Obesity Science & Practice

- ORIGINAL ARTICLE OPEN ACCESS

Addressing Physical Inactivity in Mexican Children: The

Role of Parents and Their Physical Literacy
Nina Eisenburger1 | Edtna Jáuregui Ulloa2 | Cinthia Veronica Villegas Balderrama3 | Karen Janeth Villegas Balderrama3 |
Sayra Nataly Muñoz Rodríguez2 | Alicia Calderón Escalante2 | Salvador Jesús López Alonso3 | Alejandra Orona Escápite3 |
Luis Alberto Flores Olivares3 | Marisol Muñoz De la Riva3 | Tobias‐Jorge Kunde1 | Antonia Tolo1 | Sebastian Vollmer1
1
Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany | 2Institute of Applied Sciences of Physical Activity and Sport, University of
Guadalajara, Guadalajara, Mexico | 3Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, Mexico

Correspondence: Nina Eisenburger ([email protected])

Received: 7 August 2024 | Revised: 29 October 2024 | Accepted: 25 November 2024

Funding: The authors received no specific funding for this work.

Keywords: childhood obesity | physical activity | weight management

ABSTRACT
Introduction: Childhood obesity and physical inactivity rates in Mexico are among the highest in the world. While parenting is
a key factor in shaping children's physical activity behavior, there is a lack of research in this area, particularly in Mexico.
Objective: This qualitative study aims to better understand aspects of parenting relevant to children's physical engagement,
including what parents understand by physical activity, how engaged they are and how important they find it, that is, their
physical literacy.
Methods: Seven focus group discussions were conducted with 43 caregivers of overweight primary school children. Inquiry
topics included components of physical literacy (i.e., motivation, confidence, physical competence, knowledge and under-
standing, engagement in physical activity), parenting practices, role modeling, perception of children's physical activity,
parental self‐efficacy and general parenting style.
Results: Although many participants stated that they were aware of their child's health problems and that they did not set a
good example themselves, most could not overcome personal obstacles to exercise such as lack of time and energy. Most
participants showed a knowledge gap about appropriate levels of physical activity or underestimated its importance. Several
reported increased motivation after participating in the focus group discussion and developed their own ideas to deal with
barriers or to support their children, such as engaging in physical activity together and introducing family routines.
Conclusion: Following a participatory approach, future studies should use these ideas to develop context‐sensitive group in-
terventions. Empowering parents by considering their physical literacy in children's weight management could be a valuable
addition to theory‐based strategies in research and practice.

1 | Introduction alarming level of 37.3%, placing it among the countries with the
highest childhood obesity rates in the world [2, 3]. Physical
Childhood obesity is a growing public health concern globally, activity is a crucial determinant of childhood obesity, influ-
with significant implications for physical and psychological encing both the prevention and management of excess weight
health [1]. In Mexico, childhood obesity has reached an [4]. Despite widespread recognition of its importance, many

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© 2024 The Author(s). Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

