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Helping patients understand how their genetic makeup can contribute to disease risk may put them on the path to health. Advancements in genetic research have increasingly provided patients with more detailed information about their genetic makeup and potential disease risk. However, is simply knowing that one has an increased disease risk enough to change behavior?

A 2016 meta-analysis reviewed the impact of communicating genetic risks of disease on risk-reducing health behaviors.¹ Did awareness of increased genetic risk of developing lung cancer improve smoking cessation results? Did awareness of an increased genetic risk of developing diabetes motivate increased physical activity? The answers may come as a surprise. Researchers found that simply telling patients they were at high risk of disease based on their genotype had no significant effect on a variety of behavioral-based outcomes, including smoking, diet, physical activity, alcohol consumption, depression, and anxiety.¹ A 2018 meta-analysis focused on cancer risk studies also reported a similar disconnect between knowing disease risk and fully implementing modified health-related behaviors.²

Connecting Knowledge and Action

It often takes more than awareness of health risks for patients to make meaningful lifestyle changes. Collaborative patient-practitioner relationships and patient-centered health strategies that are driven by the patient’s values, needs, and goals help to connect knowledge and action. IFM educator David Rakel, MD, has researched the power of the therapeutic relationship to help change health outcomes. In the following video, he explains how this relationship can help improve health outcomes for patients struggling with depression

Lifestyle interventions may help prevent the development of chronic diseases and improve health,^3-8 yet their development and implementation may represent somewhat of a challenge, as many practicing clinicians have had little formal training in lifestyle counseling. A 2013 survey found that 71% of medical schools provide less than the recommended 25 hours of nutrition education, and 36% provide less than half that amount.⁹ In addition, despite the prevalence of obesity and overweight people in the US, only a minority of healthcare providers engage in lifestyle and weight loss counseling with their patients.^10,11

Recognizing the large impact from social and behavioral risks on health, the Association of American Medical Colleges in 2016 called for greater incorporation of behavioral and social sciences into medical school and training curricula, as well as for competencies related to behavior counseling.¹² A 2017 study indicates that US primary care clinicians may incorporate risk factor management and routinely ask about lifestyle habits.¹³ In addition, the United States Preventive Services Task Force currently encourages primary care physicians to offer intensive behavioral treatment, which includes lifestyle counseling, to all patients with obesity, either directly or by referral.¹⁴

Primary care physicians are ideally placed to address lifestyle risk factors with their patients, and functional medicine helps synthesize the latest medical research with a model of care that integrates lifestyle factors and focuses on developing the therapeutic relationship. Collaborative patient-practitioner partnerships are foundational in functional medicine, promoting a patient’s engagement and empowerment in their health journey and developing effective and sustainable treatment strategies. Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

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THE POWER OF PROCESS: CREATING POSITIVE OUTCOMES WITH DAVID RAKEL, MD

FUNCTIONAL MEDICINE RESEARCH: QUALITY OF LIFE, ITERATIVE HEALTH, AND THE THERAPEUTIC PARTNERSHIP

References

1. Hollands GJ, French DP, Griffin SJ, et al. The impact of communicating genetic risks of disease on risk-reducing health behavior: systematic review with meta-analysis. BMJ. 2016;352:i1102. doi:1136/bmj.i1102
2. Usher-Smith JA, Silarova B, Sharp SJ, Mills K, Griffin SJ. Effect of interventions incorporating personalised cancer risk information on intentions and behaviour: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2018;8(1):e017717. doi:1136/bmjopen-2017-017717
3. Marquis-Gravel G, Hayami D, Juneau M, et al. Intensive lifestyle intervention including high-intensity interval training program improves insulin resistance and fasting plasma glucose in obese patients. Prev Med Rep. 2015;2:314-318. doi:1016/j.pmedr.2015.04.015
4. Fianu A, Bourse L, Naty N, et al. Long-term effectiveness of a lifestyle intervention for the primary prevention of type 2 diabetes in a low socio-economic community – an intervention follow-up study on Reunion Island. PLoS One. 2016;11(1):e0146095. doi:1371/journal.pone.0146095
5. Su W, Chen F, Dall TM, Iacobucci W, Perreault L. Return on investment for digital behavioral counseling in patients with prediabetes and cardiovascular disease. Prev Chronic Dis. 2016;13:E13. doi:5888/pcd13.150357
6. Spassova L, Vittore D, Droste DW, Rösch N. Randomised controlled trial to evaluate the efficacy and usability of a computerised phone-based lifestyle coaching system for primary and secondary prevention of stroke. BMC Neurol. 2016;16:22. doi:1186/s12883-016-0540-4
7. Song HY, Nam KA. Effectiveness of a stroke risk self-management intervention for adults with prehypertension. Asian Nurs Res. 2015;9(4):328-335. doi:1016/j.anr.2015.10.002
8. Wadi NM, Asantewa-Ampaduh S, Rivas C, Goff LM. Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness. Public Health Nutr. 2022;25(2):422-436. doi:1017/S1368980021003682
9. Adams KM, Butsch WS, Kohlmeier M. The state of nutrition education at US medical schools. J Biomed Educ. 2015;2015:357627. doi:1155/2015/357627
10.  Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care. 2013;51(2):186-192. doi:1097/mlr.0b013e3182726c33
11.  Kahan SI. Practical strategies for engaging individuals with obesity in primary care. Mayo Clin Proc. 2018;93(3):351-359. doi:1016/j.mayocp.2018.01.006
12.  Aspry KE, Van Horn L, Carson JAS, et al. Medical nutrition education, training, and competencies to advance guideline-based diet counseling by physicians: a science advisory from the American Heart Association. Circulation. 2018;137(23):e821-e841. doi:1161/CIR.0000000000000563
13.  Johansson H, Weinehall L, Sorensen J, Dalton J, Jenkins P, Jerdén L. Lifestyle counseling in primary care – the views of family physicians in United States and Sweden: Helene Johansson. Eur J Public Health. 2017;27(Suppl 3):ckx189.078. doi:1093/eurpub/ckx189.078
14.  Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. Am Psychol. 2020;75(2):235-251. doi:1037/amp0000517