Special Supplemental Nutrition Program for Women, Infants, and Children - Essay Example

 Child Nutrition Act of 1966 The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Diabetes Among Children in Low-Income Households Though an excellent far-reaching program, the WIC program as designed in 1966 has not gone far enough in prevention of childhood obesity leading to increased Type II diabetes rates in children in low-income households. According to the Centers for Disease Control (CDC), childhood Type II diabetes has increased rapidly in the United States since 1998. The percentage of children who are obese has increased by 5% from 1998 to 2008 and those with Type II Diabetes has increased from 12.4% in 1998 to 14.8% in 2008. The program as originally written follows. Special Supplemental Nutrition Program for Women, Infants, and Children Sec. 17. o42 U.S.C. 1786 (a)Congress finds that substantial members of pregnant, postpartum, and breastfeeding women, infants, and young children from families with inadequate income are at special risk with respect to their physical and mental health by reason of inadequate nutrition or health care, or both. It is therefore, the purpose of the program authorized by this section to provide, up to the authorization levels set forth in subsection(g) of this section, supplemental foods and nutrition education through any eligible local agency that applies for participation in the program. The program shall serve as an adjunct to good health care, during critical times of growth and development, to prevent the occurrence of health problems, including drug abuse, and improve the health status of these persons. Childhood Type II diabetes stems from poor nutrition and from childhood obesity (Zuguo, Kelly, Gummer et.al.1998) Low income children are at greater risk for problems with nutrition as well as obesity. The prevalence of overweight in children increased from 18.6% in 1983 to 21.6% in 1995 based on an 85% cut off point for height and weight (Zuguo, et.al., 1998). Childhood obesity is now the most common health problem facing children followed by Type II diabetes (Strauss & Knight, 1999). It was, at one time, accidents. Maternal obesity was the most significant predictor of childhood obesity, cognitive score, and household income are significant. Children who live with single mothers are significantly more likely to become obese by age 6 than children with nonworking parents, nonprofessional parents and children whose mothers did not complete high school(Straus & Knight, 1999). Since 1973, the Centers for Disease Control and Prevention has assisted states in monitoring key growth and hematologic indicators of nutritional status of low income US children who participate in the publicly funded health and nutrition programs such as WIC. Early periodic screening, diagnosis and treatment programs and clinics funded through maternal and child health program grants have helped fund this work. Most of the data is monitored and analyzed by the PedNSS (Pediatric Surveillance System). The PedNSS data shows a higher proportion of young infants and more black and Hispanic children have low mean birth weight but when followed for 6 years, this same group of children shifts to a consistent increase in the prevalence of obesity followed by early Diabetes at age 10. There has been a general upward shift in weight for height distribution. This of course then extends to preschool children, school children and adolescents. Throughout the US. Children 48-59 months have the highest relative increase in overweight. This prevalence is higher in girls than boys and urban children and Hispanic children are highest (Zuguo, 1998). Criteria The WIC program was designed to supplement foods and nutrition education through any eligible local agency that applies for participation in the program. The program shall serve as an adjunct to good health care, during critical times of growth and development, to prevent the occurrence of health problems (usda.gov) The following criteria will be used to evaluate the efficacy of the WIC program in preventing the occurrence of health problems (Type II diabetes stemming from Obesity) in children living in low income families. Economic advantages and economic disadvantages Social advantages and social disadvantages The WIC program is the largest supplemental food program in the US providing food, nutrition, counseling and healthcare screening for women during pregnancy, infants and children age 5 and under (Black, Cutts, Frank et.al., 2004). It is administered by the United States Department of Agriculture through grants to the states. There were 88,000 participants in 1974 and 7.5 million in 2002. The budget was almost $4.5 billion (Black et.al., 2004). It is to be remembered that this is a grant program, not an entitlement program so Congress does not have to appropriate funds. The program has had an increasing cost and there have been many questions about its efficacy. Economic Advantages Nutritional risk determines whether admitted to the WIC program or not. Patients who are in low income households are known to be at nutritional risk for many reasons. Some of those have to do with the cost of food and some with other issues such as transportation. Many people who live in low income neighborhoods do not have a way to get to a grocery store and there are more fast food restaurants in low income neighborhoods than regular neighborhood (gao.gov). There are also usually small food markets that sell high fat, high carbohydrate food. Up until recently school lunch programs were high on fat and carbohydrates, also, though some of that is changing. This makes the WIC program the only healthy addition of food many of these people are getting. In order to participate in the program, you must be at 185% of the poverty level. In other words a family of four can make $34,873 and not be eligible (Black, et.al., 2004). Evaluation conducted during pregnancy show that WIC decreases fetal death rates as well as prematurity. Evaluations show that postnatal there is faster weight gain during infancy and lower rates of anemia. Evidence continues to accumulate that WIC protects young children from low income families from negative health and growth consequences and when compared to children that do not need WIC, the numbers of obese children with diabetes does not change (Black, 2004). Most of the studies reviewed recommend eliminating waiting lists and logistic barriers to WIC participation to help with adequate growth and health of infants and children in low income situations. Food insufficiency remains a problem in the United States. 