If you’re responsible for a corporate health program, you’re no doubt looking for every opportunity to reduce the huge cost burden — both economic and human — of chronic disease associated with obesity.
Scientists agree that most obesity is multifactorial and caused by a complex web of interrelated biological, psychological and environmental factors. Considering the complexity of the processes through which people gain weight, and the extreme difficulty most experience in changing their behaviors and habits to lose it, corporate health programs need to use every tool in the toolbox. This includes genetics.
Genes influence healthy behaviors
Genes contribute to a variety of factors that lead to unhealthy lifestyles and obesity. This happens directly (by influencing how the body uses and stores energy) and indirectly (by influencing specific habits and behaviors).
Geneticists at Newtopia continue to perform exhaustive reviews of the scientific literature to identify consistent associations between candidate genes and relevant traits or behaviors that can be accompanied by actionable recommendations for the development of healthy behaviors and habits. To date, we have selected four genes to test for and incorporate into our habit change experience:
- MC4R (the appetite gene), which regulates how quickly a person feels full after eating
- DRD2 (the cravings gene), which influences reward-seeking behaviors such as the consumption of high-carb foods or alcohol, or emotional eating, in order to trigger the release of dopamine
- FTO (the fat gene), which influences how a person metabolizes fat
- BDNF (the resilience gene), which creates a protein associated with vulnerability to stress
Genetic testing supports the development of actionable recommendations that fit each individual’s specific needs. It’s why Newtopia is exploring new genes to further enhance and demystify our behaviors around sleep and activity.
How behavior genetics works in practice
Let’s take an example of a typical participant in a corporate health and well-being program. Maria is 52 years old, has a BMI of 28 (she’s 5 foot 5 inches tall and weighs 168 pounds) and has one health condition — high cholesterol, for which she’s taking a statin medication. She also has a family history of type 2 diabetes, so she’s been told to be mindful of her weight and lifestyle.
Her goals are to lose 18 pounds (to normalize her BMI to 25), reduce her diabetes risk, improve her cholesterol profile (and possibly get off the statin), and increase her energy and overall self-confidence.
Maria opts into the genetic testing component of the experience and provides a saliva sample using a simple cheek swab. Her test results show that she has variations of three of the four relevant genes — the appetite gene, the cravings gene and the fat gene.
Maria’s coach incorporates this information into her hyper-personalized habit change experience, addressing her delayed sense of feeling full with recommendations such as drinking a glass of water before a meal, filling her plate and immediately putting away the leftovers, and eating more slowly and mindfully to allow her brain to catch up to her stomach. He also helps her identify her triggers for emotional eating and suggests coping mechanisms such as calling a friend or engaging in healthier behaviors like going for a walk to help relieve stress. People with Maria’s variant of the fat gene respond better to a high-protein diet and higher-intensity exercise, so her coach works with her to develop a sustainable diet that is 40% protein, 30% carbs and 30% fats and helps her build up to exercising at 70%-80% of her maximum heart rate.
Enabling precision lifestyle medicine
This precision lifestyle medicine approach works. Research we recently presented to the American Society of Human Genetics highlights the measurable impact of including genetic testing in a corporate lifestyle-intervention program. At the end of 12 months, program participants who had opted into the genetic testing component had achieved 25% greater weight loss (an average of 4% versus 3.2%). They also had 1.3 times higher odds of meeting the critical weight loss threshold of 5% of body weight, which not only results in significant health benefits, but comes with a sharp reduction to the corporate health plan costs.
In some cases, the superior outcomes associated with genetic testing are due not only to the greater precision of the habit change interventions themselves but also to the increase in engagement triggered by the new knowledge. Many people who have given up trying to lose weight after too many unsuccessful efforts find the genetic information liberating. It gives them permission to stop blaming themselves for their weight struggles, leading to increased motivation and a stronger commitment to try again.
Not everyone will feel comfortable using their genetic information in this way, so it’s important to allow participants the opportunity to opt in at a later date — after they’ve established a trusted relationship with their Inspirator (health coach), for example. It’s also important to emphasize that the testing is about behavior genetics; this is aimed at helping people achieve their goals more quickly, not identifying predisposition to diseases. And, of course, all providers and labs must comply with the Genetic Information Nondiscrimination Act — so employers and health insurers will not have access to the test results.
Increasing the odds of success
Studies suggest that in some people, genetics may account for up to 80% of the predisposition to be overweight. Genetic predisposition is not destiny, though. People can change their habits and their future. Identifying the genetically influenced physiological mechanisms that push people to overeat, for example, can enable the creation of a more effective plan to counter those influences through behavior change.
Although genes are just one factor in the complex healthy lifestyle and weight-management equation, the science, and the outcomes both suggest that taking genetic influences into account can help increase the likelihood that corporate health program participants will be able to achieve meaningful, sustainable lifestyle and improvement that leads to long-term improvements in health.