Obesity Science & Practice, 2024; 10:e70028 1 of 12

https://doi.org/10.1002/osp4.70028
children in Mexico engage in insufficient physical activity [5] for children with obesity and their parents (data was not
and it is often overlooked in the context of childhood obesity included in this study). Afterwards, the guidelines were
prevention and treatment in Mexico [6, 7]. adapted and finalized. In January 2023, a comprehensive
training session was conducted via Zoom in which the
Parenting is a key factor in shaping children's physical activity research teams of all different locations agreed on data
behavior, especially in early childhood [8–10]. Parents can serve collection procedures, the administration of questionnaires and
as role models, provide support and encouragement, and create anthropometric measurement.
environments conducive to active, healthy living [11, 12]. Next
to the parent weight, the physical activity level of the parents is Following a convenience approach, the research team then
among the most robust predictors of child weight status [11–13]. visited three public elementary schools in proximity to the
In a study by Carter et al., for example, parental physical activity research team's institutions, two in Chihuahua and one in
and body mass index (BMI) influenced physical activity and Guadalajara, and introduced the research project to the school
BMI in adolescents (8–14 years) both directly and indirectly principal. After the principal's approval, parents and caregivers
through instrumental support (e.g., signing the child up for a were invited to an information session about the project. All
sports team) and encouragement (e.g., engaging in physical participants gave their consent for voluntary participation (see
activity with the child [14]). Supporting Information S1). The anthropometric measurements
of the children were taken during a third visit. Prior to the focus
However, in the Mexican context, parents see full responsibility group discussion, the short version of the International Physical
for children's obesity in the children, not in themselves [15]. Activity Questionnaire (IPAQ) in Spanish was handed out to
Many Mexican caregivers reduce childhood obesity to an assess self‐reported energy expenditure of the participating
aesthetic problem and are unaware of the associated health risks parents, as well as a questionnaire containing questions on
[16]. In general, national surveillance systems that monitor educational background and the number of children (see Sup-
physical activity behaviors among Mexican children have porting Information S1, S2).
revealed a lack of data in the family and peer domain in all
recent analyses from 2012 to 2022 [5, 17]. This is surprising
given that intervention programs which include physical activ- 2.2 Study Population and Sample Size
ity, particularly those in which parents exercise together with
|
children, appear to be the most effective in reducing weight in A total of 785 children (186 in Guadalajara, 599 in Chihuahua
Mexican children [7]. A deeper analysis of the parental role in [n = 348 and 251 at two different elementary schools]) in grades
this context is urgently needed for developing evidence‐based one through six were measured (49.8% girls) with an average
interventions against childhood obesity that empower and age of 9.01 � 2.23 years. The average BMI of the sample was
capacitate parents in Mexico [18, 19]. 18.28 � 4.18 and BMI Z‐score of 0.35 � 1.54. Inclusion criteria
for participation in this study were written consent from parents
In line with Davison et al. integrated Model of Physical Activity or caregivers, age (> 5 ≤ 12) and classification as overweight or
Parenting, this study therefore sought to analyze (a) parent's obese according to Centre for Disease Control and Prevention
physical literacy including whether and how parents engage in (CDC) 2000 Growth Chart. 192 children (21.1%) were eligible
physical activity and what deep personal attitudes, beliefs, and for inclusion. A flow chart on the inclusion of participants can
perceptions they have about it and (b) how they pass these be found in Figure 1.
patterns and beliefs on to their children [20]. Physical literacy is
defined as the motivation, confidence, physical competence,
knowledge, and understanding to value and take responsibility
for engagement in physical activities for life [21]. Due to its 2.3 | Questionnaire Development
suggested importance for participation in lifelong physical ac-
tivity, physical literacy is a growing field of research [22]. To our The theoretical framework of the interview guidelines was built
knowledge, however, there is no study to date that examines the upon the concept of physical literacy and different aspects of
physical literacy of adults in Mexico or in the context of physical parenting that are most relevant to the child's physical
activity parenting. engagement [10, 22]. As there is no standardized measurement
method yet [20], the interview questions were derived from the
existing literature. Table 1 shows the primary interview ques-
tions and the underlying definitions and references. The full
2 Methodology interview guidelines can be found in the supplements.
|
2.1 | Study Design
2.4 | Data Collection
This qualitative study is based on seven focus group discus-
sions with parents and caregivers of overweight or obese 2.4.1 | Anthropometric Data Assessment
children that were held in Guadalajara and Chihuahua,
Mexico, between February and August 2023. After a literature Following a standardized protocol, height and weight mea-
review and the development of the interview guide, an initial surements of children and parents were performed barefoot
exploratory test event was carried out in December 2022 in with a calibrated standard scale (Tanita HD‐366/BC‐558) and a
Oaxaca, Mexico, which was conducted in a treatment center transportable stadiometer (Seca 213). Height was measured in

2 of 12 Obesity Science & Practice, 2024

FIGURE 1 | Flow chart of participants.

cm; weight was measured in kg and included light clothing. A white board for all participants to see, and two observers took
triplicate was measured, and the mean value was used for this notes on body language and responses. The participants sat in a
study. BMI (weight [kg]/height2 [m2]) and BMI Z‐Scores were circle and the sessions were audiotaped. In the second part of
assessed using the following equation: (BMI/M(t))L(t) − 1)/(L the focus group discussions, a so‐called carousel of ideas was
(t) � S(t), where M(t), L(t), and S(t) reflect age‐ and gender‐ used, where the questions had been written in advance on four
specific parameters of the child [34]. In accordance with the posters. The posters were distributed in different corners of the
CDC Growth Chart, children on or above the 85th percentile room and the participants could write down their answers or
were classified as overweight and those above the 95th add to them by moving from one poster to the next. This pro-
percentile were considered obese [35]. According to the classi- cedure was repeated three times in Guadalajara and twice in
fication of the World Health Organization, adults with a BMI of Chihuahua, each time with different participants. Originally,
25 or more were classified as overweight and those with a BMI the study was also to be conducted in Oaxaca, but the data
of 30 or more were classified as obese [36]. collected at a treatment center was incomplete and not
comparable.

2.4.2 | Focus Group Discussions

2.5 | Data Analysis
Focus groups with parents and caregivers were conducted in
Spanish. During the focus group discussion, a moderator led the The audio recordings and the posters which were used during
discussion, an assistant visually collected the responses on a the focus groups were transcribed in Spanish. The transcripts

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TABLE 1 | Primary interview questions with underlying definitions and references.

