Can merely learning about obesity genes affect eating behavior?

The vices and virtues of medical models of obesity

Despite numerous public health organizations supporting the pathologization of obesity and considering recent obesity rates a health crisis, many researchers in the humanities, social sciences, and even in the health sciences remain unconvinced. In this paper, we address a set of arguments coming from these academic fields that criticize medical models of obesity for their supposedly flawed diagnostic categories that shift focus onto individuals and support moralizing judgements. Clarifying some key claims in these models and explicating the view of obesity in terms of energy dysregulation, we aim to tease apart misunderstandings and argue that not only do these models not say what they are often accused of saying, but their apparent vices may actually be virtues in helping to combat stigma. Building on the social psychology of stigma and disease labeling, we then suggest that current medical models are largely supportive of many moral and political aims promoted by critics of these models.

Schoolhouse risk: Can we mitigate the polygenic Pygmalion effect?

BACKGROUND

Although limited in predictive accuracy, polygenic scores (PGS) for educational outcomes are currently available to the public via direct-to-consumer genetic testing companies. Further, there is a growing movement to apply PGS in educational settings via 'precision education.' Prior scholarship highlights the potentially negative impacts of such applications, as disappointing results may give rise a "polygenic Pygmalion effect." In this paper two studies were conducted to identify factors that may mitigate or exacerbate negative impacts of PGS.

METHODS

Two studies were conducted. In each, 1188 students were randomized to one of four conditions: Low-percentile polygenic score for educational attainment (EA-PGS), Low EA-PGS + Mitigating information, Low EA-PGS + Exacerbating information, or Control. Regression analyses were used to examine differences between conditions.

RESULTS

In Study 1, participants randomized to Control reported significantly higher on the Rosenberg Self-Esteem Scale (RSES), Competence Scale (CS), Academic Efficacy Scale (AES) and Educational Potential Scale (EPS). CS was significantly higher in the Low EA-PGS + Mitigating information condition. CS and AES were significantly lower in the Low EA-PGS + Exacerbating information condition compared to the Low EA-PGS + Mitigating information condition. In Study 2, participants randomized to Control reported significantly higher CS and AES. Pairwise comparisons did not show significant differences in CS and AES. Follow-up pairwise comparisons using Tukey P-value correction did not find significant associations between non-control conditions.

CONCLUSION

These studies replicated the polygenic Pygmalion effect yet were insufficiently powered to detect significant effects of mitigating contextual information. Regardless of contextual information, disappointing EA-PGS results were significantly associated with lower assessments of self-esteem, competence, academic efficacy, and educational potential.

The undue influence of genetic information on senior medical students' treatment decisions

BACKGROUND

Knowledge of the genetic basis of health conditions can influence how the public perceives their own and others' health. When there are known genetic associations for such conditions, genetic essentialist biases facilitate deterministic thinking and an over-emphasis of genetic causality. This study investigates the role that genetic essentialist biases play in medical decision-making.

METHODS

Senior postgraduate medical students (N = 102) read a scenario in which a patient presents with gastroenterological symptoms. Half of the students were told that the patient tested positive for HLADQ2 - a gene implicated in, but not deterministic of, coeliac disease. The other half received no genetic information. Students were assessed on their recommendations for investigation and management using a multiple-choice questionnaire. Twenty-two of these students participated in a qualitative follow-up which used focus groups and semi-structured interviews to explore the reasoning behind students' responses.

RESULTS

Management recommendations differed between the two groups, with those receiving genetic information more likely to recommend a gluten free diet. Recommendations for further investigation did not differ significantly between groups. Interviews suggested that these findings arose despite the students' good understanding of the common non-deterministic nature of genes, such as HLADQ2.

CONCLUSION

Differences in management recommendations suggest that the inclusion of genetic information unduly biased students towards a premature diagnosis of a serious health condition, coeliac disease. Follow-up interviews introduced the possibility that observed manipulation-based differences may have been based on anticipated expectations of examiners, rather than perceived future clinical practice. Based on the present results it is unclear whether intentional exam-taking strategies fully account for medical students' decisions, or if they contribute in addition to the activation of genetic essentialist biases. Further research in clinical settings may ascertain whether genetic essentialist biases would truly influence medical student and doctors within their clinical practice environment.

Biobehavioral susceptibility for obesity in childhood: Behavioral, genetic and neuroimaging studies of appetite

Modern food environments are conducive to overeating and weight gain, but not everyone develops obesity. One reason for this may be that individuals differ in appetitive characteristics, or traits, that manifest early in life and go on to influence their behavioral susceptibility to gain and maintain excess weight. Classic studies showing that eating behavior in children can be measured by behavioral paradigms such as tests of caloric compensation and eating in the absence of hunger inspired the development and validation of psychometric instruments to assess appetitive characteristics in children and infants. A large body of evidence now suggests that food approach traits increase obesity risk, while food avoidant traits, such as satiety responsiveness, decrease obesity risk. Twin studies and genetic association studies have demonstrated that appetitive characteristics are heritable, consistent with a biological etiology. However, family environment factors are also influential, with mounting evidence suggesting that genetic and environmental risk factors interact and correlate with consequences for child eating behavior and weight. Further, neuroimaging studies are revealing that individual differences in responses to visual food cues, as well as to small tastes and larger amounts of food, across a number of brain regions involved in reward/motivation, cognitive control and other functions, may contribute to individual variation in appetitive behavior. Growing evidence also suggests that variation on psychometric measures of appetite is associated with regional differences in brain structure, and differential patterns of resting state functional connectivity. Large prospective studies beginning in infancy promise to enrich our understanding of neural and other biological underpinnings of appetite and obesity development in early life, and how the interplay between genetic and environmental factors affects appetitive systems. The biobehavioral susceptibility model of obesity development and maintenance outlined in this narrative review has implications for prevention and treatment of obesity in childhood.

