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.