Unhealthy diet, excessive screen time, and inadequate physical activity have been identified as critical childhood obesity risk factors, but lack of access to healthy food and food insecurity also contribute to the problem. “Developing tailored message programs that engage children, involve parents, and provide practitioners with information on a child’s behavioral intentions may help capitalize on teachable real-time clinical encounters,” says Valerie B. Duffy, PhD, RD.

A Tailored Intervention

Studies suggest that technology may help with childhood obesity prevention by tailoring health information and motivational messages to children and parents as well as by helping screen for food insecurity and providing useful resources that minimize stigma. For a study published in Nutrients, Dr. Duffy and colleagues examined the acceptability and usability of the pediatric-adapted liking survey (PALS), a simple proxy of behaviors that correlates with biomarkers of dietary intake and indirect measures of adiposity in children and has good test–retest reliability. “Implementation of PALS is feasible for a variety of clinical settings, takes minutes to complete, and can be completed by children aged 5-18 years,” Dr. Duffy says.

For the study, 245 children and their parents or caregivers reported on the child’s activity and behaviors using the online PALS tool. Participants received two to three messages tailored to the responses to motivate behavioral improvements or reinforce healthy behaviors (see Figure for an example). “Specifically, the screener asked participants what foods and activities they liked or disliked,” says Dr. Duffy. “This information was leveraged to develop tailored messages that promoted healthy behavior across the spectrum of weight (healthy behaviors at any size). The messages also were not different based on the family’s food security status, as reported by the parent.” The usefulness of the messaging program was assessed by the willingness of the child to change or maintain the message target behavior.

PALS Is Easy to Complete & Encourages Thoughts About Behavior

According to the results, more than 90% of children and parents agreed that PALS was easy to complete and encouraged thoughts about the child’s behaviors. “PALS was easy to administer and fun to use for children,” Dr. Duffy says. Most children reported that they would “like to” or “love to” change at least one behavior from less healthy to healthier (Table). More than 75% of children and parents reported that the tailored messages were helpful and favorable for improving or maintaining the targeted behavior.

“Both children and parents reported high acceptability and usefulness of PALS and the tailored messages that positively motivated and reinforced healthy behaviors,” says Dr. Duffy. “Most children liked or had a favorable response to change toward healthier behaviors. Our findings indicate that PALS and tailored messages could be useful for obesity prevention as an initial step toward encouraging children to adopt healthier behaviors.” She adds that clinicians can use information from PALS to prime their conversations before patient encounters.

Empowering Behavior Change With Parent Involvement

“Obesity prevention should reach all children to promote enjoyable healthy eating and physical activities,” says Dr. Duffy. “This is increasingly important for income-disadvantaged children without access to regular healthcare. Having both children and parents report on a child’s behavior, receive tailored messages, and discuss similarities and differences can inform brief motivational interviewing to help identify shared goals for behavioral changes. Involving parents in the dialogue can promote a collaborative environment to make healthier options available and improve food choices. Parental involvement can also lead to more positive modeling of healthy behaviors for their children.”

The online PALS platform and message program could broaden the reach for obesity prevention. “This program could empower children and their parents to begin the process of changing behavior,” says Dr. Duffy. “It can also identify behaviors that the child would most likely change with support from their parents. Ultimately, both children and their parents need to be engaged in these efforts.”

According to Dr. Duffy, future research will aim to identify how well PALS and the message program can be integrated into clinical practice and to determine its potential incorporation into multi-component obesity prevention efforts. “As a next step, we want to see how we can use technology—perhaps adding a gamification component—to further bolster messages promoting healthier behaviors,” she says.


The University of Connecticut College of Agriculture, Health and Natural Resources has curated educational, fact-based nutrition and exercise resources to help answer the most common questions about raising healthy young adults. The information, available in both English and Spanish, can be accessed for free at https://healthyfamilyct.cahnr.uconn.edu/.

Chau S, Oldman S, Smith SR, Lin CA, Ali S, Duffy VB. Online behavioral screener with tailored obesity prevention messages: application to a pediatric clinical setting. Nutrients. 2021;13:223. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828782/.

Sharafi M, Perrachio H, Scarmo S, et al. Preschool-Adapted Liking Survey (PALS): a brief and valid method to assess dietary quality of preschoolers. Child Obes. 2015;11:530-540.

Vosburgh K, Smith SR, Oldman S, Huedo-Medina T, Duffy VB. Pediatric-Adapted Liking Survey (PALS): a diet and activity screener in pediatric care. Nutrients. 2019;11:1641.

Smith S, Johnson S, Oldman S, Duffy V. Pediatric-adapted liking survey: feasible and reliable dietary screening in clinical practice. Caries Res. 2018;53:153-159.

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