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New Study: WIC Food Improves Preschool Children’s Diet Quality

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One in five American children entering elementary school is overweight, highlighting the critical need to improve the diets of younger children. And that makes the findings of a new research study even more compelling. A University of California study published in the journal Pediatrics today shows that food provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) improves the diet quality of preschool children. 

The study’s authors are June Tester, UCSF Benioff Children’s Hospital Oakland; Cindy Leung, UC San Francisco School of Medicine, Center for Health and Community; and Patricia Crawford, Nutrition Policy Institute, which operates under UC’s division of Agriculture and Natural Resources. (Read a Q&A with study co-author Pat Crawford here)

Background: 

WIC is a national program administered by the USDA‘s Food and Nutrition Services agency (FNS). WIC delivers grants to states to provide a range of services to improve “the health and nutrition” of pregnant women, infants and children up to the age of 5 years. These services include supplemental food voucher packages and nutrition education. More than 4 million American children are currently served by the WIC program.

WIC was created as a two-year pilot program in 1972, via an amendment to the Child Nutrition Act of 1966. The amendment was introduced by Senator Hubert Humphrey of Minnesota. Within a short time, the program was operating in forty-five states. In 1975, WIC was established as a permanent USDA program.

In 2007, based on research provided by the Institute of Medicine (IOM – now the Health and Medicine Division of the National Academies of Sciences), changes were recommended to revise the WIC food package to align more closely with the IOM’s dietary recommendations. The changes took effect in 2009. Among the changes? Adding more fruits, vegetables and whole grains to the food voucher package. The changes also included lower-fat milk and a 50% decrease in the juice allotment (healthier portions of whole fruit were added). For information about the kinds of foods WIC packages contain, click here.

Foods for Children and Women
Maximum monthly allowances of WIC supplemental foods in the new WIC food packages. Foods for Children and Women. Source: http://www.fns.usda.gov/wic/final-rule-revisions-wic-food-packages

Why the Study Matters:

This UC study is the first to use a nationally representative sample to report on what are viewed as significant improvements in the “diet quality in young children associated with the WIC package change.”

The researchers “analyzed the diets of 1,197 children, ages 2 to 4 years, from low-income households before and after the 2009 change in the food package.”

Study co-author and pediatrician June Tester said, “The change in the WIC food package is an important policy change in the effort to improve the quality of diets of young children…”

The study is also the first to use the updated Healthy Eating Index (HEI-2010), the tool that enables us to assess how America’s dietary patterns match up with the nation’s Dietary Guidelines. Learn more about the Healthy Eating Index in the following interview with the USDA’s Angela Tagtow where she discusses the 2015 Dietary Guidelines. The following are excerpts from long here interview: part 1 and part 2.

DISCLOSURE: UC Food Observer editor Rose Hayden-Smith agreed to submit questions for review to the USDA in advance of her Q&A with Angela Tagtow. The final transcript was also reviewed by the USDA prior to publication. Hayden-Smith and Tagtow have known each other for eight years, since participating together in the W.K. Kellogg Foundation-funded Food and Society Policy fellows program in 2008-2009. This is the first of a two-part series. The second part of the series discusses the process for adopting the 2015 Dietary Guidelines, the shift to more holistic “eating patterns” and the backlash against suggestions to include environmental sustainability.

 

Q: What is concerning you about America’s health?

Ms. Tagtow: As a public health dietitian, my entire career has been about promoting healthy eating and physical activity. It’s always been the focus of my efforts. Coming to the USDA has provided an opportunity to truly be at the forefront of efforts to drive change to improve the health of this country. The one thing that is so concerning is that nutrition remains one of the most powerful tools at our disposal to make an immediate and direct impact on diet-related chronic disease – and subsequent health care costs – in this country, yet we struggle to do so. That is my biggest concern.

Over the last thirty years, diet-related chronic diseases have continued to rise. We know that diet is a direct cause of these diseases – Americans are not eating according to the Dietary Guidelines, yet we can’t seem to find that tipping point. There are many influences on the food system that are preventing us from achieving that tipping point. Now, I do have hope and have seen changes with our approaches in addressing overweight and obesity, and other diet-related chronic diseases. These approaches expand beyond direct interventions. Diet interventions are very helpful with individuals, but it takes much more of a comprehensive systems approach to looking at food settings, food policies, investing in programs – whether government or other programs – to assure that healthy food is always the easy choice. USDA has made great strides on this front with healthier school meals, a revised WIC food package and significant expansion of farm-to-school efforts. Systemic changes as to be part of the formula.

I applaud the USDA and HHS team on the production of graphics that convey complex information in the 2015 Dietary Guidelines. In particular, there is a graphic that shows current eating patterns. A bar graph shows where we are meeting the guidelines and where we aren’t…on almost every food group we’re not anywhere near meeting the Dietary Guidelines.

The other set of data that gives me concern is the Healthy Eating Index. On a scale of 1 to 100 – the current Healthy Eating Index – the average diet quality across the nation – is 59. That’s an increase of almost 10 index points, making a slight increase in the last 15 years with improving the American diet. Although this gives me hope, with that trajectory, we’re just not going to meet the Healthy People 2020 goals. We ALL need to do more.

