The forgotten parent: Fathers' representation in family interventions to prevent childhood obesity

The cross-sectional association of parental psychosocial status with children's Body Mass Index z-score and the mediating role of children's energy balance behaviors - the ABCD Study

OBJECTIVE

Investigate the cross-sectional association between the psychosocial status of mothers and fathers and the BMI z-scores of their 10 to 12-year-old children. Explore whether this association is mediated by children's diet, physical activity, screen time and sleep. Analyze the moderating effect of the educational levels of both the mother and father on the association.

DESIGN

In a cross-sectional study design, children's height and weight were measured following a standardized protocol. Parents completed the validated Depression Anxiety and Stress questionnaire, while diet quality, sports participation, time spent in bed and screen time were assessed through child-report using previously validated questions.

PARTICIPANTS

The data for this study were obtained from the Amsterdam Born Children and their Development study, involving children aged 10 to 12 years and both of their parents (N = 1315).

RESULTS

The majority, 80%, of the parents were highly educated and born in the Netherlands, and 68% of the children had a healthy BMI. Maternal or paternal psychosocial status was not significantly associated with children's BMI z-score (maternal β -0.0037; 95% CI: -0.008 to 0.0007, paternal β 0.0028; 95% CI: -0.007 to 0.002). Screen time mediated the association between paternal psychosocial status and children's BMI z-score (β = 0.010, 95% CI: 0.002; 0.020). Children's diet, physical activity, and sleep did not mediate the association between paternal psychosocial status and children's BMI z-score. Parental educational level was not a moderator.

CONCLUSIONS

This research is unique in including four energy balance behaviors and including both mothers and fathers' psychosocial status. Children withfathers experiencing poorer psychosocial status engaged in more screen time which partly explained their higher BMI z-score.

Scoping review of obesity interventions: Research frontiers and publication status

Obesity and overweight are significant global health issues, and numerous obesity intervention studies have been conducted. Summarizing current knowledge of interventions aims to inform researchers and policymakers to keep up-to-date with the latest scientific advancements and trends. In this review, we comprehensively retrieved and screened 4,541 studies on obesity intervention published between 2018 and 2022 in the Web of Science Core Collection, and objectively presented research frontiers using bibliometric analysis. The research frontiers of intervention are mainly focused on dietary, exercise, pharmacological interventions, bariatric surgery, environmental, and cognitive interventions. Time-restricted eating is the hottest research topic, followed by probiotics and Roux-en-Y gastric bypass. Gut microbiota is located in the "Basic and transversal themes" quadrant with a high centrality and low density, which has great development potentiality. Obesity intervention is becoming increasingly common,and we advocate for researchers to undertake more focused research endeavors that consider the specific characteristics of diverse populations or patients.

Mental Health and Feeding Styles in Parents of Formula-Fed Infants

Background: Nonresponsive feeding styles can contribute to rapid weight gain in infancy and subsequent obesity in childhood. There is a need to investigate factors such as parental mental health symptoms (stress, depression, and anxiety) that may contribute to nonresponsive feeding styles. The purpose of this study was to investigate the relationship between parental mental health symptoms and feeding styles in parents of healthy, term formula-fed infants during the first year of life. Methods: A cross-sectional, descriptive correlational design was employed using online surveys. We recruited participants through Facebook groups and pediatricians' offices. Instruments included a demographic questionnaire, the Perceived Stress Scale-10, Patient Health Questionnaire-Depression Module-9, 7-item Generalized Anxiety Disorder Assessment, and Infant Feeding Style Questionnaire. Results: Participants were 306 parents of formula-fed infants. Greater depressive symptoms was the strongest predictor of the pressuring style (β = 0.54), while greater symptoms of stress (β = -0.13) and anxiety (β = -0.28) were associated with lower pressuring scores. Greater depressive symptoms was the strongest predictor of the laissez-faire style (β = 0.48), while greater symptoms of stress (β = -0.17) and anxiety (β = -0.23) were associated with lower laissez-faire scores. Engaging in ≤50% of the infant's feeds was the strongest control variable predictor for the pressuring and laissez-faire styles. None of the mental health variables were significantly related to the restrictive style. Conclusions: We recommend increased screening for depressive symptoms in parents of infants and responsive feeding support, especially for those experiencing depressive symptoms.

The role of fathers in child development from preconception to postnatal influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) program

A growing body of literature highlights the important role of paternal health and socioemotional characteristics in child development, from preconception through adolescence. Much of this research addresses the indirect effects of fathers, for instance, their influence on maternal behaviors during the prenatal period or via the relationship with their partner. However, emerging evidence also recognizes the direct role of paternal health and behavior for child health and adjustment across development. This critical review presents evidence of biological and sociocultural influences of fathers on preconception, prenatal, and postnatal contributions to child development. The National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) program incorporates in its central conceptualization the impact of fathers on family and child outcomes. This critical synthesis of the literature focuses on three specific child outcomes in the ECHO program: health outcomes (e.g., obesity), neurodevelopmental outcomes (e.g., emotional, behavioral, psychopathological development), and positive health. We highlight the unique insights gained from the literature to date and provide next steps for future studies on paternal influences.

Household Food Waste Intervention Is Feasible, Acceptable, and Effective

OBJECTIVE

The primary objective of this study was to assess the feasibility and acceptability of Weeknight Supper Savers, a family-based intervention designed to promote meal preparation and food waste reduction.

METHODS

The 4-week program was piloted using a single-arm, prepost design. Based on the Theory of Planned Behavior, the intervention included a chef-led online cooking class, a food waste toolkit, and 4 text messages/wk. Postintervention surveys were used to assess the feasibility and acceptability of the interventions.

RESULTS

Eighteen families (95%) attended their scheduled cooking class. All parents who completed the survey (17 mothers and 12 fathers) reported being satisfied with the overall program, the cooking class, and the toolkit. Approximately 73% of the children (n = 21) reported being satisfied with the overall program, and 77% reported being satisfied with the cooking class and the toolkit.

CONCLUSIONS

The intervention was feasible and well-received by families. Results could help inform future public health programs focused on reducing household food waste.

Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry

BACKGROUND

Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents' dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers' engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers' views on instilling healthy behaviours in their children.

METHODS

Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10-19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches.

RESULTS

A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents' sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge.

CONCLUSIONS

The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity

In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.

Mothers' experiences of reducing family mealtime screen use in Australian households with young children

OBJECTIVE

Screen use at mealtimes is associated with poor dietary and psychosocial outcomes in children and is disproportionately prevalent among families of low socio-economic position (SEP). This study aimed to explore experiences of reducing mealtime screen use in mothers of low SEP with young children.

DESIGN

Motivational interviews, conducted via Zoom or telephone, addressed barriers and facilitators to reducing mealtime screen use. Following motivational interviews, participants co-designed mealtime screen use reduction strategies and trialled these for 3-4 weeks. Follow-up semi-structured interviews then explored maternal experiences of implementing strategies, including successes and difficulties. Transcripts were analysed thematically.

