Improving Family Functioning in Obesity Treatment for Mexican American Women

总结 墨西哥裔美国妇女不成比例地受到肥胖和肥胖相关疾病的影响，例如 2型糖尿病肥胖和糖尿病在墨西哥裔美国人家庭中高度一致。鉴于年轻的 有家族史的女性糖尿病发病年龄，针对肥胖的母亲及其成年女儿 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 改善体重管理行为的采用和维持。包括家庭成员在内 治疗也可以作为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的 家庭主义。与传统的个人层面的肥胖治疗方法相比， 在家庭主义的基础上，将促进共同的目标，合作解决问题，并共同应对， 家人一起对待彼此。使用时要考虑的一个重要结构 代际墨西哥裔美国人家庭是在文化适应的差异，这可能会转化为 态度和行为的差异。父母和孩子之间文化适应的差距更大， 与较低的家庭功能有关（例如，沟通差、冲突大、凝聚力低）。 然而，通过改变互动模式来促进双文化能力的干预措施， 有效改善家庭功能。因此，本研究将进行随机对照试验， 行为体重管理干预结合简短结构化咨询对家庭的影响 功能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）或标准行为治疗加关系技能培训 （SBTR）。参加SBT或SBTR的双胞胎将参加每周24次的营养和体能训练课程， 活动教育沿着行为矫正技术。参加SBTR的Dyads还将获得 基于经验的关系技能培训，从一般家庭系统的概念， 行为家庭/夫妇治疗方法，以支持家庭主义，双文化主义和沟通 能力。为期12个月的试验将包括干预阶段（1-6个月）和维持阶段 (7-12月）。将在基线和干预及维持治疗结束时进行评估 阶段。主要结果是体重减轻。次要结局包括治疗依从性（会话 出勤和自我监测记录），糖尿病风险的生理指标（血红蛋白A1 c，腰围 腰围和体脂百分比），健康行为（饮食和身体活动），心理健康- 存在（抑郁和感知压力）和家庭功能（主观自我报告和客观行为 编码）。SBTR组中的二元组预计在初级和次级方面取得更大的改善， 结果优于STB组。此外，家庭功能干预对小学生心理健康的影响 并将检查次要结果。

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.