With approximately a third of U.S. children overweight and children struggling with weight problems at earlier ages, preventing obesity early in childhood is a pressing Government policy goal. In response, policymakers are experimenting with a range of novel policy proposals, such as regulating food served in schools, taxing snack foods, and limiting advertising to children. Despite the media attention paid to these anti-obesity policies, the Federal Government is already deeply engaged in food policy through its $53 billion annual expenditure in food assistance programs for low-income families. This assistance is provided in a range of forms, which overlap substantially during the early childhood period—beginning with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and ending with the National School Lunch Program (NSLP) when children enter formal schooling.
Because Federal food assistance programs, by design, intervene early in children’s lives and serve low-income children most likely to be overweight, these programs hold real potential to combat the obesity epidemic by reversing early risk factors and setting in place healthy weight trajectories. However, the ability of the programs to combat the obesity epidemic is under question, as these programs were originally designed to encourage food expenditure at a time when alleviating hunger, rather than preventing obesity, was the primary policy objective. Further, mounting evidence suggests that the Food Stamp Program (FSP), now the Supplemental Nutrition Assistance Program (SNAP), may be associated with increased body mass index (BMI) for adult women. Is this also true for these mothers’ young children? To answer this question, we used new data on young children, ages 3 and 5, who comprise a primary target population for the various Federal food assistance programs to examine the relationship between receiving food assistance and children’s BMI. We asked: Is Federal food assistance part of the early childhood obesity solution or part of the problem?
We examined the effects of changes in Federal food program participation on young children’s weight status (BMI) by using data from the longitudinal Fragile Families and Child Well-Being Survey (FFCWS), waves III and IV.
In 1998-99, participating parents and infants were recruited in 20 large U.S. cities, which vary in terms of cost-of-living factors (such as grocery prices) that may influence the effectiveness of food assistance policies. The analytic sample (n=681) was limited to low-income children born to U.S.-born parents who participated in the In-Home portion of the study at both age 3 (2001-02) and age 5 (2003-04). Because children may receive food assistance through multiple Federal programs during early childhood and each program may have a unique effect on children’s weight, the effect of each type of food assistance was examined while controlling for simultaneous participation in other programs. As many of the same characteristics affecting children’s weight may also influence whether or not families are eligible for and use Federal food assistance programs, individual-level fixed-effects models were estimated.
The results demonstrate that participation in Federal food assistance programs can affect the BMI of young children. However, distinguishing among the multiple food assistance programs that low-income children may receive during their early childhood years, as well as the food environment in which these programs are experienced, is necessary. In particular, subsidized meals (either in child care or schools) exhibited a protective effect, leading to lower BMIs for children receiving these meals. This finding suggests that efforts to combat childhood obesity might be enhanced by increasing access to subsidized meals through a range of strategies, such as increasing outreach to child care providers not participating in the Child and Adult Care Food Program, providing schoolwide presumptive eligibility for Title I schools, and instituting summer food programs for schoolchildren and their families.
Yet, the study also warns of the potential for food assistance programs to exacerbate the childhood obesity problem. This outcome was most likely for the FSP—the program that provides the broadest food choice to families. In cities with high food prices (those in which FSP benefits provide the least purchasing power), participation in FSP was related to increases in BMI among the poorest children. Efforts to prevent childhood obesity need to take seriously this important role of local context, in which the same Federal program, with the same Federal guidelines and benefit plans, can have a different effect in some parts of the country than in others. This study highlights one such factor—food prices—although many other contextual effects are likely to influence the relationship between Federal food assistance and childhood obesity in a similar way.
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