Future research is needed to examine whether this measure may be used in clinical practice to identify barriers to a healthy family lifestyle, to tailor interventions for families.

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Introduction:Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weightrelated behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic. Method: Participants included 258 parents of children aged 6 -18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample. Results: Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, 2 (144) ϭ 278.60, p Ͻ .001, comparative fit index ϭ .90, root mean square error of approximation ϭ .05, standardized root mean square residual ϭ .06. Discussion: The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention.

Objective: Successful weight loss early in treatment is a key factor for long-term weight management success in adolescence. Yet prior research has not examined factors in the home environment related to risk for increased weight status as potential predictors of early weight management success. The primary goal of the present study was to explore the impact of modifiable household factors on baseline weight status and early weight status change among adolescents participating in an outpatient weight management program to identify clinical targets of early intervention. Method: Parents of adolescents (N = 188) presenting to an interdisciplinary weight management clinic within a children's hospital completed measures at initial presentation. Objective adolescent weight status was collected at baseline and 2-month follow-up (n = 97). Results: Household chaos was significantly associated with weight status at presentation to the clinic, F(3, 181) = 3.85, p = .011. Similarly, household chaos was the only unique predictor of weight change from baseline to 2 months, F(3, 92) = 3.03 p = .033. Conclusions: Household factors, particularly household chaos, have often been overlooked in the adolescent obesity literature but are likely key contributors to early intervention response in a clinical weight management. This study highlights the importance of assessing and intervening on chaos in the household as higher levels of chaos may negatively impact early treatment outcomes among adolescents with obesity. Implications for Impact StatementThe present study suggests that household chaos may be a key modifiable factor impeding adolescent weight loss early in treatment. Although not often considered in prior research, chaos may serve as a key target for future weight management interventions to promote improved outcomes during adolescence.

Weight-based victimization (WBV) is associated with poor weight-related outcomes in adolescence. Family support may be one protective factor against the negative impact of WBV. The goal of this study is to examine the moderating effect of family support on the association between WBV and early weight loss for adolescents in a clinical weight management program. Parents of adolescents (N = 78) completed psychosocial measures at baseline. Objective height and weight were measured at baseline and followup (Visit 3). The overall model was significant ( p = .02), explaining 12.76% of the variance in weight change over the first 2 months of treatment. As hypothesized, there was a significant moderating effect of family support on the association between WBV and weight change ( p = .04), accounting 5.0% of the variance in weight change. Increased support from the family buffered the negative impact of WBV on early treatment outcomes for adolescents in a weight management program.