Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed Review Article The forgotten parent: Fathers' representation in family interventions to prevent childhood obesity K.K. Davison a,b, ⁎ , N. Kitos a , A. Aftosmes-Tobio a , T. Ash a,b , A. Agaronov b , M. Sepulveda c , J. Haines d a Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States b Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States c University of Arizona, United States d University of Guelph, Guelph, Ontario, Canada ARTICLE INFO Keywords: Childhood obesity Family interventions Content analysis Fathers Parents ABSTRACT Despite recognition that parents are critical stakeholders in childhood obesity prevention, obesity research has overwhelmingly focused on mothers. In a recent review, fathers represented only 17% of parent participants in > 600 observational studies on parenting and childhood obesity. The current study examined the re- presentation of fathers in family interventions to prevent childhood obesity and characteristics of interventions that include fathers compared with those that only include mothers. Eligible studies included family-based interventions for childhood obesity prevention published between 2008 and 2015 identified in a recent sys- tematic review. Data on intervention characteristics were extracted from the original review. Using a standar- dized coding scheme, these data were augmented with new data on the number of participating fathers/male caregivers and mothers/female caregivers. Out of 85 eligible interventions, 31 (37%) included mothers and fathers, 29 (34%) included only mothers, 1 (1%) included only fathers, and 24 (28%) did not provide in- formation on parent gender. Of the interventions that included fathers, half included 10 or fewer fathers. Across all interventions, fathers represented a mere 6% of parent participants. Father inclusion was more common in interventions targeting families with elementary school-aged children (6–10 years) and those grounded in Ecological Systems Theory, and was less common in interventions focused on very young children (0–1 years) or the prenatal period and those targeting the sleep environment. This study emphasizes the lack of fathers in childhood obesity interventions and highlights a particular need to recruit and engage fathers of young children in prevention efforts. 1. Introduction Childhood obesity is a pressing public health problem with short and long term health consequences (Reilly et al., 2003; Daniels, 2006). Given that children's diet and physical activity behaviors are estab- lished in the context of the family (Birch and Davison, 2001; Davison and Birch, 2001; Ventura and Birch, 2008; Trost and Loprinzi, 2011), engaging parents and families in the prevention of obesity is critical (Monasta et al., 2011; Waters et al., 2011). Despite widespread re- cognition of the pressing need to engage parents in childhood obesity interventions, research has overwhelmingly focused on mothers. In a 2016 systematic review and content analysis (Davison et al., 2016), our research team documented the inclusion of fathers in more than 600 observational studies on parenting and childhood obesity published since 2009. Results showed that fathers represented only 17% of all parent participants, with an average of 139 fathers per study compared with 672 mothers per study. Father inclusion in parenting interventions is similarly low (Panter- Brick et al., 2014). This pattern is problematic given research illus- trating improved child outcomes when parenting interventions include mothers and fathers compared with those that only include mothers (Lundahl et al., 2008). Research increasingly supports the need to in- clude fathers in childhood obesity interventions. In a nationally re- presentative US sample, over 70% of fathers with co-residential chil- dren aged 5 years or younger reported that they fed or ate a meal with their child every day over the previous 4 weeks (Jones, 2013). Simi- larly, fathers consider themselves responsible for feeding their children and helping with meal preparation including grocery shopping (Khandpur et al., 2014). Fathers' parenting approaches have in turn been linked with children's weight-related behaviors and outcomes. For https://doi.org/10.1016/j.ypmed.2018.02.029 Received 28 August 2017; Received in revised form 20 February 2018; Accepted 26 February 2018 ⁎ Corresponding author at: Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building 2, Rm 331, Boston, MA 02115, United States. E-mail address: kdavison@hsph.harvard.edu (K.K. Davison). Preventive Medicine 111 (2018) 170–176 Available online 28 February 2018 0091-7435/ © 2018 Elsevier Inc. All rights reserved. T