据eurekalert网站2006年12月19日报告，美国的食品券计划项目（The Food Stamp program）和妇女、婴儿及儿童营养补充特别项目（WIC）主要由美国农业部食品和营养服务局提供资助，旨在消除低收入人群和高收入人群之间在营养保健方面存在的不平等状况，目前这些项目已经取得了重大进展。虽然已经取得了一些成功，但这些由联邦政府提供资助的营养项目还是受到了批评，批评者担心这些计划将导致美国普遍流行肥胖。为了消除这种忧虑，塔夫茨大学傅莱曼营养科学与政策学院院长，科学博士艾琳•肯尼迪及其大学同事近期撰写了一份报告，他们还通过两党连立的美国全国州长联合会最佳实践中心(NGA)编写了该报告的补充摘要。他们在报告中建议修改现行政策：允许继续实施食品标志项目和妇女、婴儿及儿童营养补充特别项目以缩小营养保健方面的不平等差距，但同时应着手应对肥胖问题。
肯尼迪说，“从总体上讲，所有人都在同超重和肥胖问题做斗争，而不仅仅是那些加入联邦政府营养项目的受益者们。”塔夫茨大学的作者们在报告中写道，事实上，负责调查营养计划与肥胖症之间潜在关系的专家小组总结称：“现有的研究并没有发现食品标志项目和WIC项目正在引发肥胖症。”报告称，食品券项目和WIC项目的参与者并没有提高其营养摄入量，但是专家小组认为，WIC项目可能会提高未出生胚儿的整体卡路里摄入量，从而导致新生婴儿的体重普遍偏高。塔夫茨大学的作者们还引用了这样一段话：“有数据显示，从1976年到2002年，在食品标志项目的女性参与者中，出现身体超重的可能性微乎其微。”
虽然该研究暗示肥胖问题与是否参与食品券项目和WIC项目无关，但是肯尼迪承认为项目参与者提供的日常饮食仍然不是最理想的保健食品，而且低收入人群出现体重增加的危险性也更大。“许多低收入家庭面临着所谓的‘双重疾病负担’，”她解释道，“这意味着那些得不到可靠食物保障的人常常会超重或变肥。现在，低收入家庭所面临的普遍问题是肥胖问题，而不是营养不良，应该调整联邦政府营养项目的目标，以应对肥胖问题，现在调整正逢恰其时。”
除了肯尼迪之外，该报告的其它合著者还包括：塔夫茨大学傅莱曼营养科学与政策学院的比阿特丽斯•罗杰斯博士和帕克•王尔德博士，他们呼吁美国农业部在促进健康的生活方式方面给予各州更多的权力和灵活性，同时还呼吁各州就营养项目展开全方位的合作，这样参与者才能得到一致的信息和最大的支持。他们建议，为了形成满意的食品标志项目营养教育计划，美国农业部应建立一套多年期更新循环机制，因为现有的年度更新循环机制妨碍了长期的可持续性和测评，可能会限制这些项目的开展。
塔夫茨大学的合著者这样写道，“全新的工作方式包括：为参与者提供更好的地理、财政和信息通道，以便让他们可以很方便地得到有益健康的食品选择方案，这样一来，食品券项目和WIC项目以及各个州的相关政策和规划就可以帮助参与者克服掉获取更好营养食品过程中的障碍。”从地理上讲，许多低收入地区限制参与者们进入拥有各种新鲜水果和蔬菜的超级市场。肯尼迪及其同事建议，各个州可以为食品供应商们提供税收鼓励和理财选择权，以吸引更多的食品供应商进入低收入地区。
为了使获取健康食品的通道更加通畅，一些州还出台了其它计划，比如农场主市场计划和未售出食品供应计划。前者为农场主提供了成本削减份额，后者则把低收入家庭和未售出食品联系起来，以避免这些食品白白浪费掉。
作者强调称，“这些计划可以得到加强。通过增强WIC项目和食品标志项目的购买力，钱可以更多地花在购买水果和蔬菜或全米类食品上，同时也降低了用于购买低健康性食品的开销。”
肯尼迪强调称，在促使联邦政府资助的营养项目发生内部环境变化的同时，应该充分利用为营养学教育所分配的有限时间，集中强调营养密度这一概念，其目的是使营养摄入量最佳化而不是使卡路里摄入量最小化。“选择营养高营养食品对每个人都是一种挑战，特别是对那些比较拮据的家庭而言就更困难了。尽管许多人认为需要花更多的钱才能买到有益健康的饮食，但研究表明食物价格的可选择性很大，一些营养密度高的食品不见得就贵。”因此，肯尼迪相信，通过与参与者沟通来影响他们的食品选择观念可以使人们的饮食更有营养，同时花的钱也不多。
“营养学团体需要向前看，需要分析我们能为食品券项目和WIC项目的参与者做些什么，如何才能给他们提供最好的服务。”肯尼迪说，“全国有许多州正在采取一些令人激动的行动。我们需要使这些激动人心的计划得到加强，同时找出能够充分发挥食品标志项目和WIC项目的方法，以促进更加健康的生活方式。”
备注：文章的题目为《创造健康州：构建更为健康的营养计划》。
如果你有兴趣了解这一主题的更多信息，或者想与塔夫茨大学傅莱曼营养科学与政策学院的大学教学人员或是其它塔夫茨保健科学研究人员进行交谈的话，请联系希博汉•盖拉哥尔，电话是：617－636－6586。
塔夫茨大学傅莱曼营养科学与政策学院是美国唯一一家独立的营养学院。该校的八个中心把科学研究应用于制定国家和国际政策，并因而享有较高的声誉。它们的主要研究课题涉及饥荒、饥饿、贫穷以及通信。20年以来，美国农业部设在塔夫茨大学的吉恩•迈伊尔人类老年营养学研究中心已对老年人良好的营养状况和良好的健康状态间的关系进行了研究。通过与联邦机构的通力合作，塔夫茨研究人员为美国农业部制定出饮食指导方针、饮食摄入量参考以及其他重要的公共政策。
英文原文：
Boston -- The Food Stamp program and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which are primarily funded through the Food and Nutrition Service of the United States Department of Agriculture, have made significant strides toward eliminating nutrition-related health disparities between low-income and higher-income groups. Despite this success, federally-funded nutrition programs have faced criticism for potentially contributing to the nation's obesity epidemic. To dispel this notion, Eileen Kennedy, DSc, RD, Dean of the Friedman School of Nutrition Science and Policy at Tufts University, and Tufts colleagues recently authored a report and accompanying issue brief through the bi-partisan National Governors Association (NGA) Center for Best Practices, and proposed policy changes that would allow the Food Stamp and WIC programs to continue reducing nutrition-related health disparities while simultaneously addressing obesity.
"The population as a whole is struggling with overweight and obesity, not just those who are enrolled in federally-funded nutrition programs," says Kennedy. In fact, the Tufts authors write that an expert panel investigating the potential link between nutrition programs and obesity concluded that the "available research on the Food Stamp program and WIC did not indicate that the programs were causing obesity." WIC and Food Stamp participants did improve nutrient intakes, but the panel determined that overall calories increased only among pre-natal WIC participants, which is thought to be a positive factor contributing to higher birth-weight babies. Tufts authors also cited that "data indicate that from 1976 to 2002, the probability of a woman being overweight grew the least among food stamp recipients."
