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Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition… O’Connor, Teresia M; Mâsse, Louise C; Tu, Andrew W; Watts, Allison W; Hughes, Sheryl O; Beauchamp, Mark R; Baranowski, Tom; Pham, Truc; Berge, Jerica M; Fiese, Barbara; Golley, Rebecca; Hingle, Melanie; Kremers, Stef P J; Rhee, Kyung E; Skouteris, Helen; Vaughn, Amber Sep 11, 2017

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RESEARCH Open AccessFood parenting practices for 5 to 12 yearold children: a concept map analysis ofparenting and nutrition experts inputTeresia M. O’Connor1* , Louise C. Mâsse2, Andrew W. Tu3, Allison W. Watts4, Sheryl O. Hughes1,Mark R. Beauchamp5, Tom Baranowski1, Truc Pham1, Jerica M. Berge6, Barbara Fiese7, Rebecca Golley8,Melanie Hingle9, Stef P. J. Kremers10, Kyung E. Rhee11, Helen Skouteris12 and Amber Vaughn13AbstractBackground: Parents are an important influence on children’s dietary intake and eating behaviors. However, thelack of a conceptual framework and inconsistent assessment of food parenting practices limits our understandingof which food parenting practices are most influential on children. The aim of this study was to develop a foodparenting practice conceptual framework using systematic approaches of literature reviews and expert input.Method: A previously completed systematic review of food parenting practice instruments and a qualitative studyof parents informed the development of a food parenting practice item bank consisting of 3632 food parentingpractice items. The original item bank was further reduced to 110 key food parenting concepts using binning andwinnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parentingpractice concepts into categories that reflected their perceptions of a food parenting practice conceptualframework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysisidentified potential solutions. Subjective modifications were used to identify two potential solutions, with additionalfeedback from the expert panel requested.Results: The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback.A parsimonious and a comprehensive concept map were developed based on the clustering of the food parentingpractice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept mapcontained 17 constructs and was informed by a previously published content map for food parenting practices.Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present bothsolutions.Conclusion: The comprehensive food parenting practice conceptual map will provide the basis for developing acalibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such anitem bank will allow for more consistency in measuring food parenting practices across studies to better assess theimpact of food parenting practices on child outcomes and the effect of interventions that target parents as agentsof change.Keywords: Food, Nutrition, Child, Parenting, Parenting practices, Family, Concept mapping, Measurement* Correspondence: teresiao@bcm.edu1USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine,1100 Bates St, Houston, TX, USAFull list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity (2017) 14:122 DOI 10.1186/s12966-017-0572-1BackgroundMost children’s eating patterns and behaviors are shapedby family influences and ultimately can have an import-ant impact on their weight status [1–3]. Research de-signed to better understand how parents influence theirchildren’s eating has grown over the past two decadesand has resulted in over 75 published articles related tothe development of unique food parenting instruments[4]. Most of this work has focused on food parentingpractices, or the specific goal-directed parent actions de-signed to influence children’s eating behaviors or dietaryintake [5]. With this growing number of available instru-ments, there is little consensus on how to measure foodparenting practices, including which instrument to useand how food parenting constructs relate to or correlatewith each other. This significantly limits our ability toevaluate the relationships between various food parent-ing constructs and children’s intake or weight status; orcompare findings across studies [6, 7].Proposed ways to advance or improve the measure-ment of food parenting practices on children’s eatingbehaviors and dietary intake include using direct orvideo observational methods [8] or employing digitaltechnologies or simulations [6]. However, many large de-scriptive cross-sectional or prospective studies, or inter-ventions will not be able to utilize such assessments dueto the associated costs or burden on participants.Enhancing the ways in which behavioral and publichealth scientists can reliably and validly assess food par-enting practices in a standard way via self-report is vitalto advancing the field. One method for improving andstandardizing the measurement of latent constructsmeasured by self-report is Item Response Modeling(IRM) of an item bank, supplemented with computer-ized adaptive testing [6, 9, 10]. In this approach, a bankof items that assesses the latent construct is developedand calibrated by IRM analysis. Computer adaptive test-ing of the calibrated item bank allows researchers toselect all or a subset of the calibrated items to use, whilemaintaining the ability to compare the resulting scorefor the latent construct across studies. For a complexidea with multiple constructs, such as those that corres-pond to food parenting practices, a conceptual frame-work is needed to inform how the food parentingpractice constructs are operationalized. While a contentmap for food parenting practices has recently been pro-posed [11], there is no tested consensus for how specificfood parenting practice concepts or corresponding itemsfit within each construct of the proposed framework. Toinform this process, this study aimed to develop a foodparenting practice conceptual framework for parentswith children 5–12 years old based on an existing sys-tematically derived item bank of food parenting practices[4] using i) an online card sort task conducted by aninternational sample of experts of food parenting andfeeding, followed by ii) a concept mapping analysis ofthe resulting grouping of food parenting concepts intoconstructs and a larger framework. The long-term goalof this project is to develop a calibrated IRM item bankthat can be used with computerized adaptive testing andcan be utilized by other researchers in the food parent-ing field internationally.MethodIdentification of expert panelScientific experts were recruited to help develop theconceptual framework. Experts were defined as re-searchers who have either a) developed nutrition-based,family interventions aimed at treating or preventingchildhood obesity and/or modifying dietary behaviors; orb) studied the role of parenting and nutrition in the eti-ology of childhood obesity. A list of experts was createdby reviewing: 1) the membership list of the InternationalSociety of Behavioral Nutrition and Physical Activity(ISBNPA); 2) the list of attendees to the 2012 pre-ISBNPA workshop focused on improving measures ofphysical activity and food parenting practices; 3) recentpublications on food parenting practices throughsearches on PubMed, ERIC, PsycINFO, and ScienceDir-ect; and 4) asking our network of researchers foradditional suggestions. In total 32 experts were identifiedand 25 experts from 8 countries (Australia, Canada,Finland, Japan, Mexico, Netherlands, UK, and USA)agreed to participate (78% response rate). All expertswere offered an honorarium ($150) for their participation.The sorting task included participation of 28 experts, the25 outside experts and three primary members of the re-search team (TB, TMO, and SOH) who did not conductthe statistical analysis. The protocol was approved by theInstitutional Review Boards at the University of BritishColumbia and Baylor College of Medicine.Identification, reduction and sorting of food parentingpracticesAn overview of the methods of this study can be found inFig. 