W5003: Promoting parenting practices that support positive eating behaviors during adolescent independent eating occasions

(Multistate Research Project)

Status: Active

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SAES-422 Reports

Annual/Termination Reports:

[07/08/2025]

Date of Annual Report: 07/08/2025

Report Information

Annual Meeting Dates: 05/19/2025 - 05/21/2025
Period the Report Covers: 05/15/2024 - 05/21/2025

Participants

Anderson, Alex (fianko@uga.edu), University of Georgia
Banna, Jinan (jcbanna@hawaii.edu), University of Hawaii @ Manoa
Gunther, Carolyn (Gunther.22@osu.edu), Ohio State University
Jones, Blake (blake.jones@byu.edu), Brigham Young University
Lora, Karina (Klora@email.gwu.edu), George Washington University
Monroe-Lord, Lillie (lmonroelord@udc.edu), University of the District of Columbia
Richards, Rickelle (Rickelle_richards@byu.edu), Brigham Young University
Shearrer, Grace (gshearre@uwyo.edu), University of Wyoming
Topham, Glade (gtopham@ksu.edu), Kansas State University
Wong, Siew Sun (Siewsun.wong@oregonstate.edu), Oregon State University
Ziegler, Amanda (amz9@buffalo.edu), University at Buffalo

Brief Summary of Minutes

The 2024-2025 W5003 annual meeting was held 05/19/2025 to 05/21/2025 virtually via Zoom online conferencing. W5003 Attendees included:

Anderson, Alex (fianko@uga.edu), University of Georgia

Banna, Jinan (jcbanna@hawaii.edu), University of Hawaii @ Manoa

Gunther, Carolyn (Gunther.22@osu.edu), Ohio State University

Jones, Blake (blake.jones@byu.edu), Brigham Young University

Lora, Karina (Klora@email.gwu.edu), George Washington University

Monroe-Lord, Lillie (lmonroelord@udc.edu), University of the District of Columbia

Richards, Rickelle (Rickelle_richards@byu.edu), Brigham Young University

Shearrer, Grace (gshearre@uwyo.edu), University of Wyoming

Topham, Glade (gtopham@ksu.edu), Kansas State University

Wong, Siew Sun (Siewsun.wong@oregonstate.edu), Oregon State University

Zeigler, Amanda (amz9@buffalo.edu), University of Buffalo

Project Administrator Update

Dr. Brett Hess, Executive Director of the Western Association of Agricultural Experiment Station Directors business operations provided an update on NIFA funding for research initiatives and possible future policy impacts on multistate research projects.

Reflections on past year and planning for upcoming year

Team members on the call provided insights about accomplishments they felt we achieved as a group in the past year. We outlined current work and our anticipated timeline for future work.

Intervention mapping and app search/review subgroup updates and application.

We reviewed drafted constructs from the intervention mapping subgroup, made revisions to them for the app review survey, implemented them into the app review survey, and tested apps using Android and iOS platforms. Minor edits to the Qualtrics survey were made based on the texting, and a list of talking points were generated to discuss with our AI expert consultant at the next day’s meeting.

Received updates from our AI expert consultant (Beatrice Moissinac) about identifying apps

Beatrice provided an update on the work completed. The W5003 team reviewed the apps identified and found that some apps were only listed as available in the Google Play Store when they were in fact also listed in the Apple Store. We will follow up with Beatrice with our findings so that she can refine the AI search, to enhance search accuracy.

Exploration of scientific literature using AI personas

A future aspect of our W5003 project is to test apps through AI personas. W5003 team members conducted a literature search to evaluate previous studies who have used AI personas in health-related research. We added relevant literature to our team’s Zotero folder.

IRB planning for future human testing phase.

We discussed possible protocol materials for beta testing with humans, recruitment strategies, sample size, and sample characteristics desired. IRB documents will be revised from a team member’s previous project and a team member will explore the procedures needed for across site IRB approval.

Leadership

Members nominated Blake Jones (Chair), Rickelle Richards (Chair-Elect), and Amanda Zeigler (Secretary) to serve in leadership positions for the 2025-2026 term. Grace Shearrer will serve as the Past Chair.