Theoretical concept Category Definition Main questions Reference

Physical Literacy Motivation An individual's What motivates you to be Motives for Physical
(oriented on Ryom et al. enthusiasm for, physically active? Activities measure
[22]; The International enjoyment of, and self‐ What feelings do you have (MPAM‐R), Ryan
Physical Literacy assurance in adopting when you are physically et al. [23]
Association [21]) physical activity as an active?
integral part of life
Confidence 1. What hinders you to be Self‐efficacy scale, Resnick
physically active? and Jenkins [24]
2. Can you remember a
situation where you were
able to overcome these
obstacles on your own?
3. If you were really
motivated to be active
today, what solutions
would you find to really
dedicate yourself to
physical activity?
Physical An individual's ability to 1. Do you feel that you are Self‐Perception Profile for
competence develop movement skills good at sports? Adults, Messer und Harter
and patterns, and the 2. How do you see your [25] (item #30, item #43)
capacity to experience a physical competence
variety of movement compared to other people
intensities and durations. your age?
Enhanced physical
competence enables an
individual to participate in
a wide range of physical
activities and settings
Knowledge and The ability to identify and 1. What do you think are Canadian Assessment of
understanding express the essential the benefits of physical Physical Literacy (CAPL)
qualities that influence activity in general (and for for children, Longmuir
movement, understand your child)? et al. [26]
the health benefits of an 2. What are the risks of
active lifestyle, and physical inactivity?
appreciate appropriate
safety features associated
with physical activity in a
variety of settings and
physical environments
Engagement in An individual taking What type of sport do you International Physical
physical activity personal responsibility for like to do? Activity questionnaire
physical literacy by freely (IPAQ), Craig et al. [27]
choosing to be active on a
regular basis. This
involves prioritizing and
sustaining involvement in
a range of meaningful and
personally challenging
activities, as an integral
part of one's lifestyle
Relevant Aspects of Parenting Concrete behaviors and 1. What do you do to Darling and Steinberg
Parenting (oriented on Xu practices strategies parents use in support you child in [28]; Holt [29]; Lindsay
et al. [10]) specific context in order to doing PA? et al. [8]
(Continues)

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TABLE 1 | (Continued)

Theoretical concept Category Definition Main questions Reference

support children in their 2. What role do you think
socialization goals you play in encouraging
your child to be physically
active?
Parents' role The process by which 1. What kind of physical Social Learning Theory,
modeling parents demonstrate activities do you do Bandura [30]
behaviors, values, and together with your child?
attitudes that their 2. What habits does your Lindsay et al. [8]; Wright
children observe and often family have in relation to et al. [31]
imitate, significantly physical activity (e.g.,
shaping their routines, rules)?
development and
character
Parental How parents view, 1. What kind of physical Lindsay et al. [8]; Quirk
perceptions of understand, and evaluate activity does your et al. [32]
children's their children's child do?
physical activity engagement in physical 2. Where and in what
exercise, including the context is your child
importance, benefits, and mainly physically active?
barriers associated with it
3. Do you think your child
is sufficiently physically
active?
Parental self‐ The subjective conviction 1. How confident are you Kieslinger et al. [47];
efficacy or belief in one's own that you can get your child Bandura [30]; Lindsay
abilities to be a good to be physically active et al. [12]; Campbell
parent and influence the when they want to play et al. [33]
child in a way that with their mobile phone?
promotes health and 2. How confident are you
success that you can get your child
to be physically active
when you don't have
much time?
General A function of two What would you do if you Sleddens et al. [46]
parenting style dimensions of parental realized that your child
behavior: The extent to does not do enough
which parents are (a) physical activity and
responsive to their spends too much time on
children's needs screen‐based activities?
(responsiveness/warmth),
and (b) controlling of their
children’ s behaviors
(demandingness)
There are four parenting‐
style typologies:
Authoritative (high
demandingness/high
responsiveness),
authoritarian (high
demandingness/low
responsiveness),
permissive (low
demandingness/high
responsiveness), and
uninvolved/neglecting
(Continues)

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TABLE 1 | (Continued)

Theoretical concept Category Definition Main questions Reference

(low demandingness/low
responsiveness), where
demandingness is defined
as control and
responsiveness as warmth