1. Previous work by our group [4] systematicallyidentified published food parenting instruments and sup-plemented the published items with additional items re-ported by parents to populate a food parenting practiceitem bank. Briefly, published articles containing at leastone scale on parenting or caregiver behaviors related to 2to 16 year old children’s eating, nutrition, or food intakewere extracted from 1) articles identified from two recentsystematic reviews; [12, 13] 2) an additional systematic re-view of articles published between January 2009 andMarch 2013 in PubMed, ERIC, PsycINFO, and Science-Direct; [4] and 3) reviewing and back-tracing the referenceof articles from steps 1 and 2. The broader age range forO’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 2 of 17the review compared to the ultimate target age range ofthe item bank (5–12 year old children) was selected inorder to capture a wide range of items. A total of 79 mea-sures were identified consisting of 1392 items measuringfood parenting practices [4]. To ensure data saturation offood parenting practices for the item bank, 135 parentswho reflected the socio-economic and ethnic diversityspecific to Canada and the US, were surveyed by an onlinepolling firm (YouGovPolimetrix, USA) about food parent-ing practices they have used or think other parents use[4]. They contributed 2240 valid (1985 unique, after re-moval of duplicates) food parenting practices, many thatoverlapped with published items [4]. To reduce the 3632food parenting practice items identified from the pub-lished literature and parent reports and make the sortingtask manageable for the experts, the binning and winnow-ing process, developed by the NIH PROMIS initiative wasused [9, 10]. “Binning,” or grouping similar food parentingpractice items, consisted of assigning the items from theliterature review and responses from the parent survey toone of 19 primary codes and a subsequent secondary code[4]. “Winnowing” or removing redundant items consistedof reviewing each bin and consolidating redundant items.The binning and winnowing process was conducted bytwo research members independently with all discrepan-cies triangulated by two other members of the researchteam until a consensus was reached among all four. Tworounds of binning and winnowing of the initial 1392 itemsfound in the literature and the 2240 parent responses tookplace (see previously published work for first round) [4]and the final round resulted in 110 key parenting practiceconcepts. A food parenting practice concept could repre-sent a number of food parenting practice items. For ex-ample, one food parenting practice concept was “I rewardmy child with something tasty (e.g., dessert) as a way toget him/her to eat [food]” where food could representFig. 1 Overview of the Methods to Develop the Food Parenting Practice (FPP) Concept Map. *Based on systematic item bank and first round ofbinning/winnowing published by O'Connor et al. [4]. **Based on content map published by Vaughn et al. [11]O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 3 of 17“healthy food”, “all his dinner”, or “fruits and vegeta-bles”. This concept represented a total of 43 itemsfrom the published literature or statements from par-ent report. The food parenting practice concepts werethen grouped into food parenting practice constructsvia Expert Panel sorting.The participating experts were invited to sort the 110key food parenting practice concepts into meaningfulgroups or constructs using the web-based ConceptMapping software (Concept Systems Inc., Ithaca, NY).To take advantage of existing substantial conceptual in-terpretation of food parenting practices, each expert wasprovided a copy of the previously published Vaughn etal. 2016 content map [11] prior to sorting and instructedto a) utilize the framework to guide their sorting and/orb) to propose a different grouping of food parentingpractice concepts. The published content frameworkgrouped food parenting practices into 19 constructsstemming from three larger domains: control, structureand autonomy promotion based on the authors’ criticalappraisal of the literature [11].In addition to sorting the concepts into meaningfulgroups, the experts were asked to name the groups theycreated. They were also instructed to not group uniquepractices together (i.e., create a miscellaneous group ofleftover practices), but instead create groups of singlefood parenting practice concepts if only one practice fitwithin the group. The sorting conducted by the expertswas reviewed to ensure that each expert sorted all 110statements and that no miscellaneous group was formed.One expert did create a miscellaneous group of 10 foodparenting practice concepts. Follow up with this expert,resulted in all those concepts being sorted into existingor new categories.AnalysisAnalysis of the sorting was conducted using non-parametric multidimensional scaling (MDS) [14]. A two-dimensional solution was used to assign each foodparenting practice concept an x/y coordinate on a pointmap. Food parenting practice concepts that appearedspatially closer to one another on the point map weregrouped by the experts closer together and thereforemay represent a similar construct. Acceptable stressvalues for MDS analysis typically range from 0.205 to0.365 when used to develop a conceptual framework[15], as opposed to when used in controlled psychomet-ric evaluations, which typically necessitate lower stressvalues (note that the MDS stress value for our solutionwas 0.267 and within acceptable range) [16].A hierarchical cluster analysis was then conducted toidentify clusters of food parenting practice conceptsfrom the MDS derived point map. Specifically, the hier-archical cluster analysis was carried out on the x/ycoordinates which were obtained from the MDS analysis.The concept mapping software utilizes the Ward’s algo-rithm for the cluster analysis because it: 1) retains thelocation of the x/y coordinates in the final solution; 2)creates non overlapping constructs; and 3) merges clus-ters based on the distance of all individual statementsinstead of using the centroid of a cluster [14].We adapted the procedure outlined by Trochim [14]to identify the appropriate number of clusters to retainin our solution. Trochim’s approach to identify the num-ber of clusters retained in the solution is iterative but es-sentially starts by: 1) reviewing an initial cluster solutionthat is derived statistically with more clusters that wouldbe anticipated; 2) adding more clusters one at a timeuntil it makes no theoretical sense to combine clusters;3) qualitatively reviewing the statistical solution to refineand fine-tune the shape of the clusters; and 4) having ex-perts review the solution and provide further input intothe analyses. As we aimed to identify two potentialsolutions, we refined this process for the following twosolutions: 1) a parsimonious solution and 2) a solutionthat approximated the Vaughn et al., 2016 content map[11] (referred