Researchers Awarded $2M Grant to Test Obesity Intervention for Hispanic Youths and Their Families

Public health researchers who developed the successful Familias Unidas intervention to prevent risky behavior among Hispanic youth are teaming up with obesity experts to determine if the program now operating in 24 Miami-Dade County middle schools can reduce obesity among Hispanic teens as effectively as it has reduced their sexually risky conduct and use of drugs, alcohol and cigarettes.

With a $2 million five-year grant awarded by the NIH’s National Institute on Minority Health and Health Disparities, Principal Investigators Guillermo “Willy” Prado, Ph.D., Miller Professor of Public Health Sciences and Director of the Division of Prevention Science and Community Health, and Sarah Messiah, Ph.D., M.P.H., research associate professor of pediatrics and public health sciences, will examine whether the addition of an obesity prevention component to the Familias Unidas curriculum can increase the physical activity and improve the diets of overweight Hispanic middle school students.

Built on the premise that adolescent problems can be resolved at home by capitalizing on the strong ties for which Hispanic families are known, Familias Unidas has reduced risky behaviors and sexually transmitted diseases among Hispanic youth by enhancing parental involvement, family cohesion, and parent-adolescent communication through small-group counseling sessions geared primarily toward their parents.

The obesity prevention program will use the same model, adding nutritionists and exercise physiologists to the mix. Over three months beginning in early 2014, parents will attend 12 weekly sessions, four of them with their children, to learn about the importance of eating healthy and staying active and how to help their children do both. In all, the investigators plan to enroll 280 adolescents and their families, half of whom will be randomized into Familias Unidas at their child’s school, and the other half to other community interventions.

Also on the research team are co-investigators Hilda Pantin, Ph.D., professor and Executive Vice Chair of Public Health Sciences who with Prado developed Familias Unidas, and Tracie L. Miller, M.D., professor of pediatrics and public health sciences, Director of the Division of Clinical Research, and co-director of the Miami Clinical and Translational Science Institute’s Miami Center for Research Participation and Partnership component. As Miller noted in organizing the first University-wide Obesity Symposium in 2011, the obesity epidemic affecting nearly one-third of adolescents in the U.S. is not merely a health problem. It must be tackled from environmental, social, cultural and other disciplines.

“This is a great example of the team science approach,” Prado said. “Hilda and I don’t have expertise in obesity, but by bringing our experience with family interventions together with Sarah and Tracie’s obesity expertise we have an opportunity to make a difference. It is a very good marriage between two groups. Without family involvement, obesity is hard to conquer.”

Much to their dismay, Prado and Messiah found few evidence-based obesity preventive interventions aimed at Hispanic youth, who largely due to diet and inactivity are more than twice as likely to be obese as their non-Hispanic white counterparts. There are even fewer programs that incorporate parental involvement as a central component, which, as Messiah says, “makes no sense.”

“We have unfairly criticized schools for the obesity epidemic, but at the end of the day children spend much more time at home and they are not the ones driving through fast-food lanes or buying groceries,” Messiah said. “The reality is that many children eat their best-quality meal, nutrient-wise, at school through the free and reduced lunch program and get their only physical activity in P.E. class. Those who bring lunch from home often have a can of soda, a bag of candy and a bag of chips. And when they go home they consume hundreds of calories in snacks while watching TV and playing video games. We can’t have an impact on the obesity epidemic without targeting the family unit.”

A Cuban-American who grew up in Miami, Prado knows firsthand the strength of Hispanic family ties. But he also knows the cultural tendency of many Hispanics to regard chubby babies as healthy and, conversely, to regard ideal-weight children as sickly. By the time he reached college, he was about 100 pounds overweight and on medications for hypertension.

“I was big most of my life,” Prado said. “To my family I was this cute, chubby kid. Then I starting eating right and going to the gym and lost all this weight. My blood pressure was finally normal, and my mom would tell me, ‘You look sick. Are you sure you are OK?’ Now she understands I am healthier.”

That is the kind of transformation Prado and Messiah hope Familias Unidas will help the parents of overweight adolescents make — not only for their children, but for themselves. While most parents who participated in the original Familias Unidas program aren’t grappling with substance or behavior problems of their own, Prado and Messiah recognize they are likely to be overweight and inactive themselves, which could make engaging them more difficult but, ultimately, more effective.

The researchers also are intrigued – and heartened – by an incidental finding of a prior Familias Unidas study that showed that middle schoolers who completed the program were significantly more active.

“We don’t know exactly why,” Prado said, “because we didn’t collect the data to really be able to answer that. But part of what precipitated this study was that serendipitous finding. We hypothesize that family involvement and family communication were key.”

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