OBESITY: A FAMILY SYSTEMS PERSPECTIVE

This study investigated the structure of the family system of obese girls between the ages of 11 and 14 who sought treatment at Children\u27s Hospital Weight Control Clinic, Boston. Five families were interviewed, once before and twice during treatment at the Clinic. All interviews were videotaped and analyzed by the researcher and two raters according to the family structural assessment format developed by Minuchin. The analyses revealed several trends in family structure. In each family there was unresolved marital conflict with the obese daughter in a conflict-diffusing role. One parent was obese and his/her obesity was an issue in the marriage. Interpersonal boundaries were diffuse, with a lack of perceived differences between obese parent and child. There were rigid boundaries between family and outside world. Subsystem boundaries were diffuse, with the obese child inappropriately involved in the marital relationship, in a cross-generational alliance with the obese parent or triangulation. There was no joint effective parental subsystem. There was low tolerance for conflict with a variety of conflict-avoiding and diffusing behaviors. Developmental stress, from the daughter\u27s adolescence and/or formation of a reconstituted family, was problematic. In four families diet prescription was followed by increased conflict and subsequent diet failure. One family responded to the diet with weight loss and change in family structure. The introduction of family systems theory as a new perspective on obesity provided understanding of its role as an integral part of family structure. In all families obesity served a protective function in maintaining the stability of the family system, and was in turn maintained by family transactional patterns. This study identified specific interactional patterns common to all five families. The findings were consistent with Minuchin\u27s (1978) profile of psychosomatic families. Obesity also served a specific function as a metaphor for marital problems. Recidivism and the development of chronicity were discussed. Suggestions for family treatment and future research were provided