herein as the comprehensive solution).The parsimonious solution was identified by first evalu-ating the simplest cluster analysis-generated solutionand determining whether adding another cluster basedon the cluster analysis made conceptual sense. Thisprocess iteratively continued and stopped when it didnot make sense to add further clusters. This solutionwas not constrained by a pre-determined conceptualframework but aimed to identify a parsimonious solu-tion, meaning we looked for larger clusters that con-tained related food parenting practice concepts. Thesolution was then examined and subjectively modified tointegrate the team’s consensus solution of the two-dimensional point map. Specifically, the content of eachcluster was examined, with emphasis on food parentingpractice concepts at the border of each cluster to assesswhether it could better fit with another cluster, prioritiz-ing neighboring clusters when appropriate. This iterativeprocess continued until the final solution was obtained.We identified the comprehensive solution by using theVaughn et al. 2016 content map [11] to initially examinea larger than expected cluster solution. We arbitrarilystarted by examining the 28-cluster solution and thendetermined whether reducing the cluster analysis de-rived solution into fewer clusters made conceptual sensebased on the Vaughn’s content map. We proceeded untilmerging could no longer be supported by the frame-work. Again, after we identified a statistical solution(potential number of clusters to retain), we subjectivelyreviewed the solution to determine an optimal solutionthat integrated the MDS results and the subjectiveevaluation of the two-dimensional point map using theO’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 4 of 17same procedure described above. Three members of theresearch team (TO, LCM & AT) independently conductedthese subjective analyses and their consensus solution waspresented to the primary team of investigators (SH, MB,and TB) who provided initial feedback for modificationand agreed on a solution to be presented to the ExpertGroup. We presented the two solutions to the ExpertGroup who were asked to select their preferred solutionand provide feedback and suggestions on that solution.One last round of modifications to both solutions wasconducted based on the expert’s feedback until consensuswas reached among the authors.ResultsExpert sortingThe 28 participating Experts sorted the food parentingpractice concepts into 3–28 categories, with a mean(standard deviation) of 18.1 (6.5) and mode of 19 foodparenting practice categories. Six Experts sorted the foodparenting practices concepts into 19 categories, the samenumber as presented by the Vaughn et al. 2016 contentmap [11]. Of those, there was overlap in the names of 5–19 constructs (mean 14.7, stand dev 5.8) with the contentmap, with only two having exactly the same structure (19/19 constructs) as the proposed content map [11]. It is notknown how many elected to use the published contentguide to inform their sorting. However, in reviewing thenames of categories proposed by the Experts, many usedat least some of the same construct names while adding toand/or deleting food constructs for their final solution.Expert preference for proposed solutionsBoth the parsimonious and the comprehensive conceptsmap solutions were presented to the original experts whoparticipated in the sorting task. Of the 27 eligible expertrespondents (TMO was excluded because she managedthe responses), 23 responded (85.2%). The comprehensiveconcept map informed by the published content map [11](Fig. 2) was preferred by 52% of experts, and another 35%preferred to present both solutions. Based on these prefer-ences, we include the comprehensive concept map in-formed by the published content map within this article,Fig. 2 Comprehensive solution for food parenting statements subjectively grouped into clusters, informed by the hierarchical cluster analysis anda published framework (Vaughn et al. [11]).O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 5 of 17but have made the parsimonious solution available onlinein an Additional file 1.Experts reported they preferred the comprehensivesolution because it was more theoretically based andthe specific differentiation of food parenting practiceshad promise for better informing which food parentingpractices were most important in influencing child eat-ing behaviors. The most common reason for preferringto present both solutions was that the two frameworkshad the potential for serving different purposes, withthe comprehensive solution being more applicable toresearchers in this area and the parsimonious solutionbeing useful for those who try to operationalize pro-moting these practices in obesity prevention programsor policy statements. A few experts suggested futurework may be able to integrate the two models into onemodel, with a more parsimonious global solution anddetailed “sub-factors” embedded within the parsimoni-ous constructs.The Comprehensive conceptual framework of foodparenting practicesThe comprehensive food parenting practices conceptmap based on the published content map [11] resultedin an 17-cluster solution from a statistically derived 16cluster solution (see Fig. 2 with concepts, constructnames, and definitions listed in Table 1) with subjectivemodifications. Vaughn et al., proposed grouping foodparenting practices into three larger overarching do-mains: Control, Structure, and Autonomy Promotion[11]. Figure 2 illustrates how the comprehensive conceptmap potentially supports these same three overarchingdimensions.Most of the food parenting practice constructs undereach dimension defined by Vaughn and colleagues’ con-tent map [11] appear to also cluster on the comprehen-sive concept map (Fig. 2). All four Coercive Controlconstructs identified on the content map were spatiallyclose and therefore labeled to belong to Control on thecomprehensive concept map: Restriction (A), UsingFood to Control Negative Emotions (B), Threats &Bribes (C), and Pressure to Eat (D). One notable differ-ence in our solution was the construct of Restriction (A)was specific for controlling weight, whereas in thecontent map Restriction was a more general concept.Another difference was the addition of a new constructunder Control, termed Intrusive Control (E). This con-struct included demanding and directive concepts wherethe parent dictated what and how much the child shouldeat. These demanding and directive concepts weredistinct from pressuring the child to eat more, as seen inPressure to Eat (D), and from the guidelines and bound-aries that parents set, found in the Rules and Limits con-struct (G) under the Structure dimension. IntrusiveControl was therefore made into a new construct. It wasincluded in the Control domain because the focus wason parents dictating to the child without child input.The proposed content map [11] identified nine con-structs under Structure, of which six were identified inthe comprehensive concept map solution: Rules andLimits (G), Food Availability and Accessibility (I), FoodPreparation (J), Modeling (K), Meal Routines (M), andPermissive (H) (or “unstructured practices” as termed byVaughn et al. [11].) The Availability and Accessibilityconstruct was separated into two constructs by Vaughnet al. [11], however, the comprehensive concept mapsolution collapsed it into one construct. In the compre-hensive concept map, there was a lack of a distinct Mon-itoring category in the Structure