Intergenerational Transmission of Proactive Health Behaviors Among Adolescents with Overweight or Obesity: The Mediating Role of Self-Efficacy and Family Cohesion

<b>Background/Objectives:</b> The family environment exerts a significant influence on the development of weight-related behaviors among adolescents. However, the lack of motivation often leads to failure in sustaining health behaviors, particularly among adolescents with overweight and obesity. This study examined whether parental healthy behaviors are associated with proactive health behaviors among adolescents with overweight and obesity and investigated the mediating roles of adolescents' self-efficacy and family cohesion in these relationships within Chinese families. <b>Methods</b>: We recruited 4932 adolescents with overweight and obesity aged 10 to 15 in Shandong Province between October and December 2024. Participants completed validated questionnaires assessing parental healthy behaviors, self-efficacy, family cohesion, and proactive health behaviors. We analyzed the data using multilevel regression models and mediation analysis, controlling for key sociodemographic factors. Subgroup analyses were conducted by gender and region level. <b>Results</b>: Both fathers' (β = 0.442, 95% CI = 0.263, 0.620) and mothers' (β = 0.525, 95% CI = 0.336, 0.714) healthy behaviors were positively associated with proactive health behaviors among adolescents with overweight and obesity in the adjusted model. Further mediation analysis revealed that adolescent self-efficacy and family cohesion significantly mediated these relationships. <b>Conclusions</b>: This work suggested that parental healthy behaviors were positively associated with proactive health behaviors among adolescents with overweight and obesity. Additionally, higher self-efficacy and family cohesion enhance these associations. The findings offered evidence-based recommendations for creating family-centered interventions targeting adolescents with overweight and obesity. Future research should employ longitudinal designs to understand these relationships better and improve the efficacy of family-based interventions for adolescents with overweight and obesity.