Psychological Pathways Through Which Social Norms and Social Identity Influence Eating Behavior: Testing a Conceptual Model

BACKGROUND

Although interventions frequently promote healthy eating, failing to consider psychosocial factors, such as social norms, may limit the effectiveness of these efforts. Perceived social norms are a well-documented determinant of eating behavior; however, there is limited understanding of the processes through which, and for whom, this relationship emerges. Using identity-based motivation as a theoretical framework, we present a conceptual model identifying one route through which descriptive social norms-beliefs about how others behave-predict eating behavior, and test whether this process varies across social identities (e.g., self-perceived weight status).

METHOD

Structured telephone interviews were conducted for a national sample of non-diabetic adults who identified as non-Hispanic White, non-Hispanic Black, or Mexican American (n = 990).

RESULTS

Multigroup SEM analysis comparing individuals who self-identified as overweight (versus "about the right weight" and underweight) demonstrated that perceiving descriptive social norms that people do not eat healthy foods predicted greater perceived barriers to eating healthy foods. Perceived barriers, in turn, predicted stronger beliefs that body weight is uncontrollable, and this relationship was stronger for participants who self-identified as overweight (relative to participants who did not identify as overweight). These beliefs subsequently predicted greater self-reported consumption of unhealthy foods (e.g., sweets), but did not predict consumption of fruits or vegetables.

CONCLUSIONS

This study extends our understanding of a psychosocial process that predicts consumption of unhealthy foods and underscores the importance of social identities for shaping responses to perceived norms.

Acceptability of predictive testing for ischemic heart disease in those with a family history and the impact of results on behavioural intention and behaviour change: a systematic review

BACKGROUND

Tests to predict the development of chronic diseases in those with a family history of the disease are becoming increasingly available and can identify those who may benefit most from preventive interventions. It is important to understand the acceptability of these predictive approaches to inform the development of tools to support decision making. Whilst data are lacking for many diseases, data are available for ischemic heart disease (IHD). Therefore, this study investigates the willingness of those with a family history of IHD to take a predictive test, and the effect of the test results on risk-related behaviours.

METHOD

Medline, EMBASE, PsycINFO, LILACS and grey literature were searched. Primary research, including adult participants with a family history of IHD, and assessing a predictive test were included. Qualitative and quantitative outcomes measuring willingness to take a predictive test and the effect of test results on risk-related behaviours were also included. Data concerning study aims, participants, design, predictive test, intervention and findings were extracted. Study quality was assessed using the Standard Quality Assessment Criteria for Evaluating Research Papers from a Variety of Fields and a narrative synthesis undertaken.

RESULTS

Five quantitative and two qualitative studies were included. These were conducted in the Netherlands (n = 1), Australia (n = 1), USA (n = 1) and the UK (n = 4). Methodological quality ranged from moderate to good. Three studies found that most relatives were willing to take a predictive test, reporting family history (n = 2) and general practitioner (GP) recommendation (n = 1) as determinants of interest. Studies assessing the effect of test results on behavioural intentions (n = 2) found increased intentions to engage in physical activity and smoking cessation, but not healthy eating in those at increased risk of developing IHD. In studies examining actual behaviour change (n = 2) most participants reported engaging in at least one preventive behaviour, particularly medication adherence.

CONCLUSION

The results suggests that predictive approaches are acceptable to those with a family history of IHD and have a positive impact on health behaviours. Further studies are needed to provide a comprehensive understanding of predictive approaches in IHD and other chronic conditions.

Genetic Risk Information Influences Risk-Taking Behavior

Research indicates that people will behave in ways that are consistent with the genes they believe they possess. We examined this tendency in the context of risk-taking. We predicted that bogus genetic testing results indicating a propensity for risk-taking would cause participants to demonstrate riskier behavior. Participants submitted saliva tests and were randomly assigned to receive bogus genetic feedback indicating high propensity or low propensity for risk-taking. They then completed a standardized measure of risk-taking behavior. Results showed that those who received feedback indicating they were genetically disposed to risky behavior demonstrated higher risk-taking behavior than those who received feedback indicating that they were genetically disposed to risk aversion. These findings extend work on genetic feedback effects to a new domain and further reveal the ways that genetic feedback shapes behavior independent of one's actual genetic propensities.

