A Call to Address Disparities in Pediatric Weight Management among Children in Single-Parent Families

Over a quarter of U.S. youth live in single-parent (SP) families. These families, especially female-headed SP families, are more likely to experience poverty, financial instability, housing insecurity, and increased parental stress, ultimately affecting family well-being and contributing to children’s risk of obesity.^1–3 Additionally, youth in SP families may engage in fewer healthy lifestyle behaviors (e.g., higher screen time and caloric intake) than children in two-parent families.^2,3 Despite these risk factors, youth in SP families are less likely to enroll in pediatric weight management programs (PWMPs). Importantly, risk factors for obesity and limited enrollment in PWMPs are not a symptom of the SP family structure itself, but instead are likely consequences of the structural inequalities and socioeconomic conditions that these families face. However, there is limited consideration for how to best support youth with obesity and their SPs to initiate and remain engaged in PWMPs. This perspective focuses on family dynamics that may contribute to obesity risk and PWMP initiation and engagement among youth in SP families.

Inherent within SP families, all household and child-care responsibilities fall to the sole adult, which may limit engagement in nonessential activities. ⁴ Reports indicate as high as 81% of families interested in PWMPs are from two-parent households, ⁵ reflecting challenges with engagement and reach to SP families. Indicating that SPs may not have the same capacity to enter PWMPs as compared with two-parent families, especially with the high number of hours (≥26) recommended by the clinical practice guidelines. ⁶ Emphasizing this point, recent qualitative research noted that SPs referenced lack of time as a reason not to participate in a PWMP. ⁷

Once in treatment, PWMP providers reported the most frequent barrier to including family members in a child’s treatment was challenging family dynamics, with divorce and separation highlighted as the most challenging dynamic they experienced. ⁸ While SPs and their children have not been a focus in PWMPs, in adult weight management, SPs were more likely to report clinically impaired levels of family functioning and less family support for health behavior change. ⁹ This finding likely extends to initiation and engagement of youth in PWMPs, in which it is expected that SPs are responsible for children’s participation and goal management. Tailored interventions are vital for SPs that support initiating behavior change and engagement with PWMPs given the intergenerational transmission of obesity between parents and children, which includes modeling of and support for healthy behaviors.

There is scant attention paid to SP families, which is likely in part due to the limited assessment of family structure as a moderator of treatment initiation, engagement, and retention and youth outcomes in PWMPs. Parent involvement is an essential component of PWMPs, and family-based care is the gold standard. ¹⁰ The disconnect between higher obesity risk of youth in SP families coupled with their lower enrollment in PWMPs indicates modifications to current engagement methods, programming, and retention efforts are needed to ensure treatments are more accessible to SP families who, on average, are faced with increased economic barriers and fewer supports.