Unsupportive parenting moderates the effects of family psychosocial intervention on metabolic syndrome in African American youth

Abstract

Background/objective: Family relationships have been linked to obesity and related disorders in youth, but few studies have provided causal evidence of this association. This study tested the impact of a family psychosocial intervention on components of metabolic syndrome-a condition driven largely by abdominal obesity-in African American youth. In particular, the study tested whether effects were strongest among those who started at highest risk, that is, with high levels of unsupportive parenting at baseline.

Subjects/methods: Randomized clinical trial of a community sample of 391 African American youth (mean age=11.2 years) conducted in 2001-2002, with follow-up metabolic syndrome assessment in 2014-2015. Participants were assigned either to receive a weekly family intervention or to a control group. The primary study outcome was the number of components of metabolic syndrome that were clinically elevated at age 25, including central adiposity, blood pressure, triglycerides, glucose and low high-density lipoproteins. Unsupportive parenting was measured by questionnaires at baseline.

Results: Significant interaction effects were found between group assignment and baseline unsupportive parenting on counts of metabolic syndrome components in youth (beta=-0.17, P=0.03). Among those who started with higher levels of unsupportive parenting at age 11, participation in the family intervention reduced the number of clinically elevated components of the metabolic syndrome at age 25 relative to the control group. No such effect was seen among those who started with good parenting. Mediation analyses suggested that changes in the psychosocial targets of the parenting intervention partially accounted for the effects amongst those high in unsupportive parenting at baseline (effect size=-0.350, s.e.=0.178).

Conclusions: These findings suggest that efforts to improve family relationships may be able to ameliorate the detrimental effects that harsh and unsupportive parenting have on obesity-related outcomes such as metabolic syndrome in youth.

Figure 1

The effect of unsupportive parenting at age 11 on youths’ counts of metabolic syndrome components at age 25 by intervention status. Numbers in parentheses refer to simple slopes for the control group and the intervention (SAAF) group. Regions of significance analyses indicate that the differences between the intervention and control groups are significant above 1.2 standard deviations of unsupportive parenting.

Figure 2

A mediation model of intervention status, changes in the targets of the parenting intervention, and metabolic syndrome at age 25 among those who were high in unsupportive parenting (top 35%, N=137, 86 intervention, 51 control) at baseline. Family socioeconomic status, youth gender, youth depressive symptoms, life stressors, and unhealthy behaviors at age 25 were controlled (not shown). Pretest represents baseline values, and posttest represents values averaged post-intervention across ages 12, 13, 16, and 17. Unstandardized coefficients with bias-corrected and accelerated 95% confident intervals are presented. Indirect effect: −0.051, 95%CI [−0.150, −0.003].