Is obesity in the brain? Parent perceptions of brain influences on obesity

Neuroimaging studies demonstrate associations of brain structure and function with children's eating behaviour and body weight, and the feasibility of integrating brain measures into obesity risk assessment and intervention is growing. However, little is known about lay perceptions of how the brain influences obesity. We investigated parent perceptions of brain contributions to obesity in three separate studies: 1) a study of mothers of adolescents recruited for neuroimaging research (n = 88), 2) a study of ethnically Chinese parents of 5-13 year olds participating in a parent feeding survey (n = 277), and 3) a study of parents of 3-15 year olds completing an online survey (n = 113). In general, parents believed that brain factors influence obesity, but considered them less influential than behaviours such as diet and exercise. Causal attributions for brain factors were correlated with attributions for genetic factors and biological factors (e.g., metabolism). Parents who perceived their child to be overweight or had a high concern about their child becoming overweight in the future rated brain factors as more important in determining their child's weight and more likely to lessen their child's ability to control their weight. Our results suggest that parents attribute obesity to the brain to a moderate degree, and that education or feedback regarding brain influences on obesity could be a promising obesity intervention component.

The symptom discounting effect: what to do when negative genetic test results become risk factors for alcohol use disorder

Most consumers of genetic testing for health conditions test negative, yet the psychological perils of this are hardly known. In three experiments (N = 2103) participants discounted repercussions of alcohol use disorder (AUD), after learning or imagining that they were not genetically predisposed to AUD. Such discounting can lead people to avoid treatment and to feel safe to continue or even increase their drinking, ironically turning the negative genetic feedback into a risk factor for AUD. Concerningly, the debriefing currently used by a direct-to-consumer genetic testing company failed to counteract this discounting among those already engaging in problematic drinking in all three studies. It was hypothesized that this discounting derives from not understanding the Causal Markov condition; once AUD symptoms are present, their ramifications remain the same regardless of whether genes or environmental factors caused the symptoms. Educating participants about this principle successfully mitigated the irrational discounting of threats of AUD.

The role of genetic essentialism and genetics knowledge in support for eugenics and genetically modified foods

People are regularly exposed to discussions about the role of genes in their lives, despite often having limited understanding about how they operate. The tendency to oversimplify genetic causes, and ascribe them with undue influence is termed genetic essentialism. Two studies revealed that genetic essentialism is associated with support for eugenic policies and social attitudes based in social inequality, and less acceptance of genetically modified foods. These views about eugenics and genetically-modified foods were especially evident among people who had less knowledge about genes, potentially highlighting the value of education in genetics.

Impact of diagnostic labels and causal explanations for weight gain on diet intentions, cognitions and emotions: An experimental online study

Disease labels and causal explanations for certain symptoms or conditions have been found to have both positive and negative outcomes. For example, a diagnosis of polycystic ovary syndrome could conceivably motivate a person to engage in weight management, which is the recommended first line treatment. Furthermore, doctors may feel more comfortable discussing weight when linked to a medical condition. However, such a diagnosis may elicit feelings of increased anxiety, perceived severity and reduced sense of control. Mixed findings are also evident for impacts of genetic explanations on psychosocial outcomes and behaviours. Using hypothetical scenarios presented in an online survey, participants were asked to imagine that they were visiting their general practitioner due to experiencing weight gain, irregular periods, and more pimples than usual. Participants were randomised to receive different diagnostic labels ('polycystic ovary syndrome', 'weight' or no label/description) and causal explanations (genetic or environmental) for their symptoms. Primary outcomes assessed included intention to eat a healthier diet and perceived personal control of weight (average score on scale 1-7 across 3 items). Secondary outcomes included weight stigma, blameworthiness, worry, perceived severity, self-esteem, belief diet will reduce risks and menu item choice. Participants were 545 females aged 18-45 years (mean = 33 years), living in Australia, recruited through a national online recruitment panel. The sample was overweight on average (BMI = 26.5). Participants reporting a PCOS diagnosis were excluded from analyses. We found no main effects of the label or explanation on intention to eat healthier or perceived personal control of weight. For secondary outcomes, those given the genetic explanation reported higher weight stigma (range 1-7; MD = 0.27, 95%CI: 0.011,0.522), greater worry (range 1-7; MD = 0.27, 95%CI: 0.037,0.496), lower self-esteem (range 10-40; MD = 1.26, 95%CI: 0.28 to 2.24) and perceived their weight as more severe (range 1-7; MD = 0.28; 95%CI: 0.05,0.52) than those given the environmental explanation, averaged over disease label given. These findings further highlight the deleterious effects of genetic explanations on psychosocial outcomes and reinforce the need for caution when communicating the aetiology of weight-related health issues.

Benefits and Harms of Hypertension and High-Normal Labels: A Randomized Experiment

BACKGROUND

Recent US guidelines lowered the threshold for diagnosing hypertension while other international guidelines use alternative/no labels for the same group (blood pressure [BP], <140/90 mm Hg). We investigated potential benefits and harms of hypertension and high-normal BP labels, compared with control, among people at lower risk of cardiovascular disease.

METHODS

We conducted a randomized experiment using a national sample of Australians (n=1318) 40 to 50 years of age recruited from an online panel. Participants were randomized to 1 of 3 hypothetical scenarios where a general practitioner told them they had a BP reading of 135/85 mm Hg, using either hypertension/high-normal BP/control (general BP description) labels. Participants were then randomized to receive an additional absolute risk description or nothing. Primary outcomes were willingness to change diet and worry. Secondary outcomes included exercise/medication intentions, risk perceptions, and other psychosocial outcomes.

