Abstract
Background
Since 1992, Health Canada has recommended that children switch from whole fat cow’s milk (3.25%) to reduced fat cow’s milk (1–2%) at age 2 years to reduce risk of obesity. Despite this, observational evidence has consistently shown that children who consume whole cow’s milk have lower measures of adiposity and risk of overweight/obesity. Intervention research is needed to understand the causal relationship between cow’s milk fat and adiposity in childhood. While traditional randomized controlled trials (RCTs) are time consuming, costly, and require many resources, usual care research within existing research cohorts may be a promising way to minimize necessary resources and expedite large, representative RCTs. However, usual care practices and perspectives on cow’s milk fat among physicians and parents are unknown.
Objectives
The objectives of this study were to first understand cow’s milk fat practice among physicians and parents, and assess the acceptability of a recommendation for whole milk. Next, we aimed to use these results to design the CoMFORT trial, which will evaluate the effect of cow’s milk fat on child adiposity.
Design/Methods
This study took place within the TARGet Kids! primary care research network. We conducted online questionnaires through SurveyMonkey (surveymonkey.com), followed by in-depth interviews with primary care physicians, and parents of children aged 2–5 years who drink milk. Questionnaire data was analyzed using descriptive statistics; interviews were recorded, transcribed and analyzed using a general inductive approach and thematic analysis. Themes relevant to our objectives were identified and described to capture core messages from both physicians and parents. Physician and parent experiences and views were reviewed by the study team to create a framework for the CoMFORT protocol, identify barriers and facilitators to the CoMFORT intervention, and inform strategies for maximizing trial enrolment and adherence.
Results
Online surveys were completed by 50 parents and 15 physicians. In-depth interviews were conducted with 14 parents and 12 physicians. At the 2-year well-child visit, 29% of physicians usually recommended reduced fat (2%) milk, 36% recommended whole fat (3.25%) milk, and 36% made no milk fat recommendation. Among parents, 62% currently provided reduced fat (0.1–2%) milk, and 38% provided whole fat (3.25%) milk to their children. Overall, physicians and parents were willing to provide whole fat milk to children over age 2 years. Thematic analysis identified three themes: trust, in evidence among physicians and in physicians among parents; fat, and its role in a child’s diet; and healthy food – what it is, and how identity interacts with the provision of healthy food. Parent and physician usual practice, and attitudes and perceptions about cow’s milk fat, confirmed the feasibility and need for a usual care RCT.
Conclusion
These findings allowed us to understand physician and parent decision making practices, attitudes towards cow’s milk fat in children’s diets, and factors that would encourage or limit adherence to the CoMFORT trial protocol. The CoMFORT trial will inform international guidelines for cow’s milk consumption in childhood and positively impact child growth and development.