Changing the Home Food Environment: Parents' Perspectives Four Years after Starting Obesity Treatment for Their Preschool Aged Child.

Changing the home food environment is key to childhood obesity treatment. However, new challenges arise as the child grows older. This study investigates parents' views on the longer-term management of the home food environment, 4 years after starting obesity treatment for their preschool-aged child. Semi-structured interviews were conducted with 33 parents (85% mothers, 48% with a university degree) of 33 children (mean age 9.3 (SD 0.7), 46% girls) from Sweden. The interviews were analyzed using thematic analysis. Two main themes were developed. Making changes in the home food environment illustrates the types of changes families make over time in relation to child development. It consists of three subthemes: covert changes, overt changes and child-directed changes. The second theme, an ongoing negotiation, captures parents' experiences of managing the home food environment as a continuous process of balancing and recalibrating in relation to present challenges and concerns about the future. It includes three subthemes: concern and care, two steps forward one back and maintaining everyday balance. Managing the home food environment is a constant process affected by everyday life, parents' strategies and the child's development. Our findings can strengthen childhood obesity treatment and help prepare parents for challenges that lie ahead.