Annual meeting dates and locations

Members agreed upon University of Wyoming (Laramie, WY) for the next annual meeting. We discussed holding the next annual meeting in fall 2025 in-person, given the May 2025 meeting was held virtually. This time frame will also be advantageous as we move into beta testing phases of the project. Preferred dates will be determined via a poll.

Accomplishments

Background:  In our previous work under W4003, we highlighted the importance of independent eating occasions (iEOs) on adolescent diet quality <a href="https://www.zotero.org/google-docs/?byfFBO">(1, 2)</a>, and that parents use expectation setting/rule and managing availability of certain foods to influence adolescent iEOs <a href="https://www.zotero.org/google-docs/?n1wgww">(3)</a>. Interestingly we found that structural (monitoring, indulgence, expectations) and autonomy support parenting practices were positively associated with both healthy and unhealthy iEO food intake by adolescents <a href="https://www.zotero.org/google-docs/?REFgoq">(4)</a>. Together, this work suggests that although parents are not present at adolescent iEOs, food-based parenting practices (monitoring, expectation setting, etc) influence adolescent iEOs.  The W5003 group is further exploring associations between parental sex, general (not food specific parenting practices), and food security and food-based parenting behaviors and adolescent iEOs using our survey results from W4003. Previous work is mixed regarding whether food parenting practices differ based on the sex or gender of the parent<a href="https://www.zotero.org/google-docs/?HZ1lhz">(5, 6)</a>. Additionally, limited work has examined the associations between general parenting styles (ex. authoritarian) and food-based parenting practices (ex. monitoring) despite a noted need for research in this area<a href="https://www.zotero.org/google-docs/?xO7KVR">(7)</a>. Finally, qualitative work has reported that parents in households with food insecurity compromise effective food-based parenting practices because of food insecurity<a href="https://www.zotero.org/google-docs/?bnD18P">(8)</a>. Together, our group is working towards addressing multiple gaps across the food parenting and iEO literature. This work will provide further context and rationale for our planned digital intervention.  Increasingly, digital technologies and media facilitate eating behaviors and parent-adolescent interactions. A recent meta analysis highlights that nutrition-specific and social media apps consistently support healthy eating habits<a href="https://www.zotero.org/google-docs/?lrK6Jo">(9)</a>. However, of the 39 reviewed studies, only 1 study tested a child and parent interactive app<a href="https://www.zotero.org/google-docs/?gvjr76">(10)</a>. The use of mobile phones is highlighted as a “top priority” given their effectiveness<a href="https://www.zotero.org/google-docs/?99FHQx">(9)</a>. However, the authors also note that the target consumers must be identified before developing the digital intervention<a href="https://www.zotero.org/google-docs/?ytKrSO">(9)</a>.  As previously recommended<a href="https://www.zotero.org/google-docs/?ytKrSO">(9)</a>, we are using a multi-stage approach to develop a digital eating behavior intervention for parents and adolescents using novel large language models (LLM, ex. ChatGPT) to identify and test existing resources. We are using the Intervention Mapping Protocol (IMP) to align our digital intervention to our targeted outcomes: promoting positive parenting practices during independent eating occasions and improving early adolescent dietary intake. Next, we have contracted a computer scientist to develop a LLM protocol to identify existing apps that align with our intervention map. This allows us to iteratively search both the Apple and Google app stores to find existing resources and to identify gaps. We will then review our LLM identified apps and test our identified apps using LLM target personas and in parent-adolescent dyads. In total, this pilot intervention will provide needed preliminary data for grant proposals to further develop our intervention.    References <ol> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> J. Banna, R. Richards, B. Jones, A. K. Anderson, M. Reicks, M. Cluskey, C. Gunther, N. K. Hongu, K. Lora, S. Misner, L. Monroe-Lord, G. Topham, S. S. Wong, E. Lim, Describing Independent Eating Occasions among Low-Income Adolescents. Int J Environ Res Public Health 17, 981 (2020).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> M. Reicks, C. Davey, A. K. Anderson, J. Banna, M. Cluskey, C. Gunther, B. Jones, R. Richards, G. Topham, S. S. Wong, Frequency of eating alone is associated with adolescent dietary intake, perceived food-related parenting practices and weight status: cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) Study results. Public Health Nutr 22, 1555–1566 (2019).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> C. Gunther, M. Reicks, J. Banna, A. Suzuki, G. Topham, R. Richards, B. Jones, K. Lora, A. K. Anderson, V. da Silva, C. Penicka, L. C. Hopkins, M. Cluskey, N. Hongu, L. Monroe-Lord, S. S. Wong, Food Parenting Practices That Influence Early Adolescents’ Food Choices During Independent Eating Occasions. J Nutr Educ Behav 51, 993–1002 (2019).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> M. Reicks, K. R. Lora, Y. Jin, A. K. Anderson, L. Monroe-Lord, B. L. Jones, G. L. Topham, J. Banna, C. Gunther, L. C. Hopkins, R. Richards, S. S. Wong, Parenting Practices Are Associated With Adolescent Food Choices During Independent Eating Occasions. J Acad Nutr Diet 123, 1479-1487.e4 (2023).