Father‐Focused Childhood Obesity Prevention Interventions: A Scoping Review

ABSTRACT

Father‐focused childhood obesity prevention interventions are emerging as novel strategies to tackle increasing childhood obesity rates. This scoping review aimed to describe the characteristics of these interventions and their participants to identify knowledge gaps and improve future interventions. A search for eligible interventions was conducted in MEDLINE (Ovid), Web of Science, and CINAHL (EBSCO) between 2023 and 2024 without date or geographic restrictions. Data were extracted using a tool developed for this review and analyzed using content analysis. Fourteen unique interventions were identified and were all conducted in developed Western countries (n = 14). Most were implemented between 2015 and 2019 (n = 9) in community settings (n = 13) and were feasibility and efficacy trials (n = 11). Most interventions targeted elementary school–aged (6–10 years) (n = 8) and middle school–aged (11–13 years) children (n = 8), followed by preschool–kindergarten–aged children (2–5 years) (n = 7); none targeted high school–aged children (14–17 years). Most interventions targeted physical activity parenting (n = 14) and sedentary behavior parenting (n = 13), with less focus on food parenting (n = 11) and sleep parenting (n = 0). Fathers from nontraditional families and racial/ethnic minority groups were underrepresented and underreported. Our findings underscore the need to increase the emphasis on food and sleep parenting in father‐focused interventions and to include fathers from diverse backgrounds to address health disparities.

1. Introduction

Childhood obesity is a critical public health concern affecting at least 39 million children globally [1], with rates expected to increase by 10% between 2020 and 2035 [2]. The health consequences, including increased risks of diabetes, cardiovascular disease, hypertension, and cancer, can persist into adulthood if not properly managed [3, 4]. The financial burden of childhood obesity is substantial, with international costs exceeding $13 billion in 2022, and projected to rise to nearly $49 billion by 2050, covering expenses related to healthcare services, such as outpatient visits, medication, and hospitalization [5]. Despite public health efforts, childhood obesity rates continue to climb, suggesting a need for new approaches. One potential strategy is to engage fathers in childhood obesity interventions, as fathers are increasingly involved in caregiving [6, 7] and play unique roles in children's weight and weight‐related behaviors.

Compared to mothers, fathers are more likely to engage in physical activities with their children, such as interactive play, roughhousing, and modeling exercise [8, 9]. Studies have found that fathers' physical activity is positively linked to their children's physical activity and healthier weight status [10, 11, 12]. Although child feeding has historically been seen as the “mothers' job,” recent data show that fathers are increasingly involved in feeding their children [6, 13, 14, 15, 16]. Most research indicates that fathers tend to use more controlling feeding practices than mothers, such as using food as a reward and pressuring children to eat [17]. Fathers' weight status, parenting skills, and eating behaviors have been shown to be associated with children's weight status and dietary habits [18, 19, 20], even when accounting for mothers' feeding practices [21]. Beyond children's physical activity and diets, fathers' involvement in children's bedtime routines has shown improvements in sleep outcomes and reduced bedtime routine challenges [22]. In comparison to mothers, fathers are more likely to resist child demands and set limits during bedtime, helping their children learn self‐soothing behaviors that contribute to better sleep patterns [23].

Despite the unique roles fathers play in children's weight‐related behaviors, prior systematic reviews continue to reveal fathers are underrepresented in childhood obesity prevention interventions. A systematic review by Morgan et al. [24] found that out of 213 eligible randomized control trials (RCTs), only 6% of participating parents were fathers in RCTs allowing the participation of only one parent. In interventions involving both parents, 92% reported lack of father involvement [24]. Similarly, a systematic review by Davison et al. [25] corroborated these findings, showing that out of 85 eligible interventions, only 31 (37%) included both mothers and fathers, with only one (1%) included only fathers. Of the interventions that included fathers, half included 10 or fewer fathers. Fathers' underrepresentation in childhood obesity interventions may be partly attributed to a lack of father‐specific recruitment strategies, limited father‐relevant content, and insufficiently trained staff to support meaningful engagement [17, 26, 27]. Additionally, in‐person programs scheduled during typical work hours can make attendance challenging for working fathers [17, 26, 28].

