Table 1.

Focus Group Discussion Guide Topics and Sample Questions on Perceptions, Strategies and Suggestions among Positive Outlier Children

Topic	Discussion Guide Questions
Changes in rules/limits	When you are at home and you want to have a snack, who gets to decide if you can have a snack? And who decides what you are going to eat or drink? ○ Have there been any changes in these rules over the last 2 or 3 years? ▪ Why do you think these changes happened? How did you feel about these changes? And what about the time you spend looking at a screen like a TV, does anybody put any rules on what you can watch and how much time you spend on the computer or video games? ○ Have there been any changes in these rules in the last 2 or 3 years? And how about sleep, like what time you go to bed at night or when you get out of bed in the morning, do any of you have to follow rules about that? ○ Have there been any change is these rules?
Changes in physical activity	Who has started a new activity that gets your body moving in the last 2–3 years or so? What were they and how did you come up with them? How did it happen that you started doing [activity]? So remember back to when you first started, how did that feel? How did it go in the beginning? Was there anything that helped you get started? Why? And was there anything that made it difficult for you to keep doing the activity at the beginning? Why did that make it difficult? How do you feel now and why do you keep doing it?
Activity 1: Child Reported Outcomes of Interesta	How do you think a child in picture K feels compared to a child in picture J? What are some things that might be hard for a child in picture K to do that might be easier for a child in picture J? What might be some reasons that a child in picture K might want to get to a lower weight? What are some ways a child could do that?
Activity 2: Facilitators, Barriers, and Potential Intervention Strategiesb	Here we have Families, Schools, and things in your Neighborhood – like parks, YMCAS, gyms, grocery stores, and here we have the Doctor’s Office. What we want each of you to do is think about what could help a child in picture K to get to a healthier weight. After thinking about this, you can use your stickers to vote on what you think can be most helpful. Why did you put your stickers on [family/community/ doctor’s office]? How do we think that [family/community/doctor’s office] could help K get to a healthier weight?
Activity 3: Child Reported Measures of Successc	Imagine that all of the suggestions about ways that the family, schools, community and the doctor’s office could help the children in K that you all just gave really worked and they helped a child in picture K get to a healthier weight. How do you think that child would feel? What do you think they would be most proud of? Excited or happy about?

^aTwo illustrations were presented to the children (Figure 2): 6 children with healthy BMIs (labeled J) and the same 6 children with obese BMIs (labeled K).

^bEach child received another handout (with illustrations of families, the doctor’s office, neighborhoods, and schools) and 10 stickers.

^cAnswers generated in this section were written on a flip chart, and the moderator asked the children to use stickers to vote on the items that would be most important to them.