used a longitudinal study design to track WIC-enrolled children from infancy through 3 years of age in New York State. Adjusted analyses showed evidence of lower levels of obesity among 3-year-old children whose mothers had received the full breastfeeding food packages compared to those children whose mothers did not receive a breastfeeding food package after the new WIC food package changes were implemented in New York State in January 2009.

    CAS  Article  PubMed  Google Scholar 

  75. Freedman DS, Sharma AJ, Hamner HC, et al. Trends in weight-for- length among infants in WIC from 2000 to 2014. Pediatrics. 2017;139(1): e20162034. doi:10.1542/peds.2016-2034. Epub 2016 Dec 13.

  76. Crespi C, Alfonso V, Whaley S, Wang M. Validity of child anthropometric measurements in the special supplemental nutrition program for women, infants, and children. Pediatr res. 2012;71(3):286–92.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Sharma AJ, Grummer-Strawn LM, Dalenius K, Galuska D, Anandappa M, Borland E, et al. Obesity prevalence among low-income, preschool-aged children United States, 1998–2008. Morbidity and Mortality Weekly Report (MMWR). 2009;58(28):769–73.

    Google Scholar 

  78. Sekhobo JP, Edmunds LS, Reynolds DK, Dalenius K, Sharma A. Trends in prevalence of obesity and overweight among children enrolled in the New York State WIC Program, 2002-2007. Public Health Rep. 2010;125(2):218–24.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Sekhobo JP, Edmunds LS, Dalenius K, Jernigan J, Davis CF, Giddings M, et al. Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations. Prev Chronic Dis. 2014;11:E181. doi:10.5888/pcd11.140152.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Sekhobo J, Edmunds L, Whaley S, Koleilat M. Obesity prevalence among low-income, preschool-aged children: New York City and Los Angeles County, 2003–2011. Morbidity and Mortality Weekly Report (MMWR). 2013;62(02):17–22.

    Google Scholar 

  81. •• National Academies of Sciences, Engineering and Medicine. Assessing prevalence and trends in obesity: navigating the evidence. Washington, DC: National Academies Press; 2016. doi:10.17226/23505. This report highlights the important role that WIC height and weight data have played in tracking early childhood obesity prevalence trends and thus contributing to our understanding of the pediatric obesity epidemic in low-income populations in the USA.

    Google Scholar 

  82. Edmunds LS, Sekhobo JP, Dennison BA, Chiasson MA, Stratton HH, Davison KK. Association of prenatal participation in a public health nutrition program with healthy infant weight gain. Am J Public Health. 2014;104(Suppl 1):S35–42. doi:10.2105/AJPH.2013.301793.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Jesaitis A, Race P. Eat well play hard—New York State’s initiative to prevent childhood obesity. Pediatr Nutr. 2000;23:11–3.

    Google Scholar 

  84. Whaley SE, McGregor S, Jian L, Gomez J, Harrison G, Jenks E. A WIC-based intervention to prevent early childhood overweight. J Nutr Educ and Behav. 2010;43(3):S47–51.

    Article  Google Scholar 

  85. Institute of Medicine. Planning a WIC research agenda: workshop summary. Washington, DC: National Academies Press; 2011.

    Google Scholar 

  86. National Academies of Sciences, Engineering and Medicine. Review of WIC food packages: improving balance and choice: final report. Washington, DC: National Academies Press; 2017. doi:10.17226/23655.

    Google Scholar 

Download references

Acknowledgements

The authors would like to thank Karla Molina for her assistance in conducting the literature review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria Koleilat.

Ethics declarations

Conflict of Interest

Maria Koleilat, Shannon E. Whaley, Kristine B. Esguerra, and Jackson P. Sekhobo declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Obesity

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Koleilat, M., Whaley, S.E., Esguerra, K.B. et al. The Role of WIC in Obesity Prevention. Curr Pediatr Rep 5, 132–141 (2017). https://doi.org/10.1007/s40124-017-0135-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40124-017-0135-6

Keywords

  • WIC
  • Obesity prevention
  • Life course perspective
  • Breastfeeding
  • Nutrition education
  • Supplemental food packages