3% of all households with children and 7.5% of low income families and children experience food insufficiency. Children of low income families are either food insufficient or micronutrient insufficient on the average. A study done by Casey, Szeto, Linsing et.al. (2001) showed that food insufficiency occurred in children in extreme low income as well as low income. WIC food was available to both groups but children in extreme low income households had fewer calorie intake than those in low income. The extreme low income group also had more children who were overweight and obese as well as diabetic. It was noted in the study that the lower the income, the more TV was watched, less fruit and vegetables were included in the diet and cholesterol levels were higher (Szeto, 2001). With this and other studies in mind, the WIC program has recently changed to include the ability to purchase more fruits and vegetables on the program(fns.usda).They aligned their new program with the 2005 dietary guidelines and then again made a change to the 2007 guidelines. These guidelines are approved by the American Academy of Pediatric Physicians, and recommended by the IOM except in instances where cost neutrality had to be achieved(fns.usda).These guidelines include the wider variety of fruits and vegetable choices as well as the addition of whole grains to the WIC coupons. Lean meat coupons are also provided. This program is now provided for children 5 years of age and younger. Disadvantages WIC, as mentioned is a grant program and felt by all involved as that program could disappear at any time. The fact that many low income children are not morbidly obese, have 2 or more cardiac risk factor and many are diabetic has become a major issue in the evaluation of the program (Crawford, Gosiner, Strode, 2004). It is not yet clear why children being helped by the WIC program are obese or diabetic. There are many factors affecting it besides the WIC program itself. Healthy behaviors are affected by the ability to get out on the street and exercise which many of these people are unable to do for safety reasons. The program though far reaching, just does not reach far enough. To be eligible the family must be %185 of poverty level which is very high. Participants are more than food deficient at that level and food may be the only thing they have if they are participating in WIC. This causes an inability to learn to choose the healthiest way to do something because they may be doing it the only way they can. This is often not understood by the healthcare workers administering the program either because they have not walked in those shoes (Crawford, 2004). California WIC program is administered by non professionals that have participated in the program and they are getting good results so this might be a process worth looking at elsewhere (Crawford. et.al., 2004). Social Advantages Low income mothers do worry about their children. In fact, they are often confused by the fact that healthcare workers tell them that a healthy baby is measured by weight but when they bring their toddler in, he is fat. This causes a lack of understanding as to exactly what is a healthy baby and child and since they are limited as to what they can do, they have a need for very specific information (Anjali, Sherman, Chamberlain, et.al., 2001). Height and weight do not often define health for these mothers and frequently they do not understand the connection between obesity and diabetes. These mothers who live in a low income world often judge whether their children are too overweight by whether or not their children are teased in school. They feel that if their children have good appetites, play outside and have a healthy diet, all will be well (Anjali, et.al., 2001). WIC is able to supply a healthy diet for many of these mothers to provide for their children though the mothers are not aware of what is a healthy serving or how to combine the foods. With these children exposed to more television, they are also exposed to more commercials showing high fat and high carbohydrate foods. There are more fast food restaurants in low income neighborhoods (Kumazeka, & Grier, 2009). There are also unsafe streets, dilapidated parks and lack of facilities for exercises. To some extent the federal safety net programs are able to help with these situations by providing Medicaid for healthcare State insurance programs for the children, and WIC program for food. This study showed, however, without the WIC program, these consequences would be much worse. Childhood Diabetes disproportionately affects low income and minority children. Children who are obese by preschool have a greater risk of Diabetes. Diabetes develops early in these children as well as hypertension, hyperlipedemia, asthma and sleep apnea. Healthy People 2010 are pushing for a goal of reducing childhood Diabetes by 5%. WIC has risen to the challenge with the expansion of their education programs for both WIC participants and those who are not. These new programs are being trialed in California and Georgia and are very successful at this time, increasing the ability of the participants to make better choices (nestor, McKenzie, Hasan, et.al. 2001). Disadvantages Though WIC shows data that post natal there is faster weight gain, it is not yet know whether that faster weight gain affects the increase in childhood obesity and diabetes (Black, et.al., 2004). WIC is also the only method of food supplement for many households and some may not be able to access it. Those that cannot access it but qualify, according to research (Black, 2004), have problems such as