WIC Approved Foods: What they do for me

Dougherty County, Georgia WIC

4/25/17

Ryan Schwarz

ARAMARK Dietetic Intern

Overview
 Southern Georgia is known for its soul food and country cooking. This can mean

large quantities of fried foods with sweet drinks and desserts. Consequently, fruits and

vegetables are often in need of an increase. With many chronic conditions arising from

unhealthy habits, it is easiest to catch it at the source and focus on prevention rather

than maintaining a disease once it is full-blown. For that reason, and to support healthy

growth in infants and children, WIC only allows certain foods to be purchased using

their vouchers. Participants of WIC may be aware that these foods are healthier options,

but they may not know why or how to incorporate them into their traditional home

cooked meals. Therefore, an informative education session was provided to scratch the

surface on that very topic.

Participants were pulled from the waiting room to sit in on a 10 minute class

describing why exactly they receive the foods they do through WIC and were given

some ideas for how to use them. Sample recipes were distributed for bean-based pizza

and a tofu stir fry. Through the use of a posttest, it was evident that the class was

effective given that each participant answered all 3 questions correctly. Those who

attended were documented and may be utilized for research measurements in the

future to analyze long-term results. The class proved to be useful and was added to the

rotating cycle of classes offered every week.

Nutrition Assessment

In South Georgia, the majority of the population being served in both community

assistance programs as well as inpatient services, is African Americans. This area of

South Georgia is notably one of the poorest areas of Georgia, with high rates of teen

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pregnancies, homelessness, lack of education, single parent households, and a number

of other disparities. Therefore, there are many factors contributing to these socio-

economic issues across all cultures and ethnicities; however, this review will simply take

a look at some of the contributing factors related to the African American culture.

First, well quantify the prevalence of the African American culture within the WIC

community and decipher some statistics about the WIC participants. The information in

this paragraph was compiled through a number of different reports kindly provided by a

WIC Supervisor, and reflect the data reported from Dec 1, 2016 through February 28,

2017. In Southwest Georgia, this particular WIC program has roughly 10,500

participants with the majority (~ 74%) being infants and children. Therefore, the other

26% are women. Of these women, only about 20-25% are breastfeeding. That means

that many babies are now children and no longer feeding, mothers had complications

with feeding, or some mothers chose not to breast feed. This indicates that around 75%

of the infant and children category are relying on baby formula and starting to introduce

real foods. This makes it a great opportunity to educate mothers on the importance of

healthy eating habits to start forming healthy behaviors for their children and prevent

health complications in the future.

Another report has shown that about 59% of the WIC participants are classified

as African American, roughly 37% as White, and 2% as multi-racial, with other cultures

not even amounting to 1%. Therefore, the target population for an education session at

WIC is women who are predominately African American and White who live in the heart

of southern soul food. Their diets are typically high in fast food consumption with fried

chicken and grits being staple foods. There is a high prevalence of obesity and it is

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reflected in the southern diets. Sweet teas are very popular as well as high fat and high

salt foods. Collard greens and cornbread are other staple foods, while fruit and

vegetable consumption is usually lacking.

The unfortunate truth is that a large portion of the African American population,

and other cultures as well, have been raised with low expectations and a significant

amount of social pressures to conform to their cultural norms. One article by Ogunyemi,

explains the authors personal experience as a new student and the social pressures

that were endured.1 Ogunyemi describes feeling fearful of being seen at the library

studying and recalls phrases such as acting white being said to and about him/her. 1

The author relates that academic achievement was outside the norm for his/her culture

and had received harsh comments, bullying, and social pressures to overcome when

performing well in school.1 This is an excellent example of how the black community is

clumped together as an ethnicity outside the white community and that the cultures of

each of them are different with varying expectations. This can lead so-called minority

groups to withhold effort in academics and prevent career development in the future.

This then leads to the poverty levels we see in these cultural communities and all of the

socio-economic issues that are indirectly affected because of that.

When looking specifically at African American women, which is the main

population of WIC participants in South Georgia, we see a large amount of social

pressure at play as well. An article by Bland and Sharma found that African American

women are less likely to express dissatisfaction with their bodies. Bland and Sharma

state that these women often have a hard time finding a safe place to be active and are

also very self-conscious about not being overly concerned with their body weight or

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size. Out of the many strategies that were studied to implement physical activity into this

population; walking, a healthy diet, and significant social support were shown to be the

most effective and applicable techniques to boost motivation for increased physical

activity among African American women.2

Overall, there appears to be a significant amount of social pressures for both

men and women, even young adults, in the African American population. This affects

many things including their academic standing, general education, job placement,

career advancement, socio-economic status, self-confidence, social implications, and

so much more. All of these things ultimately affect many of the health problems we see

today in this specific population and lowering that social pressure while normalizing

education would be a great place to start implementing a change.

Nutrition Diagnosis

Food and Nutrition Related Knowledge Deficit (NB 1.1) related to lack of in-depth

education on significance of WIC approved food, as evidenced by verbal participant

suggestions and paper evaluation forms regarding the importance of food choices,

indicating a general knowledge deficit on WIC approved foods and their significance.

