Improving healthy eating in families with a toddler at risk for overweight: a cluster randomized controlled trial.

OBJECTIVE: To ascertain whether a parent education program based on Satter's division of responsibility in feeding children (DOR) is effective in enhancing parent/child feeding interactions for children with an overweight/obese parent. The primary hypothesis was that the intervention would decrease parental pressure to eat. METHODS: Sixty-two families with a child between 2 and 4 years with at least 1 overweight/obese parent were randomly allocated using a cluster design to either the DOR intervention or a control group. The control group focused on increasing family consumption of healthy foods and activity levels and enhancing child sleep duration. The primary outcome was parent pressure on their child to eat. RESULTS: The DOR intervention was superior to the control group in reducing the pressure to eat. Two moderators of pressure to eat were found: disinhibition of eating and hunger. The parents in the DOR group, irrespective of disinhibition levels, lowered the pressure to eat, whereas those in the control group with low disinhibition increased the pressure to eat. There were similar findings for hunger. Gender moderated restrictive feeding with DOR parents lowering restriction more than parents of the control group in girls only. CONCLUSION: The DOR intervention was more effective in reducing the parent pressure to eat and food restriction (in girls only) than the control group.

Picky eating during childhood: a longitudinal study to age 11 years.

Picky eating is a common disorder during childhood often causing considerable parental anxiety. This study examined the incidence, point prevalence, persistence and characteristics of picky eating in a prospective study of 120 children and their parents followed from 2 to 11 years. At any given age between 13% and 22% of the children were reported to be picky eaters. Incidence declined over time whereas point prevalence increased indicating that picky eating is often a chronic problem with 40% having a duration of more than 2 years. Those with longer duration differed from those with short duration having more strong likes and dislikes of food and not accepting new foods. Parents of picky eaters were more likely to report that their children consumed a limited variety of foods, required food prepared in specific ways, expressed stronger likes and dislikes for food, and threw tantrums when denied foods. They were also more likely to report struggles over feeding, preparing special meals, and commenting on their child's eating. Hence, picky eating is a prevalent concern of parents and may remain so through childhood. It appears to be a relatively stable trait reflecting an individual eating style. However no significant effects on growth were observed.

Guided mentorship in evidence-based medicine for psychiatry: a pilot cohort study supporting a promising method of real-time clinical instruction.

OBJECTIVE: Evidence-based medicine has been promoted to enhance clinical decision making and outcomes in psychiatry. Residency training programs do not routinely provide instruction in evidence-based medicine. Where instruction exists, it tends to occur in classroom settings divorced from the clinical decision-making process and is focused narrowly on appraisal of evidence quality. The goal of this pilot study was to develop and evaluate the promise of a method of "hands-on" instruction in evidence-based medicine done in real clinical time. METHODS: A modularized curriculum to promote decisionmaking strategies using evidence-based medicine during the course of actual patient care was delivered by an attending physician mentoring a small team on the inpatient and consultation-liaison psychiatry services at Stanford. A staggered cohort of 24 consecutive trainees was followed between August and January 2007. Measures of trainees' skills in evidence-based medicine were assessed before and after mentoring. A blinded grader scored each inventory according to an explicit, predefined rubric. Demonstrated proficiency in delivery in each of the core skills of evidence-based medicine was assessed as a secondary outcome measure via the attending physician's unblinded subjective evaluation of trainee performance. Subjective descriptions of the experience were obtained via review of trainees' evaluations. RESULTS: Postmeasures of knowledge and skills in evidence-based medicine increased significantly relative to baseline. The Cohen's d effect size was large and clinically meaningful. The majority of trainees were able to demonstrate adequate proficiency of skills by attending subjective evaluation. Trainees' subjective experiences overall were positive. CONCLUSION: Guided mentoring in evidence-based medicine appears promising for further study.

Risk factors for childhood overweight.

PURPOSE OF REVIEW: We review the 2004 literature on risk factors for childhood overweight. Given the steady increase in the prevalence of childhood overweight, the identification of risk factors is of increasing importance. RECENT FINDINGS: A number of studies confirmed that parental overweight is the most potent risk factor for childhood overweight. Childhood temperament was found to mediate the effects of parental overweight with a difficult temperament increasing the risk of overweight. Newer findings implicate regular consumption of fast food and sweetened drinks as risk factors, as well as sedentary behavior; although a meta-analysis suggested that the effects of the latter factor are small. Other work was consistent with the finding that parental overcontrol of children's feeding behavior, particularly for those at high risk of developing overweight, may lead to overweight. SUMMARY: Identification of groups of children at high risk for becoming overweight offers the potential for early intervention to reduce the intergenerational transfer of obesity. This is an area for future research because the nature of effective intervention is at present unclear. There is a suggestion that focused behavior change efforts on one target such as reducing the intake of sweetened beverages may be more successful than attempts to make broader dietary changes. There is also evidence that targeting parental behaviors may be more effective than interventions directed solely toward children, suggesting that modification of the environment that a child is exposed to during early development may have a lasting effect.