The neighborhood food environment modifies the effect of the 2009 WIC food package change on childhood obesity in Los Angeles County, California

Abstract

Background: Food packages provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were revised in 2009 to better align them with the Dietary Guidelines for Americans. This study was conducted to evaluate whether the effect of the food package change on childhood obesity varied by the food environment in the neighborhoods where WIC-participating children live. Methods: Administrative data from participating children in Los Angeles County, California (2003-2016) were merged with geocoded food vendor information by neighborhood of residence. Obesity risk at age 4 was compared between children receiving old (2003-2009) and new (2010-2016) WIC food packages using sexstratified Poisson regression models, with interaction terms between WIC package and neighborhood density (number per square mile) of healthy and unhealthy food outlets. Results: The new food package was associated with a significant decrease in obesity risk. Among boys, the new food package was associated with 8 to 18% lower obesity risk at all healthy and unhealthy food outlet densities, and the association was not modified by neighborhood food outlet density. Among girls, the association of the new food package with obesity risk was protective in neighborhoods with high healthy and low unhealthy food outlet densities, and adverse in neighborhoods with high unhealthy and low healthy food outlet densities. The effect of the new food package among girls was modified by unhealthy food outlet density, with significantly smaller (p-value = 0.004) decreases in obesity risk observed in neighborhoods with higher unhealthy food outlet density. Conclusions: The impact of the food package change was modified by the neighborhood food environment among girls only. Future policy changes should incorporate consideration of ways to mitigate potentially inequitable geographic distribution of the health benefits of policy changes.

Provider–Patient Interactions as Predictors of Lifestyle Behaviors Related to the Prevention and Management of Diabetes

“…In this regard, investing in individual (micro-level) approaches to combat T2DM remains a critical action. These individual-level interventions should complement, rather than compete with, the sometimes more popular policy/system (macro-level) interventions that have been implemented by federal and state public health agencies during the past two decades, including those focused on childhood obesity prevention [40][41][42] and other chronic disease control targets for the general population [43][44][45].…”

Longer Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children Is Not Associated with Reduced Sugar-Sweetened Beverage Intake among Black Participants

“…Broader environmental conditions may contribute to increased disparities following interventions targeting health behaviors, with behavioral effects of interventions being stronger for children in less adverse neighborhood environments [ 24 ]. Prior research in the LA County WIC population identified a larger reduction in obesity prevalence in neighborhoods with higher healthy food outlet density and lower unhealthy food outlet density [ 25 ]. Differences in neighborhood environments (e.g., food environment, including food outlets and information about foods) between Black and non-Black WIC-participating children may contribute to the observed differences in the relationship between WIC participation duration and rates of SSB intake through reduced availability of healthy beverages and increased abundance of SSBs.…”

Provider-Patient Interactions as Predictors of Lifestyle Behaviors Related to the Prevention and Management of Diabetes

“…In this regard, investing in individual (microlevel) approaches to combat T2DM remains a critical action. These individual-level interventions should complement, instead of compete with, the sometimes more popular policy/system (macro-level) interventions that have been implemented by federal and state public health agencies during the past two decades, including those focused on childhood obesity prevention [40][41][42] and other health promotion in the general population [43][44][45].…”