There is a need for instruments to assess parents’ problems regarding their children’s overweight and parents’ self-efficacy in managing these problems. The Lifestyle Behavior Checklist (LBC) could be a valuable addition to existing parenting instruments, especially if it can be shown to have good psychometric properties. The present study was the first to validate the LBC outside Australia (cross-national validation). In the Dutch context, the translated LBC was found to be a reliable and reasonably valid questionnaire to measure weight-related parental self-efficacy. However, the questionnaire appeared to be somewhat less valid in our sample than in the Australian validation studies.
The LBC Problem scale was significantly negatively correlated to the general parenting construct nurturance (positive parenting dimension), and positively correlated to restrictiveness (negative parenting dimension) and psychological control (negative parenting dimension). The Confidence scale was negatively correlated to psychological control, and positively correlated to nurturance. These small but significant correlations indicated that the parenting constructs were related but not identical to the Problem and Confidence scales. The correlations were in the hypothesized direction. In the Australian validation study , the LBC Confidence scale was found to correlate moderately well with the Parenting Scale by Arnold , which measures ineffective parenting (including permissive or authoritarian discipline).
Internal consistency of both scales was relatively high in both the test and retest. Correlation coefficients indicated relatively high test-retest reliability. These were comparable to the scores reported by the Australian validation study (rs = 0.87 for the Problem scale, rs = 0.66 for the Confidence scale).
The Confidence scale seemed to be less sensitive than the Problem scale as regards detecting differences between parents of healthy weight children and parents of overweight children. In the Australian validation study , statistically significant differences between groups with different weight status were found for both scales. However, that study did not compare parents of overweight children with those of healthy weight children, but compared parents of healthy weight children with those of obese children. This difference in samples probably explains why the mean scores of parents of Australian obese children on all Problem scale items were substantially higher than the scores of the parents of overweight children in our sample. Scores on Confidence scale items were substantially lower among parents of obese children in the Australian study.
We found an interaction effect between child weight status and the Problem scale for nurturance. For parents of overweight and obese children, there was a high negative correlation between the LBC Problem scale and nurturance, whereas a small negative correlation between the LBC Problem scale and nurturance was found for the parents of healthy weight children. We already knew from an earlier review  that the parenting dimension nurturance was positively related to overweight-preventing behaviors. Parents of overweight children may have a different parenting style than those of healthy weight children. The finding in the current study that nurturance by parents of overweight children is strongly negatively correlated to children’s weight-related problem behaviors confirms the protecting influence of nurturance.
The LBC includes 15 items related to dietary behavior, while only 4 items are related to physical activity or sedentary behavior and 6 items are related to the child’s overweight. Although an increasing number of studies have shown the importance of sedentary behavior in determining the development of overweight and obesity , it is conceivable that the relatively high proportion of diet-related items is in line with the actual everyday concerns of parents. Parents may indeed have more concerns about feeding their child , whereas they may not have too many concerns about their child watching too much television  or not being physically active. Earlier studies even found that parents often do not know that watching too much television is related to the development of obesity [35, 36].
The LBC may also serve as a basis for an intervention or recruitment. It can be an important instrument to map parental problems, as it may also provide us with an opportunity to make parents aware of possible problems regarding to their children’s overweight. We know that the programs aimed at the prevention of obesity often struggle with recruitment problems [37, 38]. However, when parents themselves recognize their child’s overweight problems, they may be more willing to take action and participate in prevention programs.
Some strong and weak points of the current study should be acknowledged. A strong point of the current study was the quality of the translation process. Four experts independently translated the questionnaire and a qualitative pretest was used to optimize the translation. However, we did not back-translate the questionnaire, which could have had additional value to the translation process. We also evaluated test-retest reliability of the LBC questionnaire. Another strong point was the relatively large sample we were able to include in the current study, making it more likely that the results can be generalized to a larger population. We recruited participants via an internet-based survey, which is known for its access to hidden populations . Nevertheless, several groups of people were underrepresented compared to the general Dutch population, as parents with a low educational level, and parents of children with overweight and obesity were somewhat underrepresented. The present study lacked a test of other types of validity (e.g., discriminant validity), implying that we only partly showed evidence for the construct validity of the scale. Please note evidence for discriminant validity of the LBC has been provided in a previous study . It should also be noted that the response on the retest was relatively low, limiting external validity of the study. However, we tested whether drop-out was selective, which was not the case. Furthermore, weight and height measures were self-reported which may be a reason for the apparent lower child’s weight status in our sample, compared to the Dutch population .
We recommend that experts who develop and evaluate interventions to prevent and treat childhood obesity should also make use of measures of parents’ self-efficacy in managing their child’s energy balance-related behaviors, to assess changes in parental perceptions of their child’s weight-related problems. The LBC can be a reliable and valid instrument to assess these intermediate intervention outcomes.