Implications for practice and research

• Conversations between parents and adolescents about healthy eating are associated with a reduction in adolescent-reported unhealthy weight-control behaviour.

• In contrast, talking to adolescents directly about the need to diet or lose weight is associated with more adolescent-reported unhealthy weight-control behaviour.

• Practitioners should advise parents that discussions with adolescents that promote healthy eating are more useful in changing health behaviours than discussions focusing on dieting or losing weight.

Context

Although the obesity epidemic has received much attention with an emphasis on healthy eating and weight control, unhealthy weight-control behaviour among adolescents remains a significant concern. There is substantial interest in preventing or treating obesity while avoiding the promotion of unhealthy weight-control behaviours. No prior study has examined whether parents discussing healthy eating habits with their adolescent offspring, as opposed to weight control or dieting, is associated with a lower prevalence of unhealthy weight-control behaviour. Berge and colleagues explored whether there was an association between the focus of parent–adolescent conversations (healthy eating habits compared with weight control or dieting) and the eating behaviours of adolescents.

Findings

Among non-overweight adolescents, about 25% of parents reported conversations with their adolescent about healthy eating habits but not weight, while 30% reported having conversations about weight. Among overweight adolescents, only about 15% of parents reported having conversations with their adolescent about healthy eating habits but not weight, while 60% reported having conversations about weight. Parental conversations about healthy eating habits were associated with a lower prevalence of unhealthy weight-control behaviour and parental conversations about weight were associated with a higher prevalence of unhealthy weight-control behaviour. Conversations about weight-control were particularly associated with unhealthy weight-control behaviour in adolescents that were overweight.

Commentary

Berge and colleagues’ study provides important practical information for parents and practitioners regarding the approaches parents can take with adolescents to promote healthy weight while avoiding the promotion of unhealthy weight-control behaviour. Specifically, the findings suggest that discussing healthy eating habits may be protective, while directly informing an adolescent that he or she weighs too much or should diet or eat less is unhelpful. As the authors acknowledge, these findings must be interpreted with some caution, as data are cross-sectional and observational, therefore causation cannot be inferred. Future work might include developing an intervention to shape parental communication with adolescents about healthy eating and weight, and testing in a randomised controlled trial the effectiveness of the intervention on obesity prevalence, unhealthy weight-control behaviour or other outcomes such as adolescent self-esteem and adolescent–parent relationships.

It is important to note that much additional work is needed to understand the nature of ‘having a conversation about healthy eating habits’. Conversations can take many forms, in terms of content and delivery. Although many parents may not state directly that the child should diet or weighs too much, a parent may struggle with the best way to communicate health messages in a sensitive manner, for example that sugar-sweetened beverage consumption and general portion sizes should be limited.

Research in younger children has focused on the possibility that restricting access to unhealthy foods may inadvertently lead to future obesity and bingeing.1–3 In today's environment, it is likely that most parents will have to communicate the need to restrict the intake of certain foods to an adolescent. Although it may be relatively straightforward to communicate to an adolescent that eating vegetables is a healthy choice, it is somewhat more challenging to sensitively communicate that the intake of unhealthy food choices should be limited and portion size regulated. Understanding the most appropriate way to sensitively communicate these aspects of healthy eating to adolescents, particularly as they gain increasing autonomy in their food choices, is an important direction of future work.