SETTING

Australia.

PARTICIPANTS

Fourteen mothers who had no university education and a child between six months and six years old.

RESULTS

A range of strategies aimed to reduce mealtime screen use were co-designed. The most widely used strategies included changing mealtime location and parental modelling of expected behaviours. Experiences were influenced by mothers' levels of parenting self-efficacy and mealtime consistency, included changes to mealtime foods and an increased value of mealtimes. Experiences were reportedly easier, more beneficial and offered more opportunities for family communication, than anticipated. Change required considerable effort. However, effort decreased with consistency.

CONCLUSIONS

The diverse strategies co-designed by mothers highlight the importance of understanding why families engage in mealtime screen use and providing tailored advice for reduction. Although promising themes were identified, in this motivated sample, changing established mealtime screen use habits still required substantial effort. Embedding screen-free mealtime messaging into nutrition promotion from the inception of eating will be important.

Experiences of childhood weight management among Norwegian fathers of children with overweight or obesity - a qualitative interview study

OBJECTIVE

Paternal participation and experiences in childhood weight management is an understudied studied area. Given the important role fathers play in childhood obesity prevention and treatment, the aim of this study was to explore Norwegian fathers' experiences of helping to prevent further weight gain in their children with overweight or obesity.

METHODS

Data were collected through semi-structured interviews with eight fathers of ten children with overweight or obesity and analysed by qualitative content analysis.

RESULTS

The analysis resulted in one overall theme: Balancing between assuming and avoiding responsibility for weight management with a desire to preserve the child's dignity, comprising two themes: 1) Alternating between concern, helplessness and responsibility, 2) Needing acknowledgement, and flexible and tailored professional support, both of which have several sub-themes.

CONCLUSION

Fathers need guidance on how to talk to their children to prevent further weight gain, while at the same time emphasizing safeguarding the child's dignity. Healthcare professionals should address parents' own emotional barriers and include fathers to a greater extent as a resource in family-centred counselling and tailor guidance and support to help with childhood weight management.

Spicing up food interactions: Development of a healthy food education activity targeting fathers and their young children

BACKGROUND

Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods.

METHODS

Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach.

RESULTS

Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention.

CONCLUSIONS

The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.

Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese

BACKGROUND

Parents from urban, lower social economic classes often encounter unique challenges in their lives, which shape how they work with their children who are overweight or obese to change their exercise and eating behaviors at home. The present study took an initial step to address a gap in the literature by describing the challenges that parents from lower social economic classes in an urban city encountered in changing exercise and eating behaviors of their children who are overweight or obese.

METHODS

A conversational style semi-structured interview with prompts and probes was conducted to 44 parents whose child is overweight or obese. Inductive content analysis and constant comparison was used to analyze the data. Data trustworthiness was established by using a variety of strategies.

RESULTS

Two major themes with eight sub-themes emerged from the data: Challenges to promote a healthy active lifestyle, and challenges from their child's development and lifestyle behavior. Eight sub-themes were: (1) Need for effective strategies for a lifestyle behavior change, (2) monitor and promote healthy choices, (3) money, time, and dangerous neighborhood, (4) scientific knowledge to promote a healthy active lifestyle, (5) developmental changes of adolescence, (6) unmotivated and lack of persistence, (7) sneaking eating, and (8) peer pressure.

CONCLUSION

The challenges, from economic to parenting, are certainly of importance, and understanding these challenges will be crucial to help school-based professionals develop interventions. Those identified challenges should be clearly placed within family-school collaboration practices.

A Hybrid Mobile Phone Feasibility Study Focusing on Latino Mothers, Fathers, and Grandmothers to Prevent Obesity in Preschoolers

OBJECTIVE

To pilot the feasibility of a mobile phone childhood obesity intervention for family caregivers of Latino preschool-aged children.

METHODS

An evidence-based early childhood obesity intervention was adapted to have cultural relevance and a shorter-length curriculum for mothers, fathers, and grandmothers of 2- to 5-year-old Latino children. Traditional in-person group sessions (four weeks) were combined with eight weeks of mobile phone content to support parenting skills and evidence-based and age-appropriate nutritional practices in either English or Spanish. A convenience sample of Latino families were recruited from WIC and Early Education Centers in East Los Angeles. Feasibility measures were collected. Child and caregiver height and weight were measured, and caregiver surveys of child dietary intake were collected at baseline, 1- and 6-month post-baseline. Changes in child's dietary intake and BMI, as well as caregiver BMI, were examined using a mixed effects linear regression model with family random intercept and nested random slope for time period of measurement.

RESULTS

The program was delivered to 64 low-income Latino families (46 mothers, 34 fathers, 16 grandmothers, and 48 children). Children had a reduction in raw BMI, BMI percentile, and BMI z-scores at 6-months post-baseline compared to baseline measurements. The study also demonstrated stable BMI outcomes among all caregivers.

CONCLUSION

The pilot study shows promise in preventing childhood obesity, and having a multi-generational impact on weight outcomes. Leveraging the high-use of mobile phones has the potential to shorten in-person interventions, and engage fathers and grandmothers who play an important role in shaping healthy weight practices in young children.

The problem of heteronormativity in family-based health promotion: centring gender transformation in Ontario, Canada

OBJECTIVES

Social scientists have demonstrated that family health work is interlinked with heteronormative gender inequities. Yet family-based public health interventions rarely incorporate a gender transformative approach or address heteronormativity as a potential health barrier in North America. Instead, attention to gender surfaces primarily in family health interventions conducted in low- to middle-income countries with majority Black and racialized populations. The objective of this article is to establish the importance of designing health interventions that account for heteronormative relations in Ontarian families by drawing on empirical data from the Guelph Family Health Study (GFHS).

METHODS

We draw on data (February-October 2019) from (1) semi-structured interviews with 20 families and with 4 health educators facilitating the GFHS home visits and (2) observational data of 11 GFHS home visits and 1 health educator training day. Informed by gender transformation theory, data were analyzed and coded to understand the impact of gender, sexuality, and place in family health interventions.

RESULTS

Pre-existing heteronormative parenting relations were reinforced through GFHS participation: the GFHS was mother-led, increasing some mothers' stress levels. Fathers tended to consider paid work a justification for disengaging from the GFHS, and their detachment sometimes obstructed mothers' intervention efforts. Health educators (all women) were caught in these relations, feeling like because of their gender, they were viewed by parents as confidants and marriage counsellors.

CONCLUSION

Findings emphasize the need for expanding the epistemic and methodological approaches to family-based health interventions, changing the demographic and geographic emphasis within the field, and designing interventions that focus on societal-level changes. Heterosexuality has not been analyzed as a risk factor within the public health field, but our findings indicate the need for further study.

Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program

Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.

Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research

Despite an increasing acknowledgement of fathers' involvement in and impact on children's lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers' involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only "burden" of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Nutrition Effects of a Family-Centered Health Promotion Program for Mexican-Heritage Children in the Lower Rio Grande Valley of Texas

Systemic and social factors, like poverty and food insecurity, negatively influence fruit and vegetable (FV) intake and body mass index (BMI) among Latino/a children. Behavioral programs are needed to support children’s nutrition. This study examined program effects on FV intake and BMI outcomes for Mexican-heritage children (9–11 years). The program used a modified stepped-wedge design in the Lower Rio Grande Valley of Texas (2019 and 2020). Promotoras led experiential nutrition education sessions and collected height, weight, and instant skin carotenoid scores (biomarker for FV intake) at pre-test (baseline), post-test (6 weeks), and maintenance (3–4 months after post-test). Mean changes and group differences in skin carotenoid scores, BMI z-scores and percentiles were obtained from analyses of variance. Linear mixed-effects models were used to determine overall program effects. Mexican-heritage children were enrolled (n = 57 and 52.6% female). An overall decrease in skin carotenoid scores was observed at post-test (−15.1; 95% CI: −24.95, −5.33). While scores varied widely (range: 17–498), an increase of 14.8 ± 23.8 points occurred in one intervention group. Compared to the control period, greater reductions in BMI outcomes occurred during the program. These findings provide evidence for the use of strengths-based approaches in behavioral nutrition programs.

Brazilian Immigrant Parents' Preferences for Content and Intervention Modalities for the Design of a Family-Based Intervention to Promote Their Preschool-Age Children's Healthful Energy Balance-Related Behaviors

Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.

Perceived challenges and strategies to achieve Canada's Food Guide recommendation to "Cook more often": Findings from parents of young children

Unhealthy diets are detrimental to health, but home meal preparation is associated with better diet quality. Among a sample of parents of children aged 2-12, this study aimed to 1) explore perceived challenges and strategies to meeting the 2019 Canada's Food Guide recommendation of "Cook more often". From October 2019 to January 2020, 8 focus groups were conducted with 40 parents (73% mothers; 78% white) from Southwestern Ontario, Canada. Sessions were audio-recorded and transcribed verbatim. A hybrid thematic approach with inductive and deductive data analysis was used. Reported challenges included time constraints, picky eating, lacking cooking skills, high price of some fresh ingredients, school restrictions on meals at school, and the influence of children's peers on food choices, mainly unhealthy snacks. Reported strategies to mitigate some challenges included planning and preparing meals ahead of time, using technology or services to make meal planning and grocery shopping more convenient, using devices and kitchen instruments, such as Crockpot®, to make cooking faster, receiving help from spouse or child(ren), and acknowledging that foods perceived as less healthful in moderation can be included in meal preparation. These findings can help inform interventions and educational campaigns to support cooking among families with young children.

Effects of a family-based lifestyle intervention on co-physical activity and other health-related outcomes of fathers and their children: the 'Run Daddy Run' intervention

BACKGROUND

Fathers are important in establishing healthy behaviors in their children, but are rarely engaged in lifestyle programs. Focusing on physical activity (PA) of both fathers and their children by engaging them together in PA (i.e. "co-PA") is therefore a promising novel strategy for interventions. The study aim was to investigate the effect of the 'Run Daddy Run' on co-PA and PA of fathers and their children, and secondary outcomes such as weight status and sedentary behaviour (SB).

METHODS

This study is a non-randomized controlled trial (nRCT), including 98 fathers and one of their 6 to 8 years old children (intervention = 35, control = 63). The intervention was implemented over a 14-week period, and consisted of six (inter)active father-child sessions and an online component. Due to COVID-19, only 2/6 sessions could be implemented as planned, the remaining sessions were delivered online. In November 2019-January 2020 pre-test measurements took place, and post-test measurements in June 2020. Additional follow-up test was conducted in November 2020. PA (i.e. LPA, MPA, VPA and volume) of fathers and children were objectively measured using accelerometry, co-PA and the secondary outcomes were questioned using an online questionnaire.

RESULTS

Significant intervention effects were found for co-PA (+ 24 min./day in the intervention compared to the control group, p = 0.002), and MPA of the father (+ 17 min./day, p = 0.035). For children, a significant increase in LPA (+ 35 min./day, p < 0.001) was found. However, an inverse intervention effect was found for their MPA and VPA (-15 min./day, p = 0.005 and - 4 min./day, p = 0.002, respectively). Also decreases in fathers' and children's SB were found (-39 min./day, p = 0.022 and - 40 min./day, p = 0.003, respectively), but no changes in weight status, the father-child relationship, and the PA-family health climate (all p > 0.05).

CONCLUSION

The Run Daddy Run intervention was able to improve co-PA, MPA of fathers and LPA of children, and decreasing their SB. Inverse intervention effects were however found for MPA and VPA of children. These results are unique given their magnitude and clinical relevance. Targeting fathers together with their children might be a novel and potential intervention strategy to improve overall physical activity levels, however, further efforts should however be made to target children's MPA and VPA. Last, replicating these findings in a randomized controlled trial (RCT) is recommended for future research.

TRIAL REGISTRATION NUMBER

This study is registered as a clinical trial (clinicaltrials.gov, ID number: NCT04590755, date: 19/10/2020).

Implementation characteristics of father-inclusive interventions in low- and middle-income countries: A systematic review

Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low-resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low- and middle-income countries. Forty-four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community-based peer-groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions.

Feasibility, Acceptability, and Preliminary Outcomes of a Father-Focused Childhood Obesity Prevention Program for Low-Income Families with Preschool-Age Children

Background: Few childhood obesity prevention interventions have focused exclusively on fathers, particularly in low-income families. The objectives of this study were to determine feasibility, acceptability, and preliminary outcomes of a father-focused childhood obesity prevention program for low-income families with preschool children (ages 3-5 years old). Methods: Father-child pairs (n = 45) enrolled in a community-based intervention in a Northeastern US state and were assigned within groups to intervention (n = 31) or a delayed comparison group (n = 14). The 8-week (2 h/week) program included nutrition, cooking, and parent education. Feasibility (enrollment, retention, and attendance) and acceptability (quality and value of program) of the program were assessed. Pre/Post measures included the Meals in our Household, Comprehensive Feeding Practices, Healthy Kids, and the Cooking Matters questionnaires. T-tests were conducted and Hedge's g was calculated to estimate effect sizes. Significance was set at p ≤ 0.10. Results: Results indicated feasibility and acceptability of the program for intervention fathers, but recruitment and retention of comparison fathers proved challenging. Small to medium effect sizes were detected for improvements in fathers' feeding pressure (g = 0.48, p = 0.005), confidence in cooking skills (g = 0.25, p = 0.09), ability to cook healthy foods on a budget (g = 0.33, p = 0.10), and frequency that fathers cooked dinner (g = 0.15, p = 0.06). There was a large effect size detected in the increase of green salad consumption (g = 0.75, p = 0.01) by fathers and a small effect size for frequency of children eating vegetables (g = 0.13, p = 0.07). Conclusions: While results are promising, further research should evaluate impact of a larger scale father-focused intervention on diet and obesity risk. The project was registered on ClinicalTrials.gov as NCT03071419.

