Childhood overweight is increasing globally, and obesity in childhood tends to persist as obesity in adulthood. This matters because obesity is associated with a number of health problems including diabetes, chronic heart disease, some cancers, and shortened life expectancy. A complex problem and growing desperation to find effective interventions have led to hand wringing and occasional blaming of everything from parents, to schools, to individual food and beverage items. Emerging frameworks, such as the one we propose in a recent paper by Kris Harrison and colleagues, contend that weight status has a genetic component although this interacts with and manifests in the various layers of everyday life. These layers or nested ecological contexts form the rich ground in which children grow. The community, the child care context, and the family are all examples of ecological contexts and each is filled with influences that undoubtedly con-tribute to weight status. I do not intend to blame but rather to explore how the family context is of primary importance for the younger generation. In fact, my work has led me to believe that effective intervention involves identifying and building on the strengths inherent in family contexts.

If the family context is implicated in childhood obesity, then it stands to reason that existing intervention efforts should have considerable focus on impacting the kin environment that surrounds children. Celia Kamath and colleagues conducted a review of evaluated childhood obesity prevention programs. They found that most did not have parental components or featured only rudimentary efforts (e.g., asking parents and children to do activity packets together at home; inviting parents to family activity nights at school). In their meta-analysis, these narrow engagement efforts had very little impact on target behaviors or BMI, probably because the family components were limited add-on and not integral parts of program design and strategy. One exception was Tom Baranowski and colleagues’ Fun, Food, and Fitness Project, a 4-week summer day camp program for girls followed by 8 weeks of internet-based activities for the girls and one of their parents. Some dietary behaviors did improve, but there was only a trend for BMI to drop for the treatment group. The authors commented that they noted lower than expected participation in the internet-based portion of the intervention, the primary avenue for parental participation. This is one example of how past efforts, at least those with published random control trial evaluations, have had only limited success in engaging parents.

Those of us engaged in program development and intervention clearly still have much work to do in effectively engaging families in the prevention of childhood obesity. At the Family Resiliency Center, I have been working with Barbara Fiese and others to foster healthy habits by building on family resiliency/strengths and leveraging existing patterns of daily life (e.g. family routines). Daily life in the family context includes numerous elements such as the food and physical activity environments. The food environment consist of typically available foods, commensality patterns such as the frequency of shared family mealtimes (SFMs), practices such as eating breakfast, the emotional tone or climate of shared family meals, and mealtime rules such as whether TV is on while eating. The physical activity (PA) environment includes available affordances for PA (e.g. bikes or a yard), family PA patterns such as the modeling or support of PA by parents and the frequency of joint activity among family members, and the emotional tone or climate that surrounds PA within the family.

Interactions in the shared meal and PA domains within the family context have been linked to positive outcomes in past research. For example, in 2007, Reed Larson, Kate Branscomb and I edited a New Directions in Child Development monograph focused on family mealtimes. We included contributions from authors across a number of disciplines and concluded that shared family mealtimes are linked to various positive outcomes, including development of cultural identity and language. Once young children enter school or out-of-home care arrangements, regular SFMs provide families an opportunity to reconnect and engage in ways that most other routines (e.g. bath time) do not. A number of studies have found a link between the frequency of SFMs and lower intake of fried foods and soft drinks and increased consumption of fruits, vegetables, and essential nutrients. In the Strong Kids project at the University of Illinois, our longitudinal study with toddlers has documented that in families with more shared mealtimes, toddlers eat more servings of fruits and vegetables as well as more dairy. They also have lower BMIs.

While past research has supported the value of frequent SFMs, little is known about the mechanism(s) by which positive impacts may be obtained. In our monograph, we suggested that shared mealtimes provide opportunities for positive family interactions that may contribute to positive child outcomes, including healthy weight. Extending this idea, beyond the quantity of SFMs, the quality of mealtime interactions matters. We can all probably recall an uncomfortable shared mealtime where an argument settled over the table like a black cloud and food seemed to stick in the throat. Of course, no family is perfect, however, when these negative interactions predominate, the opportunity space provided by SFMs shrinks considerably. Frequent SFMs are only supportive of good outcomes if those mealtimes are mostly positive, that is, low in destructive conflict and rich in cohesion and expressiveness.

