Response to Satter: Make the Healthy Choice the Easy Choice

Dear Editor:

Our study, indeed, does not specifically utilize Ms. Satter's approach that she advocates in her letter, ¹ but rather the approach summarized in the 2011 Institute of Medicine (IOM) Early Childhood Obesity Prevention Policies report that discusses the development of self-regulation among preschoolers. ² Though Ms. Satter offers some evidence of her approach as being effective for adults, she offers no evidence of it being effective in promoting healthy weight outcomes among preschool children. In our randomized, control pilot study, on the other hand, we demonstrate the effectiveness of our approach to reduce the risk of overweight in preschool Latino children living in low-income households studied in “Pediatric Overweight Prevention through a Parent Training Program for 2–4 Year Old Latino Children.” ³

In our study, we taught families to create an environment where the child finds the healthy choice to be the easy choice, a strategy that is described by Thomas Frieden, MD, director of the CDC ⁴ ; by making the healthy choice the easy choice, it allows the child to self-regulate their food and beverage consumption within this context. In the IOM report Early Childhood Obesity Prevention Policies, nutritious and healthy foods are defined interchangeably as lean and low-fat protein foods, whole-grain products, fruits and vegetables prepared with little or no added sugar, salt, or fat, and low-fat or fat-free milk and dairy products. ²

In our study, we followed a similar definition of healthy and nutritious foods. Children at home and child care according to the evidence reviewed in the IOM Early Childhood Obesity Prevention Policies document “should be introduced to healthy food and given frequent opportunities to try them” to develop lifelong healthy eating habits. The IOM report concludes: “thus it is critical that health care providers, researchers, and policy makers explore ways to limit access to energy-dense, nutrient-poor foods for even young children.” ² Parents are the gatekeepers to the foods available in the home and should be counseled and encouraged to have a home environment where the food available to preschoolers is healthy and wholesome. We recommend that our study findings be examined in a larger sample of children. We welcome empirical comparisons between our approach and any enhancements others think will improve outcomes. Ultimately, positive study outcomes should dictate approaches to be used.