Question
What should nurses tell patients who blame their difficulties losing weight on their genes?
Answer
A recent article in The Daily Telegraph (Knapton, 2016) summarises the findings of a study published in the journal Nature Communications, which describes the identification of a defective gene that causes carriers to find fatty foods irresistible. The researchers found that carriers of the gene, MC4R, were able to detect the fat content of otherwise identical meals and ate significantly more of the one containing the greatest calorie content due to fat. Similar results were obtained testing deserts that were similar apart from increased calorific content due to sugar.
This and similar research presents nurses with responsibilities for supporting patients to lose weight with a dilemma. On the one hand, it could be argued that nurses have a professional responsibility to base advice on research based evidence (Nursing and Midwifery Council, (NMC) 2015:7), and there is no doubt that obesity and weight gain have a genetic component (summarised by Bray & Bouchard, 2014). Research also demonstrates that patients struggling with weight loss gain psychological benefit in the relief from the self-blame and guilt they feel when they struggle, if informed by testing that they have a genetic propensity towards weight gain (Meisel and Wardle, 2013).
On the other hand, it is important to remember that genetic components are only one factor that influences weight gain; environmental and behavioural factors also play a significant part (summarised by Mackenbach, 2016). This has significant implications for nurses involved in health promotion and those supporting weight loss who, when counselling patients who blame their genes for their difficulties in losing weight, could respond by advising patients that, although genes can have an influence, this doesn’t mean that their efforts to change their behaviour and environment are destined to fail. More usefully, nurses could use motivational interviewing techniques alongside exercise and dietary advice to provide patients with the emotional support needed to achieve and maintain a healthy weight (McHale et al., 2016) in addition to developing specific, personalised weight loss plans (Dombrowski et al., 2016).
References
Bray, G.A. and Bouchard, C. eds., 2014. Handbook of Obesity–Volume 2: Clinical Applications (Vol. 2). CRC Press.
Dombrowski, S.U., Endevelt, R., Steinberg, D.M. and Benyamini, Y., 2016. Do more specific plans help you lose weight? Examining the relationship between plan specificity, weight loss goals, and plan content in the context of a weight management programme. British Journal of Health Psychology.
Mackenbach, J.D., 2016. Exploring obesogenic environments: The role of environmental factors for obesity-related behaviours and obesity. (Doctoral Thesis) [online] available at http://dspace.ubvu.vu.nl/handle/1871/54633 accessed 8th October 2016
Meisel, S.F. and Wardle, J., 2014. ‘Battling my biology’: psychological effects of genetic testing for risk of weight gain. Journal of Genetic Counseling, 23(2), pp.179-186.
McHale, C.T., Laidlaw, A.H. and Cecil, J.E., 2016. Direct observation of weight-related communication in primary care: a systematic review. Family Practice, p.cmw045.
Nursing and Midwifery Council 2015. The Code: professional standards of practice and behaviour for nurses and midwives [online] available at https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf accessed 8th October 2016
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