"That's the routine": A qualitative exploration of mealtime screen use in lower educated Australian families with young children

BACKGROUND

Family meals are an opportune context for initiating healthy eating habits in young children. However, using screens at family mealtimes may negate some of the associated nutritional and social benefits. In High Income countries, frequent mealtime screen use is common, particularly in families of low socioeconomic position (SEP). This study aimed to explore experiences and acceptability of mealtime screen use in families of low SEP with young children.

METHODS

Qualitative interviews with 25 mothers of low SEP were conducted via telephone or Zoom™ using Photo Interviewing and a semi-structured interview script. Transcripts were analysed thematically using a Constructivist paradigm.

RESULTS

Many parents reported an eagerness for reducing family mealtime screen use. Three major themes were identified in explaining the reasons behind levels of engagement in family mealtime screen use. These included parental self-efficacy, such as parental confidence in saying no to screens at mealtimes, physical resources such as having enough space in the home for a functioning dining table without view of a television, and temporal priorities such as prioritising screen use for managing children's difficult behaviour at mealtimes over long-term health considerations.

CONCLUSIONS

This study highlights that although family mealtime screen use is likely linked with a range of child behaviours and parenting practices that may negatively influence children's dietary intake and social engagement, parents often considered screens acceptable at mealtimes. Nonetheless, parents' desire to reduce family mealtime screen use provides an important opportunity to determine how best to support parents to achieve this.

Why do preconception and pregnancy lifestyle interventions demonstrate limited success in preventing overweight and obesity in children? A scoping review protocol

Adverse family-based lifestyle factors in the preconception period, pregnancy and early-childhood are major risk factors for childhood obesity and there is a growing consensus that early life interventions to prevent overweight and obesity in children are required. However, results from recent systematic reviews of preconception and pregnancy interventions have demonstrated mixed success. Therefore, this protocol presents a study aiming to summarise and evaluate complex preconception and pregnancy intervention components, process evaluation components, and authors' statements, with a view to improving our understanding regarding their success and informing design or adaptation of more effective interventions to prevent childhood obesity. A scoping review will be conducted, using the frameworks of the JBI and Arksey and O'Malley. A two-step approach will be used to identify relevant literature: (1) systematic searches will be conducted in the databases PubMed, Embase and CENTRAL to identify all eligible preconception and pregnancy trials with offspring data; and (2) CLUSTER searches will be conducted to find linked publications to eligible trials (follow-ups, process evaluation publications). Two researchers will independently select studies, chart, and synthesise data. A qualitative thematic analysis will be performed in which statements related to process evaluation components and authors' interpretations will be coded as "reasons". A descriptive analysis will be performed to evaluate intervention complexity using a complex intervention framework (AHRQ series; Medical Research Council guidance). The results of this study, which will be discussed with an expert group as part of a consultation stage, aim to identify gaps and inform the design or adaptation of future preconception and pregnancy interventions and approaches to potentially increase success rates. We expect that our results, which will be submitted for publication in a peer-reviewed journal, will be of interest to researchers, families, and practitioners concerned with good preconception and prenatal care, and healthy child outcomes.

Feasibility of using activity trackers and apps to increase physical activity in whole families: The Step it Up Family intervention

Objective

This study examined the feasibility of an activity tracker and app intervention to increase physical activity in whole families.

Methods

This was a single-arm feasibility study with pre-post-intervention measures. Between 2017 and 2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family programme in Queensland, Australia. It was delivered using Garmin activity trackers and apps, weekly motivational text messages and an introductory session. Online surveys and semi-structured interviews conducted with parents assessed intervention usage, acceptability, usability, perceived usefulness, use of physical activity self-management strategies and programme influence. Analyses included descriptive statistics, Wilcoxon signed-rank test and qualitative content analysis.

Results

Overall, 38 families completed the post-intervention survey (95% family retention; 90% children, 95% mothers, 88% fathers). Garmin activity tracker usage was high (i.e. nearly 24/7 during the 6 weeks intervention). Families also used the Garmin apps regularly (i.e. mostly 2-6 times per week). Further, 80% of mothers and 52% of fathers read the motivational mobile text messages. Usability and perceived usefulness of the Garmin activity trackers and apps were rated high. Both parents significantly increased their use of physical activity self-management strategies from pre to post-intervention. Parents expressed that the intervention had increased awareness of physical (in)activity in the family, encouraged to be active and promoted outdoor family activities.

Conclusions

Using activity trackers and apps to increase physical activity in the whole family was well received by children and parents which suggests that this intervention approach is feasible. However, further testing is needed amongst more diverse family populations. These early findings support the implementation of a randomised controlled trial to examine intervention efficacy.

Situating the Father: Strengthening Interdisciplinary Collaborations between Sociology, History and the Emerging POHaD Paradigm

(1) Background: Albeit the main focus remains largely on mothers, in recent years Developmental Origins of Health and Disease (DOHaD) scientists, including epigeneticists, have started to examine how a father's environment affects disease risk in children and argued that more attention needs to be given to father's health-related behaviors for their influence on offspring at preconception (i.e., sperm health) as well as paternal lifestyle influences over the first 1000 days. This research ushers in a new paternal origins of health and disease (POHaD) paradigm and is considered a welcome equalization to the overemphasis on maternal influences. Epigeneticists are excited by the possibilities of the POHaD paradigm but are also cautious about how to interpret data and avoid biased impression of socio-biological reality. (2) Methods: We review sociological and historical literatures on the intersection of gender, food and diet across different social and historical contexts to enrich our understanding of the father; (3) Results: Sociological and historical research on family food practices and diet show that there are no "fathers" in the abstract or vacuum, but they are differently classed, racialized and exist in socially stratified situations where choices may be constrained or unavailable. This confirms that epigeneticists researching POHaD need to be cautious in interpreting paternal and maternal dietary influences on offspring health; (4) Conclusions: We suggest that interdisciplinary approach to this new paradigm, which draws on sociology, history and public health, can help provide the social and historical context for interpreting and critically understanding paternal lifestyles and influences on offspring health.

