Participants in the TEENS Talk study (N=20) were a subset of adolescent (aged 16‐18 y) and parent or caregiver dyads who completed the TEENS+ randomized clinical trial, a 4-month multicomponent IHBLT [40]. Parent adolescent dyads were randomized to one of two 4-month treatments in which parents were either engaged as helpers in their child’s weight management via parent skills training based on authoritative parenting or engaged in their own behavioral weight management. All adolescents received nutrition education with dietary goals, supervised physical activity, and behavioral support [40]. Families were eligible for TEENS Talk after completing the final 12-month follow-up assessment for TEENS+. During recruitment for this study, 41 TEENS+ families were eligible for participation, and 40 were approached (1 was not approached due to a parent moving out of the country and being unable to be contacted). Of those who were eligible, 5 declined and 15 were unresponsive to contact attempts or lost to follow-up. Exclusion criteria for the TEENS+ trial included type 2 diabetes and a history of metabolic and bariatric surgery. Detailed methods and procedures for the TEENS+ trial may be found elsewhere [40]. Following their 12-month follow-up assessments, TEENS+ participants were contacted by study staff via email and telephone and invited to participate in this qualitative study, with recruitment continuing until the target sample size was reached. The target sample size was informed by prior research and selected to ensure adequate data for achieving thematic saturation [41].

Trained interviewers conducted semistructured interviews via Zoom (Zoom Communications, Inc), with separate interviews for adolescents and parents. Interviews were approximately 50 minutes in duration (range 29-85 min for adolescent interviews; range 26-71 min for parent interviews). Adolescent participants were asked open-ended questions about their current health and weight management behaviors (eg, “What, if any, weight management behaviors are you working on now?”), perceived facilitators and barriers to engagement in health behaviors (eg, “What helps you keep up with weight management behaviors?”), the parental role and other support in health behaviors (eg, “What, if any, role do your parents play in supporting your weight management behaviors?”), and preferences for continued weight management support during the transition into emerging adulthood (eg, “Thinking about getting older and becoming a young adult, potentially living apart from your family, what do you think will help you set up your environment to make you successful with weight management behaviors?”). Parents were asked corresponding questions about their adolescents’ weight management behaviors, the parental role as their teen transitions to emerging adulthood (eg, “As your teen transitions from adolescence to young adulthood, how might your role providing support for weight management change?”), and ideas for additional support (eg, “Would you be interested in support as part of a specifically focused on teaching you strategies and how to provide support to your adolescent/young adult during this transition? If so, what topics would like to be covered?”). Interviews were audio recorded, transcribed verbatim, and checked for accuracy. The SRQR (Standards for Reporting Qualitative Research) guidelines (Checklist 1) [42] were followed for this manuscript.

All study procedures were approved by the Virginia Commonwealth Institutional Review Board (HM20022326). For parents and adolescents aged 18 years or older, written consent was obtained. For adolescents younger than 18 years of age, parental permission was obtained and adolescents provided verbal assent. All data in this study were deidentified before the coding process. Participating families were provided with a US $50 gift card, which was given to the parent, as compensation for their time.

A modified grounded theory approach combined with thematic analysis was used to guide qualitative coding [41], with the goal of identifying key themes and generating insights to inform future intervention development. Transcripts were reviewed and coded by the coding team, comprising a clinical psychologist (LC), postdoctoral fellows (KG and KT), and a graduate doctoral student (MW). Specifically, coding and theme development were conducted iteratively, beginning with open coding to capture emerging ideas, followed by grouping similar codes into broader themes. Themes were reviewed and refined through ongoing comparison within and between interviews. The coding framework included categories (eg, skills maintained, skills discontinued, facilitators, and barriers), codes, subcodes (when appropriate), and descriptions of codes and examples (when appropriate). The coding framework was updated as needed through team discussions to ensure clarity and consistency.

