Table 3.

Themes and sub-themes with representative quotes

Theme	Sub-theme	Representative quote
Positive experience with programme	Classes	‘… just being able to engage and being able to meet other families with similar things going on. With the cooking class … there was a lot of other families there and it was just nice to be around other people that were kind of in the same boat.’
	Staff support	‘The folks in the program have just been so encouraging and said you’ve been fine given the circumstances and it’s just important to not let that discourage you and to just keep going. That has helped a lot.’
	Individualized/holistic approach	‘While we [were] sent there because of certain concerns our doctors had, they treated us with total body care and that really meant a lot to me.’
	Approachability of staff	‘It’s nice having someone to talk to who knows things and being able to ask them questions and stuff.’
Logistical challenges of participation	Time	‘The only issues I’ve had with the program is the time commitment. It is a big time commitment … Another thing is I find it hard myself to make some of the activities, the family activities, because I do work and a lot of them are 5:30 pm and that sort of thing and I live further away.’
	Travel	‘I think for my family the hardest part about it is the distance. We live about an hour and 45 min from the program and that was challenging. It limited the things that we could participate in. So we would come for appointments but then it wasn’t really feasible a lot of times to come to any of the different classes or activities or different things that were offered periodically because it was just so far.’
	Missed school	‘… during the school year it gets challenging and once my older daughter was really into high school, missing school and getting out early were problematic. The school … wouldn’t excuse the time away … once we got further into high school I didn’t realize just how difficult and how rigid they were going to be about you ever missing school even with a doctor’s note.’
	Missed work	‘It made it difficult to get some of my work done. I had to miss a lot of work and that sort of thing but I adjusted for it.’
	Lack of teen focused programme	‘My daughter was not interested any longer. She thought that it was too many little kids and not enough kids her age so she just became disinterested in what was going on.’
	Parking	‘It was difficult for our family at the time to come to the hospital and pay the parking fees and that kind of thing. And try to get there on time because the hospital is just not a real user friendly place to visit I guess.’
Improved health	With and without weight loss	With weight loss: ‘When she’s with [the program] she’s doing more, she’s more active. She was losing weight and everything when we were going consistently …’
		Without weight loss: ‘But I think the thing that they probably did get out of it that I didn’t think about beforehand because I was more focused just on weight loss was healthy ideas about themselves - food, body image …’
	Improved health behaviours	‘We have made some good lifestyle changes that hopefully will help us through the rest of our lives.’
	Improved confidence	‘A lot of the program has benefitted him … the activities and the things that he participated in actually brought his self-esteem up and broadened his horizons of what he can do physically.’
Parent and child differences	Desire for structured treatment (parent)	‘It’s been less successful than we hoped. We haven’t had a lot of results. It’s been more drawn out and less specific than we had hoped. But I can’t say that it’s been a negative experience. It’s been generally positive but not very actually productive.’
	Family time (child)	‘It’s brought us together more as a family. It’s made opportunities for us to do things as a family activity.’
	Prepared for clinic (parent)	‘I think that they did a really good job preparing. There were phone conversations before we ever came and there was an Orientation - there was a lot of information beforehand. I think that they did a good job preparing us for the program and what was to be expected and that sort of thing.’
Importance of structure and expectations of weight loss	Concrete guidance on behaviour changes	‘I think accountability on some things helps people … I can lose weight better with [another program] because there’s somebody else watching the scale that I have to be held accountable to. I think it’s kind of the same even in changing habits. There needs to be some sort of accountability.’
	Greater weight loss and weight loss expectations	‘I mean obviously it would have been great if my girls had sustained weight loss from participating in the program and we didn’t really see that happen.’