Julia Lubsen

Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marjorie S. Rosenthal

Subject Area(s)

Medicine, Public health

Abstract

Background: Family functioning is a family's ability to communicate, solve problems, carry out tasks and support each other. Unhealthy family functioning may be a risk factor for obesity and non-adherence to treatment of chronic diseases. Fair Haven Community Health Center, a federally qualified health center in New Haven serving a patient population with high rates of obesity and diabetes, holds screenings for prediabetes and diabetes to identify patients who are eligible to participate in the family-based Diabetes Prevention Program (DPP) for prediabetic adults and the Bright Bodies (BB) program for overweight children.

Hypotheses: Unhealthy family functioning is associated with obesity and a diagnosis of prediabetes or diabetes at diabetes screenings. Unhealthy family functioning is associated with suboptimal enrollment, attendance, participation and weight loss in the DPP/BB program. The family-based DPP/BB program will improve family functioning.

Methods: We enrolled participants at diabetes screenings in an observational cohort study. To assess family functioning, we administered the General Functioning subscale of the McMaster Family Assessment Device (FAD-GF). We measured participants' BMI and performed metabolic testing, including 2-hour oral glucose tolerance testing. We followed participants for subsequent enrollment, participation and outcomes in the DPP/BB program.

Results: We enrolled 129 participants ages 13-73 at diabetes screenings. Just over half of participants (53%) had unhealthy family functioning, defined as a baseline FAD-GF score > 2.0. Participants with private insurance had healthier family functioning scores than participants with Medicaid (p = 0.012). Healthy family functioning was significantly correlated with higher BMI in adult participants, r (102) = -0.257, p = 0.009. There was no association between family functioning and a diagnosis of prediabetes or diabetes. In a small longitudinal sub-sample (n=14), participants with healthy family functioning lost significantly less weight during the program compared to participants with unhealthy family functioning (-0.61 + 3.83 lbs vs. -5.02 + 3.21 lbs), p = 0.042.

Conclusion: Unexpectedly, healthy family functioning may be a risk factor for adult obesity in this predominantly Latino and African-American population with high rates of obesity, and may be associated with barriers to successful weight loss in a lifestyle intervention program. Further research is necessary to validate our results and determine which factors related to families, food and culture might explain the link between healthy family functioning and obesity.

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This is an Open Access Thesis.

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