Between 2000 and 2014, modest declines have been observed in the prevalence of obesity among young children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).1 In a comment and response letter published in JAMA Pediatrics,2 authors Jian Zhang, MD, and Andrew R. Hansen, DrPH, report contradictory findings, particularly in a study that demonstrated no such reductions in obesity among children participating in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014.3

The findings from these analyses indicate that one element may be implicated in the declining obesity rates in these studies: the WIC. According to Drs Zhang and Hansen, participants in NHANES featured similar exposures to risk and protective factors, and the majority (70%) were non-WIC enrollees. The authors suggest that the regulation of food purchasing in the WIC program may have played a role in the reduction in obesity prevalence whereas non-WIC enrollees had more freedom to purchase a greater variety of food options according to parental or guardian consent.

The diametrically opposed results from the 2 studies indicate that the obesity pandemic may be partly attributed to social environment. Ultimately, these findings may help guide “effective policy interventions to create social environments that make healthy choices easier,” such as the WIC food packages introduced in 2009. Although modest reductions in obesity have been observed in WIC enrollees, it should be noted that the government-regulated food assistance program hinders greater variety in food choices, thereby limiting the ability of purchasers to make nutrition choices that extend beyond the policy-allowed fare.

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Childhood obesity continues to be a public health issue that requires improved policies and interventions at both the individual and population level. Interventions and policy changes may help reduce the risk for preventable chronic health issues in the next generation. “Social engineering efforts, in particular policy intervention, to prevent childhood obesity must continue,” the authors wrote, “and effective components identified from the WIC program should be scaled up beyond WIC.”


  1. Pan L, Park S, Slayton R, et al. Trends in severe obesity among children aged 2 to 4 years enrolled in special supplemental nutrition program for women, infants, and children from 2000 to 2014. JAMA Pediatr. 2018;172(3):232-238.
  2. Zhang J, Hansen AR. Special supplemental nutrition program for women, infants, and children program, a social experiment on effective strategies to prevent severe obesity among preschool children. JAMA Pediatr. 2018;172(7):704.
  3. Skinner AC, Perrin EM, Skelton JA, et al. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity (Silver Spring). 2016;24(5):1116-1123.