Recognizing this gap, father‐focused childhood obesity interventions have started to emerge, such as the Dads and Daughters Exercising and Empowered (DADEE), Healthy Kids Healthy Dads (HKHD), and Papás Saludables Niños Saludables (a culturally tailored variant of HKHD) [29, 30, 31]. These father‐focused childhood obesity prevention interventions use fathers as change agents to promote healthy weight gain among children by equipping fathers with the knowledge and skills needed to exercise more and eat healthier with their children and families.

With father‐focused childhood obesity prevention interventions on the rise, there is a need to identify service gaps and opportunities to improve existing childhood obesity interventions. To achieve this, it is necessary to understand the characteristics of father‐focused childhood obesity interventions that have been implemented and the characteristics of the participants. Because these interventions are still emerging and potentially heterogeneous, a scoping review is required to first assess the range of research on this topic before synthesizing the effectiveness of existing studies [32, 33, 34, 35]. A search of MEDLINE (Ovid), Web of Science, and CINAHL Complete (EBSCO) revealed that there have been no scoping reviews on this topic. This scoping review will be the first to highlight valuable information on the nature of and knowledge gaps in father‐focused childhood obesity prevention interventions, focusing on intervention and participant characteristics. Specifically, this scoping review aims to answer the following questions:

1. What are the characteristics (e.g., intervention type, evaluation design, year of implementation, country, theory used, total direct contact time of intervention, setting, primary and optional intervention recipients, behavioral domains targeted for fathers, and age of target child) of father‐focused childhood obesity prevention interventions?

2. What are the characteristics of the father participants (e.g., age, race/ethnicity, marital, socio‐economic and/or immigration status, relationship to child, and family structure/background)?

2. Methods

We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR) to conduct and report our study [35].

2.1. Inclusion Criteria

We used the population, concept, context framework to develop the inclusion criteria and search strategy [36].

2.2. Population

This scoping review considered studies focusing on fathers with at least one child under the age of 18. We defined father‐focused interventions as those that targeted fathers primarily as the change agents for childhood obesity prevention. Our definition of father included any male parental figure in a child's life defined through biological, legal, and/or social relationships (i.e., not exclusive to biological fathers).

2.3. Concept

Studies that examined the impacts of childhood obesity prevention interventions targeting fathers were considered for this review. We defined childhood obesity interventions as those that self‐identified as such or reported at least one weight outcome of the children (e.g., weight, BMI, waist circumference, skinfold thickness, waist, and waist‐hip circumference ratio). We defined interventions as preventive if they did not explicitly focus on weight loss or management or if they did not recruit only children with obesity. Family‐based interventions that equally target both fathers and coparents were excluded. Interventions must target fathers and clearly indicate that they are the focus. Interventions that included coparents but focused on fathers primarily were included. We also included studies regardless of the health profile of the fathers.

2.4. Context

This review considered studies conducted in any geographic location or in any setting (school, communities, online/virtual, etc.). Due to the lack of translation support at the authors' institution, only those published in English were included. No date restriction was imposed.

2.5. Type of Sources

This scoping review considered both experimental and quasi‐experimental study designs, including randomized controlled trials, nonrandomized controlled trials, pretest/posttest studies, and interrupted time‐series studies. We excluded review articles (e.g., narrative reviews, systematic reviews, and meta‐analyses), gray literature (e.g., dissertations, reports, and conference proceedings), and protocol papers.

2.6. Search Strategy

The search strategy development started with identifying a sample set of search terms from prior childhood obesity intervention reviews. We initially selected the search terms from Morgan et al.'s [24] Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review due to its close alignment with our scoping review. Thereafter, the search terms were refined in collaboration with a librarian by reviewing the text words contained in the titles and abstracts of three gold‐standard father‐focused childhood obesity prevention articles [37, 38, 39]. The search terms comprised three concepts: (1) participants (e.g., father, male caregiver, and dad), (2) outcome (e.g., overweight, weight, and diet), and (3) intervention (e.g., prevention and education) (see Table 1). We implemented an initial pilot search in MEDLINE (Ovid), Web of Science, and CINAHL (EBSCO) and confirmed the search captured the three gold‐standard father‐focused childhood obesity prevention articles. No modifications to the search terms were made after this process, and they were used for the full‐scale articles search. The three article‐search databases were chosen in collaboration with a University of Guelph librarian, as these are common databases for the topic of our scoping review. The reference lists of articles included in the review were also reviewed for additional articles. An initial literature search was conducted in June 2023, and an updated search was completed in April 2024.

