September 30, 2022, 2:27 p.m. Michael Devitt — Making sure that children eat the right foods and get enough exercise is a team effort. Although family physicians can help by tracking children’s height and weight, asking questions and offering advice, parents play an essential role in how their kids think and act — and that naturally extends to behaviors like eating healthy and being physically active.
A new study illustrates how mothers and fathers contribute to their children’s dietary choices and physical activity levels. The study found that kids were significantly more likely to eat fruits and vegetables when their mother encouraged them to do so, and that both parents had a significant positive effect when they encouraged their kids to be physically active.
The findings come as the United States continues to grapple with rising levels of childhood overweight and obesity. Analysis of National Health and Nutrition Examination Survey data from the CDC indicates that as of March 2020, the prevalence of obesity in children and adolescents ages 2 to 19 years was 19.7% (up from 19.3% for 2017-2018), with the rate increasing with age, from 12.7% for those ages 2-5 to 22.2% for those ages 12-19.
“These findings are so important as we continue to see an increase in patients with overweight and obesity, including our pediatric patients,” said Lynn Fisher, M.D., a member of the Academy’s Commission on Health of the Public and Science. “We know that this leads to health conditions later in life such as high blood pressure, diabetes, and arthritis. This study may give us some insight on how parents could influence healthy lifestyle choices of their children.”
In the study, 22 groups of mothers, fathers and their children completed up to eight randomly prompted assessment surveys per day for seven consecutive days. At each prompt, mothers and fathers reported whether in the preceding two hours they had encouraged their child to eat fruits and vegetables, cooked or prepared fruits and vegetables for their child, encouraged their child to be physically active, or took the child someplace for physical activities.
Analysis of the prompts found that when mothers encouraged their children to consume fruits and vegetables, the children were significantly more likely to report having eaten fruits and vegetables. Children also were more likely to eat fruits and vegetables when their fathers encouraged them to do so, but not to the same degree as when their mothers did.
Children also were significantly more likely to report participating in physical activities when they received encouragement from either their mother or father, although maternal encouragement appeared to have a greater overall impact.
While there was some evidence that paternal support (such as preparing fruits and vegetables for the child) increased fruit and vegetable consumption and that maternal support (such as driving the child someplace to be physically active) increased physical activity, no within-subject results for parental support were found to be statistically significant.
The authors noted some limits to their research, particularly the small sample size, participants self-reporting their responses, and lack of a clear definition of the term encourage.
Despite these concerns, the authors pointed to the study design and use of real-time assessments as strengths that could be employed in further trials. They also called for research that incorporates both children’s report of mothers’ and fathers’ support for physical activity and children’s perceptions of parental support for physical activity to better understand children’s interpretations of parenting behaviors that may affect their physical activity levels.
“These findings have implications for future just-in-time parenting interventions to promote children’s fruit and vegetable consumption and physical activity,” the authors wrote. Prompting parental encouragement from both parents at specific times, for example, may boost consumption of fruits and vegetables and levels of physical activity.
Fisher, who also serves as an assistant professor in the Department of Family and Community Medicine at the University of Kansas School of Medicine-Wichita, said that the findings give family physicians new tools to consider when talking with parents about their children’s physical activity choices and dietary habits.
“We want to provide evidence-based care, and this small study currently is pointing to an association of how moms can influence an increase in the intake of fruits and vegetables and how moms and dads can both influence an increase in physical activity levels,” said Fisher. “I would like to see it replicated on a larger scale and with more diverse family structures such as single-parent families or same-gender parents, to see if the associations the study found hold true.”
Fisher noted that some of the findings caught him by surprise.
“I don’t think I had really ever considered if it would make a difference which parent was encouraging the child to eat fruits and vegetables,” he said, “but if the association holds true in future studies, I will focus more efforts on the mom to encourage good dietary habits since it may have more of an impact.”
Fisher also said that he is encountering more parents seeking information on improved eating and physical activity habits for their children and offered suggestions on how parents can modify their actions to serve as examples for their children.
“I typically discuss that it is important for parents to model healthy behaviors,” Fisher said. “If parents won’t eat vegetables or fruits or engage in physical activity, then it may be hard to influence children to do those things. So, it is usually an opportunity for the whole family to focus on making small changes to the diet by slowly adding in more fruits and vegetable and eating less sugary foods. I also encourage families to find a physical activity that everyone can do together such as playing at the park or riding bicycles.”
The Academy has produced information on childhood overweight and obesity on familydoctor.org, along with articles on related topics such as body image and self-esteem, effective ways to reduce a child’s screen time, and the importance of developing good nutrition habits early in life.
The Academy’s EveryONE Project has also developed resources to help both children and adults address overweight and obesity. These include a series of screening guides FPs can use to determine their patients’ social needs, and the Neighborhood Navigator, which connects patients with social resources in their neighborhoods.