ATLAS.ti Qualitative Data Analysis Software (version 23) was used to apply codes to segments of the transcripts. Coders independently double-coded a subset of transcripts (20%, or 4 transcripts), which yielded high coder agreement (intraclass correlation coefficient>0.80), suggesting that independent coders were consistently applying the same codes to the same transcripts. The coding team then independently analyzed transcripts for adolescents and parents (separately). Any ongoing discrepancies in coding were discussed until resolved during weekly team meetings, and all disagreements were fully resolved through discussion. To enhance reflexivity and minimize bias, the team engaged in regular debriefings throughout data analysis to examine assumptions, question interpretations, and ensure that participant voices guided theme development. To enhance trustworthiness, multiple researchers independently reviewed and verified the findings. All transcripts and versions of the codebook were saved as separate documents to create an audit trail of changes.

The average adolescent age was 16.5 (SD 0.6) years and parent age was 48.4 (SD 6.9) years. The average BMI for adolescents at baseline in the TEENS+ trial was 34.98 (SD 6.5) kg/m². The average adolescent age of TEENS+ participants when they completed the IHBLT TEENS+ program was 14.8 (SD 1.11) years, with a range of 11 months to 2 years and 11 months since active treatment. See Table 1 for participant demographics. Overall themes identified were related to engagement in weight management behaviors (eg, skills maintained and discontinued, barriers and facilitators to weight management behaviors) and the support needed to engage in behavioral weight management during the transition to emerging adulthood.

Adolescents and parents described progress in adolescent weight management following the 4-month TEENS+ program. Subthemes emerged in the following categories related to engagement in weight management behaviors: (1) skills maintained, (2) skills discontinued, (3) facilitators of engagement in weight management, and (4) barriers to engagement in weight management.

Adolescents and parents described a variety of weight management skills, including exercise, nutrition, and self-regulation, that were maintained following the 4-month IHBLT treatment. The 5 most frequently maintained behaviors described by adolescents were: exercise, portion control, self-regulation or self-weighing, improved diet quality (eg, eating more healthy foods), and nutrition swaps. One adolescent described the importance of fitting exercise into their daily routine:

Adolescents and parents also described differences in maintaining weight-management behaviors, such that adolescents frequently noted that portion control was a behavior they had maintained, whereas parents commonly reported maintaining mindful choices about what to eat or buy. A parent described how they make mindful choices for their family: “We are definitely more aware and really just trying to stay away from the processed foods” (Parent ID 04, 48 y, female, African American or Black). See Table 2 for additional sample quotes.

Adolescents and parents also described discontinuing certain weight management behaviors following IHBLT treatment. The most common behavior that both adolescents and parents reported had ended was monitoring food intake (eg, logging or tracking food and counting calories). For example, adolescents described forgetfulness and low motivation as barriers to monitoring their food intake:

Other commonly discontinued skills reported by both adolescents and parents were exercise, self-weighing or self-regulation, and meal planning or preparation. Parents also described portion control as a skill that was difficult for their adolescents to maintain after the IHBLT program. One parent noted:

See Table 2 for additional sample quotes.

Adolescents and parents described several factors that facilitated ongoing weight management behaviors in Figure 1. For example, both highlighted the value of maintaining a consistent routine and having multiple opportunities for physical activity (eg, a yoga mat, a treadmill, or a gym membership). One adolescent emphasized how simplicity and consistency supported healthy eating:

Many parents described the intervention resources and materials as valuable supports for maintaining their own weight management behaviors and assisting their adolescent’s ongoing efforts. For example, “I think the TEENS program had given him the resources to make the decisions and [help him] practice the healthy lifestyle” (Parent ID 04, 48 y, female, African American or Black).

Adolescents also noted that their environment, including their home food environment, served as facilitators for their weight management. One adolescent described the importance of healthy food being easily available, “We have fruit sitting around the counter, so when you walk in you see them” (Teen ID 06, 16 y, female, African American or Black).

Adolescents and parents highlighted a range of challenges that hindered their ability to sustain weight management behaviors following the intervention, as shown in Figure 1. Prioritizing health behaviors and time management were frequently described as barriers to weight management for both adolescents and parents. For example, 1 adolescent described the issue of competing responsibilities as a barrier to meal preparation:

Other frequently described barriers for adolescents and parents include environmental factors (eg, working in fast-food service) and other family members’ behaviors (eg, parents or siblings are not focused on weight management). Parents also noted that adolescent food preferences, motivation, and energy were barriers. One parent stated, “I’ve been looking at menus because he’s a very picky eater, doesn’t like to try new things…so it’s kind of hard for me to find a new meal to offer up” (Parent ID 08, 65 y, female, White).

