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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?

Researchers have 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.¹ Behavior change is a complex process, and simply providing genetic risk information without incorporating a theoretical perspective on lifestyle modifications may diminish the potential impact.¹ Genetic information should be shared with patients in a way that promotes change and improves health outcomes.¹ For example, collaborative patient-practitioner relationships and patient-centered health strategies that are driven by the patient’s values, needs, and goals may help to connect this knowledge into 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.² 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.³ A 2017 study indicates that US primary care clinicians may incorporate risk factor management and routinely ask about lifestyle habits.⁴ 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.⁵

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.

Medical literature suggests that adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases like cancer, diabetes, and cardiovascular diseases.⁶ The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low-risk lifestyle factors in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low-risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low-risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. The low-risk lifestyle factors included: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (?30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).⁶

Functional Medicine Considerations

Establishing and maintaining a strong, empathic relationship with the patient may be the most crucial factor for his or her success in the long-term with lifestyle changes such as weight loss, tobacco cessation, and increased activity level.^7,8 It’s important to remember that patients with chronic conditions may already be overwhelmed by burdensome illnesses and treatments and have a difficult time incorporating behavioral modifications into their daily routine. Lifestyle goals and targets can be tailored to patients’ preferences and progress while building confidence in small steps.⁸

To this end, IFM practitioners utilize a Diet, Nutrition, & Lifestyle Journal found in the IFM Toolkit to identify areas where patients might modify their behavior to achieve positive outcomes. By examining lifestyle choices related to diet and exercise, functional medicine practitioners are able to assess the body’s complex physiological processes and suggest ways to decrease chronic disease risk.

Each day, the patient is asked to track their food and drink intake, as well as their quantity and quality of sleep and relaxation, exercise and movement, stress, and relationships. The bottom section of the journal asks patients to assess their mental, emotional, and spiritual states for each day. In order to track these factors over different periods of time, the Diet, Nutrition, & Lifestyle Journal is available in three versions: one-day, three-day, and seven-day.

Practitioners can use the information provided in the journal to create personalized recommendations specific to diet and lifestyle to help the patient change their habits for better health. Lifestyle goals and targets can be tailored to patients’ preferences and progress while building confidence in small steps. Patients who are mindful of their decision-making when it comes to lifestyle change, and who are more conscious of the benefits of changing an unhealthy behavior, may find it easier to adhere to clinician-prescribed behavior modification.

An individual’s health trajectory is influenced by a variety of factors—from the environment that surrounds them to the unique genetic and biochemical expressions of their DNA. A functional medicine approach can play a critical role in reversing chronic disease and supporting restorative wellness by providing personalized care.

Related Articles

Helping Patients Sustain Lifestyle Change With Team-Based Care

Lifestyle Interventions to Modify Cardiovascular Disease Risk

The Multidirectional Nature of Mental Illness, Chronic Disease, & Sleep

References

1. Driver MN, Kuo SI, Dick DM. Returning complex genetic risk information to promote better health-related behaviors: a commentary of the literature and suggested next steps. Transl Behav Med. 2023;13(2):115-119. doi:1093/tbm/ibac071
2. Sadiq IZ. Lifestyle medicine as a modality for prevention and management of chronic diseases. J Taibah Univ Med Sci. 2023;18(5):1115-1117. doi:1016/j.jtumed.2023.04.001
3. 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
4. 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
5. 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
6. Li Y, Schoufour J, Wang DD, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020;368:l6669. doi:1136/bmj.l6669
7. Brandt CJ, Søgaard GI, Clemensen J, Søndergaard J, Nielsen JB. Determinants of successful eHealth coaching for consumer lifestyle changes: qualitative interview study among health care professionals. J Med Internet Res. 2018;20(7):e237. doi:2196/jmir.9791
8. Brandt CJ, Clemensen J, Nielsen JB, Søndergaard J. Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study. BMJ Open. 2018;8(3):e017466. doi:1136/bmjopen-2017-017466