RESULTS

There was no difference in willingness to change diet across label groups (P=0.22). The hypertension label (mean difference [MD], 0.74 [95% CI, 0.41-1.06]; P<0.001) and high-normal BP label (MD, 0.45 [95% CI, 0.12-0.78]; P=0.008) had increased worry about cardiovascular disease risk compared with control. There was no evidence that either label increased willingness to exercise (P=0.80). However, the hypertension (MD, 0.20 [95% CI, 0.04-0.36]; P=0.014), but not high-normal label (MD, 0.06 [95% CI, -0.10 to 0.21]; P=0.49), increased willingness to accept BP-lowering medication compared with control. Psychosocial differences including lower control, higher risk perceptions, and more negative affect were found for the hypertension and high-normal labels compared with control. Providing absolute risk information decreased willingness to change diet (MD, 0.25 [95% CI, 0.10-0.41]; P=0.001) and increase exercise (MD, 0.28 [95% CI, 0.11-0.45]; P=0.001) in the hypertension group.

CONCLUSIONS

Neither hypertension nor high-normal labels motivated participants to change their diet or exercise more than control, but both labels had adverse psychosocial outcomes. Labeling people with systolic BP of 130 to 140 mm Hg, who are otherwise at low risk of cardiovascular disease, may cause harms that outweigh benefit. Registration: URL: http://www.anzctr.org.au/; Unique identifier: ACTRN12618001700224.

Experimental Examination of Social Transmission of Health Information using an Online Platform

The "viral" nature of information transmission has the potential to transmit both accurate and inaccurate information. The present experiment examines the social transmission of health information, focusing on disorder etiology. Participants were placed in one of three generations of social transmission chains. The first generation read information concerning one of four fictitious disorders, pairing one disorder (Physiological or Psychological) with one etiology (Genetic or Environmental). Then, to ensure minimal loss of information (which is common in open-ended recollections), participants recalled key aspects of the disorders through multiple-choice questions. Their selections were used to modify the vignettes for the second generation and the third generation read the second's recollections. All participants also evaluated diagnosed patients on social distance and disgust. Findings suggest that genetic etiology was better recalled when paired with a psychological disorder than a physiological one. Participants desired more social distance from psychological disorders' patients (regardless of etiology) and showed higher disgust for environmental etiological patients (regardless of disorder). Implications focus on the role of content biases in the transmission of health information and misinformation.

Exploring people's thoughts about the causes of ethnic stereotypes

Much research has shown that people tend to view genes in rather deterministic ways—often termed genetic essentialism. We explored how people would view the causes of ethnic stereotypes in contexts where human genetic variability was either emphasized or downplayed. In two studies with over 1600 participants we found that people viewed ethnic stereotypes to be more of a function of underlying genetics after they read an article describing how ancestry can be estimated by geographic distributions of gene frequencies than after reading an article describing how relatively homogeneous the human genome was or after reading a control essay. Moreover, people were more likely to attribute ethnic stereotypes to genes when they scored higher on a measure of genetic essentialism or when they had less knowledge about genes. Our understanding of stereotypes is a function of our understanding of genetics.

Genetic essentialism: The mediating role of essentialist biases on the relationship between genetic knowledge and the interpretations of genetic information

PURPOSE

Genetic research, via the mainstream media, presents the public with novel, profound findings almost on a daily basis. However, it is not clear how much laypeople understand these presentations and how they integrate such new findings into their knowledge base. Genetic knowledge (GK), existing causal beliefs, and genetic essentialist tendencies (GET) have been implicated in such processes; the current study assesses the relationships between these elements and how brief presentations of media releases of scientific findings about genetics are consumed and affect the readers.

METHODS

An Australian national survey of GK, GET, and existing causal beliefs about health phenomena (heart disease and obesity) was conducted. Participants were also exposed to news headlines that offered genetic and non-genetic partial explanations of the same health phenomena and reported their evaluations of these headlines, as well as the effects of the headlines on their personal understanding of the health phenomena.

RESULTS

GK was negatively-associated with GET. Whereas GK did not directly predict the evaluation and effects of the genetic headlines, GET did. GK predicted the effects of the headlines indirectly via GET and via GET and existing causal beliefs.

CONCLUSION

GET seem to predict unwarranted effects of exposure to news headlines about genetic science, whereas GK seems to indirectly mitigate the same unwarranted effects.

Investigating the Efficacy of Genetic, Environmental, and Multifactorial Risk Information When Communicating Obesity Risk to Parents of Young Children

BACKGROUND

Effectively communicating with parents about children's obesity risk is of critical importance for preventive medicine and public health.

PURPOSE

The current study investigates the efficacy of communications focused on two primary causes of obesity: genes and environment.

METHODS

We compared parental feeding responses to messages focused on (i) genetics alone, (ii) family environment alone, (iii) genetics-family environment interaction (G × FE), and (iv) no causal message. We also examined whether parental guilt mediates the effect of message type on feeding. Our sample consisted of 190 parents, half mothers and half fathers, of children 3-7 years old. After receiving one of the four types of messages, parents chose foods for their child using the Virtual Reality Buffet measure. Parents responded to questionnaires in the lab and at 1-week follow-up.

RESULTS

In the VR Buffet, parents did not feed their children differently in message provision conditions versus control. There were, however, differences among message provision conditions wherein mothers who received any genetic information chose higher-calorie meals in the VR Buffet. At 1-week follow-up, parents who received information about genetics alone reported feeding their child more junk food and fatty meat on self-report food frequency assessments; there were no such differences for sugary beverages, sugary foods, or fast foods. Parental guilt was typically higher for participants who received family environment information alone but did not mediate the relation between information provision and feeding outcomes.