were read line by line by the research team and checked for the ratio of given answers within the corresponding super
quality. Some quotes were translated into English for the anal- category.
ysis by at least two members of the research team, with the
Mexican colleagues checking the accuracy of the translations.
Qualitative data were managed and analyzed using MAXQDA 3.1 | Physical Literacy
2024 (VERBI software). Following the grounded theory, a
deductive, theory‐guided approach was first used to develop a 3.1.1 | Physical Engagement, Competence and
schematic set of codes around the a priori developed system Motivation
derived from the predetermined themes of the questionnaire
(i.e., the theoretical concepts and their categories, see Table 1; Fifty‐three comments related to parents' and grandparents' own
[37]). Second, two researchers independently applied the initial engagements in physical activity. While 11 people (21.6%) said
coding scheme to each transcript and identified new emergent that they do not do any sport at all, walking (29.5%) was the
themes based on an inductive data‐driven approach. Using the most common form of exercise mentioned in the focus group
constant comparison method, the themes and subthemes of the discussions, followed by gym (13.7%), dancing (11.8%), and
coders were compared and resorted, and coding discrepancies soccer (5.9%). The results of the IPAQ showed that on average
were resolved through consensus. Responses were allowed to be 48.24 � 90.98 min of vigorous exercise, 50.55 � 73.21 min of
coded under multiple categories [38]. Finally, selective coding moderate exercise and 107.56 � 150.22 min of walking per day
was performed to identify the most relevant code categories for were performed, resulting in an average MET of
the underlying study. IBM SPSS Statistics 29.0 was used for 5832.52 � 7771.32. The participants stated that they sat for an
descriptive analysis of continuous and categorical variables. average of 235.08 � 207.88 min a day. The majority reported
Different types of physical activities measured using the IPAQ positive feelings about their physical competence in relation to
were ranked by intensity: sedentary (1.5 metabolic equivalent new, unfamiliar sports (66.7%) but not in comparison to others
[METs]), walking/light (3.3 METs), moderate (4.0 METs), and of the same age (60.0% negative).
vigorous activity (8.0 METs) [39].
Eighty‐five comments were related to the factors that could
This study was conducted in line with the principles of the motivate participants to be physically active. The majority
Declaration of Helsinki [40]. Ethics approval was granted by the (35.2%) stated satisfaction and psychosocial well‐being as
University of Göttingen for the ethic request with the number drivers for physical activity (e.g., “I went into a stage of medium‐
06.01.23 in February 2024. severe depression and that's what got me out of it, so if I don't go
and exercise, I start to feel depressed again” [GDL FG 3 Audio,
Pos. 3]). This category also included destress and relaxation,
3 | Results distraction and pleasure.

A total of 43 parents and caregivers (83.7% female) took part in Physical health was mentioned 14 times (25.9%) as a motivator
the five focus group discussions with an average of seven par- for physical activity. Increased energy levels (7.4%), the own
ticipants, of which 35 were mothers, 3 fathers and 5 grandpar- child (7.5%), body image and beauty including losing or stabi-
ents. The participants were 39.33 � 10.04 years old and had a lizing weight (5.6%) were also common motivators (e.g., “I still
BMI of 30.56 � 5.29. The children (46.5% girls) had an average have a lot of pictures and I never want to be like that again”
BMI of 27.75 � 1.89 and a BMI Z‐score of 2.01 � 0.43. The five [CHH FG1 Audio, Pos. 29]). Other drivers (1.9%–3.7% each)
interviews lasted 71.55 � 35.43 min on average. Of the 37 people were socializing, music, having time for themselves, seeing how
who provided information on their highest educational qualifi- other people were motivated, and making it an important daily
cation, 10.8% stated that they had only completed primary routine.
school, 18.9% secondary school, 21.6% high school and 27.0% a
university degree. 21.6% indicated that they had another or no
educational qualification. 3.1.2 | Confidence

There were three subcategories relating to physical literacy (504 Of 89 comments on obstacles that prevented them or the chil-
comments) and three subcategories relating to parenting (459 dren from being physically active, most participants mentioned
comments). The percentages given for the subcategories refer to lack of time (24.0%). Some parents elaborated on this and

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differentiated between different responsibilities such as house- or generally better lifestyle habits (3.8%). With regard to chil-
hold chores, work and childcare: dren, it was also stated that sport and exercise can promote
healthy child development (13.2%), better concentration, and
I just don't have the time. The truth is that I get up academic performance (3.8%).
every day at 5:30 in the morning, I have a son in high
school, and I have to get up to make him lunch so he Among the 37 risks of physical inactivity and sedentary
can go to high school at 6:30. Then I prepare the other behavior, physical illness (63.9%) such as “hypertension,”
“cardiovascular disease” or “diabetes” was mentioned most
one so I can drop him off at school and go to work.
frequently, but also obesity (19.4%) and depression or stress
After work, I come home to do my housework and (11.1%). Although the main topic of discussion was physical
finish the things I have to do at home, organize the activity as a determinant of childhood obesity, 32 participants
uniforms… Then it is 10 o'clock at night and I go to touched on other causes of obesity. Nutrition (21.9%) was
sleep, I don't have time for myself, I just don't have mentioned the most, but also genetics (18.8%), the COVID‐19‐
time. pandemic (18.8%), increased cellphone use (12.5%), or person-
(GDL FG 1 Audio, Pos. 3) ality (9.4%). Concerns about parental neglection (18.8%) were
also expressed, as shown in the following statement:
The second most common explanation for not exercising was
insecurity (12.0%), directly followed by pain, illness or (fear of) Many times, when we are absorbed with work at
injury (10.7%), lack of energy (9.3%, e.g., “I try to do everything, home, independently of many things, children feel
but there comes a time when you say that your body is tired, and unmotivated. They feel sad, like they feel the rejection
it is not performing the same way anymore and the only thing of mom or dad who is very busy but doesn't pay
you want to do is rest” [GDL FG 2 Audio, Pos. 3]), and acces- attention to me [the child].
sibility including high costs (8.0%).
(GDL FG 2 Audio, Pos. 3)
Lastly, the lack of a suitable trainer (8.0%), of prioritization
(8.0%), of self‐confidence (6.7%) or motivation (5.3%), feeling
shame (5.3%) and bad weather (2.7%) also prevented people
from engaging in physical activity. With children, it was also 3.2 | Parenting
other hobbies or preferences such as painting that discouraged
physical activity. 3.2.1 | Perception of Children's Physical Activity

