Review of the WIC Food Packages, Institute of Medicine, Washington, DC
Good afternoon. My name is Dr. Diana Zuckerman, and I am the President of the National Research Center for Women & Families. The Center is a non-profit, non-partisan organization that promotes the health and safety of women, children and families, by using objective, research-based information to encourage more effective programs and policies. We applaud the Committee’s report and their commitment to strengthening the WIC program by improving the food packages based on the latest science.
The WIC program provides essential help to our most vulnerable children and mothers, and the need for this vital program continues to grow. The latest census data show that the number and percentage of Americans living below the poverty line increased for the third consecutive year in 2003, especially for our nation’s children. One-third of Americans living below the poverty line are children, and one in five children in our country are poor. These statistics help explain why WIC currently serves almost one of every two infants in this country and one in four children between the ages of one and four.
As you determine how to implement your findings, we urge you to keep in mind that the food packages are not just a source of nutritional support, but also serve as an incentive to bring women into the WIC clinic and engage them in nutrition education, breastfeeding education and support, and referrals for health care. If parents decide not to enroll their children in WIC because the children’s food package is too small to be worth the effort, then the entire family will not reap any of the program’s benefits.
Tragically, food insecurity and hunger are facts of life for this many Americans. Although WIC is designed as a supplement, many families struggle to maintain adequate food supplies even with their WIC packages. And, research studies have found that the quality of non-WIC foods is much lower and includes such unhealthy foods as french fries, sweetened drinks, and candy.
As this country becomes more culturally diverse, so do the groups served by WIC. In 2002, Hispanics became the largest group (38 %) of WIC participants. There have also been increases in the proportion of Asians and Pacific Islanders served by WIC. The food packages are a symbol of what the government thinks is needed for good nutrition. To respect cultural differences and to help all families that need the program, WIC must offer food packages with a wider selection of foods and food prescriptions, offering participants choices that reflect the diversity of the WIC population.
The current packages do not address cultural differences in eating habits. States should have the flexibility to design food prescriptions to accommodate the cultural preferences and dietary consumption patterns of their WIC participants. For example, milk and cheese are not traditional foods in some cultures, and there is a high incidence of lactose intolerance among groups served by WIC. States should be allowed to substitute or add nutritionally equivalent foods that are locally available and desirable. For example, yogurt, calcium-fortified soymilk, and calcium-rich vegetables could substitute for some of the milk or cheese. Canned beans, chicken, and tofu could be substituted for dried beans, eggs, and peanut butter. Offering canned beans is especially essential, since dried beans are a WIC food item that are often not redeemed, possibly because dried beans require extensive cooking. WIC participants need a wide variety of food options within each target nutrient and food group. The bottom line: WIC families need to find foods that they are familiar with, that are easy to prepare, that they will eat, and that meet their nutritional needs.
I am sure that everyone here agrees that the current WIC packages are deficient in fruits and vegetables. Juices should be only one item in a fruit and vegetables category that is part of packages II, III, IV, V, VI, and VII. Package IV offers 288 fluid ounces of juice, well above the American Academy of Pediatrics recommendation of 123-186 ounces. The juice amounts in package II and IV should be reduced and replaced with fresh, canned and/or frozen fruits and vegetables. Fruit juices tend to be high in calories, whereas whole fruits and vegetables contain needed fiber that is not present in juices. Frozen and canned options must be included because fresh fruits and vegetables often cost more and are less available in low-income neighborhoods. Fruits and vegetables should be offered in addition to any produce available through the WIC Farmers’ Market Nutrition Program (FMNP). Unfortunately, FMNP is not offered in all states and is only offered in the summer months in a limited capacity.
We also recommend an increase in whole grain offerings and more choices of grain products, including tortillas, cornmeal, whole grain breads and rice. The criteria for these products should include recommended levels of iron, sugars, whole grains, saturated fats and trans fatty acids. Consumption of whole grains is associated with lower risk of type 2 diabetes, heart disease, stroke, and obesity. Two-thirds of Americans eat less than one serving of whole grains per day, whereas the U.S. Department of Health and Human Services recommends three servings per day. Whole grains are of particular concern since low-income individuals consume 40% less whole grains than individuals with high incomes.