dimension as definedby the published content map, which may be due to themultiple published items on monitoring being con-densed down into one monitoring concept (# 38) for thissorting task. In the solution presented here it falls intothe Rules and Limit construct, but future studies willneed to assess whether it should be a separate constructin the Structure dimension.Different from Vaughn’s et al. content map, three newcategories were identified in the comprehensive conceptmap under the Structure dimension: Prompt to Eat (F),Exposure to a Variety/Selection (L) and Redirection & Ne-gotiation (N). Upon review of the solution, some expertsidentified similarities of the concepts clustered in Promptto Eat to concepts clustered under Pressure to Eat. How-ever, the two clusters were spatially separate from eachother on the map. Therefore, Prompt to Eat was identifiedas a distinct construct from Pressure to Eat and reflectedmore gentle reminders for a child to eat, as opposed topushing the child to eat beyond satiety as seen in Pressureto eat. This difference suggests that the Experts may dis-tinguish varying degrees of how parents remind or pushtheir child to eat and some Experts felt that Prompt to Eatwas a form of Structure instead of Control. Exposure to aVariety/Selection was not identified by the published con-tent map but concepts that clustered into this constructspatially fell into the Structure dimension on the compre-hensive concept map. On face validity, these conceptsmay be an extension of availability, but the concepts werespatially separate from the Availability and Accessibilityconstruct on the map and therefore made into a new con-struct. Redirection & Negotiation was also not a constructin the content map proposed by Vaughn et al., but doeshave some overlap with the content map’s Limited/GuidedChoices (which was not present in the solution presentedin Fig. 2). Future work will need to explore the overlapand differences between these two constructs.The Autonomy Promotion dimension had the mostdifferences between the comprehensive concept mapand the previously proposed content map [11]. SimilarO’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 6 of 17Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2)ConceptNumberFood Parenting Practice Concept Hierarchal Analysis PointMapCluster AssignmentaQualitative ContentMap Cluster AssignmentDefinitionControl54 I restrict my child’s food intaketo control his/her weight.3 A: Restriction forWeightDue to concern for child’s weight,parent restricts access to or discouragesconsumption of certain foods, largeportions, multiple servings, or frequentsnacks.68 I tell my child to avoid certain food ordrinks as they can make him/her fat.122 I use food to soothe my child. 2 B: Using Food toControl NegativeEmotions“Parent uses food to manage or calmthe child when he/she is upset, fussy,angry, hurt, or bored.” [11]23 I give my child food to keephim/her occupied.217 I reward my child with somethingtasty (e.g. dessert) as a way to gethim/her to eat [food/healthyfood/all his/her dinner].3 C: Threats and Bribes Parent threatens to take or takes somethingaway for misbehavior or promises/offerssomething to the child to coerce theminto desired behavior. Threats and bribesrelated to food include those used tomanage child’s general behavior by usingfood as reward or threat; or using threatsor bribes to influence the child’s eatingbehaviors. (modified from Vaughn et al.) [11]18 I tell my child that I will take awayprivileges (e.g., screen time) if s/hedoes not eat (./healthy food type).319 I punish my child (e.g., send awayfrom table, spank) if s/he does notwant to finish his/her plate, tastea food, or eat fruit or vegetables.320 I promise my child [unhealthyfood] as a reward for good behavior.324 I scold or show disapproval whenmy child eats too much.325 I show disapproval by arguing withor yelling at my child for not eating[healthy food].373 I use scare tactics to discouragemy child from eating unhealthy foods.488 I use threats to get my child to eat. 489 I make my child feel guilty when s/hedoesn’t eat vegetables or finish his/hermeal.3105 I withhold dessert as a consequencefor bad behavior.3106 I discipline my child if s/he consumesan unhealthy food/drinks withoutmy permission.416 I make sure my child eats [all theirdinner/all their fruits/vegetables]before s/he can have dessert.4 D: Pressure to Eat Parent is forceful or demanding inorder to push the child to eat food,when child is either not interested ineating, not hungry, or does not wantto eat or taste the food that is servedduring a meal or snack. The parentdoes not take into consideration thechild’s current hunger or satiety, northe child’s food preferences.(modified from Vaughn et al.) [11]O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 7 of 17Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2) (Continued)42 I beg my child to eat (./at leastsomething from his/her plate).451 I make my child eat all the foodon his/her plate.452 I get my child to eat morevegetables, even if s/he says“I’m not hungry.”453 I insist/force my child to “try onebite” or taste a [food/healthy food].421 I trick my child into eating [healthyfood] by mixing it with other foodor disguising it.5 E: Intrusive Control Parent dictates how and what thechild should eat. Parent tells their childwhat to do and expects their child tocomply without question. (NEW)37 I tell my child to eat [healthy food]or not eat [unhealthy food/drinks]but do not follow this myself.539 I decide what my child should eat(./at meals/snacks).640 I don’t allow my child to eat morethan I think s/he should.541 I make my child eat [healthy food]every day.555 If my child eats more than usual atone meal, I try to restrict his/hereating at the next meal.572 I make my child eat his/her fruitand vegetables first at mealtimesor snacks.587 I criticize my child about the foods/he eats.497 I decide when my child eats his/hermeals and snacks.5Structure49 I have to strongly encourage mychild to eat foods that are goodfor him/her.1 F: Prompt to Eat Parent suggests to the child orprompts the child to eat foodwithout being forceful and withoutconsequence. There is no focus oneating beyond satiety. There is anemphasis on promoting to eatnutritious food. (NEW)50 I encourage my child to eat all thefood on his/her plate.198 I try to convince my child to eatfruit or vegetables instead of cakeor candy.1100 I tell my child to eat fruit andvegetables.238 I monitor or keep track of the[healthy/unhealthy food/drinks]my child eats/drinks.7 G: Rules and Limits Parent has and makes knownexpectations, guidelines, orboundaries for how much or whatkind of foods the child eats, maintainsthe timing or routine of meals, orpromotes a certain order in whichfoods are eaten. The parent can monitorwhether the child sticks to the rules.