CONCLUSIONS

While none of the messages improved feeding above the control condition, GxFE messages were associated with a better overall profile of outcomes. As such, it may be beneficial for messaging for parents about children's obesity risk to include content that reflects the complexity of genetic and environmental contributions to obesity risk.

Making Sense of Genetics: The Problem of Essentialism

"Psychological essentialism" refers to our tendency to view the natural world as emerging from the result of deep, hidden, and internal forces called "essences." People tend to believe that genes underlie a person's identity. People encounter information about genetics on a regular basis, as through media such as a New York Times piece "Infidelity Lurks in Your Genes" or a 23andMe commercial showing people acquiring new ethnic identities as the result of their genotyping. How do people make sense of new scientific findings that are inherently complex if they don't have years of specialized training and education at their disposal? Given the substantial overlap between a lay understanding of genetics and lay intuitions about essences, we argue that, when most people are thinking about genes, they are not really thinking about genes in the complex ways that good scientists are. Combating people's essentialist biases can be a formidable challenge. Although we have identified some promising results of trying to reduce people's genetic essentialist tendencies, there is still much to learn about how these essentialist biases can be countered. It is important to help people understand genetic information so they are able make well-informed decisions about their lives.

Illness representations among adolescents with attention deficit hyperactivity disorder: associations with quality of life, coping, and treatment adherence

Research into the causes and outcomes of attention deficit hyperactivity disorder (ADHD) has been extensive, yet little is known about the perception of ADHD as a disorder and its related outcomes among diagnosed youth. The present study applied the Common-Sense Model of Illness Representations (CSM) to examine the perception of ADHD and its association with quality of life (QoL), coping strategies, and treatment adherence among 63 diagnosed adolescents (10-18 years). Adolescents recruited from clinics, parent support groups, and an educational service completed self-report measures of the key constructs. Results indicated that adolescents generally perceive their ADHD as mildly threatening; four illness beliefs (perceived impact, personal control, timeline, and coherence) are significant predictors of coping and four (perceived impact, causes, personal control, and treatment control) are that of QoL. Adolescents who perceived minimal impact, expected longer duration, had strong sense of coherence, and believed in personal control of ADHD coped with the disorder more actively. Those who made weaker attribution to psychological and environmental causes, believed in personal control and the effectiveness of behavioral treatment enjoyed better QoL. In addition, female adolescents seem to experience more difficulties in the management of ADHD than male counterparts. These findings have potentially important clinical implications, suggesting that perceptions of ADHD related to the disorder's impact, duration, coherence, and personal control, may be important for clinicians to address when caring for adolescents with the disorder.

Cognitive and Affective Responses to Mass-media Based Genetic Risk Information in a Socio-demographically Diverse Sample of Smokers

Many individuals receive information about genomics from the mass media. When media reports are about conditions that are considered behavioral, such as smoking, they may negatively affect some health-promoting cognitions. We examined how informing adult smokers about the genetic basis for nicotine addiction influenced smoking-related health cognitions and affect and whether responses varied by socio-demographics or genetics beliefs. We recruited 392 smokers (Mage = 44.5, 52.8% African American, 51.3% no college experience, 66.2% women) from public locations in a mid-sized Midwestern city. They were randomly assigned to read a news article describing either a pharmacy's decision to stop selling tobacco (n = 78) or the discovery of a gene associated with increased risk of nicotine addiction and lung cancer (n = 314). Participants also completed a survey assessing socio-demographics, health cognitions (quit intentions, self-efficacy, response efficacy, perceived risk), affect (worry, anticipated regret), genetic determinism, and other genetics beliefs. ANOVAs revealed no statistically significant main effects of genetic information on any health cognitions or affects. Linear regressions revealed that socio-demographics and genetics beliefs moderated very few effects. This suggests that concerns that mass media-based dissemination of genetic discoveries may have detrimental effects on smoking-related cognitions and affects are likely unwarranted.

Transmission of disorder and etiological information: Effects on health knowledge recollection and health-related cognition

Biased transmission of health knowledge has far-reaching effects on information reproduction and health-related cognitions. We examined whether transmissions of different types of disorder and etiological information influence recollections of health knowledge and evaluations of patients, by simulating the digital transmission of information. Transmission chains of four non-interacting persons (i.e., four generations) were formed. The first generation read three vignettes describing fictitious patients with one of three disorders (physiological, psychological, culture-bound) uniquely paired with one of three etiologies (genetic, environmental, unknown etiology). Next, they evaluated patients’ well-being, rated desired social distance, and recalled the vignettes. These written recollections replaced the original vignettes for a second-generation of participants, whose recollections were used for the third generation and so on. The framing of disorders affected recollections of etiology, in which culture-bound framings resulted in the poorest recall of etiologies. Participants also perceived the culture-bound disorder as the least serious but desired the most social distance from patients diagnosed with it, when compared to other disorders. The study showed that health information is selectively attended to and reproduced, possibly affected by perceived self-relevance. Faulty recollections and framing of disorders affect health cognitions, potentially instigating biased transmission of disorder- and patient-related narratives.

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents' experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7-30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219-252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.