Promotoras de Salud in a Father-Focused Nutrition and Physical Activity Program for Border Communities: Approaches and Lessons Learned from Collaboration

Promotoras de salud (promotoras) have been a valuable part of community research for Latino families, such as in the recruitment or delivery of health promotion programs. However, there has been limited discussion of how to integrate a promotora model into a father-focused program to support nutrition and physical activity within Latino families. This manuscript's purpose is to describe how to engage and collaborate with promotoras in a father-focused, family-centered program for Latino families living in colonias near the U.S.-Mexico border. As part of a longstanding community-academic partnership, the authors outline approaches and lessons learned from collaboration with promotoras during the design (including formative work and training), implementation, and evaluation of a behavioral program-¡Haz Espacio para Papi! (HEPP, Make Room for Daddy!). Promotoras' contributions supported the entire program, from design through evaluation. The team of all-female promotoras created a balance between the needs and preferences of the community and the goals and requirements of the research. While there is considerable time and human capital required for collaboration, the mutual benefits can make this work meaningful to all involved.

Associations of mothers' and fathers' structure-related food parenting practices and child food approach eating behaviors during the COVID pandemic

BACKGROUND

During the COVID-19 pandemic, many mothers and fathers have spent more time at home with their children, warranting consideration of parenting practices around food during the pandemic as influences on obesogenic eating behaviors among children. Structure-related feeding practices, particularly around snacking, may be particularly challenging yet influential in the pandemic setting. Parent sex and levels of feeding-related co-operation among parents (co-feeding) are understudied potential influences on parent-child feeding relationships.

METHODS

We investigated relationships between structure-related parent feeding and child food approach behaviors during the COVID-19 pandemic, while considering potential moderating influences of parent sex and co-feeding levels. An online survey was completed by 318 parents (206 mothers and 112 fathers) of 2-12-year-olds who were living in states with statewide or regional lockdowns in May/June 2020 within the US. Mothers and fathers were drawn from different families, with each survey corresponding to a unique parent-child dyad. Parental stress/mental health, co-feeding (Feeding Coparenting Scale), structure-related food and snack parenting (Feeding Practices and Structure Questionnaire and Parenting around SNAcking Questionnaire), and child eating behaviors (Child Eating Behaviour Questionnaire) were assessed. Relationships of parents' structure-related food and snack parenting practices with their child's emotional overeating and food responsiveness behaviors were examined using structural equation modelling. Further, we investigated whether these relations were moderated by parent sex or level of co-feeding.

RESULTS

Parent sex differences were seen in parental stress, mental health, and co-feeding, but not in structure-related food and snack parenting or child food approach eating behaviors. Structure-related food parenting was negatively associated with emotional overeating. However, structure-related snack parenting was positively associated with emotional overeating and food responsiveness. While regression paths varied between mothers vs. fathers, as well as by co-feeding levels, neither parent sex nor co-feeding levels significantly moderated relationships between parent feeding and child eating variables.

CONCLUSIONS

Future studies of food and snack parenting and co-operation in relation to feeding among mothers and fathers within a familial unit may be critical to identify intervention strategies that draw on all family resources to better navigate future disruptive events such as the COVID-19 pandemic.

ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care

BACKGROUND

Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring).

METHODS/DESIGN

The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling.

DISCUSSION

To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.

Changes in perceived parental self-efficacy after a Child-Centred Health Dialogue about preventing obesity

Aim

This randomised controlled trial evaluated changes in parental self‐efficacy and children's weight, after a Child‐Centred Health Dialogue about preventing obesity.

Methods

We randomly assigned 37 Child Health Centres in Skåne county Sweden to provide usual care or the dialogue intervention. They included centres from high and low socioeconomic areas. The outcomes were changes in parental self‐efficacy and any moderating effect on their children's body mass index 1 year later.

Results

The baseline data were based on 1115 mothers and 869 fathers representing 1197 children (52% females) aged 4 years (3.9–4.2) with a standardised body mass index (zBMI) of 0.1 ± 0.9. The participation rates at follow‐up, 1.1 ± 0.2 years after the intervention were 817 mothers and 508 fathers. Overall, parental self‐efficacy had decreased by the 1‐year follow‐up. There was a significant intervention effect on maternal self‐efficacy in promoting physical activity, however with unclear clinical relevance. Mothers' change in perceived self‐efficacy in promoting a healthy diet seemed to moderate the intervention effect on zBMI change in children with zBMI > 0 with −0.01 (95% CI: −0.025 to −0.001; p = 0.03).

Conclusion

Our study suggested a possible link between increased maternal self‐efficacy in promoting a healthy diet and a favourable development of zBMI.

Implementation and evaluation of an educational intervention to prevent risk factors for the development of non-communicable diseases in Mexican families of suburban communities

Non-communicable diseases (NCD), are not transmitted from person to person, are long-lasting and usually of slow evolution. Worldwide cause 71% deaths, in Mexico during 2016 were the cause of 80% of registered deaths; population in socioeconomic disadvantage is more vulnerable. It is urgent to develop strategies that can prevent NCD, thus, the objective of this study was to design, implement and evaluate an educational intervention strategy (EI), to prevent and control risk factors for the development NCD in families of two vulnerable communities. The research design was mixed, the stages were developed based on a risk communication (RC) model and was performed in three stages: 1) EI Design, 2) Implementation and 3) Evaluation of the intervention. In the contextualization, risk factors were found in the participants who were integrated in the design of the educational strategy. The EI implemented was effective in increasing knowledge about NCD and practice of healthy habits, such as increasing the consumption of fruits and vegetables. Additionally, the guidance of EI at the family level has the advantage of creating a support network for these changes. However, pending issues remain, such as the design of effective strategies to reduce the consumption of sugars and sugary drinks.

Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes

Background

Although paternal involvement in the perinatal period is associated with benefits for maternal-child health and reduced obesity risk, fathers are seldom included in perinatal or obesity prevention efforts. Engaging community leaders and fathers as stakeholders in intervention development is a critical step in designing a father-inclusive intervention that is efficacious and responsive to their needs.

Methods

We conducted a structured engagement study, including community stakeholder engagement and qualitative interviews with new fathers, to inform the development of a prospective randomized controlled trial that includes mothers and fathers as equal partners in infant obesity prevention. We interpreted stakeholder feedback through the Consolidated Framework for Implementation Research (CFIR) framework.

Results

Between September 2019 and April 2020, we held a Community Engagement meeting, formed a Community Advisory Board, and conducted 16 qualitative interviews with new fathers. Stakeholder engagement revealed insights across CFIR domains including intervention characteristics (relative advantage, complexity, design quality & packaging), outer setting factors (cosmopolitanism and culture), individual characteristics (including self-efficacy, state of change, identification with the organization) and process (engagement and adaptation). Stakeholders discussed the diverse challenges and rewards of fatherhood, as well as the intrinsic paternal motivation to be a loving, supportive father and partner. Both community leaders and fathers emphasized the importance of tailoring program delivery and content to meet specific parental needs, including a focus on the social-emotional needs of new parents.

Conclusions

A structured process of multidimensional stakeholder engagement was successful in improving the design of a father-inclusive perinatal obesity prevention interventions. Father engagement was instrumental in both reinforcing community ties and increasing our understanding of fathers’ needs, resulting in improvements to program values, delivery strategies, personnel, and content. This study provides a practical approach for investigators looking to involve key stakeholders in the pre-implementation phase of intervention development.