TABLE 1.

Search terms for search strategy.

Participants	Outcomes	Setting
Father* OR Dad? OR Daddy OR Daddies OR Male caregiver* OR Male parent* OR Paternal OR Husband*	Obes* OR Overweight OR Waist OR Weight OR BMI OR Physical activit* OR Exercis* OR Sedentar* OR Inactivity OR Eating OR Nutrition OR Sleep* OR Screen* OR Diet* OR Food* OR Lifestyle	Intervention* OR Program* OR Education* OR Prevention*

2.7. Study Selection

Following the search, all identified citations were imported into Zotero [40] to remove duplicates. Six reviewers, namely, four authors (BKL, SL, PM, and RK) and two research assistants, independently screened titles and abstracts in duplicate against the inclusion criteria using Rayyan [41]. Additional duplicates were removed in this stage. In the full‐text screening stage, four authors (BKL, SL, IYP, and RK) reviewed articles against the inclusion criteria in duplicate using Qualtrics [42]. Disagreements between the reviewers at any stage were resolved through discussion with or by a third reviewer (either BKL or SL). A pilot screening using a small subset of the articles was conducted at each stage, and full‐scale screening began when interrater agreement reached at least 85%. The number of results and sources of the search, along with reasons for the exclusion of full‐text studies not meeting inclusion criteria, is presented in a PRISMA flow diagram (see Figure 1) [43].

FIGURE 1.

PRISMA flow diagram of articles selection.

2.8. Data Extraction

BKL, SL, and IYP collectively developed an initial data extraction tool based on Ash et al. [44] for this study to extract data from included articles. The initial data extraction tool was pilot tested for feasibility by BKL, SL, IYP, and RK using 15 articles with different cultural contexts and intervention types. A refined data extraction tool was developed and pilot tested by BKL and PM using five articles and achieved above 85% agreement. BKL and PM used the refined data extraction tool to extract data from the remaining articles in duplicate. Data extracted were verified by SL. Extracted data included specific details related to intervention and participant characteristics as indicated in the research questions.

2.9. Data Analysis and Synthesis

Data analysis was conducted between May and June 2024. The analytical unit was intervention. When multiple articles were published on the same intervention, each article was reviewed as a separate entity, and the data were synthesized into a single entry during data extraction [44]. Once the data were extracted, we used content analysis to systematically document intervention and participant characteristics and address the identified knowledge gaps. Content analysis is a research method that aims to generate an objective, systematic, and quantitative description of a topic of interest [45, 46].

2.9.1. Intervention Characteristics

Intervention type was coded as pilot/feasibility trial, efficacy trial, effectiveness trial, and dissemination trial. If an intervention self‐identified with more than one type, it was coded at the highest level (e.g., if an intervention self‐identified as a pilot and efficacy trial, it was coded as an efficacy trial). Evaluation design was coded as either randomized‐controlled trial or quasi‐experimental trial. Implementation year was coded as 2005–2009, 2010–2014, 2015–2019, or 2020 or after. The theory used was coded as social cognitive theory, self‐determination theory, ecological models, behavior change wheel, family systems theory, or other. Total direct contact time for fathers was coded as less than 6 h, 6 to less than 11 h, 11 to less than 16 h, or 16 to less than 21 h. Intervention setting was coded as home‐, community‐, school‐based, or virtual. We did not count supplemental home assignments or activities as home‐based components. As for primary intervention recipients, these were coded as fathers only, father–daughter dyads, father–son dyads, father–child dyads, or others. Optional intervention direct recipients (i.e., those who were invited to participate in sessions with fathers but were optional) were coded as mothers/female caregivers/partners, nonenrolled siblings, grandparents, or none. Weight‐related parenting behavioral domains targeted were coded as diet, physical activity, screen time/media use/sedentary behaviors, and sleep. Lastly, target child age at baseline was coded based on school levels: preschool–kindergarten (2–5 years), elementary (6–10 years), middle (11–13 years), and high school (14–17 years). Although the target age range of children may have spanned multiple of our categories, we followed the approach of Ash et al. [44] and first coded the category the intervention's target age range primarily fell within. Then, we only coded additional categories if the age range extended into those by a minimum of 2 years. Multiple categories could be selected for theory used, intervention setting, optional intervention recipients, weight‐related parenting behavioral domains targeted, and target child age thus potentially exceeding 100% in total percentages after coding.