low weights, anemia, and being short. Healthcare workers should not assume that defining overweight according to the growth charts has meaning to all mothers. Help mothers focus on activity and healthy diet instead. Targeting interventions for ethnic minority and low income populations has also been a problem for WIC as many of the groups that are participating or need to participate speak another language so cultural issues need to be dealt with somewhat differently than they have been in the past (Cole, 2003). Fighting the battle of childhood obesity and childhood type II diabetes in low income families will depend on changing the social and physical environment in which these communities exist. This will take a lot bigger network with WIC as part of it. Collaboration of these teams becomes more important than ever before (Welsh, Cogswell, Rogers, et.al., 2005).The program is only provided for children 5 years and younger. There is a great need to provide an increase in the age covered to 12. Qualifications The WIC program is being scrutinized quite closely at this time and there is a great need so efficacy is important. They must implement the programs that have been discussed here. Decrease the income point that presently qualifies Decrease the numbers that are in line that do qualify Make the ability to apply more available in neighborhoods where some of these people cannot travel. Provide instruction in languages other than English Provide strong education points for mothers showing them how less food meets their child's need. Continue to provide the new vouchers for fresh food and vegetables. Increase the age of a child participant from 5 to 12. Help these families understand the attachment of diabetes and heart disease to obesity Short Term Provide study data to show the connection of diabetes to childhood obesity Put together education needed for mothers and families Ramp up the already in place programs to get mothers exercising, a healthy mother will make for more healthy children. Increase the age of a child participant from 5 to 12. Long Term Get income levels changed Policy changes for playgrounds and exercise areas for children in low income areas. Rally Congress to make this a full time program instead of a granted one Do more studies to show whether or not childhood diabetes can be prevented with the WIC program. In conclusion Childhood diabetes is at epidemic proportions throughout the World and certainly the United States. This is an effect of the rampant obesity in young children that is now extending into adolescence. There are many issues out there that affect this including the food available and not available to low income families. Children are affected not only physically but socially by being extremely overweight and statistically they do poorly in school which extends another generation of children living in poverty. The WIC program proves to be doing its job but it cannot reach as far as it needs to. The country must look at programs like this see what needs to happen to improve and support them, for the good of the children of the next generation. Resources Anjali, J., Sherman, S., Chamberlain, et.al. (2001). Why don't low income mothers worry about their preschools being overweight? Pediatrics. 107(5) 2001. Accessed April 9, 2010, available at [ http://pediatrics.aapublications.org]. Besharov, DJ, Germanis,P. (1999). Is WIC as good as they say? Public Interest. 134. 21-36. Black, M., Cutts, D., Frank, D. (2004). Special supplemental nutrition program for women, infants, and children participation and infants' growth and health: a multisite surveillance study. Pediatrics 114(1). Accessed April 9, 2010. Casey, P., Szeto, K., Lansing, S., Bogle, M., Weber, J. (2001). Children in food insufficient, low income families. Archives of Pediatrics and Adolescent Medicine. 1551. 508-514. Cole, N. (2001).The prevalence of overweight among WIC children. US dept of Agriculture. available at http://www.fns.usda.gov/oane Kumazika, s., Grier, S. (2008). Childhood diabetes in miniority communities. Pediatrics. 26(8). accessed April 10, 2010. available at [http://www.pediatrics.org/cgi/content/ful/115/e223]. Nestor, B., McKenzie, J., Hasan, N., Absabha, R. (2001). Client satisfaction with the nutrition education component of the California WIC program. Journal of Nutrition Educators. 33(83). 88-94. Ogden, C., Flegal, K., Carrol, M., Johnson, C. (2002). Prevalence and trends in overweight in US children and adolescents. JAMA. 1728-1732, Pohjonen, T., Ranta, R. (2001). Effects of a worksite physical exercise intervention of physical fitness, perceived health status, and work ability among home care: Preventive Medicine. 32. 465-75. Strauss, R., Knight, J. Influence of the home environment on the development of obesity in children. Pediatrics. 103(6). pg. 85 Trevino, R., Marshall, R., Hal, D., Rodriquez, R. (1999). Diabetes risk factors in low income Mexican American children. Diabetes Care. 22(2). 201-7. Accessed April 9, 2010. available at [http:www.cnahl.com/cgi-bin/refsvc?jid=1029&accno=1999o25472 (PMID: 10333934nlmvid:7805975] United States Department of Agriculture, Food and Nutrition Service: Child Nutrition Act of 1966. Accessed April 9, 2010. available at [http://www.fns.usda.gov/cnd/Governance/Legislation/CNA-10-2008.pdf] United States Government Accountability Office. (2001). Food Assistance: WIC Faces Challenges in Providing Nutrition Services. Available at http://www.gao.gov/new.items/do2142.pdf Welsh, J., Cogswell, M., Rogers, S., Rochett, H., Mei, Z. (2005). Overweight among low income preschool children associated with sweet drinks. Pediatrics. Accessed April 9,2010. Available at[http://www.pediatrics.org/cgi/content/full/115/e225]. Zuguo, M., Kelly, S., Grummer, L. et.al. (1998). Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983-1995. Pediatrics. 101. 1028-1035.Accessed April 9, 2010 available at [ http://pediatrics.aapublications.org]. http://www.fns.usda.gov/wic/benefitsand services/revisiontofoodpkg-background.htm http://archpedi.ama-assn.org/cgi/content http:www.cmahl.com/cqi-bin/refsvc?jid=1581&accno=201351011. Read More