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> L. S. Taillie, Who’s cooking? Trends in US home food preparation by gender, education, and race/ethnicity from 2003 to 2016. Nutr J 17, 41 (2018).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> A. L Deslippe, T. M O’Connor, M. Brussoni, L. C Mâsse, The association of food parenting practices with adolescents’ dietary behaviors differ by youth gender, but not by parent gender. Appetite 169, 105846 (2022).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> H. Patrick, E. Hennessy, K. McSpadden, A. Oh, Parenting styles and practices in children’s obesogenic behaviors: scientific gaps and future research directions. Child Obes 9 Suppl, S73-86 (2013).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> R. Hevesi, M. R. Downey, K. Harvey, Living in food insecurity: A qualitative study exploring parents’ food parenting practices and their perceptions of the impact of food insecurity on their children’s eating. Appetite 195, 107204 (2024).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> A. Seid, D. D. Fufa, Z. W. Bitew, The use of internet-based smartphone apps consistently improved consumers’ healthy eating behaviors: a systematic review of randomized controlled trials. Front Digit Health 6, 1282570 (2024).</a></li> <li><a href="https://www.zotero.org/google-docs/?H4rRFE"> F. J. He, P. Zhang, R. Luo, Y. Li, Y. Sun, F. Chen, Y. Zhao, W. Zhao, D. Li, H. Chen, T. Wu, J. Yao, C. Lou, S. Zhou, L. Dong, Y. Liu, X. Li, J. He, C. Wang, M. Tan, J. Song, G. A. MacGregor, App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial. BMJ 376, e066982 (2022).</a></li> </ol> Project Objectives: <ol> <li style="font-weight: 400;">Examine the association between key parenting practices and positive eating behaviors during iEOs among low-income, multi-ethnic early adolescents.</li> <li style="font-weight: 400;">Develop digital communications for parents and/or early adolescents such as mobile apps, virtual parent coaching/supervision, virtual cooking experiences, and online planning tools that promote parenting practices that support healthy food choices during iEOs among early adolescents (11-14 years).</li> <li style="font-weight: 400;">Implement and evaluate a pilot intervention for parents and early adolescents (11-14 years) to promote positive parenting practices during independent eating occasions and to improve early adolescent dietary intake during these occasions based on digital communications developed in Objective 2.</li> <li style="font-weight: 400;">Prepare a grant proposal to revise and implement a full-scale intervention and disseminate findings to health professionals.</li> </ol> Short-term Outcomes: W5003 Project Work Intervention mapping: In the past year, we continued advancing the design of our intervention using the Intervention Mapping Protocol (IMP). IMP is a multi-step process that involves developing: a hypothesis; program objectives; performance objectives; mediators; and theory-based methods. In doing so, intervention strategies are aligned with intervention outcomes, and mediators of behavior change.  Naturally, this method increases confidence in establishing a cause-effect relationship of the intervention and outcomes via key mediators of behavior change.  Based on the current research, our overarching hypothesis is: Increasing the availability of healthy foods in the home (i.e., availability) (behavioral target) will improve early adolescents’ dietary quality of food consumed during iEOs (primary outcome) and their overall dietary quality (secondary outcome), and weight status (tertiary outcome). The rationale for selecting ‘availability’ as the behavioral target versus other food parenting practices (e.g., role modeling, setting expectations, etc) was multifold. First, the current evidence demonstrates that availability is the most widely used food parenting practice by caregivers of early adolescents during iEOs, and it has exclusively positive effects on dietary choices during iEOs (i.e., greater fruit/vegetable intake) as reported by both parents and adolescents. Additional rationale for selecting availability included the relevance of availability versus other parenting practices (e.g., modeling, setting expectations) in the context of iEOs when parents are not present with their child.  The proximal program objectives stem from the hypothesis and are as follows: <ol> <li style="font-weight: 400;">Improve the dietary quality of foods available in the home by significantly increasing the number of healthy foods and decreasing the number of less healthy foods available in the home over the past 7 days; p</li> <li style="font-weight: 400;">Improve child diet quality during iEOs by significantly increasing Healthy Eating Index (HEI) scores and daily servings of fruits/vegetables to the 2020-2025 Dietary Guidelines for Americans recommendations (5/d) and significantly decreasing daily servings of sugar-sweetened beverages; p</li> </ol> We next created matrices containing the behavioral performance objectives relating to each of the program objectives (1 and 2 above) for each level of intervention: individual (child) and interpersonal (caregiver).  