2Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 1700 N 35th Street, Lincoln, NE 68583, US
Methods: The study used an explanatory sequential mixed methods design conducting quantitative survey followed by participant interviews. Forty parents of healthy weight children and 42 parents of overweight/obese children (6-17 years) completed FCM surveys in their homes (quantitative phase) followed by in depth interviews (qualitative phase) with a subsample of 25 parents of 11 healthy weight and 14 overweight/obese regarding FCM.
Results: Motives of food’s taste and health value scored highest among all the parents. Mood (17.9 ± 4.8 vs. 15.7±4.5, P=0.03) and weight control related motive scores (15.9 ± 3.9 vs. 13.1 ± 3.4, P=0.001) were higher among parents of overweight/obese children compared to parents of healthy weight children. During interviews, parents of both healthy weight and overweight/obese children had similar views regarding price, convenience in food preparation, children’s taste preference and food familiarity as important FCM. Parents of overweight/obese children mentioned that lack of support from other family members influenced their FCM while this was not expressed by parents of healthy weight children.
Conclusions: parents considered food’s health value as an important motive, they often traded healthy foods with unhealthy foods due to other factors such as price, convenience, familiarity, and children’s taste preference. The results provide a further understanding of parental FCM.
Keywords: Food choice motives; healthy weight; overweight; children; parents
While it is important to identify the key food choice motives from parents and determine how they are associated with children’s dietary intake, it is equally important to have a deep understanding about why parents have these motives, whether their actual decisions for what kind of foods (healthy or unhealthy) they purchase and provide to their children truly reflect the motives parents reported on the survey, and the other factors that influence parents’ food choices. These questions cannot be fully answered without a qualitative approach to explore parents’ perceptions on these issues. To our knowledge, no studies have used a mixed method approach which can provide a more complete picture in understanding parents’ food choice motives when providing foods to their children in the home. Thus, in the current study we used a mixed method study design to: 1) identify parental food choice motives and compare these motives between parents of overweight/obese and parents of healthy weight children; and 2) explore parental views in depth to further understand what motivates parents to make choices when providing healthy or unhealthy foods to their children.
Each interview was audio taped and took approximately 45 minutes to complete. The interview questions were modified from previously published studies and were pilot tested with four study participants for clarity and comprehension [11, 12]. Questions were then revised and a semi-structured interview format was used. Interviews occurred after quantitative data collection was completed. The interview began with a general knowledge question regarding how parents would define a healthy food and followed with questions on their food choice motives when providing foods to their children in the home. Each question included probing questions which elicited further detailed answers from the participants. Following are the interview questions:
1.“What is your definition of a healthy food?”
2.“Tell me about the sort of things that motivates what you buy at the grocery store and bring home to your children?”
3.“Suppose your child has asked you to buy a food or beverage at the store that is not what you think he or she should eat or drink. How do you handle that situation?”
