Research supports BC families in building healthy habits to prevent childhood obesity

Unhealthy eating patterns, low physical activity, and a lot of sedentary or screen-related habits are linked to childhood obesity risk, which can lead to elevated blood pressure, sleep problems, orthopedic issues, and mental health challenges. Obesity-prevention resources that only focus on providing information often fall short because many families already know the basics. The biggest challenge is implementation.

“For the past 20 years, my research has focused on finding better ways to support families in shaping healthy behaviours to prevent childhood obesity,” says Dr. Louise C. Mâsse, an investigator at BC Children’s Hospital Research Institute (BCCHR) and professor in the School of Population and Public Health at the University of British Columbia. Weight and its associated behaviours reflect a mix of influences, which may include biology and genetics, the environment, family factors, culture and food traditions, developmental needs, and media exposure.

One of the most promising ways to promote long-term child health is family-based programs. They’re helpful because they focus on aspects that families can most directly influence, such as nutrition, physical activity, screen time, and co-parenting agreement. While these programs are strongly recommended, they often show modest effects, perhaps due to overreliance on a single caregiver — typically mothers — and their little attention to co-parenting aspects.

“Children are influenced by multiple caregivers — not only their mothers — yet, these other family members are largely underrepresented in research,” says Dr. Olivia De-Jongh González, a research associate in the Mâsse lab at BCCHR. Family-based programs tend to have better outcomes when all the caregivers are involved and aligned, and when barriers to attendance are removed. “It’s easier to engage more than one caregiver when they can participate from home, at their own pace.” For this reason, most studies led by Dr. Mâsse’s team involve e-health tools, such as the app delivering the Good Start Matters mHealth Parenting program.

This mobile health program was designed to help families address everyday routines so that children aged three to six receive consistent support across different settings and caregivers. “In our programs, we focus on strengthening healthy routines and responsive parenting and co-parenting practices rather than having weight loss goals,” says Dr. Mâsse. The researchers also remind us that children in larger bodies can be healthy, and children in smaller bodies can have health risks. Families concerned about their children should talk to their pediatrician.

The program aims to promote structured and autonomy promoting parenting practices, and reduce controlling practices. From a psychological perspective, structure and autonomy are related to healthier habits. “They support self-regulation, routine, and motivation without escalating power struggles or undermining the child’s needs and preferences,” says Dr. De-Jongh González, who led the parenting project as a postdoctoral researcher in the Mâsse lab.

In everyday life, the combination of structure and autonomy-promoting practices involves giving children meaningful choices within healthy boundaries. The caregivers set clear rules and routines — explained in age-appropriate language — and the child chooses among the options available. “As an example, if parents want to support their child to stay active, they might decide to enroll them in a physical activity, and the child can choose their favourite option from a short list,” says Dr. De-Jongh González.

Controlling parenting practices are not recommended, as they can be intrusive and undermine a child’s ability to self-regulate. Forcing a child to finish their plate when they’re no longer hungry is a great example of a controlling style, according to Dr. De-Jongh González. Another example is tricking a child into eating certain ingredients by hiding them in the food, instead of supporting gradual acceptance. “These types of strategies can increase conflict and reduce self-regulation over time, even if they seem to work in the short term,” she says.

Having knowledge about good parenting practices is important but rarely enough to change behaviours. “Our work is grounded in behavioural theory because theory helps us identify and target mechanisms that drive sustained behavioural change,” says Dr. Mâsse. Family-based programs can be especially helpful when families are dealing with stress, habits, and routines that are hard to shift because they translate general advice into practical tools.

Currently, Dr. Mâsse’s team is examining the effectiveness of the mHealth program, work recently described in the JMIR Research Protocols journal. They aim to understand how families behave in relation to nutrition, physical activity, co-parenting agreement, and screen time, among other aspects. The findings will help provide recommendations to refine the program. “We are also investigating which level of engagement is enough to drive meaningful benefits, which families benefit the most, and what appears to be driving change,” says Dr. De-Jongh González.

This research builds on the strong evidence that early childhood is a critical period when physical activity, screen use, and eating patterns are formed. Caregivers have an important role in shaping these routines. “Our program has never been about blame,” says Dr. De-Jongh González, noting that families are juggling time constraints, financial issues, stress, childcare schedules, and competing demands. “Our goal is to design support that respects those realities, so we are working to offer practical tools that will support feasible, sustainable changes that work in everyday family life.”