Over the last three decades, a marked increase in the prevalence of overweight or obese Canadian adolescents has raised concerns [1
]. To help manage this ongoing problem, research suggests that engaging in positive health behaviours such as increased physical activity (PA) among other behaviours can act as a protective factor against obesity [3
]. However, adoption of these weight-related health behaviours can be impacted by a number of proximal influences, including the family environment [5
]. Indeed, there is evidence that even among children at genetic risk for developing obesity, family/home environment moderates their likelihood of developing obesity in childhood [6
]. Therefore, understanding the familial factors that can influence behaviour change among overweight or obese adolescents is essential in order to target these powerful influences.
Parents, in particular, can influence their children directly through parenting practices (i.e., rules or routines) and their own health behaviours, such as modeling PA. Parenting practices are specific actions or strategies parents use to help socialize their children’s behaviours [7
]. In the context of PA, parental support in the form of emotional (e.g., encouragement) [9
] and logistical (transportation to parks or playgrounds) [11
] support have been positively associated with adolescents’ PA. In contrast, results have generally been mixed when examining parent PA (modeling) on adolescents’ PA [13
]. For instance, accelerometer studies have found positive associations between parent and child/adolescent moderate-vigorous physical activity (MVPA) [14
], while self-report studies remain inconsistent [16
]. Together, these studies highlight the role of parents in influencing their adolescents’ behaviours. However, the majority of this research has involved children and adolescents of normal weight. Evidence exploring the relationship between parenting practices and overweight or obese adolescents’ PA is lacking [17
In recent years, family context has emerged as an important factor in the formation of adolescents’ PA behaviours. Two main contextual elements of interest include parenting style and family functioning. Parenting style is the emotional climate in which parents raise their child or the way parents interact with their child [18
]. According to Baumrind [19
], three parenting styles exist, including authoritative, authoritarian, and permissive: Authoritative parents exercise control in a supportive and understanding way, by encouraging verbal interaction. Authoritarian parents exercise high control in the form of demands and obedience, while discouraging verbal interaction. Permissive parents exercise minimal control by giving in to their child’s demands and provide little to no structure. On the other hand, family functioning acts as an all-encompassing dimension that focuses on how family subsystems interact with one another in terms of their cohesion and flexibility to impact the entirety of behaviors in the family unit. Although research in this area is generally sparse, recent models suggest that since parenting styles and family functioning are considered to be contextual elements, they may function at a higher level and act as moderators [21
]. Specifically, parenting style and family functioning have the ability to act as moderators and impact child development (e.g., PA behaviours) indirectly by changing the effectiveness of parenting practices and modeling behaviours [18
]. As a result, how children react to and perceive their parents’ wishes/demands may stem from the broader familial environment [7
]. More specifically, parenting styles and family functioning can attribute a positive or negative undertone to the strategies employed by parents. For instance, parents who exhibit a more controlling parenting style by setting strict boundaries on children’s outdoor play may be viewed by their child as heavily controlling if the exchange between the parent and child is such that parents enforce rules which the child must obey—ultimately hindering outdoor play. Alternatively, rule setting has the potential to be regarded as warm if the parent-child dynamic involves an age-appropriate discussion on the reasoning behind the rules, openness to change rules, etc. [25
]. Moreover, Kitzmann and colleagues [18
], allude to the idea that parents’ attempts to engage their children in activities may be more successful when they already enjoy interacting and spending time together as a family (high family functioning). As a result, children may adopt more positive PA behaviours than those families who do not spend much time together (low family functioning). However, more research into these higher-level dimensions is needed to understand the extent to which context promotes PA behaviours among adolescents who are overweight or obese.