2.9.2. Father Participant Characteristics

For father participant characteristics, we coded the number of fathers that participated at baseline and their mean age. The number of fathers that participated was coded as 1–50, 51–100, 101–150, 151–200, 201–250, or 251 or more. Mean age was coded as less than 20, 20–29, 30–39, 40–49, or 50 or older. We also coded if the intervention contained fathers from the following underserved or nontraditional groups: low socioeconomic status (SES) via low education and low income, racial/ethnic minorities (i.e., Asian, Black/African American, Hispanic/Latino, Indigenous, and multiracial/other/non‐White), immigrant fathers, single fathers, nonbiological fathers/father figures, and fathers in same‐sex relationships. For low education, we defined it as having a high school diploma or less. For low income, it was determined by either (1) self‐identified by the study, (2) an annual household income less than $25,000USD for US‐based interventions, (3) being in the two most deprived quintiles of the Index of Multiple Deprivation (IMD) [47] for UK‐based interventions, or (4) being in the bottom two quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage from the Australian Socioeconomic Indexes for Areas (SEIFA) [48] for Australian‐based interventions. Fathers from families participating in low‐income qualifying programs (Women, Infants, and Children Services; Supplemental Nutrition Assistance Program; free or reduced school lunch; Head Start, etc.) were also considered low income for US‐based interventions. We also coded majority of fathers as immigrants if an intervention did not report their immigration status but stated the number of years they had been living in that country instead. We coded fathers as single if they were widowed, divorced, or unmarried. If the intervention only included the “married” category and the reported percentage of these participants was below 100%, the difference in participants was assumed to be single and thus coded as such (e.g., if 81% of fathers were reported as married, it was assumed that 19% were single). Lastly, we coded whether the intervention sample included fathers from each previously mentioned fathers' characteristic comprised at least 51% of the sample to differentiate between interventions with only a few fathers from a certain category and those with at least half the total sample of fathers in that category. In cases where studies did not report certain characteristics, these were coded as “not reported.” Lastly, if any of the participant characteristics were reported ambiguously or did not meet our established criteria, we coded them as unclear and thus excluded them in our final counts.

3. Results

A total of 25 articles covering 14 unique interventions were reviewed. Citations of the included articles are outlined in Table S1.

3.1. Intervention Characteristics

Intervention characteristics are summarized in Table 2. Table S2 contains details of each intervention's characteristics. The most common intervention types were pilot/feasibility trials (n = 6; 43%), followed by efficacy trials (n = 5; 36%), effectiveness trials (n = 2; 14%), and dissemination trials (n = 1; 7%). A little over half (n = 8; 57%) of the interventions used a randomized controlled trial design, whereas the rest employed a quasi‐experimental design (n = 6; 43%). Over half (n = 9; 64%) took place between 2015 and 2019, with others were conducted earlier (n = 3; 21%) or in 2020 or later (n = 2; 14%). None were implemented before 2005. Geographically, the interventions were mostly in Australia (n = 7; 50%) and the United States (n = 5; 36%), with one each in Belgium (7%) and the United Kingdom (7%). It should be noted that all Australian interventions were developed and implemented by Morgan et al. [29, 37, 49, 50, 51, 52, 53], and of the interventions conducted outside of Australia, two were cultural adaptations of Morgan et al.'s original Healthy Dads Healthy Kids program [49]: Healthy Dads Healthy Kids UK and Papás Saludables Niños Saludables.