Quantitative phase |
Qualitative phase |
|||
Characteristics |
All participants |
Healthy weight* |
Overweight/obese* |
All participants |
Children |
||||
N |
82 |
40 |
42 |
25 |
Age, year (mean ± SD) |
9.80 ± 2.6 |
9.4 ± .4 |
10.2 ± .4 |
9.6 ± 1.6 |
Sex, N (%) |
|
|||
Boy |
26(31.7) |
14 (35.0) |
12 (28.6) |
8 (32.0) |
Girl |
56(68.3) |
26 (65.0) |
30 (71.4) |
17 (68.0) |
Race/ethnicity, N (%) |
|
|
||
White |
59(72.0) |
31 (77.5) |
28 (66.7) |
22 (88.0) |
Black |
11(13.4) |
5 (12.5) |
6 (11.9) |
1 (4.0) |
Hispanic |
9(11.0) |
4 (10.0) |
5 (14.3) |
1 (4.0) |
Asian-American |
2(2.4) |
0 (0.0) |
2(4.8) |
1 (4.0) |
Other |
1(1.2) |
0 (0.0) |
1 (2.4) |
0 (0) |
Weight status |
|
|||
Healthy weight |
40 (48.7) |
14 (56.0) |
||
Overweight/obese |
42 (51,3) |
11 (44.0) |
||
Parents/care giver |
|
|||
Age, year (mean ± SD) |
38.9 ± 6.4 |
36.8 ± 5.9 |
40.8 ± 6.4 |
39.0 ± 7.6 |
Sex, N (%) |
|
|||
Male |
7 (8.5) |
1(2.5) |
6 (14.3) |
3 (12.0) |
Female |
75 (91.5) |
39 (97.5) |
36 (85.7) |
22 (88.0) |
Family income, N (%) |
|
|
||
<$25,000/year |
18 (22.8) |
4 (10.5) |
14 (34.2) |
6 (24.0) |
≥$25,000/year |
61 (77.2) |
34 (89.5) |
27 (65.8) |
19 (76.0) |
College graduate |
42 (51.2) |
24 (60.0) |
18 (42.9) |
14 (56%) |
Working full time, N (%) |
37 (45.7) |
11 (28.2) |
26 (61.9) |
11 (44.0) |
Single-parent household, N (%) |
23 (28.0) |
5 (12.5) |
18 (42.9.) |
6 (25.0) |
Table 3 shows the scores of parental food choice motives between healthy weight and overweight/obese children. The food choice motive “contains a lot of vitamins and minerals” was scored higher for parents of healthy weight children (6.13 ± 0.88, P=0.046) compared to overweight/obese children (5.88 ± 1.38). The total scores of the subscales of mood related motives (overweight/obese, 17.93 ± 4.79; healthy weight, 15.70 ± 4.54; p=0.03) and weight control related motives (overweight/obese, 15.90 ± 3.91; healthy weight, 13.10 ± 3.42; p=0.001) were higher among parents of overweight/obese children compared to parents of healthy weight children.
Family food choice Motives |
N (%)* |
Keep us healthy |
|
Totally/Most/Somewhat disagree |
1 (1.2) |
Neither agree nor disagree |
1 (1.2) |
Totally/Mostly/Somewhat agree |
80 (97.6) |
Is nutritious |
|
Totally/Most/Somewhat disagree |
2 (2.4) |
Neither agree nor disagree |
0 |
Totally/Mostly/Somewhat agree |
80 (97.6) |
Contains a lot vitamin/minerals |
|
Totally/Most/Somewhat disagree |
2 (2.4) |
Neither agree nor disagree |
8 (9.8) |
Totally/Mostly/Somewhat agree |
72 (87.8) |
Contains natural ingredients |
|
Totally/Most/Some what dis agree |
5 (6.1) |
Neither agree nor disagree |
11 (13.4) |
Totally/Mostly/Somewhat agree |
66 (82.5) |
Contains no additives |
|
Totally/Most/Somewhat disagree |
9 (11.0) |
Neither agree nor disagree |
20 (24.4) |
Totally/Mostly/Somewhat agree |
53 (64.7) |
Help us to cope with stress |
|
Totally/Most/Somewhat disagree |
21 (25.6) |
Neither agree nor disagree |
33 (40.2) |
Totally/Mostly/Somewhat agree |
28 (34.1) |
Tastes good |
|
Totally/Most/Somewhat disagree |
0 (0) |
Neither agree nor disagree |
0 (0) |
Totally/Mostly/Somewhat agree |
100(100) |
Smells nice |
|
Totally/Most/Somewhat disagree |
4 (4.9) |
Neither agree nor disagree |
7 (8.5) |
Totally/Mostly/Somewhat agree |
71 (86.6) |
Looks nice |