Sixty‐one comments dealt with means of overcoming barriers While the moderators made an effort to focus the discussion
to physical activity. Routine and organization (43.2%) were on physical literacy on the parents' experiences, this section
mainly mentioned in this subcategory. It involved ideas such looks at what the parents had to say about their children.
as seeking family support with childcare, involving a specialist, Regarding the perception of the quantity and quality of
shorter exercise sessions, or having someone else accompany physical activity engagement of the children, the caregiver's
them. Seven comments (15.9%) related to the need for perse- statements were ambiguous. Whilst some parents reported
verance, commitment, and discipline. Increasing motivation that their children practiced sport several times a week
(11.4%) was also frequently mentioned, including the idea of (45.3%), it was also stated that more exercise would be good
“just getting started,” exercising together with the child, or for children and that they were too inactive (54.7%). In
changing personal priorities. In addition to external motivators general, there were several mentions of increased media us-
such as improving accessibility and availability (9.1%), some age and physical inactivity. Five parents said that they
comments were also related to personal attitude (6.9%), for thought 30 min of exercise a day was enough for their chil-
example, being more optimistic or daring to move out of their dren, while others did not elaborate on this. Fourteen com-
comfort zone. ments referred to being aware of the child's health status or
excess weight, for example,

Mine just wants to eat and eat, and I tell him it hurts
3.1.3 | Knowledge and Understanding
you, that you can't be like that, and he doesn't want to
drink natural water, just sweet stuff. And I scold him
In 94 comments, participants described the general benefits of
physical activity, with health (physical [28.3%] and mental and point it out to him, but he keeps doing what he's
[71.7%]) being mentioned most frequently. Comments on doing, he just wants to eat.
physical health included “more agility,” “better condition,” (GDL FG 3 Audio, Pos. 3)
“better motor skills” or “it helps cardiovascularly.” Mental
health involved improved self‐esteem and confidence. Twelve Parents said that when their children did sport, they did it
comments (22.6%) referred to general well‐being and a better mostly at school (25.7%), outside or in the park (25.6%), at home
quality of life. According to some participants, physical activity (23.1%), or at a sports facility (23.1%). The sports that their
has given them energy (9.4%), distracted from worries (9.4%) children engaged in most frequently mentioned by the parents
and contributed to weight loss (3.8%), better appearance (1.9%), were soccer (18.9%) and dancing (16.2%).

