10 In this article, we evaluate whether national and state-level trends in obesity prevalence among WIC-participating 2- to 4-year-old children changed after the 2009 WIC package revision, adjusting for sociodemographic composition and other risk factors for childhood obesity. A focus on state-level trends is particularly important given the level of control that state WIC agencies have over program administration 1 states had discretion for implementing certain aspects of the revised food packages and may have differed in the extent to which healthier foods were made available. 8 Given the variation in childhood obesity rates by state, 9 evaluating longer-term trends in obesity prevalence and the potential differential impact of the WIC package change by state is critical. The Centers for Disease Control and Prevention (CDC) reported a decline in the prevalence of obesity and severe obesity among WIC-participating children from 2010 to 2014 but did not directly test whether the WIC package change was associated with a change in childhood obesity trends. On the basis of these well-documented improvements in nutrition after the WIC package change, the risk of childhood obesity among WIC-participating children may also have declined.
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