TABLE 2.

Intervention characteristics of included interventions (N = 14).

		Total n (%)
Intervention type
	Pilot/feasibility trial	6 (43)
	Efficacy trial	5 (36)
	Effectiveness trial	2 (14)
	Dissemination trial	1 (7)
Evaluation design
	Randomized controlled trial	8 (57)
	Quasi‐experimental trial	6 (43)
Implementation year
	2005–2009	1 (7)
	2010–2014	2 (14)
	2015–2019	9 (64)
	2020 or after	2 (14)
Country
	Australia	7 (50)
	Belgium	1 (7)
	United Kingdom	1 (7)
	United States	5 (36)
Theory a
	Behavior change wheel	1 (7)
	Ecological models	1 (7)
	Family systems theory	5 (36)
	Self‐determination theory	4 (29)
	Social cognitive theory	12 (86)
Direct contact time with fathers (hours)
	Less than 6	0 (0)
	6 to less than 11	3 (21)
	11 to less than 16	8 (57)
	16 to less than 21	3 (21)
Setting a
	Community‐based	13 (93)
	Home‐based	0 (0)
	School‐based	0 (0)
	Virtual	2 (14)
Primary intervention recipient(s)
	Fathers only	0 (0)
	Father‐daughter dyads	2 (14)
	Father–son dyads	0 (0)
	Father–child dyads	12 (86)
Optional intervention direct recipient(s) a
	Mothers/female caregivers/partners	9 (64)
	Non‐enrolled siblings	4 (29)
	Grandparents	1 (7)
	None	5 (36)
Weight‐related parenting behavioral domain targeted a
	Food	11 (79)
	Physical activity	14 (100)
	Screen time/media use/sedentary behaviors	13 (93)
	Sleep	0 (0)
Target child age at baseline a
	2–5 years (preschool–kindergarten)	7 (50)
	6–10 years (elementary school)	8 (57)
	11–13 years (middle school)	8 (57)
	14–17 years (high school)	0 (0)

^a Totals may exceed 100% because multiple categories could be selected for theory used, intervention setting, optional intervention direct recipients, weight‐related parenting behavioral domains targeted, and target child age.

All interventions reported theoretical underpinnings, with the majority based on Social Cognitive Theory (SCT) (n = 12; 86%). Other theories included Family Systems Theory (n = 5; 36%), Self‐Determination Theory (SDT) (n = 4; 29%), the Behavior Change Wheel (n = 1; 7%), and the Ecological Model (n = 1; 7%). Most interventions (n = 8; 57%) had a total direct contact time with fathers of 11 to less than 16 h, with none exceeding 20 h. Nearly all (n = 13; 93%) were delivered in community settings, with only two (14%) in virtual settings.

None of the interventions targeted only fathers; 12 (86%) targeted father–child dyads and two (14%) targeted father–daughter dyads. Many interventions reported including optional participants in some of the intervention activities such as mothers/partners/caregivers (n = 9; 64%), nonenrolled siblings (n = 4; 29%), and grandparents (n = 1; 7%). All interventions targeted physical activity, and nearly all (n = 13; 93%) targeted screen time/media use/sedentary behaviors. Eleven interventions targeted food parenting (n = 11; 79%), but none targeted sleep parenting. The most common child age ranges targeted were elementary‐school ages (6–10 years) (n = 8; 57%), preschool–kindergarten ages (2–5 years) (n = 7; 50%), and middle‐school ages (11–13 years) (n = 8; 57%). No interventions targeted fathers with children of high‐school ages (14–17 years).

3.2. Participant Characteristics

Participating fathers' characteristics are summarized in Table 3. Table S3 contains details of each intervention's participant characteristics. Nearly half (n = 6; 43%) of the interventions had 1–50 fathers at baseline. About a quarter (n = 3; 21%) included 51–100 fathers, and another 21% (n = 3) included 151–200 fathers. No interventions included more than 200 fathers. Most interventions (n = 9; 64%) had fathers with a mean age of 40–49, and a third (n = 5; 36%) included fathers with a mean age of 30–39.

