Children eat up to 500 meals a year in early care and education settings, and the adults there routinely pressure them to eat, rush mealtimes and use food as reward. All three undermine self-regulation and are associated with obesity risk. A Hybrid Type 3 cluster-randomised trial across 88 sites in Arkansas and Louisiana will randomise 1:1 to a co-designed deimplementation package or usual practice, with a waitlist crossover at two years.
The design is unusual in a useful way. Deimplementation research has concentrated almost entirely on getting clinicians to stop prescribing things; this targets an entrenched cultural behaviour in a non-clinical setting. The primary outcome is direct observation of mealtimes rather than self-report, which is the right choice for a behaviour people know they are not supposed to exhibit. Child outcomes include BMI and skin carotenoid levels.
This is a published protocol. There are no results, no effect size and nothing to act on yet. It is here because the trial is registered and the question - whether feeding practice can be removed rather than added - sits directly upstream of the paediatric obesity that ends up in diabetes clinics.
- Nothing changes in clinic today; this is a registered protocol, not a readout.
- When counselling families, name the three practices specifically: pressure to finish, rushed meals, food as reward.
- Ask about childcare and school mealtimes, not just what happens at home.
- Note the outcome measure: observed mealtime behaviour beats questionnaire report for practices people know are frowned upon.
- Watch for results at 12 and 24 months post-intervention before changing any advice.
Why it matters
It reframes childhood feeding advice as removing harmful practices rather than adding healthy ones, which is a different and harder task.
Don't overread it
This is a protocol paper: no outcome data have been reported, and the intervention has not been shown to work.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for diabetes & endocrinology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free