For Program Objective 1 (Significantly increase the number of healthy foods and decrease less healthy foods available in the home over the past 7 days): Children and caregivers will … <ul> <li style="font-weight: 400;"> Read Nutrition Facts </li> <li style="font-weight: 400;"> Plan for healthy/well-balanced meals and snacks </li> <li style="font-weight: 400;"> Develop grocery shopping list </li> <li style="font-weight: 400;">Grocery shop for a variety of healthy foods (select healthy foods) (e.g., shopping the perimeter)</li> <li style="font-weight: 400;"> Purchase healthy foods on a budget (e.g., food pantries, free/reduced food outlets (churches), SNAP, school backpacks (take home), shop seasonally)</li> </ul> For Program Objective 2 (Significantly increase daily servings of fruits/vegetables to meet Dietary Guidelines for Americans recommendations (5/d); significantly decrease daily servings of sugar-sweetened beverages during iEOs) Children and caregivers will … <ul> <li style="font-weight: 400;">Read Nutrition Facts </li> <li style="font-weight: 400;">Know portion sizes </li> <li style="font-weight: 400;">Choose/consume a variety of healthy foods </li> <li style="font-weight: 400;">Identify/select healthy meals and snacks </li> <li style="font-weight: 400;">Prepare healthy meals and snacks (e.g., washing and prepping fruits/vegetables)</li> <li style="font-weight: 400;">Avoid/limit processed foods </li> </ul> After formulation of performance objectives, a list of personal determinants for each performance objective were generated based on the theoretical foundation of this research (Social Cognitive Theory, SCT). We then selected personal determinants for children at the individual level and caregivers at the interpersonal level based on importance (i.e., strength of the association of the determinant with the behavior) and changeability (i.e., likelihood that the intervention may impact the determinant). They were: behavioral capabilities (knowledge, skills) and self-efficacy.  We then coupled the performance objectives with the selected determinants, resulting in matrices of change objectives. See Appendix A. The change objectives state precisely what needs to change in the determinants’ behavioral outcomes in order to accomplish the performance objectives. They were developed using action words and followed by a statement of what is expected to result from the intervention. Because two target groups were selected, two different matrices of change were developed under each program objective.  Next, we selected theory-based methods to influence change in the determinants at the individual (child) and interpersonal (caregiver) level based on the theoretical framework of the intervention (Social Cognitive Theory) and in reference to methods described by Bartholomew et al. (1998, 2011). A list of all change objectives linked with a specific determinant were made, and the theoretical methods were then matched with the corresponding determinant. See Appendix B.  The final step in IMP is to identify practical strategies that will be designed to put the theoretical methods into practice. Because we do not know what specific practical changes might/will be in the app, we decided to develop a checklist of questions for the app review/reviewer. The checklist will help us identify practical strategies within the app that align with our theory-based methods identified for eliciting change in the targeted behavior. Specifically, does the app contain practical strategies that allow for: <ul> <li style="font-weight: 400;">Facilitated learning</li> <ul> <li style="font-weight: 400;">Defined as: learning through facilitation by an educator that guides/empowers the learner through active participation, collaboration, and critical thinking</li> </ul> <li style="font-weight: 400;">Vicarious learning</li> <ul> <li style="font-weight: 400;">Defined as: learning by watching/observing others perform the behavior</li> </ul> <li style="font-weight: 400;">Role modeling</li> <ul> <li style="font-weight: 400;">Defined as: learning by watching/observing/emulating a role model perform the skill/behavior</li> </ul> <li style="font-weight: 400;">Mastery experience</li> <ul> <li style="font-weight: 400;">Defined as: practicing the newly learned skill/behavior</li> </ul> <li style="font-weight: 400;">Social support</li> <ul> <li style="font-weight: 400;">Defined as: receiving social support from others in performing/practicing the new skill/behaviors</li> </ul> <li style="font-weight: 400;">Feedback</li> <ul> <li style="font-weight: 400;">Defined as: receiving feedback from other individuals, including peers, via discussion and problem solving</li> </ul> </ul> App Review Protocol Refined Over the past year, we partnered with an AI expert (Beatrice Moissinac) and refined our app review protocol. We determined that the first two rounds of review that we anticipated conducting manually could be automated through AI. The initial AI review will include inclusion and exclusion criteria related to app contents, reviewer ratings, and recency of revisions. These search criteria were modeled after the work done by Mauch et al (2018).   We refined the original round three survey review to better align with the work the intervention mapping group performed, while still maintaining the adaptation from the validated AQEL tool (DiFilippo et al, 2017). For example, we ensured that our app review survey included questions to evaluate if the app would help the target audience reach our program and performance objectives, mediators of behavior change (knowledge, skills, self-efficacy), and theory-based methods (facilitation, vicarious learning, mastery). These questions were refined at the May 2025 annual meeting, with W5003 pilot testing of apps identified by Beatrice and refining the survey further.  