Impact of family dynamics on the eating behaviors of overweight or obese children: A qualitative study of parents or grandparents

Background Obesity has become a major global public health issue. The occurrence and progression of childhood overweight and obesity result from the combined effects of multiple factors, including genetic factors, lifestyle, psychological factors, and the social environment. Among these, the family, as the primary setting where children acquire early life experiences and develop initial behavioral habits, exerts a profound influence on the development and reinforcement of their eating behaviors. However, previous studies have rarely considered the family as a dynamic interactive system when examining its role in shaping children's eating behaviors. In particular, in-depth qualitative exploration remains lacking regarding how specific processes, such as role division and intergenerational interactions among family members, influence children's eating behaviors. Objective To explore how family dynamics influence the eating behaviors of children with overweight/obesity from the perspectives of parents or grandparents. Methods A qualitative study was conducted using purposive sampling to recruit 19 parents/grandparents of children with overweight or obesity for semi-structured in-depth interviews. Van Manen's data analysis method was applied for thematic extraction and interpretive analysis. Results Three themes and ten subthemes were identified. Theme 1 focused on interaction patterns within the nuclear family in child dietary management, including four subthemes: The theme 1 was relevant with the impact of parental weight-loss attitude differences on collaborative dietary management, the maternalization of feeding responsibilities and the time-energy pressure on mothers, the shaping of children's eating behaviors through parent–child interaction styles, and excessive food provision driven by concerns about nutritional deficiency. Theme 2 addressed the multiple effects of intergenerational involvement on children's eating behaviors, encompassing three subthemes: practice patterns and intergenerational division of labor in grandparental participation in child dietary management, intergenerational differences in dietary management beliefs against the backdrop of social change, and the intergenerational transmission and continuity of family dietary habits. Theme 3 pertained to the empowerment of family dietary management by external support systems, comprising three subthemes: reconstruction of family feeding patterns triggered by medical diagnosis, the sustaining role of social media platforms in promoting healthy eating behaviors, and the implementation of health tools to assist eating behavior monitoring. Conclusion The formation and modification of eating behaviors in children with overweight and obesity are jointly shaped by interactions within the nuclear family, intergenerational involvement, and external support systems. Discrepancies in parental weight-loss attitudes weaken feeding coordination; the maternalization of feeding responsibilities places mothers under dual time and energy pressures between career and family; authoritarian parent–child interactions tend to trigger child resistance and avoidance behaviors; and concerns about growth and development may drive parents toward excessive food provision. At the intergenerational level, grandparents demonstrate both autonomy and adaptability in child dietary management, with their traditional beliefs being updateable through external information input and active learning; nevertheless, family dietary habits tend to persist through intergenerational shared meals, forming entrenched taste preferences and eating routines in children. Medical diagnosis serves as a critical turning point, while social media platforms and online health-related applications empower family dietary management through informational, emotional, and instrumental support respectively. Future childhood obesity interventions are recommended to shift from individual behavior guidance toward to combination with family-system support, assisting family members in reaching consensus on dietary management rules and integrating external resources such as medical services, social media platforms, and health tools to construct a family-centered weight management support system for children.