(modified from Vaughn et al.) [11]O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 8 of 17Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2) (Continued)44 I do not allow my child to eator drink an hour before mealsor after a certain hour of the day.745 I ask others not to give my childunhealthy food (candy, sweets,salty snacks).756 I limit or do not allow my childto eat/drink certain [unhealthyfood/drinks].659 I insist my child eat meals/snacksat the table.874 If I allow my child an unhealthymeal/snack the next meal snackmust be healthy.699 If my child eats junk food, s/hemust also include somethinghealthy.611 I allow my child to have whateversweets and snacks s/he choosesat social occasions or to celebratean achievement.10 H: Permissive Feeding “Parent allows child completecontrol of their eating, includingtiming and frequency of meals andsnacks, and amount and type offoods eaten.” [11] Parent does notimpose limits and will providedifferent foods for the child fromwhat the rest of the family eatsbased on the child’s preferencesand whims. Parent facilitates lessnutritious food selection by keepingthose in the home or taking thechild place those foods are served.14 I serve dessert to my child if s/heis no longer hungry for her/hismain dish but is willing to eatdessert.861 I take my child to eat at fast foodplaces.1079 I serve/offer unhealthy foods [atmeals/snacks/for dessert].991 I offer my child seconds. 896 I eat/drink unhealthy foods/drinkswith my child.103 I give my child money to buyfood (snacks, treats, or meals).107 I allow my child to eat whenevers/he is hungry or shows signs ofhunger.108 I allow my child to buy [unhealthyfood type] if s/he wants it as a snackor meal.910 I serve what my child demands atmeals.912 I make or allow my child to makesomething else if s/he does notlike what is served.915 I give into my child’s food demands(./after saying no)9O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 9 of 17Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2) (Continued)69 I allow my child to eat unhealthywhen we are away from home (e.g.,doing errands, driving to practices).980 I allow my child to have seconds ifs/he finishes foods from his/her plateat dinner.881 I let my child eat unhealthy foodwhenever s/he wants.982 I let my child substitute a food s/hedoes not like for one s/he likes.10107 I allow my child to skip meals. 8110 I allow my child to eat unhealthywhen we are on vacation.927 I hide or intentionally keep less[healthful food/drinks] out of mychild’s reach.27 I: Food Accessibility/AvailabilityThe amount and types of foodsthat a parent brings into the home;or how readily accessible the parentmakes healthy and unhealthy foodsin the home. Accessibility includesmaking foods ready and easy to eat,such as washing, cutting up andmaking food easy to see and reachfor the child. (Modified from Vaughnet al.) [11]28 I keep or have ready to eat fruitsand vegetables in the fridge formy child to eat (e.g., pre-cut, clean).1029 I avoid having [unhealthy food/drinks]available at home.1075 I make sure that I have healthy foodsin the house (./that my child likes).1076 I have unhealthy foods in the house(./that my child likes).1031 I include [healthy food] in my child’slunch/snacks/meals (./that s/he likes).10 J: Food Preparation The planning, preparation andcooking methods that a parentemploys when providing or servingmeals and snacks, which mayimpact the healthfulness of thefoods served. (Modified fromVaughn et al.) [11]32 I balance all food groups in mychild’s meals.1043 I plan and prepare my child’smeals/school lunches (./fromscratch).1093 I prepare food in a low-fat orhealthy way for my family.1194 I use pre-packaged, conveniencefood for meals.1026 I show enthusiasm about eatinghealthy foods.14 K: Modeling Eating specific behaviors theparent engages in themselves infront of child that may entice theirchild to emulate his/her eatingbehaviors, food choices, or amountsof food. It can either be in regardsto nutritious foods or less nutritiousfoods. It is distinct from creatingopportunities to role model eatingbehaviors such as having a familymeal together.O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 10 of 17Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2) (Continued)34 I eat/drink [healthy food/drinks]in front of my child (./even if theyare not my favorite).1135 I avoid eating/drinking [unhealthyfood/drinks] in front of my child.1195 I take a second helping of foodat dinner in front of my child.1130 I serve [healthy food] multipletimes and in different ways toencourage my child to developa taste for it.12 L: Exposure toVariety/SelectionParent exposes the child tonutritious and/or different food ona regular basis, includes variety ofways to prepare or eat nutritiousfood, and may allow choice for thechild. (NEW)71 I expose my child to a varietyof fruits and vegetables (./sinces/he was little).1278 I serve/offer [healthy food type](./each day, for snacks, for a side-dish,for breakfast/ for dinner/for dessert)1292 To ensure my child eats a particularfood (e.g., vegetables), I serve it withfood my child likes.12108 I suggest places to eat out that havehealthy selections for my child.1258 I try to minimize distractions duringmealtimes (e.g., watching TV,answering phone calls, texting,playing with toys).12 M: Meal Routines “Parent implements consistencyand predictability around meals andsnacks with regard to their location,timing, presence of family members,conversational tone, and presence/absence of distractions.” [11]60 I make sure my family eats togetheras often as possible.114 I give my child small portions to gethim/her to eat a particular food ornew foods.13 N: Redirection andNegotiation“Parent engages with child to cometo an agreement about what or howmuch the child will eat. Negotiationallows for resolution of differentopinions between parent and childby finding an acceptable compromise.”[11] Parent uses tactics to take thechild’s mind off of certain foods ordrinks, provides them with alternatives,or shares food to decrease portionsize. The tactics are not forceful andthere are no consequences if notsuccessful.5 I offer/provide my child healthyoptions when s/he asks forunhealthy food or treats.136 I negotiate with my child abouthow much unhealthy or healthyfood s/he eats or drinks.1577 I encourage my child to eat[vegetables] by playing gameswith my child at meals times orby challenging him/her to eat it.13102 I encourage my child to drinkwater when s/he feels hungry.13O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 11 of 17Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2) (Continued)103 To discourage my child fromeating a particular food, I givehim/her something else to do.13104 I encourage my child to controlhis/her intake of unhealthyfood/drinks by sharing it.13Autonomy Support1 I take into account the [healthyfood/drinks] my child likes whenshopping for food or preparingmeals.12 O: Child involvement Parent acknowledges the child is anindependent individual and takesinto consideration the preferencesand wants of the child by activelyinvolving the child during mealplanning, grocery shopping, mealpreparation, or mealtime, with thegoal to motivate more nutritious intake(modified from Vaughn et al.) [11]2 I allow my child to servehim/herself and decide howmuch food s/he eats.129 I let my child have a lot of sayin what is eaten or prepared formeals.1413 I let my child season the vegetables,such as adding ketchup or cheesesauce, to make them taste better.757 I talk to my child during meals. 