Health care centers are ideal settings to identify and motivate parents to adhere to healthier lifestyles in order to reverse their child's excessive weight. However, such promotions are time- and resource-consuming, and primary health care needs new approaches to engage parents. In this study, we present an app for that purpose, with tailored recommendations for parents regarding young children's lifestyles with gamification mechanics for parents, and a serious game for their children, aged 3-6 years. Health care center based questionnaires were used to assess parent's acceptance of the app. We also determined their enrollment and retention rates with a pilot study, in order to test the implementation of a randomized controlled trial in the future. In the pilot study, we tested their engagement with the app during a 4-week period through a monitoring website. In the acceptance test, parents rated the app a median score of seven on a 10-point scale. In the pilot study, all parents in the intervention group used the app. The retention rate was 71.4%. This study indicated some areas of improvement related to gaming mechanics in order to increase participation. Health care center's professionals and parents of children with overweight/obesity accepted this innovative approach.

Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children’s age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children’s eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents’ perceptions of the child’s weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann–Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child’s excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child’s weight with additional strategies.

The Home Self-Administered Tool for Environmental Assessment of Activity and Diet (HomeSTEAD) survey evaluates a broad spectrum of food parenting practices related to parental use of control, autonomy support, and structure. This study aims to test the psychometric properties of the Portuguese version of the HomeSTEAD family food practices survey in parents of 3–12 year old children. Data were collected from 184 parents/caregivers. We performed an exploratory factor analysis (EFA), calculated the internal consistency coefficients of each subscale, and tested for associations with children’s food intake and weight. Based on the EFA, 61 items were included in the Portuguese version of the HomeSTEAD family food practices survey, and were distributed among four Coercive Control Practices (16 items); five Autonomy Support Practices (17 items); and nine Structure Practices (28 items). All scales demonstrated an acceptable level of internal consistency. A higher body mass index (BMI) SD score in children was associated with higher levels of restriction and weight talk by parents and distractions during meals. Higher levels of distractions during meals were also associated with higher sweets intake in children. Additionally, higher levels of parental modeling and the establishment of rules and limits were associated with lower intake of sugar-sweetened beverages. These associations provide preliminary evidence of the HomeSTEAD family food practices survey’s construct validity and attest to its potential to assess parental strategies and provide useful information to improve children’s eating.