Learning one's genetic risk changes physiology independent of actual genetic risk

Millions of people now access personal genetic risk estimates for diseases such as Alzheimer's, cancer and obesity¹. While this information can be informative^2-4, research on placebo and nocebo effects^5-8 suggests that learning of one's genetic risk may evoke physiological changes consistent with the expected risk profile. Here we tested whether merely learning of one's genetic risk for disease alters one's actual risk by making people more likely to exhibit the expected changes in gene-related physiology, behaviour and subjective experience. Individuals were genotyped for actual genetic risk and then randomly assigned to receive either a 'high-risk' or 'protected' genetic test result for obesity via cardiorespiratory exercise capacity (experiment 1, N = 116) or physiological satiety (experiment 2, N = 107) before engaging in a task in which genetic risk was salient. Merely receiving genetic risk information changed individuals' cardiorespiratory physiology, perceived exertion and running endurance during exercise, and changed satiety physiology and perceived fullness after food consumption in a self-fulfilling manner. Effects of perceived genetic risk on outcomes were sometimes greater than the effects associated with actual genetic risk. If simply conveying genetic risk information can alter actual risk, clinicians and ethicists should wrestle with appropriate thresholds for when revealing genetic risk is warranted.

Influence of the disease label 'polycystic ovary syndrome' on intention to have an ultrasound and psychosocial outcomes: a randomised online study in young women

Study question

Does the disease label 'polycystic ovary syndrome' (PCOS) have an impact on desire for medical testing and psychosocial outcomes?

Summary answer

When given the disease label PCOS in a hypothetical scenario, participants had higher intention to have an ultrasound, perceived the condition to be more severe and had lower self-esteem than those not given the disease label.

What is known already

Widening diagnostic criteria and improved imaging sensitivity have increased the number of reproductive-aged women diagnosed with PCOS from 4% to 8% to up to 21%. The uncertain clinical benefit of knowing this diagnosis needs to be weighed against the potential for poor psychological outcomes in women labelled with PCOS.

Study design, size, duration

This experimental online study randomised 181 young women to receive one of four hypothetical scenarios of a doctor's visit in a 2 (PCOS disease label versus no disease label) x 2 (information about unreliability of ultrasounds in clarifying diagnosis versus no information) design.

Participants/materials, setting, methods

Participants were university students (mean age: 19.4). After presenting the scenario, intention to have an ultrasound, negative affect, self-esteem, perceived severity of condition, credibility of the doctor and interest in a second opinion were measured. Participants were then presented with a second scenario, where the possibility of PCOS overdiagnosis was mentioned. Change in intention and perceived severity were then measured.

Main results and the role of chance

Participants given the PCOS label had significantly higher intention to have an ultrasound (mean = 6.62 versus mean = 5.76, P = 0.033, 95% CI(difference) = 0.069-1.599), perceived the condition to be more severe (17.17 versus 15.82, P = 0.019, 95% CI(difference) = 0.229-2.479) and had lower self-esteem (25.86 versus 27.56, P = 0.031, 95% CI(difference) = -3.187 to -0.157). After receiving overdiagnosis information, both intention and perceived severity decreased, regardless of condition (both P < 0.001).

Limitations, reasons for caution

This study used hypothetical scenarios; it is likely that for women facing a real diagnosis of PCOS, outcomes would be more affected than in the current study. The hypothetical design, however, allowed the symptoms and risks of PCOS to be held constant across conditions, the impact on intention and psychosocial outcomes directly attributable to the effect of the disease label.

Wider implications of the findings

These findings demonstrate the potential negative consequences of PCOS labelling. It is crucial we consider the impact of the label before diagnosing more women with PCOS when clinical benefit of this diagnosis is uncertain.

Study funding/competing interest(s)

This paper was written with support from a NHMRC grant awarded to the Screening and Test Evaluation Program. J.J. is supported by an NHMRC Early Career Fellowship. K.M. is supported by an NHMRC Career Development Fellowship. The authors declare that no competing interests exist.

Trial registration number

ACTRN12617000111370.

Trial registration date

20/01/2017.

Date of first patient's enrolment

01/06/2015.

Eating Decisions Based on Alertness Levels After a Single Night of Sleep Manipulation: A Randomized Clinical Trial

Study Objectives

To determine the relationship between an ecologically-relevant change in sleep behavior and its subsequent effects on daytime alertness and feeding behavior.

Methods

Fifty healthy, young participants (10 male, 40 female) completed two 3-hour study sessions that were at least five days apart. The first session was a baseline evaluation. On the night prior to Session 2, the amount of time in bed was manipulated to be 60%-130% of the individual's habitual sleep time. Within both sessions, subjective (Stanford Sleepiness Scale) and objective (Psychomotor Vigilance Test) alertness were measured. During the middle of each session, a 40-minute ad libitum meal opportunity allowed participants to eat from eight different food items. Food healthfulness, caloric density, distribution, and number of calories were measured and compared to alertness levels.

Results

The induced variation in time in bed resulted in induced variation in both subjective and objective (p < .05) measures of alertness. Decreased subjective alertness was associated with increased total caloric consumption (p < .05), and a greater number of calories consumed from less healthy food (p < .05), as rated by both the investigators and by the participant. Decreased objective alertness was associated with less healthy food choices (p < .05), and the consumption of more food from the calorically-dense items (p < .05).