|
Totally/Most/Somewhat disagree |
3 (3.6) |
Neither agree nor disagree |
8 (9.8) |
Totally/Mostly/Somewhat agree |
70 (85.3) |
Cheers up our family |
|
Totally/Most/Somewhat disagree |
5 (6.0) |
Neither agree nor disagree |
24 (29.3) |
Totally/Mostly/Somewhat agree |
52 (63.5) |
Is not expensive |
|
Totally/Most/Somewhat disagree |
4 (4.8) |
Neither agree nor disagree |
9 (11.0) |
Totally/Mostly/Somewhat agree |
68 (83.0) |
Is cheap |
|
Totally/Most/Somewhat disagree |
15 (18.3) |
Neither agree nor disagree |
19 (23.2) |
Totally/Mostly/Somewhat agree |
48 (58.6) |
Is good value for our money |
|
Totally/Most/Somewhat disagree |
2 (2.4) |
Neither agree nor disagree |
5 (6.1) |
Totally/Mostly/Somewhat agree |
75 (91.5) |
Takes no time to prepare |
|
Totally/Most/Somewhat disagree |
21 (25.6) |
Neither agree nor disagree |
13 (15.9) |
Totally/Mostly/Somewhat agree |
48 (58.5) |
Is low in fat |
|
Totally/Most/Somewhat disagree |
12 (14.6) |
Neither agree nor disagree |
17 (20.7) |
Totally/Mostly/Somewhat agree |
52 (63.4) |
Is low in calories |
|
Totally/Most/Somewhat disagree |
13 (15.9) |
Neither agree nor disagree |
20 (24.4) |
Totally/Mostly/Somewhat agree |
49 (59.7) |
Helps our family in weight control |
|
Totally/Most/Somewhat disagree |
9 (11.0) |
Neither agree nor disagree |
15 (18.3) |
Totally/Mostly/Somewhat agree |
57 (69.5) |
Is familiar to us |
|
Totally/Most/Somewhat disagree |
20 (24.4) |
Neither agree nor disagree |
15 (18.3) |
Totally/Mostly/Somewhat agree |
41 (50) |
Healthy weight* |
|
P value† |
|
|
|||
N |
40 |
42 |
|
Motivation choice scores‡ |
|
|
|
Health |
|||
Keep us healthy |
6.58 ± 0.59 |
6.26 ± 1.08 |
0.21 |
Is nutritious |
6.53 ± 0.64 |
6.19 ± 1.17 |
0.17 |
Contains a lot vitamin/minerals |
6.13 ± 0.88 |
5.88 ± 1.38 |
0.046 |
Is high in fiber |
5.05 ± 1.45 |
5.10 ± 1.54 |
0.68 |
Total score for the section‡ |
24.27 ± 2.87 |
23.43 ± 4.57 |
0.32 |
Natural Content |
|
||
Contains natural ingredients |
5.70 ± 1.24 |
5.64 ± 1.36 |
0.47 |
Contains no additives |
4.98 ± 1.19 |
5.02 ± 1.65 |
0.095 |
Total score for the section |
10.68 ± 2.21 |
10.67 ± 2.77 |
0.98 |
Mood |
|||
Help us to cope with stress |
3.50 ± 1.60 |
4.43 ± 1.73 |
0.58 |
Help us relax |
3.93 ± 1.51 |
4.45 ± 1.53 |
0.81 |
Keep us awake |
3.62 ± 1.68 |
3.81 ± 1.90 |
0.48 |
Cheers up our family |
4.87 ± 1.30 |
5.24 ± 1.32 |
0.14 |
Total score for the section§ |
15.70 ± 4.54 |
17.93 ± 4.79 |
0.03 |
Sensory appeal |
|
||
Tastes good |
6.48 ± 0.64 |
6.48 ± 0.60 |
0.91 |
Smells nice |
5.80 ± 1.16 |
6.00 ± 1.31 |
0.2 |
Looks nice |
5.53 ± 1.15 |
5.78 ± 1.08 |
0.4 |
Total score for the section§ |
17.80 ± 2.60 |
18.12 ± 2.89 |
0.6 |
Food price and convenience |
|
||
Is not expensive |
5.79 ± 1.20 |
5.69 ± 1.35 |
0.58 |
Is cheap |
4.73 ± 1.75 |
5.12 ± 1.47 |
0.42 |
Is good value for our money |
6.05 ± 0.96 |
6.00 ± 1.13 |
0.5 |
Takes no time to prepare |
4.05 ± 1.50 |
4.74 ± 1.47 |
0.45 |
Total score for the section§ |
20.48 ± 4.47 |
21.55 ± 3.26 |
0.21 |
Weight control purpose |
|
|
|
Is low in fat |
4.35 ± 1.31 |
5.17 ± 1.45 |
0.77 |
Is low in calories |
4.23 ± 1.27 |
5.02 ± 1.52 |
0.46 |
Helps family in weight control |
4.53 ± 1.49 |
5.71 ± 1.33 |
0.58 |
Total score for the section§ |
13.10 ± 3.42 |
15.90 ± 3.91 |
0.001 |
Familiarity |
|
||
