Editor’s Note: Feria Ladha, MD, PhD (she/her/hers) is a resident physician in pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is an aspiring physician-scientist with research interests in cardiac genetics and developmental biology. - Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
The Special Supplemental Nutrition for Women, Infants, and Children (WIC) program has been an integral part of our society since 1972 and provides nutritional assistance to pregnant, postpartum, and breastfeeding mothers and their children up to age 5 with the goal of minimizing nutritional risks associated with poverty. While WIC has been shown to be associated with improved birth outcomes, cognitive outcome, and reducing risk of food insecurity, WIC food packages were not designed to prevent obesity. In 2009, WIC food packages were changed to both provide proper nutritional support and reduce the risk of developing chronic disease, and follow-up studies showed that these changes led to a reduction in childhood obesity risk. While changes in the food package content impacted childhood obesity risk, it is yet unknown whether these changes are cost effective.
Erica Kenney, ScD, and colleagues from the Harvard T.H. Chan School of Public Health utilized microsimulation models to determine if WIC food package changes led to cost-effective impact from 2010 to 2019; their article, entitled “Cost-Effectiveness of Improved WIC Food Package for Preventing Childhood Obesity,” is being early released this week in Pediatrics (10.1542/peds.2023-063182). This analysis estimated cases of obesity prevented and costs per quality-adjusted-life year (QALY) gained for the estimated 14.0 million children 2–4 years of age participating in WIC. QALY measures the cost of each additional years of quality life a person gains due to an intervention. The typical cost per QALY gained that is considered cost effective is between $50,000 to $150,000.
The authors found that:
- The updated WIC food package prevented about 60,000 cases of childhood obesity in 2019 and was a great investment, costing only $10,600 per QALY gained.
- The updated food package decreased the socioeconomic gap in obesity prevalence.
Twice as many cases of obesity could have been prevented if all 2–4-year-old children eligible for WIC received WIC, and this could have led to an additional $93.4 million saved in healthcare costs.
The WIC food package change not only provided health benefits but also improved health equity at an extremely low cost! The natural next step would be to determine the best ways to enroll all young children with low incomes in WIC. I know that I will be encouraging my families to enroll.
