What if your doctor could prescribe an effective diet program for you based on your DNA? Researchers are predicting that, in the future, using genomics to help individuals control their weight might become reality. If these predictions do come true, it will be important to have a ready evidence-base on how to best implement and communicate about genomic weight management approaches. Right now, however, important unanswered questions remain – how will incorporation of genomics in clinical encounters change patient experiences of the medical visit? How will these conversations change patient behavior? And will these effects be uniform among patients with different backgrounds and in different contexts?
Before we can answer these questions, we have to consider one that’s a little more technical – how should researchers investigate the outcomes of a clinical situation that isn’t happening yet? Some researchers are turning to virtual reality technology to do just that. Studies immerse patients in medical visits of the future to find out how they will respond.
Researchers from the National Human Genome Research Institute and National Cancer Institute took this approach to study the potential influence of discussing genomic factors in weight management in a virtual medical visit. In this study, researchers investigated patient reactions to receiving messages either about genomic or behavioral factors in weight during the visit. Previous research showed that patients trusted a virtual doctor more and perceived less weight stigma from him when he talked about genetics. This time, researchers also looked at how contextual and patient factors including patient race and emotion might influence patients’ interpretation of genomic information and their experience of the interaction with a White, male doctor. The researchers recruited 200 women affected by overweight and obesity and who racially identified as either White or Black. They explored patient response to the interaction by assessing body language and other implicitly-driven behaviors that can indicate patient engagement and positive versus negative feelings about the interaction.
This study showed that the patients’ responses to hearing about genomic factors in weight differed depending upon their race, and sometimes, on their emotional state as well. In the study, when the virtual physician presented information about genomics and weight, Black participants reported feeling more stigmatized by the virtual doctor and reported trusting him less. They also exhibited voice pitch changes that indicated less engagement in the interaction. Those Black participants who were also made to feel anger additionally increased their interpersonal distance (i.e., leaned away from the physician) during the encounter indicating further disengagement from the interaction. In contrast, White participants trusted the virtual doctor more and felt less stigmatized when he talked about genomic factors. These patterns are consistent with research showing that the historical context can predispose individual of Black or African-American backgrounds to perceive genetic information as evocative of stigma or race-based mistreatment, and thus feel more negatively about it.
What this tells us is that if and when doctors incorporate genomic information into weight management clinical interactions, the effects of this information will not be uniform, and in fact, it has the potential to be detrimental. We will need to pay close attention to contextual and patient factors to understand how these interactions will influence patient beliefs, experiences of the interaction, and ultimately, patient health. As always, more research is needed, but, at least to some extent, we may need to practice precision implementation of precision medicine.
Read the original article: Persky, S., Ferrer, R.A., & Klein, W.M. (2016). Nonverbal and paraverbal behavior in (simulated) medical visits related to genomics and weight: A role for emotion and race. Journal of Behavioral Medicine, 39, 804-814. DOI: 10.1007/s10865-016-9747-5