Dietary Intakes Compared to Recommendations - Graph
Dietary Intakes Compared to Recommendations. Percent of the U.S. Population Ages 1 Year and Older Who are Below, At, or Above Each Dietary Goal or Limit. Source: http://health.gov/dietaryguidelines/2015/guidelines/chapter-2/current-eating-patterns-in-the-united-states/

Q: What do you think are the largest challenges Americans face in terms of achieving a healthy overall diet?

Ms. Tagtow: One of the single largest challenges Americans think they face probably relates to our perception of time. We think that it takes additional time or costs too much to eat healthfully. Perhaps that is true to an extent. I also think that the myriad of influences on our food decisions throughout our day – whether it’s the food setting where we purchase our food or the environment where we consume it – can sabotage healthy eating goals. There are so many opportunities to advance this work in behavioral design and behavioral economics and how they influence food and consumption choices. We need to continually strive to create settings and environments where healthy food is the easiest choice. And this can help erase the perception that it takes more time to eat healthfully. The setting can support our healthy eating goals.

Q: If you could get the average American to make one or two dietary changes, what would they be?

Ms. Tagtow: I keep coming back to our current consumption patterns. There are so many opportunities to make small changes and shifts in our eating choices.

That part is nearly limitless…each and every time you eat – or drink – you are making a decision and have an option of making a shift to a healthier choice. The easiest thing people can do – and the science is so strong here – is focusing on fruits and vegetables to make shifts. People can increase the amount consumed, or make a shift within groups, for example, from red and yellow to dark and leafy green vegetables.

A key is to identify things you can easily do and enjoy doing that would result in a change…and lead, perhaps, to a lifetime habit. And it’s about making small shifts over time…and realizing an optimal diet once you’ve met your goals.

Elementary Pupils Collecting Healthy Lunch In Cafeteria

Q: Part of your work at CNPP has been to shepherd the 2015 Dietary Guidelines through the review and adoption process. What would you want the public to understand about that process?

Ms. Tagtow: Because it is an extensive process, it does take 2-3 years. We’re always engaged in some phase of the process.

The process of developing the Dietary Guidelines is extremely rigorous. We made extensive efforts to make sure that the process was transparent, but most importantly, that the scientific integrity behind the process was of the highest standards. The extensive rigor, transparency and strategies that support scientific integrity have totally driven this process.

And I know there have been lots of discussion in media and certain groups that express that perhaps the process doesn’t meet those characteristics, but I stand firm that it does.

The core of the Dietary Guidelines has remained relatively consistent over time, but has advanced with the science. Even though the core messages have remained relatively consistent, there’s been an evolution of science in nutrition. I’d say maybe we’re hitting our adolescent stage when it comes to the science of nutrition, if you will.

The science started out looking at the connection between nutrients, health and chronic disease. Then the science evolved to food groups. Now, the research has grown to where we can look at an entire dietary pattern and its influence on health. We need to let the public know that the Dietary Guidelines are built on the current body of nutrition science. The Dietary Guidelines are not based on a report that comes out tomorrow, or a media headline. They are based on a thorough review of the entire body of nutrition science. That’s why there is consistency from edition to edition. The science becomes more robust and methodology more rigorous. I anticipate down the road it will be even more robust and even more rigorous.

The Dietary Guidelines Advisory Committee also provides research recommendations. Because of the recent level of engagement, I anticipate that in the next 5, 10, 15 years, we will have emerging and expanded bodies of science available to us to inform the Guidelines.

I also think we need to continue to make very clear that the Dietary Guidelines edition released in January is intended for a professional audience. By that, I mean health practitioners, government officials, government programs, policy folks, etc. They are not written for consumers. And that’s an important point to elevate. Because of that, we at CNPP take the next step and translate and test messages based on the Dietary Guidelines and reach out to consumers through a variety of communications and marketing efforts to make sure messages resonate.

 

About Angela Tagtow: Angela (“Angie”) Tagtow has served as the Executive Director for the Center for Nutrition Policy and Promotion (CNPP) at the U.S. Department of Agriculture (USDA) in Washington, D.C. since July 2014.

The CNPP is the smallest USDA agency and focuses on improving American health. It is probably best known for its work in developing and promoting the Dietary Guidelines (in partnership with theDepartment of Health and Human Services). These guidelines are reviewed every five years.

Tagtow is a registered dietitian who is nationally known for her expertise in nutrition research and advocacy. She has extensive experience working on issues related to the USDA’s food programs. Tagtow worked in a leadership position with the Iowa Department of Public Health’s (IDPH) Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Program.

She has served in a variety of leadership positions within the Academy of Nutrition and Dietetics, Iowa Academy of Nutrition and Dietetics, Society for Nutrition Education and Behavior and the American Public Health Association. Her research has been extensively published. She launched and was the managing editor of the Journal of Hunger & Environmental Nutrition and also served on the editorial board of the Childhood Obesity Journal. She co-founded a statewide non-profit focused on health and food systems.

Tagtow recently served as an Endowed Chair, Senior Fellow at the University of Minnesota, College of Food, Agricultural and Natural Resource Sciences. Previously, she was a Food and Society Policy Fellow with the University of Missouri, Thomas Jefferson Institute and the Institute for Agriculture and Trade Policy (programs funded by the W.K. Kellogg Foundation). She is a graduate of the University of Northern Iowa and Iowa State University.

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