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Nutrition Program Needs New Recipe

Report calls for more focus on fruits, vegetables, grains and breast-feeding

FRIDAY, May 6, 2005 (HealthDay News) -- The government's nutrition assistance program for low-income women and children may get a major overhaul.

A new report from the Institute of Medicine calls the program, known as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), outdated and inadequate. The report proposes sweeping changes intended to encourage participants to eat more fruits, vegetables and whole grains, and mothers to breast-feed their infants.

In the current program, the only fruits and vegetables available are juice for children aged 4 months and older and carrots for mothers who are breast-feeding, despite new national nutritional guidelines that emphasize fresh produce.

The U.S. Department of Agriculture, which sponsored the study, now has 18 months to act on the recommendations. If accepted, the revisions would be the most significant since the program began in 1974.

"It's very important because the WIC program itself ends up providing food to an enormous number of women and children," said Dr. Tom Farley, co-author of Prescription for a Healthy Nation and a professor of community health sciences at Tulane University School of Public Health and Tropical Medicine in New Orleans. "It sets the standard for how people ought to eat beyond the WIC program. If it changes WIC policy, it would be huge."

WIC is one of the largest nutrition assistance programs in the United States. In 2003, it provided assistance to almost 8 million participants each month. In 2000, it served about half of all U.S. infants and about a quarter of children aged 1 through 4 and many of their mothers.

The authors of the report are hoping that any changes will impact the nation's rising epidemic of obesity and its related health problems, which disproportionately affect low-income and minority populations.

"We think it will have an indirect impact because the packages will fit better with nutritional messages about eating more fruits and vegetables," said study co-author Suzanne P. Murphy, a research nutrition professor at the University of Hawaii. "It's a teaching tool. It will help low-income people's understanding of what a good quality diet would look like and that, in turn, should decrease overall excess intake."

The WIC program operates through a system of so-called food "packages," which are often actually vouchers or checks that can be redeemed at participating grocery stores. These packages are largely the same as they were 30 years ago.

In the new report, the overall caloric content of the packages was kept fairly constant while nutritional content was increased, Murphy added.

"Many low-income families depend on these packages to give their children an adequate diet, and decreasing the caloric contribution could actually lead to food insecurity," she said.

In other words, the suggested changes are more qualitative than quantitative, the most fundamental being the inclusion of a variety of fruits and vegetables for all individuals aged 6 months and older.

The report recommended that WIC participants be given vouchers or coupons for fresh produce totaling $10 per month for each woman, and $8 a month per child. That amount corresponds to one to two servings of fruits and vegetables a day (12 pounds and 10 pounds of fresh produce for women and children, respectively), the authors stated.

While the amount may seem small, the researchers used data from the markets on the prices of fruits and vegetables. The data is from 2004, meaning it's slightly outdated. "With our estimates, you might get slightly less cups of fruits and vegetables from $10 a month, but I don't think it would be drastically different," Murphy said.

The average monthly expenditure for food vouchers through WIC is $35 per participant.

The report also recommended that breakfast cereals now be whole-grain only and the food packages should include whole-grain bread or brown rice, among other things.

To keep costs to the same $35 per month per participant, the report recommended reducing the amount of juice, eggs, cheese and milk offered.

Milk choices should be limited to 2 percent fat or less for women and children over the age of 2, the report stated. Children younger than that should get whole milk. Yogurt should be allowed as a substitute for some milk for women and children, while tofu and soy beverages should be allowed as replacements for milk for women.

Mothers were strongly encouraged to breast-feed, and the report suggested that breast-feeding mothers receive packages with greater amounts and wider varieties of food.

The report, however, only addresses part of the problem. Another aspect is access and availability of fresh produce and other recommended foods. "Low-income people live in neighborhoods where they're less likely to have access to supermarkets and, if you go into the corner stores, they tend to not have many fruits and vegetables," Farley said. "If you change the way that food is marketed with price or availability, you can have a big impact on people's consumption."

The big question for now is whether the report's recommendations will be adopted at all.

"WIC was designed at a time when the big problem of poor people was lack of protein," Farley said. "It was designed to meet that but also, in part, to meet the interests of the meat and dairy industry. It's possible the industry will resist this. It's also possible they will recognize the overwhelming evidence."

More information

Visit the U.S. Department of Agriculture for more on the current WIC program.

SOURCES: Suzanne P. Murphy, Ph.D., R.D., research nutrition professor, Cancer Research Center of Hawaii, University of Hawaii, Honolulu; Tom Farley, M.D., professor, community health sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans; WIC Food Packages: Time for a Change
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