By Amber Hsiao
Originally published in the2x2project.org
Potatoes—the Senate Appropriations Committee may have approved the inclusion of them this spring as part of the Special Supplemental Nutrition Program for Women, Infants and Children (known as WIC). But, while legislators and representatives from the National Potato Council hashed it out over whether to include fresh spuds on the WIC-approved food list, it’s important to remember the larger role WIC takes in influencing the diets of low-income families.
As the third largest federal nutrition assistance program, WIC provides a safeguard for those at risk for malnutrition and hunger, serving nearly half of all infants up to age one and one-quarter of all children up to their fifth birthday. Since its inception, it has also improved the health of its participants.
Other programs such as the federal Supplemental Nutritional Assistance Program (SNAP), previously known as food stamps, have not made as much progress. While SNAP has been shown to alleviate hunger in those living below 130 percent of the federal poverty level (and up to 200 percent in some states), some believe that it could benefit from programmatic changes to better align with dietary guidelines.
For example, in October 2009, WIC implemented drastic changes by aligning its food packages with the recommendations of the Institute of Medicine, the American Academy of Pediatrics and the 2005 Dietary Guidelines for Americans. The food packages provided healthier options (for example, lowering fat content by swapping out whole milk for two percent milk in children ages two to five). The result: improved health and obesity outcomes.
Given the swell of obesity and increasing health care costs, the WIC changes reflected a concerted effort by the public health community and policymakers to make public health and nutrition-related messages more consistent.
The changes reduce obesity by encouraging a more nutritious diet based on current science. Overcoming legislative and political hurdles allowed the program to make it easier for nine million women and children nationwide to make better nutritional choices.
This has led to promising health trajectories for children in the state of New York, in particular. Researchers at Columbia University found that in the six months following the state’s early implementation of the new packages in January 2009, daily fruit, vegetable and whole grain consumption increased in children.
Looking at body mass index, the proportion of one-year‐olds above the 95th percentile (the obese cut-off for children) decreased, leading to nearly 186,000 fewer obese children in New York alone.
Imagine if these dietary habits were sustained into adulthood, past the point where children age out of WIC when they reach their fifth birthday. What would be its cumulative impact on obesity rates, disease and health care costs?
To ensure that the successes of WIC are not lost later in life, one suggestion has been made to place more stringent guidelines on SNAP’s allowable foods. SNAP serves close to one in three U.S. children. Nearly 80 percent of SNAP participants from birth to the age of five also receive WIC benefits. When a child ages out of WIC, SNAP provides a critical continuum for their nutrition and well-being. So while improvements are made to the WIC side of a child’s diet, the SNAP purchases may be hindering, or even reversing, WIC gains.
For example, since sugary beverages lack nutritional value, they cannot be purchased using WIC. But, they can be purchased using SNAP. To some, this represents a fundamental misalignment of SNAP’s mission. Its allowable foods list is undermining the potential for much better returns on the capabilities of both programs. A program whose mission is to allow households to “obtain a more nutritious diet” should strive to actually do so.
Major changes to population health are never easy, particularly when they involve changing dietary behaviors. But states must start somewhere. The U.S. Department of Agriculture (USDA) should borrow from the successes of the WIC program’s restrictions to inform its understanding of the impacts of SNAP restrictions.
One proposal has been made to put restrictions on SNAP foods, which could save taxpayer money by reducing the purchases of nutrition-less beverages, preventing obesity earlier and averting associated health care costs in the long run. Arguments have been made that the USDA should not be using taxpayer money to subsidize the purchase of the single largest known contributor to obesity.
"There are complaints that (taxpayers) are getting charged twice, once for the SNAP program and then again for the Medicaid and Medicare costs when people get diseases," said Sanjay Basu, an assistant professor of medicine Stanford, who co-authored a study simulating a SNAP ban on soda and energy drink purchases. The study predicted that the ban would result in 1.12 percent fewer adults (281,000) and 0.41 percent less children (141,000) becoming obese.
The study also simulated what would occur if SNAP gave a 30-cent reward to food stamp users for every dollar spent on fruits and vegetables—a scenario that was recently piloted by the U.S. Department of Agriculture in select SNAP participants in Hampden County, Mass., through the Healthy Incentives Pilot (HIP).
The Basu simulation found that a subsidy for fruits and vegetables did not significantly affect health outcomes, which is in line with the USDA pilot’s interim results that adults increased their fruit and vegetable consumption by a quarter of a cup daily.
Even with the incentive, however, the majority of SNAP participants in the HIP study still did not meet the recommended daily intake of fruits and vegetables.
Conversely, others believe that paternalistic policies that limit food choices could adversely and disproportionately affect low‐income communities, leading some people to stigmatize people on food stamps. Some also worry that efforts to limit certain purchases could lead to a reduction in the overall budget allocated to SNAP.
While the USDA does not provide a figure for how much SNAP spends on sugary beverages, estimates range between $2 billion to $4 billion a year. Hunger advocates have expressed concern that cutting sugary beverages from the list of eligible items for purchase would inadvertently lead to a cut in benefits equal to the yearly amount spent on these beverages.
The USDA has already invested heavily in updating and improving the WIC package. But, while policymakers debate something as seemingly minute as potatoes for WIC, SNAP continues largely unregulated. Change is a crucial part of a comprehensive, coordinated national effort to tackle the obesity epidemic and SNAP could be the next policy to which the positive impacts of WIC are extended.
Edited by Joshua Brooks