title: Parental perceptions regarding lifestyle interventions for obese children and adolescents with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) affects 30% of obese children globally. The main treatment for NAFLD is to promote gradual weight loss through lifestyle modification. Very little is known regarding parental perspectives about the barriers and facilitators that influence the ability to promote healthy lifestyle behaviours in children with NAFLD.
  
  
  OBJECTIVE
  To explore and describe parental perspectives regarding barriers to and facilitators of implementing lifestyle modification in children with NAFLD.
  
  
  METHODS
  A mixed-methods approach, including qualitative methodology (focus groups) and validated questionnaires (Lifestyle Behaviour Checklist), was used to assess parental perceptions regarding barriers to and facilitators of lifestyle change in parents of children with healthy body weights (control parents) and in parents of children with NAFLD (NAFLD parents).
  
  
  RESULTS
  NAFLD parents identified more problem behaviours related to food portion size and time spent in nonsedentary physical activity, and lower parental self-efficacy than parents of controls (P<0.05). Major barriers to lifestyle change cited by NAFLD parents were lack of time, self-motivation and role modelling of healthy lifestyle behaviours. In contrast, control parents used a variety of strategies to elicit healthy lifestyle behaviours in their children including positive role modelling, and inclusion of the child in food preparation and meal purchasing decisions, and perceived few barriers to promoting healthy lifestyles. Internet sources were the main form of nutrition information used by parents.
  
  
  CONCLUSIONS
  Lifestyle modification strategies focused on promoting increased parental self-efficacy and parental motivation to promote healthy lifestyle behaviour are important components in the treatment of obese children with NAFLD.
authors.affiliation: Department of Agricultural, Food and Nutritional Science, University of Alberta;
authors.forename: Ingrid Rivera
authors.initials: IR
authors.lastname: Iñiguez
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Stollery Children's Hospital; ; Department of Pediatrics, University of Alberta, Edmonton, Alberta.
authors.forename: Jason
authors.initials: J
authors.lastname: Yap
authors.affiliation: Department of Agricultural, Food and Nutritional Science, University of Alberta; ; Department of Pediatrics, University of Alberta, Edmonton, Alberta.
authors.forename: Diana R
authors.initials: DR
authors.lastname: Mager
keywords: Barriers and facilitators; Lifestyle modification; Nonalcoholic fatty liver disease; Parental self-efficacy