WIC: A Key Player in the Fight Against Childhood Obesity
It was an honor for me to share the podium with a number of very distinguished and highly respected experts during a recent Altarum Institute Policy Roundtable on Capitol Hill. I happened to speak after Dr. Maxine Hayes, the state health officer for the state of Washington, and found her presentation to be very engaging and enlightening.
Even though I have worked with the Women, Infants, and Children program for more than 30 years, there’s always another way of looking at it. Twenty years ago, I would have said that WIC is a maternal and child health and public health program. Today I would have to agree with Dr. Hayes, who reminded us all that WIC is really about primary prevention. WIC participation saves taxpayer dollars in the babies’ early years and contributes to the prevention of several chronic diseases in both the mom and the child later in life. WIC is also taking on a very important role in fighting an epidemic that poses one of the greatest new threats to childhood health: obesity.
The Unites States is in the midst of an obesity epidemic. For the past 30 years, obesity has increased in all segments of the population regardless of age, gender, or ethnicity. Among women of childbearing age, the percentage of obesity nearly tripled from 12.3 percent in 1980 to 34 percent in 2008. In children 2–5 years old, the prevalence more than doubled from 5 percent in 1980 to 12.4 percent in 2006. Researchers predict that if the rate of overweight and obesity continues to grow at the current pace, 75 percent of adults and about 24 percent of children will be overweight or obese by 2015.
While there is no evidence that women and children enrolled in WIC are more likely to be overweight compared to the general U.S. population, there is evidence that overweight and obesity disproportionately affect ethnic minority groups and low-income populations. The prevalence of overweight and obesity was highest among non-Hispanic blacks (78.2 percent) and Mexican-American women (76.9 percent) compared to 61.2 percent non-Hispanic white women. And women with incomes below the poverty level were more than twice as likely to be obese compared to women in higher incomes. Since WIC serves low-income women and children, and since more than 60 percent of total WIC participants are Hispanic or black, obesity will obviously have a disproportionate impact on the WIC population.
One of the most powerful aspects of the WIC program in helping fight obesity is its sheer scale: WIC touches more than half of all infants born in the U.S. and about a quarter of the children in the entire country. With this kind of reach, WIC has the potential to positively affect the lives of millions of children.
The structure of WIC also ensures that it can have a large effect on obesity prevention. Before, during, and after pregnancy are critical times because data show that children whose mothers were obese during early pregnancy were 2.5 times more likely to be overweight during their preschool years, and about 70 percent of overweight children will become overweight adults. During the pregnancy, WIC also promotes breastfeeding and educates the mom on successful breastfeeding in the critical first couple of weeks and beyond.
WIC can also have a very strong impact because it touches children at such an early age. Children establish healthy eating patterns early in life. WIC teaches the appropriate time to introduce solids, when and how to wean from the bottle, healthy snacks and meals, and what to expect when trying to feed that “terrible two year old.” Moreover, the cornerstone of WIC is quality nutrition education. It is participant centered and focused on behavior change, and individualized information is reinforced at every visit.
WIC plays a critical role in linking families with needed health and nutrition services, making referrals to their health care provider when needed and making sure that they apply for Medicaid or the Supplemental Nutrition Assistance Program if eligible. WIC is often the entrance to public health and the health care system, and we help families get the services that they need.
Even though WIC serves more than half the babies born in this country, we know that we can’t do it all, nor should we. We need partners that are all on the same page. That was evident during the National WIC Association WIC Breastfeeding Summit that took place in Washington, D.C., on March 9. Partners from all across the WIC and breastfeeding communities convened to show their support and begin the development of a WIC breastfeeding plan. Research shows that breastfeeding is the very first and best intervention against childhood obesity and thus should be a cornerstone of any obesity prevention effort.
To me, the most remarkable part of the day was the caliber of partners who came, including the undersecretary of agriculture for the Food and Nutrition Service, the acting deputy surgeon general, the president-elect of the American Academy of Pediatrics, our national WIC program director, and the chief of the Maternal and Child Nutrition Branch of the Centers for Disease Control and Prevention. There were also association and corporate partners, WIC participants, and even some breastfeeding moms (with their babies!). All were in strong support of breastfeeding and working together with WIC to improve breastfeeding initiation, exclusivity, and duration.
We agreed during the summit that we still have a lot of work to do, like bringing in even more key partners and working to fix those “breastfeeding-broken hospitals” and “breastfeeding-unfriendly workplaces.” Sadly, there are still hospitals that insist on giving newborn breastfeeding babies a bottle of formula, sometimes even against the parents’ wishes. And many places of employment are simply not supportive enough of the breastfeeding mother. The WIC community cannot fix these problems alone but can provide the leadership and participate in the coalitions that may affect the hospitals and workplaces.
Over two years ago, the National WIC Association wrote and distributed the paper “WIC: Preventing Maternal and Childhood Overweight and Obesity.” The paper listed seven recommendations along with strategies for implementation. The recommendation where I find the greatest potential is “collaboration.” We must remember that obesity prevention is everybody’s business. If we listen carefully to what other programs and partners are working on, we would see a lot of overlap and common ground. For example, one obesity prevention strategy is to increase access to healthy foods, including fruits and vegetables – that’s also a goal of the hunger prevention community. Another obesity prevention strategy is exclusive breastfeeding, which is also a goal for infant mortality initiatives, disaster preparedness, oral health, and hunger prevention. And prevention of overweight and obesity will help prevent chronic diseases, so there’s another community to bring in the loop.
But the balancing act that I sometimes find challenging as a state WIC director is finding the win-win situation. While I want to “play well with others,” my goal (first and foremost) is to protect the integrity of the WIC program mission and my participants. If we add more and more services to their WIC appointment, we risk losing participants and then nobody wins. We can all agree on the common goal of ensuring that WIC can help in the fight against childhood obesity, but as we move forward, we must find that balance of ensuring success while keeping the integrity of the underlying program intact.
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