1462 I ask my child to suggest how s/hecan eat more healthy food.1583 If my child does not want to taste afood, I do not try to make him/hereat it.784 I let my child prepare his/herlunch/snacks.1485 I involve my child in meal andsnack preparation.1486 I let my child choose fruits andvegetables while grocery shopping.1433 I encourage my child to eat[healthy food] by making the foodinteresting (e.g., cutting into shapes,preparing it in a variety of ways, orseasoning it).14 P: Encourage HealthEatingNon-directive methods to suggestthat the child try or eat a healthyfood, but is not forceful and doesnot have consequences associatedwith child not following through.These non-directive methods includegentle verbal cues or reminders,non-verbal methods by making foodmore appealing or interesting for child.It also includes promoting self-regulationof intake by children to not eat beyondsatiety. (Modified from Vaughn et al.) [11]36 I tell my child how much I like afood to encourage him/her to eat it.1546 I encourage my child to eat/drink/try [healthy food] (./but do notforce him/her to do so)1547 I encourage my child to eat/drink[healthy food/drinks] instead ofor before [unhealthy food/drinks].15O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 12 of 17to the proposed framework, Child Involvement (O)was a distinct construct under Autonomy Promotion.However, the two proposed constructs of Praise andEncouragement were combined into a single Encour-age Healthy Eating (P) construct, while the two pro-posed Nutrition Education and Reasoning constructswere combined into a single Education/Reasoning (Q)construct. Lastly, the proposed construct Negotiation,which Vaughn et al. suggested belonged in AutonomyPromotion [11] was instead collapsed with Redirectionin the Structure dimension (Fig. 2).Five concepts (13, 26, 27, 83, and 87- Fig. 2) weregrouped with clusters spatially removed from theirclosest cluster on the point map, because the researchteam deemed they fit better conceptually. Food parent-ing practice concepts 13 (I let my child season thevegetables, such as adding ketchup or cheese sauce, tomake them taste better) and 83 (If my child does notwant to taste a food, I do not try to make him/her eatit), were spatially closest to Rules and Limits andPermissive Feeding, respectively. However, the teamproposed both concepts fit better into Child Involve-ment, which includes concepts that allow the parentto consider their child as an individual when motivat-ing them to eat more nutritious foods. Concepts 26(I show enthusiasm about eating healthy foods.) wasspatially within Child involvement (P), but was movedinto Modeling (M), to capture the concept of enthusi-astic modeling [17], as per recommendation ofExperts. Concept 27 (I hide or intentionally keep less[healthful food/drinks] out of my child’s reach) hassometimes been classified as a form of covert control,but several experts felt it better fit into J: Availability/Accessibility. Concept 87 (I criticize my child aboutthe food s/he eats.), was initially grouped with Pres-sure to Eat concepts, but it did not promote eatingmore food like the other concepts in Pressure to Eat.It was therefore moved to the adjacent new constructIntrusive Control which focused on directive and in-trusive parental control of their child.Table 1 110 food parenting concepts grouped into 17 clusters based on qualitative cluster assignment informed by published FoodParenting Framework [11] of expert’s sorting (corresponds with Fig. 2) (Continued)48 I tell my child that his/her friends/sibling(s)/favorite characters like the[healthy food] as a way to encouragehim/her to eat it.1570 I remind/encourage my child to stopeating or to not take more foodwhen s/he feels full.1590 I praise my child for eating healthyfood or fruit and vegetables.16101 I help my child set a goal to eatmore fruit and vegetables.1563 I persuade my child to eat healthyfood by explaining why it’s important(e.g., you will feel better, good for you,you’ll grow big and strong, do betterat school).16 Q: Education/Reasoning Explanations given by parent to childto educate the child about foods’nutritional qualities, such as the benefitsof eating healthy foods or theconsequences of eating unhealthyones. Parent uses logic or explanationsto persuade the child to change his orher eating behavior (modified formVaughn et al.) [11]64 I teach my child that certain food/drinksshould only be consumed in moderation.1665 I tell my child that certain food or drinksare not good for his/her health or teeth.1666 I use mealtimes to teach my childabout healthy eating.1667 I teach my child about healthy eatingby reading food labels and playingeducational games.16109 I give my child ideas on how to eathealthier (e.g., eating more fruits andvegetables).16aThis refers to the cluster the item was assigned based on the original 16-cluster solution identified by the cluster analysis. This is visually depicted in Fig. 2 as thegray shadow clusters and illustrates how many subjective changes were made to generate the proposed 17 cluster solutionO’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 13 of 17The parsimonious conceptual framework of foodparenting practicesThe parsimonious solution was derived from the 4-cluster statistical solution which expanded to a 7-clustersolution after it was subjectively reviewed and endorsedas part of the consensus process. The final model can befound in Additional file 1: Figure A (online) with con-struct names, definitions and corresponding conceptsfound in Additional file 1: Table A (online). The subject-ive separation of clusters was performed because the in-creased number into 5, 6 or 7 clusters resulting from thehierarchical cluster solution did not fit based on face val-idity. Instead, subjective modifications to the 4-clustersolution were based on the research team’s currentunderstanding of the published literature. The firstmodification was due to one of the 4 clusters containingunique concepts for different forms of coercive control(e.g. punitive restriction and pressure to eat). Prior re-search suggests that parents use pressure to eat morewith picky eaters or underweight children, and it hasbeen associated with lower weight status among childrenin several cross-sectional and longitudinal studies [18–21].On the other hand, restriction has been more commonlyassociated with higher child weight status in cross-sectional and longitudinal studies and may be a responseto children who are heavier or are more food responsive[18–21]. These divergent outcomes associated with pres-sure to eat and restriction suggested these two constructsmay be conceptually different and should be measured in-dependently of each other. Therefore, all the concepts inthis group that reflected pushing children to eat more(whether coercive or not) were moved to the Pressure toEat construct (Cluster 1). All the concepts that reflectedthe use of punishment or coercion to restrict the amountthat children could eat remained in the Restriction con-struct (Cluster 2).The next modification involved a large cluster thatemerged from the 4 cluster solution which containedconcepts related to parental Rules and Expectations(Cluster 4), along with two concepts (concepts 22 and23) that theoretically did not belong with the others.These two concepts on the border of the cluster weremore consistent with the idea of Emotional Feeding, firstidentified by Wardle et al. [22], and were thereforeseparated into a different construct named EmotionalFeeding (Cluster 3).The statistically derived 4-cluster solution includedone large cluster that combined concepts for creatingstructure for a child with indulgent food parenting prac-tices. Indulgent feeding style has consistently been asso-ciated with higher child weight status in cross-sectional[23] and recently in a longitudinal study [24]. However,structure is believed to be protective from excessiveweight gain among children and for ensuring adequateconsumption and growth for children with low weightstatus. It was considered whether these constructs are atthe opposite ends of one spectrum, but we believed