TABLE 3.

Participant characteristics of included interventions (N = 14).

	Total n (%)
Sample size (fathers at baseline)
1–50	6 (43)
51–100	3 (21)
101–150	3 (21)
151–200	2 (14)
201–250	0 (0)
251 or more	0 (0)
Fathers' mean age at baseline (years)
Less than 20	0 (0)
20–29	0 (0)
30–39	5 (36)
40–49	9 (64)
50 or older	0 (0)

	Any representation n (%)	Fathers making up at least 51% of the sample n (%)
Fathers with low SES and minority background
Low education (high school or less)	11 (79)	5 (36)
Low income a	13 (93)	2 (14)
Racial/ethnic minorities	6 (43)	6 (43)
Immigrant fathers	9 (64)	4 (29)
Racial/ethnic groups b
Black/African American	1 (7)	0 (0)
Hispanic/Latino	5 (36)	4 (29)
Asian	1 (7)	0 (0)
Multiracial/other/non‐White	2 (14)	1 (7)
Indigenous/Aboriginal fathers	3 (21)	0 (0)
Fathers with nontraditional family backgrounds
Single fathers	8 (57)	0 (0)
Nonbiological fathers/father figures	2 (14)	0 (0)
Fathers in same‐sex relationships	0 (0)	0 (0)

^a Self‐identified by the study or defined as either < $25,000USD annual income or ranking in the two most deprived quintiles of the IMD for UK‐based interventions or ranking in the bottom two quintiles of SEIFA for Australian‐based interventions or being from a family participating in low‐income qualifying programs.

^b Totals may exceed 100% because multiple categories could be selected.

Representation of fathers from underserved or nontraditional groups varied. Eleven interventions (79%) reported including fathers with low education levels, and 13 interventions (93%) reported including fathers with low income. However, only a third (n = 5; 36%) had at least 51% of fathers with low education, and just two interventions (14%) had at least 51% of fathers with low income. Six interventions (43%) reported including fathers from racial/ethnic minorities, with all six having at least 51% of their sample from these groups. Hispanic/Latino fathers were the most commonly represented minority group (n = 5; 36%), with four (29%) interventions having at least 51% Hispanic/Latino fathers. Asian, Black/African American, and multiracial/other non‐White fathers were less commonly represented, and none had at least 51% of their sample from these groups. Only one intervention (7%) reported including at least 51% of fathers from a non‐White background. Three interventions (21%) reported including Indigenous/Aboriginal fathers, but none had a significant percentage of the sample. Immigrant fathers were reported in nine (64%) of the interventions, but only four interventions (29%) had at least 51% immigrant fathers. Over half (n = 8; 57%) reported including single fathers, and only two interventions (14%) reported nonbiological fathers/father figures. No interventions reported having at least 51% nonbiological fathers, single fathers, or fathers in same‐sex relationships.

4. Discussion

This study reviewed father‐focused childhood obesity prevention interventions, revealing a general lack of such. Several key knowledge and service gaps were identified: a lack of interventions outside of Australia and the United States, few interventions tested beyond the feasibility and efficacy stages, none considering sleep parenting behavior, none targeting high‐school age children, and an overall lack of noncommunity‐based interventions (i.e., home‐ or virtual‐based). Representation of fathers from nontraditional family backgrounds (i.e., those in same‐sex relationships, single, and nonbiological fathers) and minority groups such as Asian, Black/African American, and Indigenous/Aboriginal fathers was also scarce.

4.1. Intervention Gaps and Implications

Overall, relatively few childhood obesity prevention interventions targeting fathers have been implemented, with most taking place in few affluent Western countries—primarily the United States and Australia. However, the prevalence of obesity and overweight continues to rise in other developed countries. For instance, approximately one third of Canadian school‐age children and 29% of European youth aged 7–9 are living with overweight and obesity [54, 55]; meanwhile, the number of children classified as obese in New Zealand rose 9.5% from 2019/2020 to 2020/2021 [56]. Our review did not identify any father‐focused childhood obesity interventions outside of developed nations, yet global reports show increases in overweight and obesity rates in low and middle‐income areas in recent years [57, 58]. For instance, in Africa, the prevalence of overweight children under 5 years old has increased by nearly 23% since 2000, whereas almost half of the children under 5 years who were overweight or living with obesity in 2022 lived in Asia [57]. Similarly, South America has also seen a steady rise in childhood obesity over recent years [58].