Although prior studies have examined parenting practices and parental modeling independently with regards to adolescent PA, less is known whether both factors are jointly important or whether parenting styles and family functioning moderate these associations. Hence, the present study examines how parenting practices, parental modeling, and adolescent PA fit within these broader family-level components. The primary aim of the study (Figure 1
) was to assess whether both parenting practices and parental modeling of PA are associated with adolescents’ PA, while examining the extent to which parenting styles and family functioning act as moderators. Given that PA parenting practices and parental modeling may be correlated, the secondary aims of this study assessed these relationships separately and examined: 1) The relationships between parenting practices adolescents’ PA behaviours while examining the role of parenting styles and family functioning as moderators, and 2) the relationships between parental modeling of PA and adolescents’ PA while examining the role of parenting styles and family functioning as moderators. Figure 1
presents conceptual relationships tested in this study guided by Bronfenbrenner’s ecological model [26
] as well as suggestions from other frameworks [7
], which considered the moderating role of parenting style and family functioning, under the assumption that the influence of specific PA parenting practices (e.g., logistic support, facilitation) and parental modeling (parent’s PA levels and self-report) on adolescent PA may be conditionally related to these higher level parental factors.
The analytic sample is characterized in Table 2
. As shown in Table 3
, adolescents and parents accumulated around half an hour of MVPA per day as measured by accelerometry and about 56 and 69 minutes of self-reported MVPA per day, respectively. The majority of parents had high scores on the authoritative parenting style scale and midrange on the permissive parenting scales, as most scored 6.0 on a scale ranging from 3 to 12. Regarding family functioning, most parents were balanced on the cohesion and flexibility ratios as the mean ratios both exceeded one.
displays associations between PA parenting practices and adolescents’ MVPA and whether associations were moderated by parenting styles and family functioning. As demonstrated in Table 4
, Model 1 (without moderators) highlights that PA parenting practices were significantly associated with adolescents’ self-report of MVPA and that there was a trend towards significance (p
= 0.06) with adolescents’ MVPA measured by accelerometry. Specifically, more healthful PA parenting practices were associated with higher levels of adolescents’ MVPA. When the moderators were included in the model, the interaction term between permissive style and PA parenting practices became significant. In contrast, PA parenting practices was the only significant predictor for adolescents’ self-report MVPA when the moderators were added. Figure 2
illustrates the interaction of permissive style by PA parenting practices, suggesting that more healthful PA parenting practices were positively associated with adolescents’ MVPA but also indicating that this association was more pronounced among adolescents whose parents use a high permissive style compared to those with a low permissive style. As shown in the graph, however, the direction of this association reverses when parents employ less healthful PA practices.
In all models, adolescents’ sex was the only significant covariate. The results suggest that adolescent boys had significantly higher MVPA than adolescent girls and this was observed for both accelerometry and self-report assessment of MVPA (Table 3
. displays associations between parental modeling of PA and adolescents’ MVPA, as well as whether parenting styles and family functioning moderated these associations. As shown in Table 5
, Model 1 (without moderators) highlights that parental modeling of PA was significantly associated with adolescents’ MVPA for both accelerometer and self-report. Specifically, parents who modeled high levels of PA were associated with increased PA among overweight/obese adolescents. When the moderators were added into these models, no significant effects emerged for parenting styles or family functioning, but parental modeling of PA remained significant.
