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Testing Satter’s Division of Responsibility in Feeding in the context of restrictive snack-management practices

2014; Elsevier BV; Volume: 100; Issue: 3 Linguagem: Inglês

10.3945/ajcn.114.091512

1938-3207

Ellyn Satter,

Food Security and Health in Diverse Populations

Dear Sir: In a recent article, Rollins et al (1) stated that they set out to test their interpretation of Satter’s Division of Responsibility in Feeding (sDOR; according to the authors, “parent provides, child decides”) relative to snack management and correctly cite Satter (2) as advocating shared control in feeding between parent and child. This research showed that when feeding is based on restriction and avoidance, there is no good way to manage children’s snacks in general and high-sugar, high-fat snack foods in particular. Moreover, it showed that sDOR cannot be successfully applied in the context of food restriction and avoidance. On the other hand, the study showed that children have lower BMIs and a lower tendency to eat in the absence of hunger (EAH; a protocol for observing a child’s likelihood of eating high-calorie snacks soon after a meal) when mothers avoid intruding on children's prerogatives of how much they eat. Rollins et al (1) examined the “parent provides” (what and when but not where) part of the equation by testing mothers on their use of restrictive feeding practices identified in previous research relative to 7 snack foods: popcorn, pretzels, chips, chocolate chip cookies, chocolate, fruit-flavored chewy candies (eg, Skittles; Wrigley), and ice cream. Feeding practices were as follows: limit buying, limit when, limit how much, limit second helpings, and (purchase but put food) out of reach. Four patterns of controlling feeding practices emerged: 1) Unlimited access: girls were allowed to choose their own snacks and eat them when they wanted to in self-determined amounts. 2) Sets (time) limits + does not restrict snacks (controlled when and how much and did not keep snack foods out of reach). 3) Sets (time) limits; restricts high-fat, high-sugar snacks (controlled when and how much and kept 50% of snack foods out of reach). 4) Sets (time) limits; restricts all snacks (controlled when and how much and kept all snack foods out of reach). Based on their relatively moderate scores in BMI and EAH, the group 1 “unlimited access” girls were the most successful. Based on increasing levels of BMI and/or EAH, girls in the other 3 groups were less successful. Group 2 girls were lowest in BMI but relatively high in EAH, indicating that the girls are likely to be at risk for excessive weight gain as they get older and are able to gain access to food on their own. Group 3 girls had the highest BMIs and lowest EAH, indicating that the girls may have become acclimated by gaining access to these foods on their own. Group 4 girls had the second-highest BMIs and a strong tendency to EAH. Measurements of approach and inhibitory control showed little variation among the four groups. Correctly following sDOR requires parents to take leadership with feeding by being reliable about providing regularly scheduled meals and snacks, taking responsibility for food selection through purchasing and meal and snack planning, and exercising their parental authority in not allowing children to have food handouts between times. Within the context of their leadership with feeding, parents give children autonomy with eating by letting them eat as much or as little as they want at those regularly scheduled eating times (3). sDOR only “works” when all of the components are in place: parents manage the what, when, and where of feeding and allow children to determine the how much and whether of eating (2). Moreover, managing structure within the context of sDOR is providing, not restricting or depriving, and the intent is to support children in eating as much as they need, not limiting their food intake (4). Within the context of sDOR, parents do not attempt to control how much the child eats in any way, not by portion control, not by running out of food, not by exhorting the child to use self-restraint, not by giving the child the “look.” As indicated in Table 1, none of the study patterns replicated sDOR. Instead, the patterns represented a deconstruction of sDOR by including some but not all of the components. Group 1 mothers, who had the most successful daughters, did not take leadership with feeding but did give autonomy with eating. In the other 3 groups, parents took only partial leadership with feeding. Group 2 mothers gave autonomy with respect to how much their daughters ate, but group 3 and 4 mothers did not. TABLE 1 Patterns of restrictive feeding practices in relation to Satter’s Division of Responsibility in Feeding1 The high BMIs of group 3 girls, as well as other research indicating that girls deprived of high-fat, high-sugar snacks show increasing EAH and BMI over time (5), indicate that successfully managing these foods requires a particular strategy. The sDOR solution (6) is to regularly include high-fat, high sugar foods, in unlimited amounts, in regular, structured, sit-down snacks. Clinical experience shows that children initially compensate for earlier deprivation by eating a great deal of these foods. However, their consumption moderates, and they adjust to eating more or less of them depending on their appetite and energy needs. Just as they do with other foods. To fully understand why the feeding strategies addressed in this research trial are inconsistent with sDOR, consider the trust-based theoretical underpinnings of sDOR. The conviction is that in the context of positive feeding, even children who particularly enjoy food and have unusually good appetite eat as much as they need of even very tasty food, and thereby show innate and positive self-control with respect to how much they eat. “Poor” food selection, such as allowing children to have high-fat, high sugar foods, only overwhelms their ability to regulate food intake when sDOR is incompletely or incorrectly applied.