Nutrition Intervention

Nutrition Education-Content, relationship to health and disease (E 1.4). The

objective, identify two WIC approved foods to use in preparing a healthier meal, written

in SMART criteria, simplifies the measurement of the educational interventions

effectiveness. The focus is specifically on knowledge of healthy foods and how to use

them and both are measurable items. By increasing the knowledge around healthier
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food items, it will in turn increase healthy food consumption and indirectly reduce empty

calorie foods. This fits right into the Healthy People 2020 objective to reduce

consumption of calories from solid fats and added sugars (NWS 17.3). Which ultimately

fits into one of Healthy Peoples overarching goals to promote health and reduce

chronic disease risk through the consumption of healthful diets and achievement and

maintenance of healthy body weights. It is certainly something that is achievable and

realistic within any given time period, especially by 2020.

Lesson Plan

A full lesson plan for the WIC Approved Foods: What They Do for Me session

can be viewed in the Appendix. The lesson was targeted to African American and

White women who are WIC recipients. The main goal was to increase the knowledge of

healthy food choices pertaining to why they are important and how to make the most of

them. It was scheduled to be about 10-15 minutes in length on 4/25/17 and geared

toward the following objectives: 1) Participants will be able to list two WIC approved

foods to use in preparing a healthy meal, 2) Participants will be able to give an example

of why iron is beneficial in a healthy diet and list one WIC Approved source of it, and 3)

Participants will be able to list one reason why whole grains are more beneficial than

refined grains. Once each objective was covered, sample recipe ideas and time for

discussion and questions was provided. A simple 3 question posttest was then

distributed relating to the 3 objectives in order to quantify how well the objectives were

met. The materials used to assemble this lesson were very minimal and simply

included: the WIC Approved Foods Power Point Presentation, the projector and related

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technology, a laptop computer and connector cords to the projector, a printed copy of

the presentation, a WIC Approved Food List pamphlet to reference as a visual, sufficient

copies of the posttest and sample recipes (also available in the Appendix), and writing

utensils for participants to use.

Marketing

The educational intervention was not promoted prior to being implemented. The

education was presented as a brief informative session while patients were in the

waiting room. The information was presented in a small room directly accessible by the

waiting room. The presentation was given on a continuous bases every 20 minutes as

needed with patient load. Immediately before each session, the instructor would step

into the waiting room and pull people into the side room where the session took place.

The patients were informed that they could come and go as their appointments were

called and they were welcome to join the session that was in progress after their

appointment. There was no price, the session was free. There were no products being

offered, just discussion about the WIC vouchers.

Resources

The educational intervention required minimal resources for its implementation.

There was no financial budget and $0 were allocated for the intervention. The

presentation simply required the Power Point software and the projector equipment.

Paper, ink, and a printer were utilized for printing a copy of the presentation, posttests,

and recipes. Writing utensils were borrowed from the WIC supplies. A WIC Approved

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Food List pamphlet was utilized as a visual reference and the Dietetic Interns along with

the help of one employee produced the education materials. The employee pulled data

and reports to aid in the identification of the target population.

Nutrition Monitoring and Evaluation

At the end of the education session, the objectives mentioned above were

measured using a posttest. The full test can be viewed in the Appendix. It consisted of

3 short answer questions relating to the objectives. Although there were only 3

participants in the class, they each gave valid answers and scored 100%. This indicates

that they were listening and do have a general understanding. The fact that the topic

was applicable to them and sample recipes were provided may have facilitated their

learning experience. People are always interested and willing to take new ideas home

with them. Probing questions before giving away the answers during the presentation

helps keep the audience engaged and thinking about what you are speaking about.

The audience should now have a little bit more knowledge of why they receive

the foods they do through WIC and how to incorporate them into their meals and regular

grocery shopping. The audience was paying attention for the good majority of the time

but some of them came in with their kids and had to try and keep them busy while

paying attention, which could have caused them to miss some information. A few other

factors that may be barriers to the implementation of these recipes include their

personal desires, lack of cooking knowledge and use of spices, lack of funds for

vegetables and healthier options, time it takes to cook, etc. There are always a number

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of obstacles to overcome but we can at least make sure to have the resources available

to make it as easy as possible to succeed.

The progress will continue to be monitored each time more students take the

class. Each student that signed in will have an education session documented under

their name which may be used as a measurement system in the future. There may be a

report to pull up that indicates who received education and who didnt which would then

allow a comparison of the differences in health status between the two groups. A diet

recall could be performed on both groups and the diets could be compared as well as

weight histories of the clients. This is just one way that the effectiveness could be

measured in relation to the Healthy People 2020 goal to promote health and reduce

chronic disease risk through the consumption of healthful diets and achievement and

maintenance of healthy body weights. The need for improvement of the lesson will be

monitored and the lesson will be incorporated into the rotating weekly webinar classes

scheduled through the Georgia WIC program.

