Improving Family Functioning in Obesity Treatment for Mexican American Women

改善墨西哥裔美国妇女肥胖治疗中的家庭功能

• 批准号: 10470321
• 负责人: BECKY MARQUEZ
• 金额: $ 67.19万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-17 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10470321
• 关键词: Acculturation; Address; Adherence; Adoption; Adult; Adult Children; Affect; Age of Onset; Age-Years; Attitude; Behavior; Behavior Therapy; Behavioral; Belief; Body Weight Changes; Body Weight decreased; Body fat; Body mass index; Buffers; Child; Code; Collaborations; Communication; Competence; Conflict (Psychology); Counseling; Couples Therapy; Daughter; Diabetes Mellitus; Diet; Eating; Education; Effectiveness of Interventions; Emotional; Family; Family history of; Family member; Glycosylated hemoglobin A; Goals; Health Benefit; Health behavior; Individual; Intervention; K-Series Research Career Programs; Link; Literature; Maintenance; Mediation; Mental Depression; Mentors; Mexican Americans; Modification; Monitor; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Outcome; Outcome Study; Parent-Child Relations; Parents; Participant; Patient Self-Report; Pattern; Phase; Physical activity; Physiological; Prevalence; Prevention; Problem Solving; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Records; Reporting; Research; Risk; Role; Structure; System; Techniques; Testing; Training; Translating; Treatment outcome; Weight maintenance regimen; Well in self; Woman; base; behavior change; cohesion; commune; coping; depressive symptoms; diabetes management; diabetes risk; efficacy testing; expectation; experience; follow-up; improved; intergenerational; intervention effect; lifestyle intervention; member; novel; nutrition; obesity risk; obesity treatment; perceived stress; primary outcome; psychologic; secondary outcome; skills; skills training; success; treatment adherence; treatment disparity; waist circumference; weight loss intervention; weight maintenance; young adult

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.

概括 墨西哥裔美国妇女受到肥胖和与肥胖有关的状况的影响不成比例的 2型糖尿病。在墨西哥裔美国家庭中，肥胖和糖尿病是一致的。给了年轻人 有家族史的女性糖尿病的发病年龄，针对母亲及其成年女儿肥胖 需要治疗。从家庭系统的角度来看，肥胖治疗的家庭水平方法可以 改善体重管理行为的采用和维护。包括家庭成员 当墨西哥裔美国人认可高水平时，治疗也可能是一种文化上的显着干预策略 家族主义。与传统的肥胖治疗方法相反，一种家庭级别的方法 基于家庭主义将促进共同的目标，协作解决问题以及公共应对 彼此对待家人。使用时要考虑的重要结构 代际墨西哥裔美国家庭是适应的差异，这可能会转化为 态度和行为的差异。父母和孩子之间的适应性差距更大 与家庭功能较低有关（例如，沟通不力，冲突高，凝聚力低）。 但是，通过改变互动模式来促进双文化能力的干预措施已经存在 有效改善家庭功能。因此，这项研究将进行随机对照试验，以测试 行为体重管理干预措施的功效，对家庭进行简短和结构化的咨询 功能。墨西哥裔美国母亲和成人女儿（n = 118个二元组）将随机分配给 接受标准行为治疗（SBT）或标准行为治疗以及关系技能培训 （SBTR）。参加SBT或SBTR的二元组将参加营养和身体 活动教育以及行为修改技术。参加SBTR的二元组也将获得 基于体验的关系技能培训，从一般家庭系统概念和 行为家庭/夫妻治疗方法支持家庭主义，双文化主义和交流 能力。 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。主要结果是减肥。次要结果包括治疗依从性（会议 出勤率和自我监控记录），糖尿病风险的生理指标（血红蛋白A1C，腰部 周长和体内脂肪百分比），健康行为（饮食和体育锻炼），心理良好 存在（抑郁和感知的压力）和家庭功能（主观的自我报告和客观行为 编码）。预计SBTR组的二元组将在初级和次级方面取得更大的改善 结果比STB组。此外，通过家庭功能对干预效果的调解对初级 并将检查次要结果。