Trial registration

ClinicalTrials.gov, NCT04477577. Registered 20 July 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04759-z.

Central American Parents' Preferences for Content and Modality for a Family-Centered Intervention to Promote Healthful Energy Balance-Related Behaviors of Their Preschool-Age Children

This formative research used a cross-sectional survey to assess interest in informational content and intervention modalities for the design of an early childhood obesity prevention intervention for Central American families from the Northern Triangle countries (El Salvador, Guatemala, and Honduras) living in the United States. A total of 74 parents (36 mothers, 38 fathers) with a mean age of 31.6 years (SD = 5.6) completed the survey; 59.5% of whom were born outside of the United States. Although most parents reported being very interested in receiving information related to the seven assessed energy balance-related behaviors, there were significant differences by parents’ gender and nativity. Most parents endorsed remote modalities for content delivery via text/SMS, WhatsApp, and e-mail. However, respondents were also receptive to in-person delivery provided by community health workers. There were also significant differences in parents’ preferences for intervention modalities by parents’ gender and nativity. Future steps should include investigating different intervention modalities and their integration into a linguistic and culturally sensitive family-based intervention to promote healthful energy balance-related behaviors of preschool-age children in Central American families originating from the Northern Triangle countries.

Designing for Multilevel Behavior Change: A Father-Focused Nutrition and Physical Activity Program for Mexican-Heritage Families in South Texas Border Communities

Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.

Dietary Outcomes of the 'Healthy Youngsters, Healthy Dads' Randomised Controlled Trial

(1) Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father-child dietary intakes. (2) Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen's d determined effect sizes, while correlation tests determined associations in father-child dietary intakes. (3) Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father-child dietary intakes for some of the dietary variables. (4) Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.

Low-income mothers' perspectives on the involvement of family members in child feeding

Nearly all research on child feeding has focused on mothers. Very little is known about other family members' roles in feeding children nor how mothers engage with these family members regarding child feeding. The objective of this study was to examine mothers' perceptions of other family members' child feeding roles and practices within low-income families, including the challenges experienced and strategies employed by mothers when sharing responsibility for child feeding. Low-income mothers (n = 100) of pre-adolescent children participated in semi-structured interviews regarding child feeding including shared responsibility for child feeding. A content analysis was then conducted to identify main themes in mothers' responses, with three main themes arising from the interviews. First, many family members were actively involved in child feeding and food-related decision-making. The majority of mothers (85%) reported that another family member was involved in feeding their child including fathers and father figures, who were involved in feeding in 63% of families. Other family members, mainly grandparents, were involved in feeding in 35% of families. Mothers identified several concerns regarding their child's eating when with other family members, particularly when grandparents fed children. Finally, mothers employed several strategies to control their children's eating when children were cared for by other family members. Future interventions to promote healthy child feeding among low-income families may benefit from helping mothers negotiate child feeding with other family members, particularly grandparents, and supporting family members' engagement in child feeding.

Latino Fathers as Catalistas (Agents of Change): Strategies to Support Latino Fathers in Childhood Obesity Prevention

Latino children are disproportionately affected by childhood obesity. Prior research has encouraged father engagement to bolster prevention efforts and outlined general strategies for father recruitment, engagement, and retention. However, behavioral nutrition or education programs with a focus on Latino fathers are lacking, which means there is little guidance for working with Latino fathers in motivation and maintenance. This perspective highlights strategies for supporting dietary and activity behaviors with Latino fathers. Researchers can apply strategies to observational studies or program development and implementation, and practitioners can use strategies to tailor education and counseling with Latino fathers as part of obesity prevention.

Food Skills: Associations With Diet Quality and Food Waste Among Canadian Parents

OBJECTIVE

To examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents.

DESIGN

Cross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits.

SETTING

Guelph-Wellington, Ontario.

PARTICIPANTS

Parents (n = 130) with children aged 2-8 years.

MAIN OUTCOME MEASURES

HEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams).

ANALYSIS

Linear regression using generalized estimating equations to determine unstandardized β estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education.

RESULTS

Food safety knowledge for cooking hot foods (β = 4.3, P = 0.05), planning (β = 4.5, P = 0.001), and conceptualizing food (β = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (β = 25.3, P = 0.05; β = 12.1, P = 0.04), conceptualizing food (β = 34.1, P = 0.01; β = 13.8, P = 0.02), and mechanical techniques (β = 39.2, P = 0.01; β = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively.

CONCLUSIONS AND IMPLICATIONS

Addressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings.

Associations between Family-Based Stress and Dietary Inflammatory Potential among Families with Preschool-Aged Children

Chronic stress is known to influence dietary choices, and stressed families often report poorer diet quality; however, little is known about how family-based stress is linked with dietary patterns that promote inflammation. This study investigated associations between family-based stress and the inflammatory potential of the diet among preschool-aged children and their parents. Parents (n = 212 mothers, n = 146 fathers) and children (n = 130 girls, n = 123 boys; aged 18 months to 5 years) from 241 families participating in the Guelph Family Health Study were included in the analyses. Parents reported levels of parenting distress, depressive symptoms, household chaos, and family functioning. The inflammatory potential of parents' and children's diets was quantified using the Dietary Inflammatory Index (DII^®), adjusted for total energy intake (i.e., the E-DII^TM). E-DII scores were regressed onto family stress using generalized estimating equations to account for shared variance among family clusters. Compared to those in homes with low chaos, parents in chaotic homes had significantly more proinflammatory dietary profiles (β = 0.973; 95% CI: 0.321, 1.624, p = 0.003). Similarly, compared to those in well-functioning families, parents in dysfunctional families had significantly more proinflammatory dietary profiles (β = 0.967; 95% CI: 0.173, 1.761, p = 0.02). No significant associations were found between parents' E-DII scores and parenting distress or depressive symptoms, nor were any associations found for children's E-DII scores. Results were not found to differ between males and females. Parents in chaotic or dysfunctional family environments may be at increased risk of chronic disease due to proinflammatory dietary profiles. Children's dietary inflammatory profiles were not directly associated with family stress; however, indirect connections through family food-related behaviours may exist. Future research should prioritize elucidating these mechanisms.

Papás Saludables, Niños Saludables: Perspectives From Hispanic Parents and Children in a Culturally Adapted Father-Focused Obesity Program

OBJECTIVE

Qualitatively assess culturally adapted lifestyle intervention, Papás Saludables, Niños Saludables (PSNS; Healthy Dads, Healthy Kids), for Hispanic fathers and children.

METHODS

Semistructured interviews of parents and children after participation in 10-week PSNS program for Hispanic fathers and children. Qualitative data double-coded inductively and deductively until consensus reached.