Conclusions

Ecologically-relevant impairments in subjective and objective alertness are associated with increased caloric intake and dysfunctional eating decisions. People experiencing reduced alertness after modest sleep loss may be more willing to eat food they recognize as less healthful, and appear to prefer more calorically-dense foods.

An experiment assessing effects of personalized feedback about genetic susceptibility to obesity on attitudes towards diet and exercise

As increasing attention is paid to possible genetic influences on susceptibility to obesity, recent studies have examined how genetic attributions can impact laypeople's weight-related attitudes and eating behavior. Little consideration, however, has been devoted to understanding the potential effects of learning that one does not have a genetic predisposition to obesity. The present study investigated the possibility that such feedback might bring about negative consequences by making people feel invulnerable to weight gain, which is termed a genetic invincibility effect. After conducting a saliva test disguised as genetic screening, participants were randomly assigned to be told that there was either a very high or very low chance that they carried genes known to increase one's risk of developing obesity. Participants who were told that they were not genetically predisposed to obesity judged the efficacy of healthy diet and exercise habits to be significantly lower than did those who were told that they were genetically predisposed and those who did not receive any genetic feedback. When prompted to select a meal from a menu of options, participants who were told that they were not genetically predisposed to obesity were also more likely than others to select unhealthy foods. These findings demonstrate the existence of a genetic invincibility effect, suggesting that personalized feedback indicating the absence of a genetic liability could have negative psychological consequences with substantial health-related implications.

Food Addiction Beliefs Amongst the Lay Public: What Are the Consequences for Eating Behaviour?

PURPOSE OF REVIEW

The current paper reviews recent research on perceptions of food addiction in the lay public. It also examines the potential consequences of such beliefs for eating behaviour.

RECENT FINDINGS

Surveys suggest that, within community samples, the majority of individuals believe that certain foods are addictive, and that food addiction causes obesity. Further, many people believe themselves to be 'food addicts', and these individuals demonstrate increased patterns of aberrant eating. However, there is also initial experimental evidence to suggest that believing oneself to be a food addict leads to short-term food restriction.

SUMMARY

To reconcile these findings, a self-perpetuating relationship between food addiction beliefs and aberrant eating is proposed. Specifically, in the short term, food addiction beliefs may encourage individuals to avoid certain foods. However, attempts at restriction may eventually lead to increased cravings and disinhibition, thus reinforcing perceptions of oneself as a food addict. These possibilities merit scrutiny in future research.

Weight Stigma Reduction and Genetic Determinism

One major approach to weight stigma reduction consists of decreasing beliefs about the personal controllability of-and responsibility for-obesity by educating about its biogenetic causes. Evidence on the efficacy of this approach is mixed, and it remains unclear whether this would create a deterministic view, potentially leading to detrimental side-effects. Two independent studies from Germany using randomized designs with delayed-intervention control groups served to (1) develop and pilot a brief, interactive stigma reduction intervention to educate N = 128 university students on gene × environment interactions in the etiology of obesity; and to (2) evaluate this intervention in the general population (N = 128) and determine mechanisms of change. The results showed (1) decreased weight stigma and controllability beliefs two weeks post-intervention in a student sample; and (2) decreased internal attributions and increased genetic attributions, knowledge, and deterministic beliefs four weeks post-intervention in a population sample. Lower weight stigma was longitudinally predicted by a decrease in controllability beliefs and an increase in the belief in genetic determinism, especially in women. The results underline the usefulness of a brief, interactive intervention promoting an interactionist view of obesity to reduce weight stigma, at least in the short term, lending support to the mechanisms of change derived from attribution theory. The increase in genetic determinism that occurred despite the intervention's gene × environment focus had no detrimental side-effect on weight stigma, but instead contributed to its reduction. Further research is warranted on the effects of how biogenetic causal information influences weight management behavior of individuals with obesity.

The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials

Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted.

Depression and genetic causal attribution of epilepsy in multiplex epilepsy families

OBJECTIVES

Rapid advances in genetic research and increased use of genetic testing have increased the emphasis on genetic causes of epilepsy in patient encounters. Research in other disorders suggests that genetic causal attributions can influence patients' psychological responses and coping strategies, but little is known about how epilepsy patients and their relatives will respond to genetic attributions of epilepsy. We investigated the possibility that among members of families containing multiple individuals with epilepsy, depression, the most frequent psychiatric comorbidity in the epilepsies, might be related to the perception that epilepsy has a genetic cause.

METHODS

A self-administered survey was completed by 417 individuals in 104 families averaging 4 individuals with epilepsy per family. Current depression was measured with the Patient Health Questionnaire. Genetic causal attribution was assessed by three questions addressing the following: perceived likelihood of having an epilepsy-related mutation, perceived role of genetics in causing epilepsy in the family, and (in individuals with epilepsy) perceived influence of genetics in causing the individual's epilepsy. Relatives without epilepsy were asked about their perceived chance of developing epilepsy in the future, compared with the average person.

RESULTS

Prevalence of current depression was 14.8% in 182 individuals with epilepsy, 6.5% in 184 biologic relatives without epilepsy, and 3.9% in 51 individuals married into the families. Among individuals with epilepsy, depression was unrelated to genetic attribution. Among biologic relatives without epilepsy, however, prevalence of depression increased with increasing perceived chance of having an epilepsy-related mutation (p = 0.02). This association was not mediated by perceived future epilepsy risk among relatives without epilepsy.

