Table 2.

Selected Themes and Sample Quotes**

Themes and Quotes
Domain 1: Barriers to Healthy Nutrition and Exercise Behaviors
Theme 1: Awareness is higher for other, acute health conditions such as asthma.
Families deal with things that are very immediate. We’re basically crisis management creatures... (Community leader)
Theme 2: Time pressures are a barrier to physical activity and to healthy eating.
Kids have 20 minutes—by the time they get in line, get their tray, sit down and eat till the time they line up, that’s 20 minutes. So they’re like eating whatever they can get in their stomach. You don’t have time to peel an orange or eat a whole apple. Time is gone. (Community leader)
McDonald’s, Burger King, anything fast—because you don’t have the time...I’ll stop at the restaurants, even though I really can’t afford it. (Parent)
Theme 3: Financial pressures make healthy nutrition and weight a lower priority.
Priorities are paying the bills, having a place to stay, having food, having your lights on, and clothes on your back. Working to pay the rent. (Community leader)
My daughter, she would like to enroll in karate classes and ...a ballet class...but I just couldn’t afford it. I couldn’t afford it. (Parent)
Theme 4: Safety issues present a barrier to physical activity.
Nothing is the way it was when we were coming up...I mean you got crime that’s going on where we’re leery of letting them go out down the street. (Parent)
The really safe place is just as far as the parent can see them. No—as far as the parent can reach out and touch them. (Community leader)
Theme 5: Kids express preferences for sedentary activities and for foods high in fat.
As she gets older she finds things that she is more interested in that aren’t really physical, like hanging out with her friends, movies, that type of stuff. (Parent)
I eat McDonald’s every day—a double cheeseburger. Sometimes I think it’s not healthy. (Child)
Domain 2: Parental Challenges and Concerns Regarding Overweight Children
Theme 6: Parents want information about healthy nutrition and healthy weight for kids.
To learn what really is healthy, cause if I were asked the question, I couldn’t even lie and say I know what healthy is, but would love to learn that. And learn that really healthy lifestyle for my daughter and myself. (Parent)
Theme 7: Kids get sweets/junk foods from sources other than home, including school and other family members.
I don’t buy candy. But when I do laundry, I find candy wrappers in her pockets. (Parent)
And we go shopping and if I want something and I don’t get it, the next day if I go over to my grandma’s house, she’ll have it. (Child)
Theme 8: Parents have difficulty setting limits on screen time (TV/computer) and food intake.
Sometimes I’m glad she got a lot of homework so she doesn’t have time for TV. (Parent)
They stay up all night playing video games, watching TV; they don’t get enough sleep. (Parent)
You could be trying to get ready for work and the TV’s there...you can’t get around the TV. (Parent)
When do you say, “This is enough?...You can’t have anymore [food].” (Parent)
Theme 9: Parents worry about the psychosocial effects of overweight on their kids.
I don’t want her to feel that...because she’s big she’s not supposed to love herself. (Parent)
And then [as kids get older] they’ll be trying to date, and that’s when it really gets tough. (Parent)
One little girl told my daughter, ‘For your birthday, I’m buying you some Slim Fast®.’ And it really hurt her feelings. I told her, ‘Everybody is different.’ (Parent)
Domain 3: Definitions of Overweight and Societal Norms
Theme 10: Bigger kids and adults are just built differently (charts don’t always apply).
My sister—I wouldn’t say she’s overweight. She’s real thick. She’s been big-boned all her life—she’s been thick from a little girl. (Parent)
According to my height I should weigh 115 pounds. I would not look like I was well if I weighed 115 pounds. Now I weigh 190 pounds. (Parent)
Theme 11: Children were more apt than parents to use size and appearance to determine if someone is overweight. (Children were looking at a figure rating scale* during discussion)
She is medium-sized. Like a girl’s supposed to look. (Child)
Theme 12: Overweight is a problem when people have functional limitations as a result.
If you see a person and...they can’t be as mobile as everyone else, that they complain of a lot of aches and pains and, you know, that’s what I...think of as overweight. (Parent)
When you can’t do what everybody else can do you won’t be ever do like your other friends could...If somebody was trying to have a swinging contest, you try to have a swing...and maybe even break the swing. (Child)
Now, when you get obesity and you can’t tie your shoe or whatever, then, yes, you have a weight problem, sure. (Parent)

**Additional quotations are available in an online appendix.