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3.2.2 | Parenting Practices and Role Modeling blocks away and they shout: “Mama, come on!” and
well no…(she laughs). What a shame that I am giving
When asked how they support the children in being physically that example to my children.”
active, many parents and grandparents said that they tried to
(CHH FG1 Audio, Pos. 31)
motivate the children (39.1%). Intending to encourage them
through moral support or explaining the benefits of sport to them
was coded under this subcategory. Others stated that they sup-
ported the children and grandchildren by driving them or signing 3.2.3 | Parenting Styles and Parental Self‐Efficacy
them up for sports, paying for or organizing sports lessons for
them (23.9%), thereby ensuring persistence. This also implied that The questions relating to parental self‐efficacy revealed that of
some decided for the children and forced them to play sports. In 37 answers, parents were rather (22.2%) or very (75.0%)
contrast, there were many who talked and negotiated with the confident that they could persuade the child to do sport even
children about which sport they might enjoy (30.4%). To ensure though he/she would rather play on their mobile phone.
the child's physical activity, some parents stayed close by to keep 20.1% stated that they were not sure whether they would be
an eye on the child for safety reasons (6.5%). able to motivate the child to do sport if they did not have
time themselves, for example, due to work. The remaining
Only four (5.5%) participants stated that they did not engage in 79.9% were confident that they could do it even without much
any physical activity with the child. Many mentioned that they time.
went for walks (39.5%), played games (19.7%), cycled or exer-
cised together (7.9% each) with the child. In contrast, during the focus group discussions, some parents
stated that they struggled with their assertiveness when trying to
I have to take him with me [even if he says] it is better impose behavior on the child, for example, “You can't do any-
not to go. I will tell him yes, yes, we have to go. And thing to the children because then they cry and then you feel
when we get there, we take a bath, we sweat, we get bad, poor kids” (CHH FG 2 Audio, Pos. 209).
active, and everything is so great. It generates a lot of
Some (8.3%) also mentioned challenges in the division of tasks
adrenaline; it makes you happy.
between husband and wife as well as the interference of
(CHH FG1 Audio, Pos. 36)
grandparents on the one hand or the lack of opportunity to
intervene as grandparents on the other.
There were 39 more comments on eight different types of
physical activities in total that the caregivers do together with
I think that sometimes they get used to one person and
the children. In addition, there were 19 comments on estab-
lishing family routines, habits and rules, including limiting cell if that person says yes. So, if I say no, then they go to
phone and television use, for example, “If she doesn't do her the other person.
homework, and if she doesn't do the activities that I set for her, (GDL FG 1 Audio, Pos. 3)
she doesn't watch TV” (GDL FG 1 Audio, Pos. 3).
As a grandmother I can't do anything. I can't do much
On Sundays we go out for sports, walking and cycling because they need the attention of their parents.
with the child. (GDL FG 3 Audio, Pos. 3)
(CHH FG 1 Poster, Pos. 102)
If they realized that the child was insufficiently physically
active, in 27 (69.2%) of the cases the participants would advise
A certain amount of time on the cell phone and then
their child to take part in sport and discuss with them what
do something, go out and play. Yes, sometimes I tell
options are available (authoritative parenting style). However,
them to go play. during the focus group discussion, the same participants made
(GDL FG 3 Audio, Pos. 3) comments that suggested a rather permissive style, for example,
“It got to the point where it was just too much to argue with
Not everyone agreed on having constant routines, however her” (GDL FG 3 Audio, Pos. 3).
(26.3%): “In my family, [there are no routines for physical ac-
tivity or media use] because we do not coincide in time” (CHH Ten participants (25.6%) said they would follow an authoritarian
FG 1 Poster, Pos. 100). parenting style and not negotiate with the child (e.g., “If you
don't force them to do it, they don't do it and they just don't take
Twenty‐seven comments dealt with the parents feeling a re- advantage of [all the opportunities].”), while three (7.6%) would
sponsibility to be good role models and taking care of their either not worry or leave the child do as he/she pleases.
physical health. In this context, some participants also talked
about their own overweight and were aware that they were not a Among the 16 comments that participants took away as lessons
good example to their children: from the discussion, many were about strengthening and sup-
porting each other as a community. Some said that they realized
I am overweight, severely overweight. So, well no, my how important it is that they looked after their own and their
condition is not the best. My children are running five child's sporting activities:

