In the summer of 1967, as a civil rights worker in the Mississippi Delta, I saw American starvation and malnutrition up close. Children there were sick and emaciated because their families lacked money to buy food. Since then, we have seen massive expansions of federal food aid for the poor. We now spend $18 billion annually on food stamps, $8 billion on school breakfasts and lunches, and $5 billion on WIC, the Special Supplemental Nutrition Program for Women, Infants, and Children.
Today, the central nutritional problem facing the poor--indeed, all Americans--is not too little food, but too much of the wrong food. But despite a striking increase in obesity among the needy, federal feeding programs still operate under their nearly half-century-old objective of increasing food consumption.
Few experts are willing to say that federal feeding programs are helping to make the poor fat, although the evidence points in that direction. But I know of no one who thinks those programs are doing much to help fight this growing public health problem.
Being overweight is not simply a matter of aesthetics. The growing girth of Americans is a major health catastrophe. Overweight people are three times more likely to have coronary artery disease, two to six times more likely to develop high blood pressure, more than three times as likely to develop Type 2 diabetes, and twice as likely to develop gallstones as people of normal weight. Obesity, of course, is more serious, causing an estimated 50 to 100 percent increase in the risk of premature death.
About 65 percent of all Americans are overweight, and nearly half of those are obese. The best estimates place the rates for the poor at 5 to 10 percentage points higher. Adolescents from needy families are twice as likely to be overweight. Yet today, low-income families have access to more free or low-cost food than ever before, and many can be enrolled in all three federal feeding programs at the same time, plus Temporary Assistance for Needy Families, a welfare program that pays out $12 billion a year.
Redesigned Programs Needed
Consider food stamps, the largest of the programs. In 2002, it is serving about 20 million people a month, providing up to $465 per month for a household of four. On the theory that the poor would be tempted to use food money for other things, the government designed food stamps as coupons (now largely using a credit card-like system) that can be used in grocery stores.
Food stamps work as intended, raising calorie consumption by as much as 10 percent more than if recipients were given cash, according to Department of Agriculture studies. It is like buying tickets for a set number of rides before entering an amusement park. The tendency is to buy more tickets than one needs and, rather than throw away the unused ones, take those extra rides before leaving. Like the tickets, unused food stamps cannot be turned in for cash. So they are used for food that recipients would not otherwise buy.
If we want people to consume food more wisely, the remedy seems simple enough: Give them cash instead of food stamps, and let them make their own decisions about how much to buy. The same Agriculture Department studies have demonstrated that "cashing out" food stamps is more convenient for the poor and does not result in unhealthful diets or mismanagement of family finances. Recipients continue to get well above the recommended levels for most nutrients. The school lunch and breakfast programs, serving almost 28 million lunches and more than 8 million breakfasts on an average day, also lead to overconsumption. Federal rules dating back to 1946 require a disproportionate number of calories in those meals, assuming that needy children will not get much dinner. Schools are required to provide 25 percent of the Recommended Dietary Allowance of calories for breakfast and 33 percent for lunch, so by the time participants get home from school, they have already eaten 58 percent of their appropriate calorie level. That leaves for dinner and snacks only 42 percent, or about 950 calories for the average student--the equivalent of a roasted chicken breast, mashed potatoes, green beans, low-fat milk and a half-cup of ice cream for the rest of the day and evening. Try telling that to a child who would also like to have an after-school or bedtime snack.
What's more, the levels of fat and saturated fat in school lunches exceed the lunch program's own standards by about 10 percent. Successive administrations have tried to reduce the fat content of the meals, but with only modest success. Much of the problem stems from portion size, the kinds of foods served and poor cooking practices. In keeping with federal rules, most schools provide lunches that have one meat, two fruits or vegetables, one bread or grain product, and milk. Preparing tasty and healthful meals in school-sized quantities requires a level of proficiency beyond that of the frequently low-paid staff found in many cafeterias.
Large, fattening school meals might have made sense decades ago, but the federal government now gives low-income families other sources of food as well. The time is long overdue for allowing schools to provide smaller and simpler meals.
WIC, too, is designed as if other federal feeding programs did not exist. It provides food vouchers and counseling to more than 7 million children and mothers each month. The free monthly food packages are worth about $120 for infants and postpartum mothers, and about $35 for each child from ages one through four.
WIC's popularity among service providers is based largely on its generous package of formula, enriched juice, and fortified cereal for infants, guaranteeing that they get sufficient nutrients. The other WIC food packages are heavily tilted toward high-calorie, high-cholesterol foodstuffs. The monthly package for one- to four-year-olds, for example, is nine quarts of fruit juice, thirty-six ounces of cereal (hot or cold), twenty-four quarts of whole or reduced-fat milk, two to two-and-a-half dozen eggs, and about a pound of peanut butter, dried beans, or dried peas. A food package like that makes sense only if it is the family's major source of food, which almost certainly is not the case. It would be better to use the package to introduce low-income families to more healthful foods, such as fruits and vegetables.
But it is WIC's nutritional counseling program that is the biggest disappointment. In addition to food packages, the program is supposed to provide nutritional advice. In practice, counselors spend an average of about fifteen minutes with mothers every three months, hardly enough to make any real difference, particularly because many other topics must be covered during those sessions, including--pursuant to congressional mandate--voter registration. WIC programs cannot increase the time spent with young mothers because federal rules establish a strict percentage of funding for the food packages and the counseling sessions.
Advocates are still pushing to get more families on WIC. But nearly 50 percent of all newborns are already enrolled in the program, whose eligibility guidelines are quite lenient. Instead of increasing the number of families in the program, WIC should pay more attention to the problems of the overweight and obese. More funds should go toward providing intensive counseling about preparing more healthful food and for actual cooking instruction. Some WIC programs already do that, but almost always with non-WIC funds. Because they cannot afford to use WIC money for those purposes, local WIC programs must raise money some other way--through grants from local foundations, for example--in order to provide meaningful help.
Although there is still some real hunger in America, it is found predominantly among people with behavioral or emotional problems, such as drug addicts and the dysfunctional homeless. That is no secret to senior policymakers and food advocacy groups. In 1998, for example, then-Agriculture Secretary Dan Glickman said that "The simple fact is that more people die in the United States of too much food than of too little, and the habits that lead to this epidemic become ingrained at an early age."
Opponents of Reform
What, then, is preventing the modernization of federal feeding programs? Of course, various industry groups have a vested interest in the continuation and expansion of feeding programs, and they are adept at lobbying Congress. For farm and dairy interests, for example, the programs are a way to get the government to purchase surplus commodities. And for unions, localities and individual grantees, the programs represent jobs and financial aid. But those vested interests alone are not powerful enough to stymie reform.
Ironically, it is liberal advocacy groups that have thwarted reform of the programs, for, to make the case for change, one must first accept that hunger has largely disappeared from America. I want to be careful here, because I have friends in such organizations and I know them to be completely dedicated to what they see as the best interests of the poor. But they seem to believe that admitting any weaknesses in federal feeding programs would make those programs vulnerable to budget cuts. How else to explain their periodic press releases about growing hunger, and their silence about overeating? Perhaps the advocates are correct to fear financial repercussions, but it makes them the main protectors of the status quo.
America's growing weight problem has many causes, primarily less exercise and more eating. Federal feeding programs may be only one part of the problem, but they urgently need to be part of the cure.
Douglas J. Besharov is the Joseph J. and Violet Jacobs Scholar in Social Welfare Studies at AEI. Peter Germanis, AEI research associate, helped prepare this article. Besharov and Germanis authored Rethinking WIC: An Evaluation of the Women, Infants, and Children Program (AEI Press, 2001).