The Institute of Medicine’s (IOM) Committee to Review the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package recommended specific changes to the WIC food package to better align nutrient intake among WIC participants with the Dietary Guidelines for Americans for participants age 2 and older and the dietary recommendations for children under age 2 (IOM, 2005). Moreover, the recommendations were intended to improve WIC participant food choices and promote healthy eating practices. The U.S. Department of Agriculture (USDA) responded by issuing an interim final rule in 2007 that updated food packages per IOM recommendations.
As designed, the revised packages provide less saturated fat and cholesterol as well as more fiber, fruits, and vegetables. Likewise, the new WIC food package rule issued by the USDA provides state agencies with increased flexibility to offer culturally appropriate food substitutions, including tortillas, canned beans, canned salmon, tofu, soy-based beverages, and brown rice. The expanded choices and wider variety of culturally appropriate foods have the potential to increase redemption of food benefits among WIC’s increasingly diverse population, improving the nutritional profile for these families. In addition, WIC can create environmental change in low-income communities through its relationship with grocery stores and mandates requiring that these stores carry minimum inventories of healthy foods, thereby increasing access not only for WIC participants but for the communities in which they reside.
Because it serves children and families in high-risk groups within the critical growth years from birth to age 5, the WIC program offers the unique opportunity to positively affect nutrition- and health-related outcomes from the standpoint of promoting healthy eating habits early in life and from a systems and environmental change perspective. Unhealthy behaviors learned early in life often persist and lead to increased health risks well into adulthood. However, evidence shows that children can be influenced to make better or healthier choices early in life (Cooke, 2004; Cooke, 2007). It follows that the greater the exposure to healthy foods (e.g., fruits, vegetables, whole grains), such as through the revised WIC food package, the more likely a child is to accept them. However, the intended benefits of the revised WIC food package will be realized only if WIC participants accept and have access to the new foods.
Because American Indian and Alaska Native households face higher levels of food insecurity, obesity, and type II diabetes than the general U.S. population, ensuring their access to and acceptance of the WIC food benefit is particularly important. Numerous studies have been conducted across the country to evaluate the revised WIC package’s implementation and impact, but to our knowledge, no studies are being conducted with the International Tribal Organizations (ITO) that serve nearly 63,000 high-risk WIC clients1 and approximately 41 percent of all American Indians enrolled in the WIC program each month (Cole, 2002). In general, ITOs have fewer resources, are more geographically isolated, and have less access to retail grocery stores and distributors than do some of their state WIC agency counterparts (Story et al., 1999).
In addition, ITOs, which primarily serve American Indian populations, might face unique cultural barriers to participant acceptance of the new WIC foods. If these challenges exist and subsequently translate into limited access to and acceptance of the recently added WIC foods (e.g., whole grains, fruits, vegetables), they will limit the positive impact that the revised WIC food package could have on the food- and nutrition-related behaviors of WIC participants in these areas.