Assessment of parental overt and covert control of child's food intake: A population-based validation study with mothers of preschoolers

Introduction: Overt and covert control are novel constructs representing two different parental feeding practices with regard to the child's ability to detect them. Preliminary research indicates that covert control is linked to a healthier diet and lower child weight status. In this study, we report the first psychometric validation of the original measures of overt and covert control outside the UK in a large sample of parents of preschoolers. Methods: Based on records from the population register, all mothers of 4-year-olds (n. =. 3007) from the third largest city in Sweden, Malmö, were contacted by mail. Out of those, 876 returned the measures of overt and covert control together with a background questionnaire and the Child Feeding Questionnaire (CFQ). Test-retest data were obtained from 64% (n. =. 563) of these mothers. The mean age of the mothers was 35.6. years; their mean BMI was 24.1, 31.5% were overweight or obese. The children were on average 4.5. years old; 48% were girls, 12.8% were overweight or obese. Results: While the fit for the original 9-item 2-factor model was poor, shorter 8- and 6-item versions were supported by confirmatory factor analysis (CFI. >. 0.95, RMSEA. <. 0.05). Internal and test-retest reliability of the shorter version was good (ICC. =. 0.65-0.71). Results also suggest that the factor structure and loadings were invariant (i.e., did not significantly differ) over time and between child sexes. Both overt and covert control factors were moderately correlated with CFQ monitoring. Overt control was also moderately related to CFQ pressure and weakly correlated with CFQ restriction. Covert control, on the other hand, was moderately related to restriction and not related with pressure. Correlations of both factors with child and parent BMI were very small. Conclusion: We found good psychometric properties of the revised versions of the overt and control behaviors in a multiethnic sample of mothers from Sweden. Future studies need to establish causal associations between overt and covert control and the obesity related outcomes.