Saturated fat in the diet contributes to obesity and increases the risk of heart disease. Thus, we recommend that saturated fat be limited from dairy sources. All milk in packages IV, V, VI, and VII should be 2%, 1%, or fat-free, with whole milk provided only if there is a child aged two years or younger. All cheeses provided through the WIC program should be low in fat.
It is also important to remember that the free infant formula in the WIC package is a disincentive to breastfeed. Breastfeeding has many health advantages for babies and recent research indicates it has health benefits for mothers as well. Low-income mothers are much less likely to breastfeed than more educated and affluent mothers, and WIC mothers are no exception. Although the WIC package for breastfeeding mothers includes food choices that are not available in other WIC packages, those choices are apparently not sufficiently generous to create a strong incentive to breastfeed. The additional juice, dried beans, carrots, and canned tuna apparently do not compete with the convenience and attraction of getting the relatively expensive infant formula for free. First of all, breastfeeding makes most mothers hungrier and thirstier, so they have to eat more. And, these mothers are well aware that infant formula is worth a lot more money than the dried beans, carrots, tuna, and additional juice and milk they would otherwise receive. That also makes the formula seem more attractive. Since breastfeeding will save health dollars in the long run, it makes sense to add — or at least substitute — more attractive choices to the package for breastfeeding mothers.
Lastly, we recommend that albacore (white) canned tuna not be offered in food packages and that only light canned tuna be offered. Our recommendation is based on the high levels of methylmercury in canned albacore tuna, which average three times as high as those in canned light tuna. The Food and Drug Administration has advised pregnant and breastfeeding women to eat no more than 6 ounces of albacore canned tuna per week, and to avoid certain types of fish entirely. It advises that young children consume even less, although the amounts depend on a child’s age and weight, and are unfortunately not specified. If the 26 ounces of canned tuna currently in the monthly package for nursing women is albacore tuna, that would exceed the FDA’s recommended maximum. Our Center has an even stricter recommendation: Because the amount of methylmercury in a 6-ounce can of albacore tuna sometimes exceeds the standard that the FDA considers safe, our Center and several other consumer groups recommend that pregnant and nursing women and young children eat no more than 6 ounces of albacore tuna each month. Fortunately, light tuna usually costs half as much as white tuna, and making this change would make more money available for the addition of yogurt, fruits, and vegetables. If tuna were made available for other packages in the WIC program, it should also be limited to small quantities of canned light tuna.
In addition to limiting the tuna in WIC packages to light tuna, it is vital that WIC recipients receive educational materials that warn of the dangers of methylmercury in swordfish, shark, tilefish, and fish that are caught in rivers and lakes. Low-income families sometimes catch fish to supplement their diet, and many states now have advisories warning about the methylmercury in locally caught fish. However, those advisories do not always come to the attention of low-income citizens.
Thank you for the opportunity to testify. I look forward to Phase II, and working with you to improve the WIC program for our country’s most vulnerable families.
Diana Zuckerman is president of the National Research Center for Women & Families in Washington, DC.
- 2003 U.S. Census Data
- Feeding Infants and Toddlers Study, Mathematica Policy Research, January 2004 Journal of the American Dietetic Association (http://www.mathematica-mpr.com/nutrition/infantfeeding.asp)
- Nutrition Assistance Program Report Series, The Office of Analysis, Nutrition and Evaluation. Report No. WIC-03-PC, WIC Participant and Program Characteristics 2002, United States Department of Agriculture Food and Nutrition Service. September 2003. Special Nutrition Programs.
- National WIC Association Position Paper: NWA WIC Culturally Sensitive Food Prescription Recommendations.
- Putnam J, Allshouse J, and Kantor L. “U.S. Per Capita Food Supply Trends: More Calories, Refined Carbohydrates, and Fats.” FoodReview 2002, vol. 25, pp. 2-15.
- U. S. Department of Health and Human Services, Dietary Guidelines for Americans. http://www.health.gov/dietaryguidelines/dga2000/document/frontcover.htm and http://www.health.gov/dietaryguidelines/dga2005/report/
- Putnam J, et al.