Most interventions were pilot/feasibility and efficacy trials, which reflect more controlled environments. Although these studies play a critical role in the preliminary planning of a full‐size clinical intervention trial, they can often overestimate intervention effects when implemented in clinical practice [59]. Thus, future interventions should emphasize real‐world testing as our study revealed that only three (21%) interventions were tested in real‐world settings (two effectiveness trials and one dissemination trial). On a similar note, almost half of the interventions were quasi‐experiments; therefore, the evidence for causality is limited. Future research should carefully consider evaluation design to eliminate potential confounding factors.

Furthermore, most interventions took place prior to 2019, with only two occurring during or after the recent COVID‐19 pandemic. Thus, the majority of the interventions may not accurately reflect fathers' current preferences, needs, or changes in their caregiving practices. For instance, the pandemic has significantly altered work dynamics (i.e., more remote or hybrid work), possibly impacting fathers' work schedules, and, in turn, their preferences for how interventions are delivered [60, 61, 62]. Fathers also appear to be more involved in children's caregiving since the pandemic as a result of spending more time at home. Therefore, it is possible that their willingness, preferences, or flexibility to participate in interventions has also shifted [63, 64, 65].

This review also found that no interventions targeted fathers' sleep parenting. This is a major gap because studies have found that fathers' involvement in caregiving is positively linked to young children's sleep behaviors (e.g., reduced nightly wakings), and longer sleep durations were associated with reduced markers of adiposity in infants and school‐age children [22, 66]. To address this, future interventions could integrate sleep parenting into their programs by educating fathers on the importance of sleep routines or how to foster sleep‐friendly environments at home. In addition, although all interventions targeted physical activity parenting and nearly all included parenting related to screen‐time/media use/sedentary behaviors, not all targeted food parenting. Considering fathers are increasingly engaged in children's diets [13, 15] and the established impacts of fathers' food parenting on children's diets [16], future father‐focused interventions should integrate food parenting components.

Our review also found that no interventions targeted high‐school age children. This may be partly due to fathers' decreased likelihood of engaging in childcare responsibilities as children in this age group gain independence. Nonetheless, research indicates that parents still play a role in influencing their adolescents' weight by serving as positive role models and through adopting different parenting styles, improving their communication skills, and altering the home environment [67]. The impacts of father‐focused interventions targeting high‐school age children remain to be explored.

Lastly, despite children of fathers with non‐Hispanic, non‐White backgrounds and of fathers from nontraditional households (e.g., single fathers, same‐sex fathers, and nonbiological fathers) being at higher risks of obesity [68, 69, 70], fathers with these backgrounds are underrepresented in father‐focused childhood obesity prevention interventions. In this review, a handful of interventions specifically targeted Hispanic/Latino fathers; however, none of the identified interventions specifically targeted Black, Asian, or Indigenous fathers. Among studies that did not target fathers with a specific racial/ethnic background, fathers' racial/ethnic backgrounds were generally not reported, limiting our knowledge on the extent racial/ethnic minority fathers' participation in these “mainstream” interventions. We suspect racial/ethnic minority fathers' participation in these “mainstream” interventions is low because of the unique barriers that they may face in participating in health initiatives, including but not limited to lack of culturally tailored contents, lack of logistical supports (e.g., scheduling conflicts, childcare, transportation, and other participation‐related expenses), ineffective recruitment and retention practices due to cultural differences between researchers and participants, and psychosocial factors such as distrust of the healthcare system and fear due to experiences of discrimination and mistreatment [71, 72, 73, 74, 75].