Adolescents and parents both anticipated numerous changes in weight management approaches as adolescents transitioned into emerging adulthood. Three subthemes emerged regarding perceived facilitators of weight management success in emerging adulthood: (1) growing autonomy, (2) continued development of relevant skills, and (3) reliance on peer and parent support.

Adolescents and their parents identified that the transition to emerging adulthood would require increased independence. Many adolescents expressed excitement over increases in their independence. For example, 1 adolescent noted that they were, “Really grateful that it is time to graduate [from high school] and move on, because it can give me more freedom” (Teen ID 03, 17 y, female, White). Other adolescents anticipated having some challenges associated with increased autonomy, with 1 adolescent describing, “I think my main worry is when you go to college…I have to make a lot of food decisions by myself” (Teen ID 12, 16 y, female, Asian). Parents also considered the impact of increases in their adolescents’ independence:

Parents expressed hopefulness that their adolescent would use this independence effectively, and that they would “Transfer these skills when I’m not around” (Parent ID 04, 48 y, female, African American or Black).

Adolescents and parents identified skills that would be necessary for an effective transition. They anticipated maintaining many of the skills they already possessed, including exercising, making healthy food choices, and maintaining healthy routines. One adolescent noted that he would need to “Just [keep] doing the same things I do now” (Teen ID 14, 16 y, male, Multiracial). Adolescents and parents also realized that there were multiple new skills they would have to learn. Participants recognized that the adolescent would need to take on some of the roles that the parent had previously held. For instance, 1 adolescent said, “The grocery thing was something I hadn’t thought of because that was something that my mom had learned about with the program, but that wasn’t a thing that stuck with me because it wasn’t relevant to me at the time” (Teen ID 07, 17 y, male, White). Adolescents also realized they would need to develop additional skills, such as time management and eating healthy while eating out, that would be particularly relevant to their life stage. For example, 1 adolescent said:

Although adolescents and parents both recognized a shift toward increased independence, they also recognized the importance of continued support from peers and family. Adolescents recognized that they would need support from “Friends that are doing the same thing” (Teen ID 19, 16 y, male, African American or Black) to ease their transition. They also anticipated needing support from family members. Adolescents hoped that their parents would take on more of a role in checking in or providing reminders. For instance, when asked how their parent could help, 1 teen stated, “They can just remind me to do it, encourage me to do it” (Teen ID 16, 16 y, male, White). Parents were also actively considering how their role might change. They acknowledged that they would continue to support their adolescent, but that:

Rather than providing instrumental support, like meal preparation and grocery shopping, they anticipated focusing on emotional support and reminders. One parent described their role as, “We have to make them feel like we’re here, we’re their safety net, we’re cheering them on, we’re always going to be in their corner” (Parent ID 05, 53 y, female, White).

Participants were asked about their interest in receiving support during emerging adulthood from a booster IHBLT program specifically designed to help them manage health goals as they transition into emerging adulthood. Most adolescent participants were interested in a booster program (n=13, 65% interested; n=5, 25% maybe interested; and n=2, 10% not interested). Participants described the topics they would like to address and their preferences for the structure of a potential booster program. See Table 3 for details.

Preferences for a booster program varied. Both parents and adolescents said that group accountability would be useful. Multiple adolescents expressed interest in including incentives, such as prizes, in the program. Both adolescents and parents identified opportunities for group exercise as being of great interest to them. Parents and adolescents also requested more cooking classes, which were a component of the original TEENS+ IHBLT program. Parents expressed interest in their adolescents having a professional to speak with about weight management, as they believed their adolescents were able to hear feedback from a professional more easily than from their parents. Preferences for the frequency and duration of sessions varied considerably (ie, group meetings 3 times a week or once a month and a program lasting 1 mo or 6 mo), as did the desire for in-person versus virtual sessions.