Engaging Fathers in the Promotion of Healthy Lifestyle Behaviors

Abstract

Parental engagement is an important component in lifestyle behavior change interventions for children as parents are uniquely positioned to establish a healthy environment and model healthy eating and physical activity habits for their children. Despite both mothers and fathers being important agents of behavioral change for their children, fathers are typically underrepresented in programming interventions. Physical activity may be an important strategy for fathers to become involved in lifestyle change with their children as, compared to mothers, fathers traditionally tend to be comfortable engaging in physical activity with their children.

‘Family involvement has been specifically shown to be an important factor in effective prevention and treatment of childhood obesity’

Parents play an important role in lifestyle disease treatment and prevention as they have direct influence on their child’s diet and physical activity habits.^1,2 As discussed by Fisher ³ in this issue, parents have the potential to affect children’s emotional and physical health. Parents are in a unique position to model healthy lifestyle behaviors and establish a healthy environment for their children with nutritious food options, proper portion sizes, and opportunities for physical activity. ⁴ Given the day-to-day contact, emotional connection, and longevity of family relationships, family engagement in lifestyle changes can create a powerful support system.

Family involvement has been specifically shown to be an important factor in effective prevention and treatment of childhood obesity.^1,2,5,6 Parent weight status is highly correlated to child weight status, and having at least one parent who is obese more than doubles the risk that the child will be obese as an adult. ⁷ Parenting style, child-feeding practices, and parental participation in physical activity are related to children’s weight status.^4,8 Parents providing direct assistance to teach children physical activity behaviors is a consistent factor significantly associated with higher levels of child physical activity. ⁹ As with many other learned behaviors, modeling is an influential mechanism through which children learn eating and physical activity behaviors from their parents.^10-12 In fact, evidence suggests it is possible to improve a child’s weight status by solely targeting the lifestyle behaviors of parents. ⁵ For these reasons, many weight management interventions attempt to include parents and encourage family-level change.^1,5,6

The Role of Mothers

Although the terms “family” and “parent” are frequently used in the literature, the individuals most likely to participate in childhood weight management interventions are mothers. ⁶ One reason for this may be the intimate role mothers play in the process of feeding their children, beginning during pregnancy.^13,14 This perceived maternal feeding responsibility tends to persist as the child ages into adolescence. ¹⁵ Especially with girls, mothers’ personal diet behaviors and perceptions of their daughter’s weight continue to be impactful on their diet behaviors and body image as an adolescent. ¹⁶

Maternal, infant, and child health has been a long-standing public health priority. ¹⁷ The rational for this is that by intervening with mothers, whole families and future generations can be affected. Consequently, numerous assistance programs are aimed at the health of mothers and children. An example of this is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which serves about 8 million participants each month. ¹⁸ These efforts are effective^19,20 and important to continue, but have a tendency to leave out fathers.

Societal Shift in Family Structure

The importance of mothers in prevention and treatment is clear; however, traditional familial roles have begun to shift. ²¹ Compared to 20 years ago, more families have both parents working. ²² As a result, parents may have increased stress and decreased time available for cooking and child-parent playtime. The level of unstructured physical activity children engage in during childcare is variable, but is suspected to be less than if at home with a parent. Adolescents who are left unsupervised after school appear to choose more screen time over physical activities. ²¹

Another change in recent years is that it has become more common for fathers to be the primary care provider in the families that have one parent staying at home with their children. ²² Given this shift, it is expected that the participation of fathers in child weight management interventions would have also increased. Instead, father participation in family-based obesity treatment programs appears to have significantly decreased from the 1970s to 2000s. ¹

The Role of Fathers

The engagement of fathers in childhood lifestyle treatment has only recently begun to be studied. Among 667 observational studies on parenting and childhood obesity, only 51% included at least 1 father and only 9% reported results separately for fathers. ²³ Despite the lack of father inclusion, the importance of fathers in the promotion of healthy lifestyle behaviors in children should not be overlooked. Children with an obese father have 4 times the risk of being obese at age 18. ⁷ Some evidence suggests that fathers’ behaviors and style of parenting may be more predictive than mothers’ of children’s weight status.^24,25

Fathers play an important role in the promotion of both physical activity and healthy eating behaviors for their children.^26,27 Lifestyle behavior studies including fathers tend to focus on physical activity behaviors rather than diet. ²³ This trend may indicate that fathers prefer and/or are more comfortable with engaging in physical activity than in altering dietary behaviors. Children of fathers who are active were 3.5 times more likely to be active than children with inactive fathers. ²⁸ While mothers tend to play a larger role in the logistical planning of physical activity, fathers are more likely than mothers to engage in modeling physical activity.^29,30 The modeling of vigorous and moderate to vigorous physical activity by fathers has been shown to be associated with higher levels of physical activity in their sons ³¹ and daughters. ²⁹ Fathers can also play an important role in weight management interventions. The Healthy Dads, Healthy Kids lifestyle intervention demonstrated that father modeling of physical activity and participating in physical activity with their children leads to significant reductions in the weight of both fathers and their children.^32-34

Recommendations for Involving Fathers

Given that a typical father’s role includes active play, health care providers should encourage fathers to engage in physical activity with their children. While randomized control trials indicate that fathers’ involvement in diet-related changes are responsible for a greater effect on weight loss outcomes than their involvement in physical activity, ³² fathers’ engagement in physical activity may act as a catalyst to make other healthy lifestyle behavior changes such as diet. The following suggestions for encouraging father participation are based on the successful Healthy Dads, Healthy Kids intervention^33-35 and outline some specific ways to encourage paternal engagement:

Learning Skills Through Play

It can be tempting for fathers to spend the majority of playtime teaching their child a specific technique. Such instruction, while valuable, is not very effective at increasing activity time. For example, instead of spending 20 minutes showing their child the proper way to throw a football, fathers can play toss and provide instruction as the child practices throwing. The skills that are learned through play may be farther-reaching than increased coordination or improved sports performance. In addition to increasing physical activity, father-child play has been identified as an important way children learn to socialize and has been linked to the regulation of emotions, popularity, and peer competence. ³⁶

The Importance of Rough and Tumble Play

Fathers should also be encouraged to engage in non–sports-related activity. A physical activity that is generally not thought of as physical activity is rough and tumble play. Fathers are more likely to roughhouse with their children than mothers, which makes it a special activity fathers can share with their children. Rough and tumble play may also help children develop social skills, as children who participated in higher amounts of rough and tumble play have been shown to be more adept in social situations. ³⁷

Conclusion

Parents play a critical role in the promotion of healthy lifestyle behaviors for their children through behavioral modeling and the establishment of a healthy environment with nutritious food choices and physical activity opportunities. While family involvement has been shown to be an important factor in the success of weight management interventions, fathers are often overlooked as agents of behavioral change for the family. Physical activity represents a particularly promising area of focus through which fathers can be engaged in lifestyle change behaviors.