it ispossible that parents can be indulgent with or withoutstructure. The last modification therefore involved sep-arating these two constructs into Indulgence (Cluster 5)and Structure (Cluster 6). The final cluster identified inthe statistically derived 4-cluster solution containedstrategies that involved parental Active Encouragementfor Nutritious Eating by their child, and remained intact(Cluster 7). Based on expert input on the solution, itemsthat may require further evaluation for fitting withineach construct are identified for future studies inAdditional file 1. A comparison of the two solutions canbe found in Additional file 1: Figure B (online).DiscussionAn international expert panel of researchers involved infood parenting practices research helped guide the de-velopment of a new Concept Map for Food ParentingPractices. Both of the final two Food Parenting PracticesConcept Maps presented here were derived from a MDSpoint map of the spatial relationships of 110 food par-enting concepts based on the sorting task of 28 foodparenting experts from around the world. One of theconcept maps (Fig. 2, Table 1) is a subjective clusteringof the food parenting practice concepts point map thatretains a more comprehensive structure and was in-formed by the developmental psychology literature citedby Vaughn et al. [11] This comprehensive concept mapshould allow researchers to evaluate the impact of eachof the proposed food parenting practice constructs onchild outcomes, how parents use these practices incombination [25, 26], and whether child characteristicsmoderate the impact of each construct. This detailedsolution will also allow researchers to select specific con-structs when testing hypothesis or developing or evaluat-ing interventions. The other concept map (Additionalfile 1: Figure A and Table A) was informed by the hier-archical cluster analysis solution and took a parsimoni-ous approach as we aimed at identifying fewer clustersor constructs. This latter approach may help scientistsenhance their measurement of food parenting practiceby reducing the burden of measurement, while assessingmore global and potentially predictive constructs. Afterthey were given the opportunity to review both solu-tions, over half of the experts preferred the comprehen-sive solution. They felt this model allows for a betterdistinction of which constructs are most predictive ofchild behavior and health outcomes and have a greaterimpact to move this area of research forward.Both the comprehensive and parsimonious solutionsrequired subjective modifications to the statistically de-rived cluster solutions from the MDS point map. TheO’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 14 of 17difficulty in interpreting any of the hierarchical clusteranalysis solutions without modifications, suggest thatthere was not great consensus among these experts forhow to conceptualize a framework for food parentingpractice, despite being provided with a published con-tent map that several of the investigators and experts inthis study helped develop. Of note, the cluster analysisof the MDS solution of only those experts that partici-pated in the development of the published content map[11] and this sorting task was also explored, with noclearer solution apparent. One expert suggested that thecomprehensive solution may be sub-factors within themore global parsimonious solution. Unfortunately, thecurrent solutions do not fully support this as illustratedin Additional file 1, where there is not always clear over-lap between the constructs defined in the two solutions.It is possible that future studies can help further refineboth solutions such that the relationships between thetwo can be better delineated.In this study, an international group of experts helpeddevelop a concept map for food parenting practicesusing a systematic approach to identify the food parent-ing practice concepts, by allowing them to sort the con-cepts into categories and interpret their sorting usingstatistical analysis. This is distinct from the approachtaken to develop Vaughn et al.’s content map [11], forwhich an overlapping group of experts were asked tocollaboratively propose a framework for food parentingpractices based on their own research and review of theliterature. This published content map currently lacksvalidation. While the intent of this study was not to val-idate the published content map, the team felt it was im-portant to allow the experts access to it. Since the foodparenting content map was not published at the timethe experts were asked to complete the sorting task, itwas provided to allow them to use all possible resources.They were instructed to use the framework only if itworked with their own conceptual approach to the sort-ing task. It is not known how many elected to do so.The work presented here was based on an item bankdeveloped from published instruments of food parent-ing practice instruments systematically identified in2013 [4]. Since that time, additional studies have beenpublished that adapted or tested the psychometrics offood parenting practice scales already included in theitem bank, to new populations [27–31]. In addition,several important new instruments of food parentingpractices have been published that could not be in-cluded in the item bank to inform the Experts’ tasks.These include the Parental Feeding Practices (PFQ)scale for Mexican American families [32], the VegetableParenting Practice scale [33], Feeding Practices andStructure Questionnaire (FPSQ-28) [34], and the Struc-ture and Control in Parent Feeding (SCPF) [35].However, several of these instruments were developedbased on previously published scales and had muchoverlap with items already included in the item bankand would likely integrate with the concepts we identi-fied. The extent to which these newer items fit withinour existing concepts will be tested empirically in thefuture.The goal of this study is ultimately to improve themeasurement of food parenting practices to allow fora more standardized assessment of food parentingpractice constructs and better comparisons of resultsacross studies. The team is currently iteratively devel-oping items to cover the constructs presented in thecomprehensive food parenting practice solution usingexisting or modified items from published scales. Fu-ture work will include testing the resulting question-naire in English with parents via cognitive interviews,and then assessing parents’ use of the food parentingpractices in a large cross-sectional study for classicaltest theory and advanced psychometric analysis (e.g.item response modeling). This will allow psychometrictesting of the proposed comprehensive model. If thecomprehensive model is a poor fit which cannot beimproved with minor alterations, the parsimoniousmodel will be tested instead. Ultimately, the goal is tocreate a calibrated item bank that can be used forcomputer assisted testing in observation and interven-tions studies. The psychometric analysis will helpachieve this by assessing whether items are stableacross participant characteristics (e.g. income andeducation) via differential item functioning within aCanadian sample. Future work will need to assess thestability of items across different cultural racial andethnic groups and in different languages. The im-provements in measuring food parenting practices willhopefully result in more consistent use of instrumentsacross studies and better understanding of the impactsof food parenting practices on child