Participation of single, same‐sex, and nonbiological fathers/father figures was also infrequently reported even though fathers with these backgrounds are on the rise [76, 77, 78, 79, 80, 81, 82, 83] and children from nontraditional families are at higher risk of childhood obesity [70]. We also suspect the participation of fathers from nontraditional households is low due to the unique barriers that they face in participating in health‐promoting interventions. For example, single and nonbiological fathers often juggle multiple responsibilities, such as work, childcare, and household duties, which may make them less available for interventions when they are being conducted [84, 85]. In fact, our review found a significant lack of home‐based and virtual interventions, making it possible that the reach of these interventions is limited and thus excludes not just single or nonbiological fathers but also those with other less traditional backgrounds and/or needs, such as shift workers or stay‐at‐home fathers. Single and nonbiological fathers, as well as same‐sex fathers, may also experience a lack of social support networks that traditional families often rely on for encouragement, advice, and assistance in promoting healthy lifestyles in their children [86, 87]. Our findings highlight the importance of considering the unique challenges faced by fathers from different family structures to foster more equitable outcomes in the childhood obesity prevention effort.

Findings related to fathers' characteristics collectively suggest that future interventions should target fathers from underserved backgrounds to fully address the health disparities experienced by these families. In an effort to keep track of the kind of fathers being served, future interventions should also document and report the inclusion of minority and underserved fathers. We were unable to discern whether fathers from nontraditional family structures or minority groups were adequately served because a great deal of interventions did not report the demographics of these fathers. This reporting is necessary to track any progress toward equity in the long run.

It is important to note that the limited number of father‐focused childhood obesity prevention interventions does not necessarily reflect a lack of interest among fathers. Evidence indicates that fathers are indeed willing to engage in programs that promote their children's health; however, many existing interventions fail to effectively reach or engage them [17, 88, 89]. Research also shows that fathers prefer recruitment materials that clearly identify them as the target audience and value parenting information that aligns with their caregiving roles and preferences [17, 20, 26]. Future studies should examine the strategies used by father‐focused and father‐inclusive childhood obesity prevention interventions to recruit fathers and address their parenting needs.

4.2. Limitations

Some limitations exist in our study. First, the effectiveness of interventions was not assessed, as it is beyond the scope of a scoping review. Our primary purpose was to focus on the characteristics of these interventions to reveal potential gaps within the literature. Furthermore, the selection of databases could have influenced the number of articles retrieved and thus may have caused potentially eligible interventions to be overlooked. The decision to use three databases was made under the guidance of a librarian, as the databases are commonly used and likely to cover a majority of articles. Additionally, we did not include dissertations, gray literature, or protocol papers. This may have limited the identification of forthcoming interventions. However, we believe these limitations would not negatively affect the interpretation of the findings, as the search for this review followed recommended guidelines [90]. Specifically, the guidelines suggest that a risk of missing relevant studies can be minimized when more than two literature databases are used and more than 10 articles are reviewed. Because this study used three databases and reviewed a total of 25 articles, the findings can be presented with confidence. We also only included articles that were published in English, potentially limiting interventions that were conducted in non‐English speaking countries. Lastly, we did not examine how each of the weight‐related parenting domains was addressed in the interventions (e.g., the duration, contents, and activities). Future studies should include these qualitative measures to provide a more comprehensive understanding of intervention strategies and contents.

5. Conclusion

This review highlights several gaps in father‐focused interventions for childhood obesity prevention. The lack of sleep parenting warrants particular attention because of the established links between sleep and weight status. The overall lack of significant representation from racial/ethnic minority groups, fathers from nontraditional family backgrounds, and fathers from various geographic locations further stresses the need for culturally sensitive and accessible interventions. Addressing these disparities can contribute to the promotion of healthy lifestyles among historically underserved and high‐risk populations, thereby helping to foster equitable health outcomes. Future interventions must also emphasize real‐world testing to understand their scalability.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1 Included interventions (N = 14).

Table S2 Intervention characteristics (coded results).

Table S3 Participant characteristics (coded results).

Latkolik S., Morelli P., Park I., Koop R., and Lo B., “Father‐Focused Childhood Obesity Prevention Interventions: A Scoping Review,” Obesity Reviews 26, no. 12 (2025): e13970, 10.1111/obr.13970.