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Improving Healthy Eating in Families With a Toddler at Risk for Overweight: A Cluster Randomized Controlled Trial

Agras, William S. MD*; Hammer, Lawrence D. MD; Huffman, Lynne C. MD; Mascola, Anthony MD*; Bryson, Susan W. MS*; Danaher, Carol PhD

Journal of Developmental & Behavioral Pediatrics: September 2012 - Volume 33 - Issue 7 - p 529–534
doi: 10.1097/DBP.0b013e3182618e1f
Original Article

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.

*Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA

Palo Alto, CA.

Address for reprints: William S. Agras, MD, Stanford University, 401 Quarry Road, Stanford, CA 94305-57222; e-mail:

This study was supported in part by a grant HD055637 from the National Institute of Child Health and Development.

Disclosure: The authors have no conflict of interest regarding this article.

Received January , 2012

Accepted May , 2012

© 2012 Lippincott Williams & Wilkins, Inc.