{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:00:48Z","timestamp":1785416448266,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020655","name":"European Health and Digital Executive Agency","doi-asserted-by":"crossref","award":["101079944"],"award-info":[{"award-number":["101079944"]}],"id":[{"id":"10.13039\/100020655","id-type":"DOI","asserted-by":"crossref"}]},{"award":["101079944"],"award-info":[{"award-number":["101079944"]}],"id":[{"id":"https:\/\/ror.org\/03xxypa75","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Childhood obesity is a complex public health issue in which parental perceptions and family dietary behaviors are pivotal. This study assessed the feasibility of the Smart Family lifestyle counseling intervention in Greek primary care. It explored changes in children\u2019s dietary behaviors relative to parental weight perception and Mediterranean diet adherence. Methods: A single-arm pretest\u2013posttest pilot study was conducted in Patras, Greece, from Health4EUKids Joint Action. The intervention consisted of four monthly face-to-face counseling sessions using the Smart Family methodology. In total, 49 parent\u2013child dyads (aged 2\u201312 years) completed the program. Data collection included child anthropometric measurements, validated food frequency questionnaires, parental perception of child weight status, and parental Mediterranean diet adherence. Results: Parents who underestimated their child\u2019s weight status had significantly higher Mediterranean diet scores than those who overestimated (p = 0.032); those with low adherence tended to overestimate and those with moderate adherence to underestimate. The largest reduction was observed for sweets and desserts (median \u22122.35 servings\/week), with significant reductions in sugar-sweetened beverages, grains and cereals, whole wheat products, and dairy. Fish and vegetable intake increased significantly, but fruit intake did not change. Changes in fast food and red meat differed significantly across Mediterranean diet score tertiles, with larger decreases in the lower tertiles. Conclusions: Smart Family counseling was feasible to deliver through trained healthcare professionals in Greek primary care over four months, with reductions in selected discretionary foods observed alongside the intervention. Parental weight perception and Mediterranean diet adherence emerged as potential barriers to change although the findings are exploratory and require confirmation in a future controlled trial.<\/jats:p>","DOI":"10.3390\/nu18121848","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:25:16Z","timestamp":1780935916000},"page":"1848","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Preliminary Dietary Outcomes of the Smart Family Lifestyle Counseling Intervention in Greek Primary Care: A Single-Arm Pilot Study from Health4Eukids"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6517-6857","authenticated-orcid":false,"given":"Emmanuella","family":"Magriplis","sequence":"first","affiliation":[{"name":"Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece"},{"name":"Laboratory of Public Health, Epidemiology and Quality of Life, Medical School, University of Patras, 26540 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niki","family":"Myrintzou","sequence":"additional","affiliation":[{"name":"Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5221-841X","authenticated-orcid":false,"given":"Ios-Ioanna","family":"Desli","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4095-6827","authenticated-orcid":false,"given":"Eleni","family":"Papachatzi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University General Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4411-3739","authenticated-orcid":false,"given":"Apostolos","family":"Vantarakis","sequence":"additional","affiliation":[{"name":"Laboratory of Public Health, Epidemiology and Quality of Life, Medical School, University of Patras, 26540 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025). Obesity and Overweight, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/pr.2015.208","article-title":"Biological, environmental, and social influences on childhood obesity","volume":"79","author":"Campbell","year":"2016","journal-title":"Pediatr. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1016\/S0140-6736(17)32129-3","article-title":"Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128\u00b79 million children, adolescents, and adults","volume":"390","author":"Abdeen","year":"2017","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1017\/S0007114508892471","article-title":"Influence of parental attitudes in the development of children eating behaviour","volume":"99","author":"Scaglioni","year":"2008","journal-title":"Br. J. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/S0031-3955(05)70347-3","article-title":"Family Environmental Factors Influencing the Developing Behavioral Controls of Food Intake and Childhood Overweight","volume":"48","author":"Birch","year":"2001","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e689","DOI":"10.1542\/peds.2013-2690","article-title":"Parental underestimates of child weight: A meta-analysis","volume":"133","author":"Lundahl","year":"2014","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/s12160-013-9587-2","article-title":"Parental Misperceptions of Children\u2019s Underweight Status: A Meta-analysis","volume":"48","author":"Lundahl","year":"2014","journal-title":"Ann. Behav. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s40519-017-0399-4","article-title":"Parental misperception of child\u2019s weight and related factors within family norms","volume":"24","author":"Hong","year":"2019","journal-title":"Eat. Weight. Disord.\u2014Stud. Anorex. Bulim. Obes."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1038\/ijo.2017.20","article-title":"Mothers\u2019 perceptions of child weight status and the subsequent weight gain of their children: A population-based longitudinal study","volume":"41","author":"Parkinson","year":"2017","journal-title":"Int. J. Obes."