Is what we usually eat |
4.36 ± 1.51 |
5.00 ± 1.62 |
0.83 |
Is familiar to us |
4.30 ± 1.73 |
4.75 ± 1.53 |
0.26 |
Total score for the section§ |
8.54 ± 3.19 |
9.25 ± 3.37 |
0.35 |
†Differences between healthy weight children and overweight/obese children using t test
‡Score signed to the responses: Total disagree=1, Mostly disagree=2, Somewhat disagree=3, Neither agree or disagree=4, Somewhat agree=5, Mostly agree=6, Totally agree=7
§Sum of the scores of all the items in the category
Nevertheless, parents felt that even though price was a major motivator when purchasing foods, providing healthy foods to their children was important and beneficial to their children’s health. Following are some of the examples of what parents said:
• “My husband and I have high blood pressure so we don’t want to add too much salt. So fresh is good and you can get fresh vegetables most of the time”.
• “Right now I am buying for health and I am trying to buy fruits and vegetables and more healthy [foods]”.
• “Basically, it is health”
Several parents (both healthy weight and overweight/obese children) felt that their children and other family members were picky eaters which made it difficult in making healthy food choices. They said: “The pickiness of everybody and it’s not just the girls; my husband is picky” and “My main challenge is someone who doesn’t like to eat what is made. They are picky eaters.”Taste changes also influenced what a parent would bring into the home. For instance, one parent said: “She used to love fruit when she was a toddler and now she hates fruits. Its funny things like she use to like yogurt but now we are trying to get her introduced to it again; you use to like it before and it was not that long ago.”
Parents also stated that eating fruits was easily accepted by children, because “of the sweet flavor”, but parents had challenges in feeding children vegetables. One parent mentioned: “I think it is the taste, because vegetables are a lot harder than fruit and fruits are sweet and yummy but vegetables are different.”
• “I am kind of in a rut, so I buy the same things”
• “What they like and what I know that I can cook that they will eat. What they like, what they will eat, and what is good nutrition for them”
• “Habit is a lot of it – things that are familiar and I already know what I can do with it. You know what I mean. I already know how to prepare it, and I am less likely to choose something that I don’t know what I am going to do with"
• “Here is our biggest challenge-is that I work 60 to 70 hours a week, so a lot of time my spouse is in charge, which means going out to eat way too much”.
• “I try to limit fries to once a week, although I get sabotaged by his dad. He likes the fries and he will buy the fries regardless if he has already had fries”.
• “The hardest thing in the family environment is to get both parents on board and on the same page, because my wife and I don’t necessarily agree on everything. I tend to be more extreme in the way I want to go and she is more lenient-you know, as far as buying things. One parent can certainly sabotage the other if you are not working together”.
• “We do not have a ton of snack food and honestly, if we do, my husband brought it in, and I don’t have too much control over that”.
