In a study released this month in Pediatrics from Freedman et al. (10.1542/peds.2016-2034) a collaboration of authors examine national trends for weight-for-length (WFL) among WIC-enrolled infants ages 3-23 months across the United States from 2000-2014 using the WIC-PC (WIC-[The Special Supplemental Nutrition Program for Women, Infants and Children]-Participants Characteristics) Survey. The sheer number of infants and children that could be included (n=16,927,120) serves to remind us how important this federally and state funded program is to the health of women and children who live at or below the poverty line. With many well-described caveats, the authors are able to provide some hopeful news, by showing decreasing WFL in this age group nationally over the final 4 years of the survey (2010-2014).
What I find fascinating and not completely explained is the state to state variation that is noted. For example, the neighboring states of Kentucky and West Virginia have the largest decrease (-7 percentage points in Kentucky) and the largest increase (+ 2 percentage points in West Virgina) in WFL among enrolled infants from 2010-2014, while nationally WFL decreased 2.3 percentage points, and these changes at the state level could not be accounted for by demographic shifts. Likely many are familiar with subway maps that correlate risk of obesity or diabetes with subway stop, emphasizing the critical importance of zipcode and neighborhood to health and wellness, but it is difficult to generalize this thinking to the state level. Differential implementation of the revised WIC food allocation packages, local initiatives, and differing state policies targeted at infant nutrition are each cited by the authors as possible causes of these state-based differences.
What are these policies? How could these be identified and shared between states? Are there perhaps local initiatives such as postpartum exercise classes for moms and babies at birthing hospitals or community centers that are targeting other goals such as maternal wellness and social networking, yet are spreading due to successful enrollment, and have the secondary impact of supporting healthy WFL in the baby? For example, does a state that is doing better have more WIC Breastfeeding Peer Helpers? This WIC program offers peer counselling and “address[es] the barriers to breastfeeding by offering breastfeeding education, support, and role modeling”; see here for more information. Do state WIC officers have the opportunity to compare policies and plans to identify successful strategies? The state-based differences noted in this fascinating article look like a golden opportunity to begin to identify policies, programs and strategies that work, or at least have had some success, at combating elevated WFL in infants and toddlers enrolled in WIC, and ultimately among all infants and toddlers.
