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For Patients, Knowing Disease Risk Is Not Enough

Knowing Disease Risk Is Not Enough

Helping patients understand how their genetic makeup can contribute to disease risk may put them on the path to health. Recently, it has become increasingly possible for clinicians to provide patients with detailed information about their genetic makeup and how their genes relate to disease risk. However, is simply knowing that one has an increased disease risk enough to change behavior?

In 2016, researchers asked the question: “Does communicating to smokers that they have an increased genetic risk of developing lung cancer motivate smoking cessation, or does telling middle aged people that they have an increased genetic risk of developing diabetes motivate increased physical activity to reduce this risk?”1 The answers, found in a large meta-analysis, may come as a surprise. While the saying may be “knowing is half the battle,” that also implies that there is another half left to go. It turns out that it often takes more than awareness of risk for patients to make meaningful lifestyle changes. 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 While knowing on its own may not be enough, other studies suggest that lifestyle interventions may help prevent the development of chronic diseases and improve health.2-7

IFM educator David Rakel, MD, has researched the power of the therapeutic relationship to help change outcomes. In the following video, he explains how this relationship, at times combined with pharmaceuticals, can improve health outcomes for patients struggling with depression.

David Rakel, MD, is the founder and director of the University of Wisconsin (UW) Integrative Medicine Program and associate professor with tenure in the Department of Family Medicine at the UW School of Medicine and Public Health.

 Yet while lifestyle modification represents a major target for improvement in patient health, it may also represent somewhat of a challenge as many clinicians may have had little formal training in lifestyle counseling. Recent research highlights this growing problem. 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.8 Despite the prevalence of obesity and overweight people in the US, lifestyle counseling centered on the critical risk factor of weight actually decreased in 2013 among US physicians.9

On the plus side, change may be on the horizon. 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.10 A 2017 study indicates that US primary care clinicians now work in a systematic way with risk factor management and routinely ask about lifestyle habits.11

Primary care physicians are ideally placed to address lifestyle risk factors with their patients, and Functional Medicine synthesizes the latest medical research with a model of care that integrates lifestyle factors. Guiding clinicians from intake through to outcomes, the Functional Medicine model creates a trajectory for effective, personalized outcomes. This unique framework provides clinicians with the tools needed to discover and address the root cause of disease and improve overall health. Learn more in the following IFM-authored articles.

Learn More About Functional Medicine

Science-based ways to overcome unhealthy eating habits

Improve health and longevity for your patients

Functional Medicine tools improve patient compliance

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. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. Pool AC, Kraschnewski JL, Cover LA, et al. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract. 2014;8(2):e131-139. doi:1016/j.orcp.2013.03.003
  8. Adams KM, Butsch WS, Kohlmeier M. The state of nutrition education at US medical schools. J Biomed Educ. 2015;357627:1-7. doi:1155/2015/357627
  9. 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
  10. 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
  11. 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). doi:1093/eurpub/ckx189.078

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