displays the association of both PA parenting practices and parental modeling of PA on adolescents’ MVPA and whether parenting styles and family functioning moderate these associations. Model 1 (without moderators) highlights that PA parenting practices and parental modeling of PA were significantly associated with self-report of MVPA. Specifically, more healthful PA parenting practices and parental modeling of PA were both associated with higher levels of adolescents’ MVPA. Although parental modeling of PA (accelerometry) was significantly associated with adolescents’ MVPA measured with accelerometry in Model 1, a trend towards significance (p = 0.07) was observed for this relationship in the final model. When the moderators were added into the model, a significant interaction between permissive style and PA practices was observed. However, this was only observed for MVPA measured with accelerometry. This is similar to our findings reported in Table 4
. This finding is illustrated in Figure 2
(see previous figure reported and description)
The purpose of this study was to examine the effect of parenting practices and/or parental modeling on the PA behaviours of overweight/obese adolescents and explore whether parenting styles and family functioning act as moderators. With regards to the primary aim of the study, when considering both PA parenting practices (i.e., facilitation, logistic support) and parental modeling of PA (i.e., PA self-report), both were significantly associated with adolescents’ self-report of MVPA—where higher MVPA occurred in families that had more positive parenting practices and modeled an active lifestyle In addition, a significant interaction between permissive style and PA parenting practices emerged for adolescents’ MVPA measured with accelerometry—where permissiveness was found to amplify the association between healthy PA parenting practices and adolescents’ MVPA. Interestingly, family functioning did not emerge as an important moderator. The findings were similar when PA parenting practices and parental modeling were examined independently (secondary aims), except that the association between parental modeling of PA and adolescents’ MVPA measured with accelerometry was significant instead of being borderline significant. Overall, the results highlight the importance of healthy PA parental practices and modeling to support overweight/obese adolescents’ MVPA as well as the role of permissiveness in further supporting their engagement in PA.
Given that most of the literature has focused on the influence of parenting practices and modeling separately [12
], the present study revealed that parenting practices and parental modeling together, may be important factors in overweight/obese adolescent PA behaviours. The few studies that have explored both practices and modeling together in the context of PA report conflicting results in comparison to the present study. Previous studies have reported that the importance of modeling is diminished by other constructs, such as parental encouragement and support [43
]. For instance, a study conducted among grade 7–12 students found parenting practices, namely parental support, to be more influential than parental modeling [43
]. However, these studies targeted a general sample of adolescents while the present study focused on overweight/obese adolescents, which may explain the discrepancies. It may be that parents who are more active or model an active lifestyle are in a better position to support their overweight/obese adolescents’ PA as they can, for example, be active together. On the other hand, adolescents who are not overweight/obese may only need support from their parents to be physically active, such as transportation to a playground, while overweight/obese adolescents may need the additional modeling component to enhance their drive and motivation to be active. Therefore, the combination of parental modeling along with specific parenting practices such as taking the child to an appropriate location for PA or encouragement may be necessary to influence the activity of overweight/obese adolescents.
Evidence to support the hypothesis that family functioning would act as a moderator on the relationship between parenting practices and/or parental modeling and adolescents’ physical activity, was not found. Of note, few studies to date have explored the role of family functioning as a moderator [18
]. In a sample of healthy adolescents, one study found evidence of family functioning as a moderator on the relationship between family meals and unhealthful weight management behaviours [46
]. Despite no literature exploring family functioning as a moderator within the context of child obesity, a review has provided some indirect evidence to help support this notion [18
]. As pointed out by correlational findings, overweight/obese children have a greater likelihood of experiencing more family conflict and less family cohesion compared to their normal-weight counterparts [47
]. Although the directionality of this effect remains unclear, these correlations suggest that in families where an overweight child is present, more support may be needed to help establish or manage positive health behaviours [18
]. Although this review provides some reasoning to support the moderating effect of family functioning on adolescent health behaviours, the evidence base remains unclear [18
]. In the present study, it is important to note that the null findings apparent for family functioning may be a result of the sample’s characteristics. Of note, families in our sample were predominantly balanced in cohesion and flexibility. Therefore, families categorized as high or low functioning may be quite similar to one another. Thus, future research should strive to capture families that truly fit into the high or low family functioning groups to better understand the true potential of family functioning.