Turning to another area of the family context, we consider physical activity. A consistent research finding is that low levels of PA are associated with overweight and obesity across the developmental span. John Pugliese and Barbara Tinsley’s meta-analysis documented the socializing influence of parents on their children and adolescents’ PA, especially their modeling of and instrumental support for PA (such as driving to PA opportunities). Studies, including an early one Stewart Trost, James Sallis and their collaborators, have established children’s self-efficacy as one link between parents and children’s PA. In other words, when parents support children’s PA, children become more confident of their ability to do PA. Another important study by India Ornelas, Krista Perreira, and Guadalupe Ayala using the national ADD Health data demonstrated that more general family patterns related to emotional climate (cohesion, parent-child communication and parental engagement) predict the PA of youth (7-12 grade). This means that beyond simply modeling, engaging with, or providing support for PA, a positive social and emotional atmosphere within the family, perhaps especially around PA, is also predictive of children moving more!

As children move into the distal ecological levels of school and community, parents often feel a sense of despair about their diminishing influence on children’s choices. Research suggests that the family context continues to impact children’s PA even after they are experiencing considerable independence in their daily lives. Kristine Madsen and colleagues followed girls from age 9 until 19. They found that after age 12, parent-reported PA was no longer associated with adolescent PA. However, beginning at age 15, perceived parent PA gained significance and remained associated with increasing levels of adolescent PA until the end of the study (age 19 for the girls). My colleagues and I in our international Up Amigos project found that Mexican late adolescents are still influenced by parental PA even as they apply to university. Those who perceived their parents to be more physically active were more physically active themselves. And sadly, the opposite was also true.

Teresia O’Connor and colleagues 2009 reviewed PA interventions that have targeted parent involvement, including as role models and even as co-participants in family-based activities. Their conclusion was that while we know that some relationship between parent PA and child PA exists, we have little evidence of how that relationship works, and we are still learning how to effectively engage parents in prevention and intervention. An example of this is the Fun, Food, and Fitness Project mentioned above which targets improving PA in part by engaging parent involvement but was not successful in impacting most measures of PA. Again, in explaining the lack of effect, the authors implicate their method of engaging parents (self-directed interaction with a website).

Our program, Abriedno Caminos, aims to prevent childhood obesity among Latino immigrant families by addressing nutrition, PA, and family interaction with whole families. This Spanish-language curriculum that includes a 10 week program with a weekly parent and child PA class consisting of brief instruction at the start of class and followed by an exercise participation period aimed to get all family members engaged in fun joint and integrated PA for 30-40 minutes. Examples include Zumba dancing, walking with pedometers, and playing playground games that parents remember from childhood. Our flexible approach included a range of PA options that proved acceptable to our pilot audiences. Our instructors focused on PA as fun, low-pressure, and family-oriented. Abriedno Caminos was effective at increasing walking in parents and moderate and vigorous physical activity in their school-aged children. This highly targeted effort shows promise but requires further testing with a randomized control group design.

Returning to the larger picture, childhood obesity is a formidable foe. However, because weight status is not isolated from the various layers of everyday life, and because children mature within a set of nested ecological contexts, we have reason to hope. This means that we have multiple areas for addressing the problem of childhood overweight and obesity. We do not have to limit ourselves to schools or medical settings. Our research and that of others suggests that one fruitful direction is a focus on the routines of everyday family life (such as shared mealtimes and joint physical activity). These represent strengths that are familiar to most families and embedded in each are multiple opportunities for improving resilience. It does suggest that creative collaborations among professionals, parents, child care providers, and researchers are necessary. Sometimes collaborations are difficult as methods, assumptions, and even our jargon differ. And blame is easy to cast. With this in mind, I say again that I am not blaming parents or the home environment for childhood obesity. Instead, I want to reframe the discussion to ask “what strengths are already in the home environment, even if in small part, on which we can build?” I suspect that one secret to defeating childhood obesity is buried in these strengths. Ben Silliman has a beautiful way of characterizing families:

"American families have always shown remarkable resiliency... Their strengths resemble the elasticity of a spider web, a gull’s skillful flow with the wind, the regenerating power of perennial grasses, the cooperation of an ant colony, and the persistence of a stream carving canyon rocks. These are not the strengths of fixed monuments but living organisms. This resilience is not measured by wealth, muscle or efficiency but by creativity, unity, and hope. Cultivating these family strengths is critical to a thriving human community."

I challenge us to honor and build on existing strengths like positive shared family meals and joint fun physical activity. Let us work together to help families carve out the will and the time to do more of these things, for many good reasons including helping their children maintain healthy bodies.