Examination of the recent revisions to the WIC food packages on early childhood obesity: Potential for mediation through breastfeeding and gestational weight gain

Background: Childhood obesity is a complex multifactorial condition.  Focusing on the relationship between the recent changes of the WIC food package and obesity without considering the constellation of variables thought to be associated with obesity will only tell part of the story. The objective of this study is to assess whether effects of the recent revisions to the WIC food packages on child BMI are mediated through effects on breastfeeding and gestational weight gain.

Methods:  Age- and gender- specific BMI z-scores and percentiles according to the CDC growth charts will be computed and used for this analysis. We will conduct path analysis using TCALIS procedure in SAS 9.3 to analyze the relationship between the recent revisions to the WIC food packages, the child’s BMI, gestational weight gain, and breastfeeding.  Specifically, path analysis will be used to decompose the effects of the recent revisions to the WIC food package on the child’s BMI into an indirect effect mediated though breastfeeding behavior and gestational weight gain and a direct effect that cannot be explained by breastfeeding behavior or gestational weight gain. Path analysis allows simultaneous estimation of regression models for all intermediate measurements and the outcome variables. We will use the EFFPART statement to examine whether our data support our path model by assessing how the variables analyzed affect each other, directly and indirectly.

Implications: Information gained from these analyses will help identify the best potential areas for obesity prevention and intervention.