RESULTS

Total of 26 fathers, 26 mothers, and 45 children interviewed. Parents and children had positive feedback about program content on culturally relevant nutrition and physical activity and reported improved father-child bonding. Mothers noted increased involvement among fathers in child's well-being. Participants suggested lengthening the program.

CONCLUSIONS AND IMPLICATIONS

Papás Saludables, Niños Saludables is an innovative approach with promise in engaging Hispanic fathers and children in a lifestyle program that emphasizes the role of fathers in children's lifestyle behaviors. Familism, respeto (respect), and promoting father-child relationships were important to engage fathers. Results from this study will inform future trials of PSNS and help identify ways to increase engagement of Hispanic men in other programs.

Does connectedness to nature improve the eating behaviours of pre-schoolers? Emerging evidence from the Play&Grow randomised controlled trial in Hong Kong

BACKGROUND

Nature-based interventions, which focus on outdoor play, mental health, and self-directed autonomous play, are becoming popular in promoting well-being. The objective of this study was to test whether connecting to nature would contribute to better feeding and eating habits in families with pre-schoolers.

METHODS

241 families with children aged two to five were randomly assigned to the Intervention (IG) and Control Groups (CG). IG received 10 sessions of a family-based programme, which included a novel Connectedness to Nature (CN) element. CG received only the government's health recommendations. The effectiveness of the intervention's primary outcomes (CN, eating/feeding behaviours) was analysed by a repeated measures structural equation model with intervention status as a causal predictor.

RESULTS

204 families (IG, n = 120; CG, n = 84) completed the measurements before and after the trial. The intervention had a medium effect on caregivers' CN (f² = 0.16, (95%CI = 0.06, 0.30)) and a large effect on children's CN (f² = 0.58, (95%CI = 0.36, 0.89)). In the IG, children's CN strongly predicted caregivers' feeding style (β = 0.48 (p < .01, 95%CI = 0.14, 0.83)) and moderately, children's eating behaviours (β = 0.21 (p = .16, 95%CI = -0.09, 0.52)). This produced a positive trend for greater vegetable consumption in the IG compared to the CG (β = 0.20 (95%CI = 0.01, 0.39) vs. β = -0.05, (95%CI = -0.18, 0.08)). Interestingly, the path values in the CG significantly reflected the traditional pattern, (e.g., parental feeding style strongly influenced children's eating behaviour (β = 0.33, p = .001, 95%CI = 0.13, 0.54).

CONCLUSIONS

The Play&Grow intervention positively increased caregivers' and children's CN. It also improved eating behaviors in children independent of their caregivers' feeding style. This may indicate a higher degree of autonomy in children's eating behaviour if they are exposed to nature. Further research should test the CN component in promotion of healthy eating in pre-schoolers.

Paternal Education and Infant Health: Variation by Race/Ethnicity

In the USA, efforts to improve unequal infant health outcomes require knowledge about how the relationship between education and infant health varies by parental gender and race/ethnicity. Drawing from a pooled random sample of over 1 million live births from the 2011 to 2017 National Vital Statistics System data, we examine the relationship between maternal and paternal education and infant health and assess how it varies by maternal racial and ethnic background. The model fit statistics suggest that the relationship between paternal education and infant health is about equal to maternal education and infant health. However, we find a weaker relationship overall between parental education and infant health among Asian and Hispanic fathers than Whites, American Indian, and Black fathers. Black fathers' education is more strongly associated with infant health than that of Black mothers. At some levels, paternal education is also more strongly related to health among Hispanic infants. The results suggest a greater focus on fathers' contributions to infant health is warranted, and programs or policies that focus on fathers could help address racial and ethnic infant health disparities.

Effects of an Activity Tracker and App Intervention to Increase Physical Activity in Whole Families-The Step It Up Family Feasibility Study

(1) Background: Interventions using activity trackers and smartphone apps have demonstrated their ability to increase physical activity in children and adults. However, they have not been tested in whole families. Further, few family-centered interventions have actively involved both parents and assessed physical activity effects separately for children, mothers and fathers. Objective: To examine the feasibility and short-term effects of an activity tracker and app intervention to increase physical activity in the whole family (children, mothers and fathers). (2) Methods: This was a single-arm feasibility study with pre-post intervention measures. Between 2017-2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family program in Queensland, Australia. Using commercial activity trackers combined with apps (Garmin Vivofit Jr for children, Vivofit 3 for adults; Garmin Australasia Pty Ltd., Sydney, Australia), the intervention included individual and family-level goal-setting, self-monitoring, performance feedback, family step challenges, family social support and modelling, weekly motivational text messages and an introductory session. Parent surveys were used to assess physical activity effects measured as pre-post intervention changes in moderate-to-vigorous physical activity (MVPA) in children, mothers and fathers. Objective Garmin activity tracker data was recorded to assess physical activity levels (steps, active minutes) during the intervention. (3) Results: Thirty-eight families completed the post intervention survey (95% retention). At post intervention, MVPA had increased in children by 58 min/day (boys: 54 min/day, girls: 62 min/day; all p < 0.001). In mothers, MVPA increased by 27 min/day (p < 0.001) and in fathers, it increased by 31 min/day (p < 0.001). The percentage of children meeting Australia's physical activity guidelines for children (≥60 MVPA min/day) increased from 34% to 89% (p < 0.001). The percentage of mothers and fathers meeting Australia's physical activity guidelines for adults (≥150 MVPA min/week) increased from 8% to 57% (p < 0.001) in mothers and from 21% to 68% (p < 0.001) in fathers. The percentage of families with 'at least one child and both parents' meeting the physical activity guidelines increased from 0% to 41% (p < 0.001). Objective activity tracker data recorded during the intervention showed that the mean (SD) number of active minutes per day in children was 82.1 (17.1). Further, the mean (SD) steps per day was 9590.7 (2425.3) in children, 7397.5 (1954.2) in mothers and 8161.7 (3370.3) in fathers. (4) Conclusions: Acknowledging the uncontrolled study design, the large pre-post changes in MVPA and rather high step counts recorded during the intervention suggest that an activity tracker and app intervention can increase physical activity in whole families. The Step it Up Family program warrants further efficacy testing in a larger, randomized controlled trial.

Fathers' food parenting: A scoping review of the literature from 1990 to 2019

BACKGROUND

While food parenting is a robust area of inquiry, studies have largely focused on mothers. Given the diversity of family structures today and increases in fathers' engagement in caregiving, fathers' food parenting warrants attention.

OBJECTIVE

We present a scoping review of research on fathers' food parenting (1990-2019). Eligible studies included peer-reviewed research published in English documenting fathers' food parenting and presenting results for fathers separate from mothers.

RESULTS

Seventy-seven eligible studies were identified. Most studies were based in the U.S (63.6%) and utilized a cross-sectional design (93.5%). Approximately half of studies used a validated measure of food parenting (54.5%) and slightly less than 30% utilized theory (28.6%). Many studies did not report information on fathers' residential status (37.7%) or their relationship to the target child (biological vs social) (63.6%). Content analysis of study findings showed that: fathers are involved in food parenting, but at lower levels than mothers; there are few consistent mother-father differences in food parenting practices; and fathers' controlling food parenting is linked with negative nutrition outcomes in children while responsive food parenting is linked with positive child outcomes.