We also evaluated the preliminary apps identified by Beatrice and found some errors in identifying existing apps through iOS platforms. Next steps will be to work with Beatrice to refine the AI search, thereby enhancing accuracy of app identification and review. DiFilippo KN, Huang W-HD, Chapman-Novakofski KM. Mobile apps for the Dietary Approaches to Stop Hypertension (DASH): App Quality Evaluation. J Nutr Educ Behav. 2018;50:620-625. Mauch CE, Wycherley TP, Laws RA, et al. Mobile apps to support healthy family food provision: systemic assessment of popular commercially available apps. JMIR Mhealth and Uhealth 2018;6:e11867. Continuation of W4003 Publications  W5003 is an approved continuation project of W4003. Because of this, in the past year, we have worked on completing survey data analysis and writing from the W4003 project while starting W5003 work. W4003 included data 622 low-income, multi-ethnic adolescent/parent dyads across the US. Detailed below are the statuses of several manuscripts from our team. <ol> <li style="font-weight: 400;">We determined whether associations between parental sex and adolescents’ dietary intake during independent eating occasions (junk foods, sugary foods, sugar-sweetened beverages (SSBs) and fruits and vegetables) were mediated by food parenting practices. Findings indicate that parent monitoring mediated the association between parental sex and SSB intake and parental sex and fruit/vegetable intake. Indulgence mediated the association between parental sex and SSB intake and between parental sex and fruit and vegetable intake. A manuscript will be submitted for publication to the Journal Eating Behaviors</li> <li style="font-weight: 400;">We are examining the association between general parenting and food parenting and the association of both domains of parenting to child diet quality in independent eating occasions. Drafts of the introduction and methods have been developed, data have been analyzed, and we are working on writing up the results. </li> <li style="font-weight: 400;">We are evaluating parenting practices during independent eating occasions by food security classification, and possible associations between parenting practices and child diet quality by food security classification. We are currently working on data analysis and manuscript writing. </li> <li style="font-weight: 400;">We are examining whether sleep differences are related to mental health outcomes (e.g., anxiety, inhibitory control) in a sample of adolescents. Mental health factors such as these have been linked to eating behaviors in previous research and we are assessing whether sleep might be related to those risk factors. We are currently working on preparing to conduct the analyses and are working on the literature review.</li> </ol> Milestones (2024-2029): (2024):To complete W-4003: Analyze quantitative survey data and prepare manuscripts peer-reviewed publications. Develop intervention strategies through the intervention mapping process and exploring technologies (such as apps, virtual nutrition education, AI) to deliver intervention through an educational module prototype. We currently have four papers using the W4003 quantitative survey data in preparation for submission. We have completed our intervention mapping and have decided to focus on mobile phone apps for our intervention education model prototype. We are currently using a LLM protocol to identify existing mobile apps to include in the education model prototype. (2025):Pilot test the education module prototype to examine how the prototype is working and get initial feedback on the prototype. We anticipate beginning to pilot the test the education model prototype using AI generated personas in late 2025 (August through December). Additionally we plan to submit institutional review board documents to universities within the group starting in Jan 2026. We anticipate beginning our pilot testing in May 2026.  (2026):Make any necessary updates or changes to the prototype and prepare to do a full assessment of its effectiveness at improving snacking and eating behaviors in early adolescents. Our assessment and updates will continue through 2027 in preparation for a full assessment to test the education module’s effectiveness at improving snacking and eating behaviors in early adolescents.  (2027):Finish conducting the pilot testing to evaluate effectiveness of the education module prototype and begin data analysis.  We will finish the pilot testing late in 2027 and will begin data analysis. (2028):Continue data analysis of intervention data and present findings at conferences. Write research publications about the findings of this intervention. We plan to finish our initial data analysis mid 2028 and develop abstracts for conferences and research publications. We will begin to develop our grant applications and decide on grant mechanisms to target.  (2029):Continue to publish findings and do analysis of intervention. Share educational materials and resources with others in cooperation with state partners. Finalize grant proposals at the annual 2029 meeting and submit to potential funding sources. We are on track to continue to publish our preliminary findings in 2029. We will share our preliminary education module with cooperative extension partners. Finally we finalize and apply for additional grant funding to further refine and develop the educational module. <a title="Appendices" href="https://drive.google.com/file/d/1lYMjqIG-tPSU9IYTamu6KqNFqU3FlEmj/view?usp=sharing" target="_blank">Appendices</a>