The association between parenting practices on adolescents’ PA behaviours was moderated by parenting styles, however, it was only partially consistent with the study hypotheses. This finding highlights that the moderating effect of parenting styles on the association between parenting practices on adolescents’ PA behaviours was more complex than anticipated. Two other studies have reported similar results, suggesting that more healthful practices performed in a more permissive way are associated with more adolescent MVPA [25
]. According to Hennessy and colleagues, two types of PA parenting practices (monitoring and reinforcement) were associated with child accelerometer PA when expressed in the context of a permissive parenting style [25
]. Similar findings were also observed by Langer and colleagues who found parental support was only associated with adolescent PA when expressed in the context of a permissive parenting style [49
]. One potential explanation for this finding may be that permissive parenting characterized by high warmth and low demand is associated with more unstructured playtime and more enjoyable activities [50
]. Therefore, being permissive in the context of PA may provide adolescents with more free time for active play and if they feel encouraged and supported by their parent with respect to PA, they may choose to be physically active.
The association between PA parenting practices, styles, and adolescents’ MVPA was only observed when adolescents’ MVPA was measured by accelerometry. While both accelerometer and self-report measures have been validated to assess PA, there are clear differences in the two measures. For instance, accelerometer data give more accurate estimates of walking-based activities and avoid many of the issues that go along with self-report, such as recall and response bias [51
]. However, it is important to highlight that accelerometers are unable to capture certain types of activities, such as swimming and activities involving the use of upper extremities. Compared to direct measures, self-report methods appear to estimate greater amounts of higher intensity (i.e., vigorous) PA than in the low-to-moderate levels [51
]. The main difference in the present study is that the self-report MVPA interaction with parenting practices and styles did not appear while it was found with the accelerometer. Measurement error with self-report tends to be higher, as noted by the increased chance of recall and response bias, which may lead to decreased power and perhaps explain why a significant interaction was not observed with the self-report data.
The study has some limitations that should be considered. First, it is difficult to assume a cause and effect relationship due to the cross-sectional nature of the study. For instance, relationships observed in this study may be bi-directional since both parents and children can shape one another [52
]. Second, measurement errors may have biased study results. MVPA was assessed with both subjective (self-report) and objective (accelerometer) measures. Self-report measures are subject to reporting biases, such as recall and social desirability bias, since individuals are known to have poor recall of past PA levels and tend to overestimate their PA (biased reporting and low validity), respectively [54
]. Therefore, inconsistency in our results may be due to these various forms of measurement error. Third, the parenting measures had some measurement challenges. Of the three parenting styles developed by Baumrind, our study only captured two (authoritative and permissive). Therefore, this may have limited our ability to adequately capture the parenting style of each parent. Additionally, as all parenting measures (parenting practices, parenting styles, and family functioning) were self-reported, our results may have been impacted by social desirability bias. As such, this may have led to an overestimation of the results. Given the strong evidence of familial clustering of obesity [57
], our study may have benefited from information on parental BMI. Including this variable in our analyses may have attenuated our results, given its association with the family PA environment as well as various parenting behaviours (e.g., monitoring child PA, setting limits for PA) [59
]. Finally, our sample included adolescent volunteers who were classified as overweight or obese and were willing to take part in an e-health intervention. Despite the fact that our results may not be generalizable to the general population, it is important to consider overweight/obese adolescents not only because they are typically understudied, but because they are frequently targeted by treatment interventions.
This is the first study to explore the moderating effects of both parenting styles and family functioning on adolescents’ PA behaviours. It is one of the only studies to examine moderating effects in a sample of overweight or obese adolescents, which is essential when trying to design effective weight-management interventions. Understanding how parenting practices and modeling interact with styles and functioning on adolescents’ health behaviours provides useful information for the development of familial interventions. It is also one of the few to use both accelerometers and self-report to directly measure and compare both parent and adolescents’ PA levels.
Findings from this study offer implications for intervention development. First, interventionists (e.g., nurse practitioners) should consider parenting factors when counselling families with an overweight or obese adolescent. As part of family-based interventions, interventionists should encourage parents to not only provide support for their child’s PA, but modify their own PA. Secondly, family context, specifically, parenting style, may help improve the efficacy of family-based interventions. For example, interventionists could teach parents that parenting styles and practices go hand in hand and elicit different PA behaviours from their adolescents.