Appendix

Lesson Plan

WIC Approved Foods: What They Do for Me

Target Audience: WIC Recipients, AA and White Women

Goal: Increase knowledge of healthy food choices pertaining to why they are important and how

to make the most of them.

4/25/17 10 minutes

Specific Objectives Procedure Learning Activity

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 (Use SMART criteria) (State how each specific objective will be met)

Introduction
Instructor(s) introduce themselves. Verbal/nonverbal group
Evaluate participants knowledge: discussion
1. Who has used WIC vouchers before?
2. Will this be the first time for any of you?
Introduce topic: Participants share reasons why they
think certain foods are/are not offered through WIC.

1. Participants will be able
to list two WIC approved
foods to use in preparing a
healthy meal.
2. Participants will be able
to give an example of why
iron is beneficial in a
healthy diet and list one
WIC Approved source of it.
3. Participants will be able
to list one reason why
whole grains are more
beneficial than refined
grains.
Body of Lesson
WIC Approved Foods and Recipe Ideas Power Point
Importance of the foods provided and how to use them:
1. WIC Approved Food List Slides 1 and 2
2. What the foods contain Slide 9
3. Healthy reminders and recipe ideas Slides 7,8, 10-12
Importance of Nutrients in our Diet Power Point
Iron and Vitamin C
1. Consequences of deficiency Slides 3 and 4
2. Benefits of adequate supply
3. WIC Approved sources of iron and vitamin C
Importance of Nutrients in our Diet Power Point
Protein and Fiber
1. Benefits of adequate supply Slides 5 and 6
2. WIC Approved source of protein and fiber

Conclusion
Recap Power Point
What did we learn today:
1. Why WIC Approved food are approved Slides 10, 13, 14
2. Ways to effectively use these foods
3. Strategies to eat healthier overall

Materials List:

1. WIC Approved Foods Power Point Presentation

2. Projector and related technology
3. Laptop computer and connector cords to projector
4. Printed copy of the presentation
5. WIC Approved Food List pamphlet to reference as a visual
6. Sufficient copies of the posttest and sample recipes
7. Writing utensils for participants to use

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Posttest

What did you learn?

1. Name one reason why iron is beneficial in a healthy diet.

2. Name one reason why whole grains are better for you than refined grains.

3. List two foods that you could combine to make a healthy meal from the WIC
Approved Foods.

Recipes

Mexican Black Bean Pizza

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 1 1/4 cups shredded Mexican Blend cheese
1/4 cup shredded Monterey Jack cheese
2 tablespoons olive oil
8 (6-inch) whole wheat tortillas
1 small onion, chopped
1 bell pepper, chopped
1 (15 ounce) can black beans, drained
1/2 cup salsa, mild or spicy
2 ounces canned chopped green chiles (optional)

Heat oven to 350F. Mix half the Mexican Blend cheese with the Monterey Jack cheese

in a bowl; set aside. Brush a baking sheet with 1 tablespoon of the oil and arrange

tortillas in a single layer. Puncture each tortilla a few times with a fork. Sprinkle half of

the cheese mixture evenly over 4 of the tortillas, then cover each with a remaining

tortilla. Bake 5-6 minutes or until browned slightly. While tortillas bake, heat remaining

oil in a skillet and cook onions and bell pepper until browned. Add beans and partially

mash with a potato masher or the back of a fork. Remove tortilla pizzas from oven and

top each with bean mixture, spreading evenly. Top with salsa, green chilies and cheese

mixture. Return to oven. Bake until cheese melts, about 10-20 minutes.

Tofu and veggie stir fry with peanut sauce

Veggie Stir-Fry Peanut sauce

1 tbsp sesame oil or any vegetable oil and 2 Tbsps. soy sauce cup peanut butter
3 cups broccoli florets 1 Tbsp. soy sauce
2 cups zucchini, quartered and cut into inch slices tsp white sugar

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2 cup white button mushrooms, quartered 1 clove garlic, minced
1 cup carrots, sliced diagonally cup water
red pepper, sliced Whisk well and serve!
1 block extra firm tofu, drained and cut in 1in stipes

Add oil to the large skillet, set on medium high. Add broccoli and carrots cook for 3-

4min, stir in zucchini, mushrooms and red peppers, saut for another 3-4 min. Add tofu

and soy sauce and saut for another 4-5min.

Serve with brown rice or whole wheat noodles and toss with peanut sauce.

References

1. Ogunyemi, Boluwaji. Cultural-Ecological Theory of Academic Disengagement

Used to Explain a Story of Race, Culture, and Education. Journal of the National
Medical Association. 2017; 109(1): 21-22. Journal of the National Medical
Association Website. http://www.journalnma.org/article/S0027-9684(16)30135-
3/abstract. Accessed March 3, 2017.

2. Bland, V. and Sharma, M. Physical Activity Interventions in African American

Women: A Systematic Review. Health Promotion Perspectives. 2017; 7(2): 52-
59. NCBI Website. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350550/.
Accessed March 3, 2017.

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