Response to: “Revisiting Motivation in Pediatric Weight Management: A Self‐Determination Perspective on the STARKIDS Cohort Findings”

Dear Editor,

1.

We sincerely thank Antunez Martinez and Wang for their thoughtful letter on our analysis of motivational determinants prior to pediatric weight management in the STARKIDS cohort [1]. Their letter raises several constructive points that allow us to clarify key aspects of our study design, analytic approach, and theoretical framing.

First, the authors correctly note that bidirectionality between obesity‐related quality of life (OB‐QoL) and readiness to change (RTC) cannot be resolved from cross‐sectional data. We wish to emphasize, however, that this limitation is explicitly acknowledged in our paper [1]. From our perspective, cross‐sectional baseline characterization is a standard and appropriate first step and designed to inform subsequent exploration. A longitudinal follow‐up analysis of the STARKIDS dataset that will directly address the temporal relationship between OB‐QoL and RTC is currently being finalized.

Second, we would like to clarify that both regression models included variables from the respective counterpart (i.e., adolescent measures in the caretakers' model and vice versa). While these cross‐informant variables did not consistently reach statistical significance, the suggested mutual influences within family units refer to our finding that parents'/caretakers' motivation determined adolescents' motivation. Therefore, mutual influence is indeed suggested. Nonetheless, we appreciate the authors' suggestion to more formally model interdependencies within family units and thank them for highlighting the potential value of family systems theory. Since we also have data on some aspects of family systems theory such as family functioning, this is a valuable idea for further exploration within the STARKIDS data.

Third, we respectfully disagree with the characterization of RTC as an oversimplification of motivation. RTC, as derived from the transtheoretical model of behavior change [2], is one of the most widely applied and empirically validated constructs for assessing motivation for behavior change in pediatric obesity, as confirmed by published reviews [3, 4]. Its selection was a deliberate, theory‐driven decision. We acknowledge that Self‐Determination Theory (SDT) is a valuable operationalization of motivation as well and also commonly used in this field [5]. However, given that our primary aim was to identify determinants of pre‐treatment readiness to behavior change in a clinical cohort, RTC represented the most appropriate construct for this purpose.

Finally, we appreciate the SDT‐informed perspective offered by the authors and agree that distinguishing between autonomous and controlled forms of motivation represents a valuable direction for future research in this field. However, we caution against inferring from the present data that the OB‐QoL and RTC association predominantly reflects controlled motivation. This interpretation, while theoretically plausible, is speculative in the absence of direct SDT measures. Future studies incorporating validated instruments would allow this distinction to be investigated empirically, and we would warmly welcome such complementary work.

In conclusion, we thank Antunez Martinez and Wang for their scholarly engagement with the STARKIDS findings and trust that the clarifications provided here help contextualize our methodological choices. We look forward to continued dialogue on this clinically important topic.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.