outcomes, andwhether child characteristics or behaviors moderatethese findings.Strengths and limitationsThis study has several strengths including a systematic ap-proach to identifying food parenting practice concepts,engaging an international sample of experts in food par-enting and child feeding in a sorting task, and using bothquantitative and subjective approaches to interpret theresulting point map solution of food parenting practices.Limitations of this methodology should also be acknowl-edged. The item bank is based on instruments publishedbefore March 2013, and therefore does not include instru-ments developed after this time. Experts varied by howmuch they relied on the previously published content map[11] to inform their own sorting, which may haveO’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 15 of 17influenced the final analysis. The cluster analysis derivedsolution of food parenting practice clusters also suggestedthere was variability in how the Experts operationalizedeach construct. Another limitation in measuring food par-enting practice concepts is they are typically operational-ized as unidirectional behaviors of parents aimed at theirchild. This may imply the assumption that we can fullyunderstand the impact of food parenting practice on childdietary behavior by applying the Concept Map in observa-tional and intervention studies. It should be acknowledgedthat food parenting practice is embedded in a more com-plex family context, including the back-and-forth interac-tions between a parent and a child, as well as sibling andmarital relationships, with reciprocal influences betweenall family members. Thus, it is likely that food parentingpractices can be best understood in the context of interac-tions within the family as a whole.ConclusionIn summary, the comprehensive food parenting practiceconcept map derived from the experts’ sorting of food par-enting practice concepts provides a conceptual map and theroadmap for the selecting and developing of items for eachconstruct. These will in turn be tested to eventually developa calibrated item bank of food parenting practices, whichwill help standardize the measurement of food parentingpractice in future observational and intervention studies.Additional fileAdditional file 1: Parsimonious solution of food parenitng practices.(DOCX 356 kb)AbbreviationsFPP: Food Parenting Practices; IRM: Item Response Modeling;ISBNPA: International Society of Behavioral Nutrition and Physical Activity;MDS: Multidimensional Scaling; NIH: National Institute of HealthAcknowledgementsWe want to thank the full set of experts who participated in this study.Without their thoughtful input this study would not be possible. Expertpanel members were given the option of contributing as an author orbeing acknowledged for their contribution to this work. All who requested tobe an authors reviewed several versions of the solutions, approved theproposed solution, and provided important feedback on the manuscript. All theauthors have reviewed and approved this manuscript. We also want to expressour sincere thank you to Drs. Karen Campbell, Jennifer Fisher, Lori Francis, ErinHennessy, Susan Johnson, Megumi Murashima, Dara Musher-Eizenman, AngelaOdoms-Young, Heather Patrick, Natalie Pearson, Ana Bertha Pérez Lizaur,Thomas G. Power, Carola Ray, Georgina Russell, Heather Ullrich-Kitzman, DianneWard and one expert who wished to remain anonymous, for participating asexperts and for making important contributions to this study.FundingThe project described was supported by award number MOP-119359 fromthe Canadian Institute of Health Research (CIHR); LCM received salary supportfrom the BC Child’s Hospital Research Institute (BCCHRI); AWW received post-doctoral support from CIHR; and AT received post-doctoral support fromBCCHRI and the Michael Smith Foundation for Health Research.This work is also a publication of the US Department of Agriculture (USDA/ARS)Children’s Nutrition Research Center, Department of Pediatrics, BCM funded inpart by the USDA/ARS (Cooperative Agreement 58–3092–5-001). The contents ofthis publication do not necessarily reflect the views or policies of the USDA, nordoes mention of organizations imply endorsement from the US government.Availability of data and materialsPlease contact authors TMO and LM for data requests.Authors’ contributionsLCM, TMO, SOH, MRB and TB designed the study. LCM oversaw the datacollection. TMO, LCM, AWW, and TP conducted the binning and winnowingto generate the food parenting concepts. LCM and AWT performed thestatistical analyses. TMO, LCM, ATW, SOH, MRB, and TB provided subjectiveinput in the analyses. TMO managed the expert feedback, revisions of thesolutions, and drafted the manuscript. All authors critically assessed drafts ofthe concept solutions and the manuscript. The authors have read andapproved the final manuscript.Ethics approval and consent to participateThe protocol was approved by the Institutional Review Boards at theUniversity of British Columbia and Baylor College of Medicine.Consent for publicationThe Experts provided consent for participating in this study. Those acknowledgedby name provided approval for us to acknowledge their participation.Competing interestsThe authors declare that they have no competing interests.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Author details1USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine,1100 Bates St, Houston, TX, USA. 2BC Children’s Hospital Research Institute,School of Population and Public Health, University of British Columbia,Vancouver, BC, Canada. 3Child & Family Research Institute, School ofPopulation and Public Health, University of British Columbia, Vancouver, BC,Canada. 4Division of Epidemiology and Community Health, School of PublicHealth, University of Minnesota, Minneapolis, MN, USA. 5School ofKinesiology, University of British Columbia, Vancouver, BC, Canada.6Department of Family Medicine and Community Health, University ofMinnesota Medical School, Minnesota, MN, USA. 7Family Resilience Center,Department of Human Development and Family Studies, University of Illinoisat Urbana-Champaign, Urbana, IL, USA. 8Sansom Institute for Health Research(PHRC), School of Pharmacy and Medical Sciences, University of SouthAustralia, Adelaide, Australia. 9Department of Nutritional Sciences, College ofAgriculture and Life Sciences, University of Arizona, Tucson, AZ, USA.10NUTRIM School of Nutrition and Translational Research in Metabolism,Maastricht University Medical Center, Maastricht, The Netherlands.11Department of Pediatrics, University of California, San Diego, CA, USA.12School of Psychology, Deakin University, Melbourne, Australia.13Department of Nutrition, Gillings School of Global Public health, Universityof North Carolina, Chapel Hill, NC, USA.Received: 26 October 2016 Accepted: 16 August 2017References1. 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Appetite. 2013;69:89–93.34. Jansen E, Mallan K, Daniels L. Extending the validity of the feeding practicesand structure questionnaire. Int J Behav Nutr Phys Act. 2015;12:90.35. Savage J, Rollins B, Kugler K, Birch L, Marini M. Development of a theory-based questionnaire to asses structure and control in parent feeding (SCPF).Int J Behav Nutr Phys Act. 2017;14(1):9.•  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:O’Connor et al. International Journal of Behavioral Nutrition and Physical Activity  (2017) 14:122 Page 17 of 17


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