Publications

Publications Anderson AK, Gunther C, Jones B, Lora K, Reicks M, Richards R, Shearrer G, Wong SS, Banna J, Hopkins L, Monroe-Lord L, Topham G. (2024). Associations between Sociodemographic Factors and Adolescent Food Consumption during Independent Eating Occasions. Ecol Food Nutr, 64(1-2), 4-19. Presentations Karina R. Lora, Grace Shearrer, Marla Reicks, Siew Sun Wong, Laura Hopkins Alex K. Anderson, Jinan Banna, Carolyn Gunther, Blake Jones, Lillie Monroe-Lord, Rickelle Richards, Glade Topham. Food parenting practices mediate relationships between parent sex and adolescent food intake during independent eating occasions. American Society for Nutrition. Nutrition 2024 meeting, Chicago, IL.

Impact Statements

Disparities in parental and adolescent socio-demographic characteristics were observed in adolescent intake of SSB, sugary foods, fruits and vegetables and junk foods during iEOs. A paper with these findings is published in Ecology of Food and Nutrition. The journal is an outlet for food and nutrition researchers and professionals, averages about 75,000 downloads annually and a CiteScore of 3.5 for the year 2023. We expect that the findings from this paper will be accessible to various stakeholders in the field of food and nutrition, and inform the design and delivery of interventions aimed at promoting healthy eating of adolescents during iEOs.
Cutting-edge technology and methodological approaches were used to align the identification of relevant apps with intervention mapping procedures that aim to promote availability parenting practices that improve adolescent iEO fruit and vegetable intakes.
Outcomes will be shared with nutrition and health professionals via publications and presentations to inform the development of interventions to improve parenting practices, Cooperative Extension staff in the form of bulletins, etc., which in turn, can positively influence eating habits of adolescents during iEOs to meet dietary recommendations and promote healthy weight.