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 I realize that I am a role model that they can learn between 32% and 53% of elementary schools in Mexico have a
from and imitate. Let's start with ourselves. physical education teacher [5]. This highlights a significant gap
in physical education, which may contribute to misconceptions
(CHH FG1 Audio, Pos. 21) about appropriate physical activity levels and the role of exercise
in preventing obesity. It has been shown that a misconception of
I learned to be thankful that we all share the same an appropriate level of physical activity leads to little behavior
experiences. change [19]. In line with this, the sample lacked knowledge
(CHH FG1 Audio, Pos. 124) about how much sport adults and children do or should do. The
IPAQ results also displayed a significant overestimation of
physical engagement in some cases—as reflected by the high
standard deviation due to extreme upper values—, possibly
4 | Discussion indicating a lack of understanding in accurately determining the
type, intensity and amount of physical activity.
By combining the construct of physical literacy with various
aspects of parenting, this qualitative study contributes to a better Not only the level of physical literacy of the parents but also
understanding of the role of parents in relation to their chil- how they pass on their personal attitudes plays a role in shaping
dren's physical (in‐)activity and obesity in Mexico. The results of the physical activity patterns of children [20]. Previous findings
seven focus group discussions show that the majority of suggest that children who grow up in authoritative homes with
participating parents and grandparents themselves were a clear daily structure yet room for negotiation are more phys-
affected by obesity and not sufficiently physically active in ically active and have a lower BMI than children who grow up
accordance with international recommendations [41]. Similar to with other parenting styles [11,45,46]. In our sample, most
earlier studies, caregivers recognized that obesity is a serious parents reported a permissive parenting style. They negotiated
health problem but potentially underestimated the degree of with the children about what they wanted but rarely set clear
obesity experienced by their children [42]. Some parents were rules and routines. In this context, future studies should also
aware of their role as role models, and that their children should look into the different roles and dynamics within family struc-
be more active and spend less time on their cellphones, recog- tures. Although mothers, grandparents and fathers were
nizing the benefits of physical activity, especially for physical included in this study, a distinction could not be made as to how
and mental health and development. However, they were un- personal experiences and perceptions of physical literacy might
able to overcome obstacles such as lack of time, motivation, or affect children's physical engagement as caregivers. Similar to
energy to increase their own and their child's physical activity earlier research (e.g., [44]), some statements in this study indi-
levels. cated that fathers were more likely to be associated with phys-
ical activity and mothers with diet, and that grandparents were
Earlier studies also emphasized the importance of parents as less strict when it comes to rules and eating, but further
role models for a healthy, active lifestyle [8,13]. For analyzing or research is needed to substantiate these assumptions.
strengthening parents' ability to engage in physical activity, the
consideration of the comprehensive concept of physical literacy, The consideration of parental practices became particularly
which takes into account the affective, physical and cognitive relevant against the background that in this study not only
wholeness of physical activity, could be a valuable tool [22]. children but also parents appeared to be negatively influenced
Because physical literacy addresses several components and by their screen behavior. Although parents recognized that it
personal resources relevant to lifelong engagement in physical may be harmful to their child, they allowed them to use their
activity (i.e., motivation, confidence, physical competence, phone or tablet to keep them occupied or even neglected the
knowledge and understanding and engagement in physical ac- children because they were busy on their phones themselves. As
tivity), it is expected that it will make physical activity in- parental physical literacy and parenting practices seemed to be
terventions more quantifiable, comparable and effective in closely intertwined, improving parents' skills, knowledge and
improving all‐round health. However, there is a lack of research self‐efficacy could be a valuable target for interventions to pre-
on the physical literacy in adults and no complete assessment vent obesogenic environments [10,12,47].
tool has been developed to date [43]. The present study attempts
to contribute to this shortcoming by grounding the theoretical At the same time, the legitimate barriers such as crime, inse-
framework of this study in the concept. curity and lack of leisure spaces in Mexico, which were also
frequently mentioned by the participants of the focus groups,
When asking about knowledge and understanding as part of the should not be underestimated. It is noteworthy that the parents
physical literacy assessment, we found that obesity was often in our study themselves put forward ideas to overcome these
attributed to non‐modifiable characteristics of the child such as barriers, such as promoting physical activity at home, playing
genetic predisposition or personality, while the role of physical sports together with the children or in groups, transporting the
activity, particularly in comparison to diet, tended to be children to sports facilities, supervising the children, or
underestimated. Previous literature also suggests that the pre- providing structure to the family's physical activity habits. These
dominant role of food in Mexican culture in particular dis- suggested practices can also lead to better relationships between
courages the relevance of physical activity or sedentary lifestyle children and parents, which may be positively associated with a
in promoting or preventing obesity [44]. A recent study found healthy lifestyle for children [48]. Following a participatory
that only 34% of Mexican children and adolescents meet approach, they should be taken into account when designing a
worldwide physical activity recommendations, and only contextualized intervention program.