CONCLUSION

To better inform family interventions to prevent childhood obesity, future food parenting research with fathers should recognize the diversity of family structures and utilize prospective, theory-based, designs.

Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial

Adults and children in Canada are not meeting physical activity guidelines nor consuming sufficient nutrient-rich foods. High engagement in these unhealthy behaviours can lead to obesity and its associated diseases. Parent-child interventions aimed at obesity prevention/treatment have assisted families with making positive changes to their nutrition and physical activity behaviours. Given that the home environment shapes early health behaviours, it is important to target both parents and children when addressing diet and physical activity. One method that has been shown to improve health outcomes is co-active coaching. The current study explored the impact of a three-month co-active coaching and/or health education intervention on the dietary intake and physical activity behaviours of parents with overweight/obesity and their children (ages 2.5-10; of any weight). Body composition (i.e., body mass index [BMI] and waist circumference), changes in parental motivation with respect to physical activity and dietary behaviours, and parental perceptions of program improvements were collected. A concurrent mixed methods study comprised of a randomized controlled trial and a descriptive qualitative design was utilized. Fifty parent-child dyads were recruited and randomly assigned to the control (n = 25) or intervention (n = 25) group. Assessments were completed at baseline, mid-intervention (six weeks), post-intervention (three months), and six-month follow-up. A linear mixed effects model was utilized for quantitative analysis. Inductive content analysis was used to extract themes from parent interviews. No significant results were observed over time for the dependent measures. Parents in both control and intervention groups reported varied program experiences, including developing changes in perspective, increased awareness of habits, and heightened accountability for making positive changes in themselves, and consequently, their families. Parents also shared barriers they faced when implementing changes (e.g., time, weather, stress). Qualitatively, both groups reported benefitting from this program, with the intervention group describing salient benefits from engaging in coaching. This research expands on the utility of coaching as a method for behaviour change, when compared to education only, in parents with overweight/obesity and their children.

The association between father involvement in caregiving and early childhood overweight or obesity

BACKGROUND

Despite the increasing trend of paternal engagement in caregiving, fathers remain underrepresented in studies on parenting and childhood obesity.

OBJECTIVES

This study examined the association between father involvement in caregiving and child's weight status within a longitudinal dataset from Japan.

METHODS

The data were obtained from a population-based cohort study in Japan (N = 29 584). The association between father's involvement in child caregiving (age 18 months) on the weight status of the same children at age 3.5 years was examined by logistic regression and linear regression analysis. Furthermore, we checked the interaction between maternal employment & father involvement by creating four mutually exclusive groups of families.

RESULTS

Children whose fathers were highly involved in caregiving were less likely to be overweight (OR = 0.90, 95% CI, 0.85-0.96). Employed mothers with high paternal involvement in caregiving were 30% less likely to have children with overweight or obesity compared to those with low paternal involvement (95% CI, 0.55-0.90).

CONCLUSIONS

Father involvement in caregiving is associated with the development of overweight or obesity in early childhood, and may also modify the association between maternal employment and child's weight status. Social policies to support shared child-rearing such as expanding paid parental leave could help families to raise children with healthy weight.

Feasibility of Targeting Hispanic Fathers and Children in an Obesity Intervention: Papás Saludables Niños Saludables

Background: Hispanic children and men carry a high burden for obesity and associated medical conditions. Healthy Dads Healthy Kids was the first obesity prevention intervention targeting fathers and demonstrated weight loss among fathers and behavior change among fathers and children in Australia. The aim of this study was to assess the feasibility of a culturally adapted version of the program for Hispanic families, Papás Saludables Niños Saludables. Methods: A randomized waitlist controlled trial with a process evaluation was conducted to assess the feasibility of Papás Saludables Niños Saludables(NCT03532048). Fathers, their partner (mother), and one to three children were enrolled. A priori feasibility criteria were: (1) recruit 40 Hispanic fathers and their families in ≤4 months; (2) retain 80% of participants for pre- and postassessments; (3) maintain ≥70% attendance to the 10 sessions; (4) obtain 80% "excellent" or "good" satisfaction from participants; and (5) collect anthropometric and behavioral data on ≥75% of participants at baseline and follow-up. Results: The study enrolled 90% (n = 36) of the goal from one local pediatric clinic between May and August 2018; retained 75% of participants for postassessment; maintained 72% attendance among those who started the program; and achieved 100% "excellent/good" satisfaction ratings among the participating fathers and mothers. One hundred percent of participants had most anthropometric and behavioral data at baseline and 72% at follow-up. Conclusions: With oversampling and improvements in the recruitment strategies, Papás Saludables Niños Saludables is feasible for a randomized controlled clinical trial to address whether a father-targeted lifestyle program is efficacious among low-income Hispanic men and their children.

Dietary habits and metabolic response improve in obese children whose mothers received an intervention to promote healthy eating: randomized clinical trial

BACKGROUND

Lifestyles habits such as eating unhealthy foodscommence at home and are associated with the development of obesity and comorbidities such as insulin resistance, metabolic syndrome, and chronic degenerative diseases, which are the main causes of death in adults. The present study compared changes in dietary habits, behaviors and metabolic profiles of obese children whose mothers attended at the hospital to group sessions, with those who received the usual nutritional consultation.

METHODS

Randomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention group and 87 in the control group. The intervention group attended six group education sessions to promote healthy eating, being this an alternative of change of habits in children with obesity. The control group received the usual nutritional consultation; both groups were followed up for 3 months. Frequency of food consumption, behaviors during feeding in the house and metabolic profile was evaluated. Mixed effect linear regression models were used to evaluate the effect of the intervention on the variables of interest, especially in HOMA-IR.

RESULTS

The intervention group reduced the filling of their dishes (p = 0.009), forcing the children to finish meals (p = 0.003) and food substitution (p <  0.001), moreover increased the consumption of roasted foods (p = 0.046), fruits (p = 0.002) and vegetables (p <  0.001). The children in the control group slightly increased HOMA-IR levels (0.51; 95% CI - 0.48 to 1.50), while the children in the intervention group significantly decreased (- 1.22; 95% CI - 2.28 to - 1.16). The difference in HOMA-IR between the control and intervention group at the end of the follow-up was - 1.67; 95% CI: - 3.11 to - 0.24.

CONCLUSIONS

The educational intervention improved some eating habits at home, as well as HOMA-IR levels; why we consider that it can be an extra resource in the management of childhood obesity.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04374292 (Date assigned: May 5, 2020). Retrospectively registered.

Intra-familial health polarisation: how diverse health concerns become barriers to health behaviour change in families with preschool children and emerging obesity

In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).