Although research suggests that participation in the WIC and Food Stamps programs is not associated with obesity, Kennedy acknowledges that diets of program participants are still not optimal for good health, and that low-income populations may be more at-risk for weight gain. "Many low-income households face what is known as the 'double burden of disease,'" she explains, "meaning that those who are food-insecure are often overweight or obese. This creates an opportunity for federally-funded nutrition programs to restructure goals to address obesity, which is now a more prevalent problem for low-income households than under-nutrition."
Kennedy and Tufts co-authors, including Beatrice Rogers, PhD, and Parke Wilde, PhD, both of the Friedman School, call for the USDA to give states more power and flexibility in promoting healthy lifestyles, and for states to combine efforts across nutrition programs so that participants receive a consistent message and maximum support. They also recommend that the USDA convert to a multi-year renewal cycle for approving food stamps nutrition education plans, as the current annual renewal cycle may limit programs by hindering long-term sustainability and evaluation.
In addition to cohesive state policy and planning, WIC and Food Stamp programs can help participants overcome barriers to better nutrition by using "innovative efforts to provide greater geographical, financial, and informational access to healthful foods options," write the Tufts authors. Geographically, many low-income areas have restricted access to supermarkets with a wide variety of foods like fresh fruits and vegetables. To attract more food providers into areas that are largely low-income, more states can offer tax incentives and financing options, suggest Kennedy and colleagues.
Other state initiatives to improve access of healthful foods have been launched as well, such as farmers' market programs that offer reduced cost shares, or programs connecting low-income households with unsold produce that may have otherwise gone to waste.
Such programs can be enhanced, note the authors, "by increasing the purchasing power of WIC and food stamp dollars that are spent on fruits and vegetables or whole-grain items, while decreasing the purchasing power of dollars spent on less-healthy options."
Kennedy stresses that along with necessary environmental changes within federally funded nutrition programs, the limited time allotted for nutrition education should emphasize the concept of nutrient density, in order to maximize nutrients but minimize calories. "Choosing nutrient-dense foods is challenging for everyone, but it can be especially difficult for families on a budget. However, despite the fact that many people believe that healthful diets cost more money, research has shown that there can be great variability among the price of foods with similar nutrient density." Therefore, Kennedy believes that "working with participants to influence their food choices could result in a more nutritious diet for less money."
"The nutrition community needs to look ahead and analyze what we can do to best serve Food Stamp and WIC participants and how these programs can play an integral role in preventing obesity," says Kennedy. "There are some exciting activities taking place in many states across the nation. We need to build on these existing initiatives and determine how we can leverage the existing Food Stamp and WIC programs to promote healthier lifestyles."