Our quantitative data showed that approximately 98% of the parents (both parents of healthy weight and overweight children) considered a food’s health and nutritional value is important when making food choices. However, in our interviews with a subsample of participants, we found that although parents realized the importance of the health values when purchasing foods they often weighed in other factors such as food’s price, the perception that healthy foods were expensive, convenience in food preparation, food’s familiarity, and children’s taste preference and their constant demanding for certain unhealthy “junk” foods. Therefore, parents ended up buying unhealthy foods such as high fat and sugary foods and beverages instead of healthier ones because these foods were familiar to the family and they were foods that their children preferred and asked for. A similar study involving parents of preschoolers found that parents struggled to make decisions between providing their families with healthy foods and letting their children to eat the foods they wanted which in most cases were unhealthy [15].
The majority of parents of both overweight and healthy weight children agreed with the statement “takes no time to prepare” when determining family food choice motives. When parents were interviewed, they confirmed this motive by stating that they had overwhelming schedules and their food choice motives were influenced by how convenient the food was in terms of preparation time. As a result, parents would often fed their children and family less healthier foods from fast food restaurants for quick meals. Thus, parents of both overweight/ obese and healthy weight children would benefit from nutrition education on how to make healthy meals that are easy and quick to prepare.
In addition, the total score for the subscale of “mood” was higher among parents of overweight/obese children compared to those of healthy weight children. This may suggest that enhancing mood is more relevant to parents of overweight/obese children as compared to parents of healthy weight children when purchasing and choosing foods. It may be that parents of overweight/obese children use food to help their children feel better or overcome emotions. A previous study also reported that emotional eating behaviors such as “eating when bored” or “eating when upset/ anger” were positively associated with children’s BMI values [16]. However, compared to other family food choice motives, items in the “mood” subscale scored the lowest (“cheers up our family”=5.08; “helps us relax”=4.20 and “keeps us awake”=3.84) among all participants including parents of overweight/obese children.
In our study, parents of overweight/obese children agreed more often with the items under the subscale of “weight control purpose” (e.g., “is low in fat”; “is low in calories”; “helps family with weight control”) compared to parents of healthy weight children. When further exploring parents’ perceptions on this matter, parents of overweight/obese children stated that they felt their spouses or partners were not supportive with healthy eating in the home and thus this would affect the type of food brought into the home, which was not voiced by parents of healthy weight children. A previous focus group study among parents of overweight children confirmed our results and found that other family members may not be supportive in healthy eating in the home and children may be receiving conflicting messages regarding healthy eating [17]. Our finding suggest that although parents of overweight/obese children were aware of the importance of choosing food items that would help their children lose weight (e.g., “is low in fat”; “is low in calories”), family dynamics (e.g.,: other adult family members undermining the effort) could be a barrier when trying to provide healthy foods to their children. Thus, strategies such as working together as a family in the meal preparation may be helpful for bringing family members of overweight/obese children together and reaching consensus in terms of feeding children healthy foods in the home.
Our study was the first to explore food choice motives among parents of both healthy weight and overweight/obese schoolaged children using a mixed method approach. The mixed method study design not only validated the outcome data by crossreferencing responses from parents through both quantitative surveys and qualitative interviews, but also provided a deeper understanding of parental motives when making food choices, thus, giving us a clearer picture of the issues investigated [18]. Our study had limitations. Due to the relatively small sample size and convenience sampling, our results may not be generalized to the larger school-age children population in the region and the country. Although we used validated self-reported measures, objective indicators may provide more accurate evaluations of parents’ motives and children‘s diets. However, our quantitative survey results on food choice motives were confirmed by the follow-up interviews with a subsample of parents of both healthy weight and overweight/obese children. Since our original study was designed to compare differences in food choice motives between overweight/obese and healthy weight children, we did not further examine parents’ motivations across different socioeconomic statues, for example, family income and parent education background. However, our interview findings nevertheless suggest that common food choice motives such as convenience in food preparation, familiarity, food price, children’s taste preference, and children consistently demanding unhealthy foods were shared among parents across different socioeconomic status.
