The role of income and neighborhood poverty in the association between the 2009 WIC food package change and child obesity among WIC-participating children in Los Angeles County, 2003-2016

Objective: To determine whether a previously reported association between the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package change and reduced child obesity risk among WIC-participating children in Los Angeles County holds across levels of family income and neighborhood poverty. Design: Analysis of prospectively collected WIC administrative data. The outcome was obesity at age 4 (BMI-for-age≥95th percentile). Poisson regression was applied to a matched sample (N=79,502) to determine if the association between the WIC food package change and child obesity was modified by family income (<50% federal poverty level [FPL], 50-100% FPL, >100% but <185% FPL) and neighborhood poverty. Setting: Los Angeles County, California. Participants: Children who participated in WIC in Los Angeles County between 2003 and 2016; children were grouped as receiving the old WIC food package (2003-2009) or the new WIC food package (2010-2016). Results: Receiving the new WIC food package (i.e. post-2009) was associated with 7-18% lower obesity risk across all family income categories Neither family income nor neighborhood poverty significantly modified the association between the WIC food package and child obesity. However, certain subgroups seemed to benefit more from the food package change than others. In particular, boys from families with income above poverty but residing in the poorest neighborhoods experienced the greatest reductions in obesity risk (RR=0.77; 95%CI=0.66-0.88). Conclusions: The WIC food package revisions were associated with reduced childhood obesity risk among all WIC-participating families in Los Angeles County, across levels of income-eligibility and neighborhood poverty.