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?
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.
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.
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Oliveira V, Frazao E. The WIC program: background, trends and economic issues. 2015 ed. Economic Research Service: U.S. Department of Agriculture; 2015.
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.
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.
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.
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.
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.
Kennedy E, Guthrie JF. Nutrition assistance programs: cause of solution to obesity. Curr Obes rep. 2016;5(2):176–83.
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.
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.
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/
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.
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.
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.
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/
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Dablea D, Crume T. Maternal environment and the transgenerational cycle of obesity and diabetes. Diabetes. 2011;60(7):1849–55.
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.
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.
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.
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.
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.
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.
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.
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.
Pérez-Escamilla R, Kac G. Childhood obesity prevention: a life-course framework. Int J Obes Suppl. 2013;3(Suppl 1):S3–5.
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
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.
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.
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.
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.
Tenfelde S, Finnegan L, Hill PD. Predictors of breastfeeding exclusivity in a WIC sample. J Obstet Gynecol Neonatal Nurs. 2011;40:179–89.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Institute of Medicine. WIC food packages: time for change. Washington, DC: The National Academies Press; 2005.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
•• 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.
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.
Ishdorj A, Capps O. The effect of revised WIC food packages on Native American children. Am J Agric Econ. 2013;95(5):1266–72.
Chiasson MA, Findley SE, Sekhobo JP, et al. Changing WIC changes what children eat. Obesity. 2013;21(7):1423–9.
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.
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.
•• 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.
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.
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.
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.
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.
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.
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.
•• 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.
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.
Jesaitis A, Race P. Eat well play hard—New York State’s initiative to prevent childhood obesity. Pediatr Nutr. 2000;23:11–3.
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.
Institute of Medicine. Planning a WIC research agenda: workshop summary. Washington, DC: National Academies Press; 2011.
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.
The authors would like to thank Karla Molina for her assistance in conducting the literature review.
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.
This article is part of the Topical Collection on Obesity
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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