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s13679-019-00361-1","article-title":"Factors Influencing Parents\u2019 and Children\u2019s Misperception of Children\u2019s Weight Status: A Systematic Review of Current Research","volume":"8","author":"Blanchet","year":"2019","journal-title":"Curr. Obes. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s12519-022-00540-6","article-title":"Parental perception of child\u2019s weight, their attitudes towards child\u2019s dietary habits and the risk of obesity","volume":"18","author":"Berasaluce","year":"2022","journal-title":"World J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/ijo.2011.182","article-title":"Family-Based Behavioural Treatment of childhood obesity in a UK National Health Service setting: Randomised controlled trial","volume":"36","author":"Croker","year":"2012","journal-title":"Int. J. Obes."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ypmed.2016.02.027","article-title":"The effects of a 2-year individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet in children","volume":"87","author":"Viitasalo","year":"2016","journal-title":"Prev. Med."},{"key":"ref_14","first-page":"CD001871","article-title":"Interventions for preventing obesity in children","volume":"7","author":"Brown","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","unstructured":"Wang, Y., Wu, Y., Wilson, R.F., Bleich, S., Cheskin, L., Weston, C., Showell, N., Fawole, O., Lau, B., and Segal, J. (2013). Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1017\/S1368980011000905","article-title":"Parental eating attitudes and indicators of healthy eating in a longitudinal randomized dietary intervention trial (the STRIP study)","volume":"14","author":"Talvia","year":"2011","journal-title":"Public Health Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1093\/ije\/dyn072","article-title":"Cohort Profile: The STRIP Study (Special Turku Coronary Risk Factor Intervention Project), an Infancy-onset Dietary and Life-style Intervention Trial","volume":"38","author":"Simell","year":"2009","journal-title":"Int. J. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1161\/HYPERTENSIONAHA.120.15075","article-title":"Attainment of Targets of the 20-Year Infancy-Onset Dietary Intervention and Blood Pressure Across Childhood and Young Adulthood: The Special Turku Coronary Risk Factor Intervention Project (STRIP)","volume":"76","author":"Laitinen","year":"2020","journal-title":"Hypertension"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1038\/sj.ijo.0803249","article-title":"Development of overweight in an atherosclerosis prevention trial starting in early childhood. The STRIP study","volume":"30","author":"Hakanen","year":"2006","journal-title":"Int. J. Obes."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1186\/s41043-025-01132-6","article-title":"Childhood overweight and obesity survey: An overlooked public health issue","volume":"44","author":"Magriplis","year":"2025","journal-title":"J. Health Popul. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ."},{"key":"ref_22","first-page":"e288","article-title":"Repeatability and validity of a food frequency and dietary habits questionnaire in children","volume":"119","author":"Farajian","year":"2009","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.numecd.2005.08.006","article-title":"Dietary patterns: A Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk","volume":"16","author":"Panagiotakos","year":"2006","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bia\u0142ek-Dratwa, A., Szczepa\u0144ska, E., Szyma\u0144ska, D., Grajek, M., Krupa-Kotara, K., and Kowalski, O. (2022). Neophobia-A Natural Developmental Stage or Feeding Difficulties for Children?. Nutrients, 14.","DOI":"10.3390\/nu14071521"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1159\/000517586","article-title":"Parental Perceptions of Children\u2019s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015\/2017","volume":"14","author":"Buoncristiano","year":"2021","journal-title":"Obes. Facts"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"M\u00e4kel\u00e4, I., Koivuniemi, E., Vahlberg, T., Raats, M.M., and Laitinen, K. (2023). Self-Reported Parental Healthy Dietary Behavior Relates to Views on Child Feeding and Health and Diet Quality. Nutrients, 15.","DOI":"10.3390\/nu15041024"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1007\/s10995-013-1326-6","article-title":"Parental Perceptions and Childhood Dietary Quality","volume":"18","author":"Adamo","year":"2014","journal-title":"Matern. Child Health J."},{"key":"ref_28","first-page":"505","article-title":"Factors associated with successful dietary changes in an energy-reduced Mediterranean diet intervention: A longitudinal analysis in the PREDIMED-Plus trial","volume":"61","author":"Toledo","year":"2022","journal-title":"Eur. J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.nutres.2019.09.009","article-title":"High and moderate adherence to Mediterranean lifestyle is inversely associated with overweight, general and abdominal obesity in children and adolescents: The MediLIFE-index","volume":"73","author":"Katsagoni","year":"2020","journal-title":"Nutr. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"111834","DOI":"10.1016\/j.nut.2022.111834","article-title":"How do the home food environment, parenting practices, health beliefs, and screen time affect the weight status of European children? The Feel4Diabetes Study","volume":"103\u2013104","author":"Papamichael","year":"2022","journal-title":"Nutrition"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1017\/S1368980018000952","article-title":"Effectiveness of a parental school-based intervention to improve young children\u2019s eating patterns: A pilot study","volume":"21","author":"Rodrigues","year":"2018","journal-title":"Public Health Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1848\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:41:54Z","timestamp":1781325714000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18121848"],"URL":"https:\/\/doi.org\/10.3390\/nu18121848","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]}}}