A national study has shown that the nutrition and weight status of children are significantly influenced by social and economic contexts, including consistent participation in federal food assistance programs such as the Women, Infants, and Children (WIC) program, Medicaid, and the Supplemental Nutrition Assistance Program (SNAP). The study, conducted through the WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS-2), illustrates the complex relationship between socioeconomic background, race, birth weight, and parental health, and early childhood health outcomes.
The researchers tracked more than 3,000 caregivers and children from infancy through five years of age, across 80 WIC sites in 27 U.S. states and territories. The sample consisted of predominantly low-income families newly enrolled in WIC. This study involved up to 16 interviews per participant, covering demographics, feeding practices, and participation in WIC, Medicaid, and SNAP. The dietary intake was estimated through 24-hour recalls, and the child’s development was assessed using BMI z-scores, referencing the Centers for Disease Control (CDC) growth charts. A classification and regression tree (CART) analysis was employed to enable the researchers to identify interactions among variables, including income, race, and program participation.
The results indicated that mean healthy eating index (HEI-2020) scores in children aged 2 to 5 years ranged from 56 to 58 out of 100, which is slightly below national averages. The engagement in WIC was highest at age two and decreased thereafter. SNAP participation was less stable. Medicaid participation was more regular. The most stable predictors of diet quality were racial and ethnic groups, particularly among Hispanic and Spanish-speaking households. Regular WIC enrollment emerged as the strongest determinant of higher HEI scores, particularly at the age of 4.
The research also discovered that birth weight was the most significant factor in determining the weight status across all age groups. Higher birth weights were associated with higher BMI z-scores, especially among female children. Other important contributors included maternal BMI, child’s sex, and sporadic SNAP usage.
Family participation, primarily among Hispanic Spanish-speaking households, in WIC programs tended to result in children who still adhere to U.S. dietary recommendations, specifically in the restriction of added sugars, sodium, and saturated fats. Conversely, SNAP benefits, when accessed inconsistently or without concurrent WIC enrollment, did not show a sustained positive impact on diet quality. This evidence suggests that the combination of nutritious food packages and nutrition education offered by WIC could be more effective in facilitating sustainable, healthy eating behaviors.
Although Medicaid has been associated with improved nutrition among adults, this study did not reveal any strong connections between Medicaid participation and the nutrition of children. This can be attributed to the fact that the data represent participation at the household level, rather than child-specific participation.
The study highlights the crucial role of stable and long-term participation in the WIC in fostering healthier eating habits among children, particularly within Hispanic communities. Social programs, such as WIC, can mitigate the risks associated with economic factors and food insecurity, although birth weight and maternal health remain strong predictors of weight outcomes. These findings demonstrate the need for targeted policies that encourage long-term participation in the program to enhance early childhood health and development among vulnerable groups.
References: Au LE, Arnold CD, Domfe C, et al. Diet quality and weight status is predicted by federal nutrition assistance program participation, health, and demographics. Curr Dev Nutr. 2025. doi:10.1016/j.cdnut.2025.107505