9 of 12
Interestingly, the caregivers stated that they had gained moti- neglected in the multidisciplinary prevention and treatment of
vation and inspiration, that they had recognized the relevance of obesity. The small sample size, which does not allow any con-
physical activity both for their child's health and wellbeing as clusions to be drawn about differences between the various lo-
well as for their own and felt less alone with their struggles cations, and the cross‐sectional approach, which does not
simply by participating in the focus group discussion. Therefore, permit any conclusions about causalities, should also be criti-
the findings suggest that a group intervention aimed at cized. The non‐response to questions limited the interpretability
strengthening the physical literacy of parents of children with and generalizability of the quantitative results in particular.
obesity and empowering them in aspects of parenting that IPAQ, despite being widely used globally, can overestimate
contribute to their children's physical engagement could be an physical activity levels by up to 20% [50]. The questions on
effective way to target childhood obesity in Mexico. parental self‐efficacy, which were asked using a questionnaire,
were of little value due to the small sample size and their brevity
The recommendations we drew from our findings, including and showed some contradiction to the results of the qualitative
examples of practical implementation that emerged from the analysis, possibly indicating comprehension problems.
discussions, are listed in Figure 2. Our findings encourage policy
makers and health practitioners to focus on two goals: (a) in-
direct parental support, increasing parents' physical engagement
as a means of becoming a role model for the child, and (b) direct 5 | Conclusion
parental support, learning and implementing favorable
parenting skills. While multidisciplinary approaches are widely This is the first study to examine the physical literacy of adults
recognized as best practices to combat obesity [49], the impli- in Mexico and in the context of physical activity parenting. The
cations derived from this study for promoting physical activity results show that the participating parents and grandparents
in Mexican children are highly relevant as they can serve as a themselves were not sufficiently engaged in physical activity
valuable addition to treatment and prevention, taking into ac- and lacked a clear understanding of all that is involved in
count the cultural specificities of Latin American culture on the supporting children to be physically active (e.g., parental self‐
one hand and being theory‐driven on the other. The imple- efficacy, personal attitudes, beliefs and lifestyle). Many recog-
mentation of theory in practice and the longer‐term effects nized the benefits of physical activity and their important role as
should be investigated in more detail in future studies. good examples for their children. Nevertheless, they failed to
overcome barriers to physical engagement, underestimated the
Limitations of our study are biases that may have occurred due importance of physical activity in children's health and obesity,
to social desirability, which were particularly amplified by the or lacked knowledge about appropriate levels of physical ac-
group setting. As the participants were informed that they were tivity. Participation in the focus group, however, seemed to in-
invited due to the overweight of their children, selection bias crease motivation and understanding. On the one hand,
must be taken into account because the motivation of the measures to increase physical activity in children and to reduce
sample, for example, may differ from others. Results may thus obesity should therefore empower and motivate parents to
not be valid for other population groups. Further limitations are become role models for an active lifestyle for their children,
information bias due to self‐reporting and disadvantages due to taking into account the principles of physical literacy. On the
the qualitative research design. For example, some participants other hand, parents should be capacitated in the application and
participated more than others, while others seemed intimidated. knowledge of appropriate parenting styles, skills and practices
In this study, we intended to look in detail at certain aspects so they can pass on their physical literacy to their children.
relevant to obesity, mainly physical activity and parenting, but Participatory and context‐sensitive approaches in Mexico could
of course other aspects, such as nutrition, should not be take place in a group setting and acknowledge the parents' own

FIGURE 2 | Lessons learned: Recommendations derived from this study.

10 of 12 Obesity Science & Practice, 2024

suggestions for overcoming obstacles to exercise in order to 9. I. van de Kolk, S. R. B. Verjans‐Janssen, J. S. Gubbels, S. P. J.
enable a transfer to their everyday reality. Kremers, and S. M. P. L. Gerards, “Systematic Review of Interventions
in the Childcare Setting With Direct Parental Involvement: Effectiveness
on Child Weight Status and Energy Balance‐Related Behaviours,” In-
ternational Journal of Behavioral Nutrition and Physical Activity 16, no. 1
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Acknowledgments
10. H. Xu, L. M. Wen, and C. Rissel, “Associations of Parental In-
As the principal investigator, Dr. Nina Eisenburger, supervised by Dr. fluences With Physical Activity and Screen Time Among Young Chil-
Sebastian Vollmer, developed the study design and was mainly respon- dren: A Systematic Review,” Journal of Obesity 2015 (2015): 546925,
sible for data analysis and drafting the manuscript. She received crucial https://doi.org/10.1155/2015/546925.
support from Tobias‐Jorge Kunde and Antonia Tolo during the literature
11. K. N. Balantekin, S. Anzman‐Frasca, L. A. Francis, A. K. Ventura,
research and data analysis. Dr. Edtna Jáuregui Ulloa led the research team
J. O. Fisher, and S. L. Johnson, “Positive Parenting Approaches and
in Guadalajara, with Sayra Nataly Muñoz Rodríguez and Alicia Calderón
Their Association With Child Eating and Weight: A Narrative Review
Escalante playing a key role in data collection. The same applies to Cinthia
From Infancy to Adolescence,” Pediatric Obesity 15, no. 10 (2020):
Veronica Villegas Balderrama and Karen Janeth Villegas Balderrama,
e12722, https://doi.org/10.1111/ijpo.12722.
who coordinated the data collection in Chihuahua, where they were
significantly supported by Dr. Salvador Jesús López Alonso, Dr. Alejandra 12. A. C. Lindsay, M. Wasserman, M. A. Muñoz, S. F. Wallington, and
Orona Escápite, Dr. Luis Alberto Flores Olivares and Marisol Muñoz De la M. L. Greaney, “Examining Influences of Parenting Styles and Practices
Riva. All authors have critically revised the final manuscript and express on Physical Activity and Sedentary Behaviors in Latino Children in the
their sincere appreciation to all participating families. Open Access United States: Integrative Review,” JMIR Public Health and Surveillance
funding enabled and organized by Projekt DEAL. 4, no. 1 (2018): e14, https://doi.org/10.2196/publichealth.8159.
13. J. Coto, E. R. Pulgaron, P. A. Graziano, et al., “Parents as Role
Conflicts of Interest Models: Associations Between Parent and Young Children's Weight,
Dietary Intake, and Physical Activity in a Minority Sample,” Maternal
The authors declare no conflicts of interest.
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