Improving Family Functioning in Obesity Treatment for Mexican American Women

摘要 墨西哥裔美国女性受肥胖和肥胖相关疾病的影响不成比例，例如 2型糖尿病。在墨西哥裔美国家庭中，肥胖和糖尿病是高度一致的。考虑到更年轻的 以母亲及其成年女儿为肥胖目标的有家族病史的妇女的糖尿病发病年龄 治疗是必要的。从家庭系统的角度来看，家庭层面的肥胖治疗方法可以 提高体重管理行为的采纳度和维持性。将家庭成员包括在 治疗也可能是一种文化上突出的干预策略，因为墨西哥裔美国人支持高水平 家庭主义。与传统的个人层面的肥胖治疗方法不同，家庭层面的方法 植根于家庭主义将促进共同目标、协作解决问题和共同应对 把家庭成员放在一起。在使用时需要考虑的一个重要构造 代际墨西哥裔美国家庭在文化适应方面的差异，这可能转化为 态度和行为上的差异。父母和孩子之间在文化适应方面的更大差距以前 与较低的家庭功能有关(例如，沟通不良、高冲突、低凝聚力)。 然而，通过改变互动模式来促进双文化能力的干预措施 有效地改善家庭功能。因此，本研究将进行随机对照试验，测试 对家庭实施行为体重管理干预的效果评价 功能正常。墨西哥裔美国母亲和成年女儿(n=118对)将被随机分配到 接受标准行为治疗(SBT)或标准行为治疗加人际关系技能培训 (SBTR)。参加SBT或SBTR的DYADS将参加每周24次的营养和体能课程 活动教育和行为矫正技术。参加SBTR的DUADS也将获得 基于经验的人际关系技能培训，借鉴一般家庭系统概念和 支持家庭主义、双文化主义和交流的行为家庭/夫妇治疗方法 能力。为期12个月的试验将包括干预阶段(1-6个月)和维护阶段 (7-12个月)。评估将在基线和干预和维护结束时进行 阶段。主要结果是体重减轻。次要结果包括治疗依从性(疗程 出勤和自我监测记录)、糖尿病风险的生理指标(血红蛋白A1c、腰围 周长、体脂百分比)、健康行为(饮食和体力活动)、心理健康- 存在(抑郁和感受到的压力)和家庭功能(主观自我报告和客观行为 编码)。SBTR组的DYAD预计将在小学和中学取得更大的进步 结果：STB组疗效优于STB组。此外，家庭功能调停对初中生的干预效果 并将对次要结果进行审查。

SUMMARY Mexican American women are disproportionately affected by obesity and obesity-related conditions, such as type 2 diabetes. Obesity and diabetes are highly concordant in Mexican American families. Given the younger age of onset of diabetes in women with familial history, targeting mothers and their adult daughters for obesity treatment is warranted. From a family systems perspective, family-level approaches to obesity treatment can improve the adoption and maintenance of weight management behaviors. Including family members in treatment may also serve as a culturally salient intervention strategy as Mexican Americans endorse high level of familism. In contrast to traditional individual-level approaches to obesity treatment, a family-level approach grounded in familism would promote shared goals, collaborative problem solving, and communal coping when treating family members alongside each other. An important construct to consider when working with intergenerational Mexican American families is differences in acculturation, which may translate into differences in attitudes and behaviors. A wider gap in acculturation between parent and child has previously been associated with lower family functioning (e.g., poor communication, high conflict, low cohesion). However, interventions that promote bicultural competence by changing interactional patterns have been effective at improving family functioning. Hence, this study will conduct a randomized control trial testing the efficacy of a behavioral weight management intervention with brief and structured counseling on family functioning. Mexican American mothers and adult daughters (n=118 dyads) will be randomly assigned to receive standard behavioral treatment (SBT) or standard behavioral treatment plus relationship skills training (SBTR). Dyads participating in SBT or SBTR will attend 24 weekly sessions focused on nutrition and physical activity education along with behavior modification techniques. Dyads participating in SBTR will also receive experiential-based relationship skills training that draws from both general family systems concepts and behavioral family/couples therapy approaches to support familism, biculturalism, and communication competencies. The 12-month trial will consist of an intervention phase (1-6 months) and a maintenance phase (7-12 months). Assessments will be conducted at baseline and at the end of the intervention and maintenance phases. The primary outcome is weight loss. Secondary outcomes include treatment adherence (session attendance and self-monitoring records), physiological indicators of diabetes risk (hemoglobin A1c, waist circumference, and body fat percentage), health behaviors (eating and physical activity), psychological well- being (depression and perceived stress), and family functioning (subjective self-report and objective behavioral coding). Dyads in the SBTR group are expected to achieve greater improvements in primary and secondary outcomes than the STB group. Additionally, mediation by family functioning of intervention effects on primary and secondary outcomes will be examined.