In conclusion, our results suggest parents face some dilemma with regards to their motivations when making food choices. Although parents considered the health value of foods as an important motive, they often traded healthy foods with unhealthy foods due to other factors such as food price, convenience in preparation, familiarity, children’s taste preference and their persistence in demanding certain unhealthy foods. Food choice motives related to mood and weight control appeared more relevant to parents of overweight/obese children compared to parents of healthy weight children. The current study using a mixed method approach provided a deeper understanding of parents’ motivations in terms of making food choices for their children at home.
- Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol rev. 2007;29:62-76. doi: 10.1093/epirev/mxm003
- Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998;101:518-525.
- Larson N, Story M. A review of environmental influences on food choices. Ann behav med. 2009;38 Suppl 1:S56-73. doi: 10.1007/s12160-009-9120-9
- McKinnon RA, Reedy J, Handy SL, Rodgers AB. Measuring the food and physical activity environments: shaping the research agenda. Am J Prev Med. 2009;36(4 Suppl):S81-85. doi: 10.1016/j.amepre.2009.01.003
- Roos E, Laaksonen M, Rahkonen O, Lahelma E, Lallukka T. Relative weight and disability retirement: a prospective cohort study. Scand J Work Environ Health. 2013;39(3):259-267. doi: 10.5271/sjweh.3328
- Wansink B. Nutritional gatekeepers and the 72% solution. J Am Diet Assoc. 2006;106(9):1324-1327. doi:10.1016/j.jada.2006.07.023
- Briggs L, Lake AA. Exploring school and home food environments: perceptions of 8-10-year-olds and their parents in Newcastle upon Tyne, UK. Public health nutr. 2011;14(12):2227-2235. doi: 10.1017/S1368980011001984
- Oellingrath IM, Hersleth M, Svendsen MV. Association between parental motives for food choice and eating patterns of 12- to 13-year-old Norwegian children. Public health nutr. 2013;16(11):2023-2031. doi: 10.1017/S1368980012004430
- Steptoe A, Pollard TM, Wardle J. Development of a measure of the motives underlying the selection of food: the food choice questionnaire. Appetite. 1995;25(3):267-284. doi: 10.1006/appe.1995.0061
- Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics. 2007;120 Suppl 4:S193-228. doi: 10.1542/peds.2007-2329D
- Berge JM, Arikian A, Doherty WJ, Neumark-Sztainer D. Healthful eating and physical activity in the home environment: results from multifamily focus groups. J Nutr Educ Behav. 2012;44(2):123-131. doi: 10.1016/j.jneb.2011.06.011
- Campbell KJ, Crawford DA, Hesketh KD. Australian parents' views on their 5-6-year-old children's food choices. Health promot int. 2007;22(1):11-18. doi: 10.1093/heapro/dal035
- Creswell JW. Educational research: Planning, conducting, and evaluating quantitative and qualitative research. 5th ed. Pearson; 2015.
- Dwyer J, Needham L, Simpson JR, Heeney ES. Parents report intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and physical activity among their preschoolers. Appl Physiol Nutr Metab. 2008;33(2);338-346. doi: 10.1139/H07-195
- Vanhala ML, Laitinen J, KaikkonenK, Keinanen-Kiukaanniemi S, Korpelainen R. Parental predictors of fruit and vegetable consumption in treatment-seeking overweight children. J Hum Nutr Diet. 2011;24(1),47-53. doi: 10.1111/j.1365-277X.2010.01133.x
- Hajna S, LeBlanc P, Faught B, Merchant A, Cairney J, Hay J, et al. Associations between family eating behaviours and body composition measures in per-adolescents: Results from a community-based study of school-aged children. Canadian Journal of Public Health, 2014;105(1):e15-e21.
- Sonneville KR, LaPelle N, Taveras EM, Gillman MW, Prosser L A. Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents. BMC Pediatrics. 2009;9:81.
- Pearce A, Kirk C, Cummins S, Collins M, Elliman D, Connolly AM, et al. Gaining children's perspectives: a multiple method approach to explore environmental influences on healthy eating and physical activity. Health place. 2009;15(2):614-621. doi: 10.1016/j.healthplace.2008.10.007