Has the WIC incentive to formula-feed led to an increase in overweight children?

We explored the relationship between the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and overweight status in children, with a focus on WIC's provision of infant formula, through secondary analyses and review of existing literature. Because of the complexity involved and the lack of previous research on the combined link between WIC, breast-feeding, and overweight status, we considered evidence for each of these relations separately. Using food-cost data from the WIC's 1996 Participant and Program Characteristics Survey, we found that the state-level average for 1 y of program benefits for women who formula-fed was over twice the value of program benefits for those who breast-fed (BF). This difference in benefit levels, or formula incentive, was negatively associated with both the in-hospital and 6-mo BF rates in state-level multiple regression models. Despite WIC's efforts to promote BF, other large-scale studies have found a negative association of program participation with BF rates. An inverse association of BF on subsequent overweight in children also has been shown in a number of studies. Despite this accumulating evidence for the protective effect of BF, it has not been seen in African American or Latino populations. In sum, there is reason to be concerned that WIC's incentive to formula-feed may have led to an increase in overweight children; yet there is too much uncertainty about the issue to conclude that this is so. Further research is needed to understand this relationship, as is the development of applied interventions to increase BF rates.