SIGNIFICANCE

Depression is associated with perceived likelihood of carrying an epilepsy-related mutation among individuals without epilepsy in families containing multiple affected individuals. This association should be considered when addressing mental health issues in such families.

Believing in food addiction: Helpful or counterproductive for eating behavior?

OBJECTIVE

Obesity is often attributed to an addiction to food, and many people believe themselves to be "food addicts." However, little is known about how such beliefs may affect dietary control and weight management. The current research examined the impact of experimentally manipulating participants' personal food addiction beliefs on eating behavior.

METHODS

In two studies, female participants (study 1: N = 64; study 2: N = 90) completed food-related computerized tasks and were given bogus feedback on their performance which indicated that they had high, low, or average food addiction tendencies. Food intake was then assessed in an ad libitum taste test. Dietary concern and time taken to complete the taste test were recorded in study 2.

RESULTS

In study 1, participants in the high-addiction condition consumed fewer calories than those in the low-addiction condition, F(1,60)  = 7.61, P = 0.008, ηp (2)  = 0.11. Study 2 replicated and extended this finding, showing that the effect of the high-addiction condition on food intake was mediated by increased dietary concern, which reduced the amount of time participants willingly spent exposed to the foods during the taste test, b = -0.06 (0.03), 95% confidence interval = -0.13 to -0.01.

CONCLUSIONS

Believing oneself to be a food addict is associated with short-term dietary restriction. The longer-term effects on weight management now warrant attention.

Genomic Information may Inhibit Weight-Related Behavior Change Inclinations Among Individuals in a Fear State

BACKGROUND

As evidence mounts regarding associations between genetics and body weight, it is essential to understand how to communicate this information, and factors like emotion that could moderate the effectiveness of messages.

PURPOSE

We assessed influences of emotion on reactions to weight-related genomic information in a virtual clinical setting.

METHODS

An online representative US sample of overweight women was randomized to receive an emotion induction (anger, fear, or neutral) paired with information about genomic or behavioral influences on weight in an interaction with a virtual doctor.

RESULTS

Receiving genomic information led to reduced attributions of lifestyle causes for weight and behavioral intentions, but only among individuals in a fear state.

CONCLUSIONS

The current study is among the first to reinforce the concern that discussing genomic underpinnings of overweight could undercut health behavior, and highlights the importance of identifying factors like emotion that influence interpretation of genomic information. Clinicaltrials.gov NCT01888913.

Resolving the Meat-Paradox: A Motivational Account of Morally Troublesome Behavior and Its Maintenance

A majority of people the world over eat meat, yet many of these same people experience discomfort when the meat on their plate is linked to the death of animals. We draw on this common form of moral conflict—the meat-paradox—to develop insights into the ways in which morally troublesome behaviors vanish into the commonplace and every day. Drawing on a motivational analysis, we show how societies may be shaped by attempts to resolve dissonance, in turn protecting their citizens from discomfort associated with their own moral conflicts. To achieve this, we build links between dissonance reduction, habit formation, social influence, and the emergence of social norms and detail how our analysis has implications for understanding immoral behavior and motivations underpinning dehumanization and objectification. Finally, we draw from our motivational analysis to advance new insights into the origins of prejudice and pathways through which prejudice can be maintained and resolved.

Psychological and behavioral effects of genetic risk testing for obesity: a systematic review

BACKGROUND

Interest is growing in the use of genetic risk testing for lifestyle-related chronic diseases, including obesity, to promote health behavior change.

OBJECTIVE

A systematic review of the literature was conducted to determine the effects that genetic risk feedback for obesity may have on psychological and behavioral factors influencing weight.

METHODS

The MEDLINE/PubMed online database was searched using predefined search terms.

RESULTS

The studies revealed that risk feedback may increase motivation to improve health behaviors, especially among individuals at higher genetic risk. Overweight and obese individuals seemed to experience additional psychological benefits when provided an external explanation for their weight status.

CONCLUSION

While the psychological benefits are promising, the clinical utility of genetic risk testing for obesity remains uncertain.

The effect of weight controllability beliefs on prejudice and self-efficacy

An experiment was conducted to test for the presence of prejudice towards obesity and whether weight controllability beliefs information reduces this prejudice and impacts on a person’s own healthy eating self-efficacy. The experiment randomly allocated 346 participants (49 males) into one of three conditions: controllable contributors toward obesity condition (e.g., information about personal control about diet and exercise); uncontrollable contributors toward obesity condition (e.g., information about genes, factors in society); and a control condition with no information given. Prejudice was present in 81% of the sample. High prejudice was predicted by low self-efficacy for exercise and weight. Weight controllability beliefs information had no significant effect on prejudice levels or exercise or healthy eating self-efficacy levels. Future research directions are discussed.

The double-edged sword of genetic accounts of criminality: causal attributions from genetic ascriptions affect legal decision making

Much debate exists surrounding the applicability of genetic information in the courtroom, making the psychological processes underlying how people consider this information important to explore. This article addresses how people think about different kinds of causal explanations in legal decision-making contexts. Three studies involving a total of 600 Mechanical Turk and university participants found that genetic, versus environmental, explanations of criminal behavior lead people to view the applicability of various defense claims differently, perceive the perpetrator's mental state differently, and draw different causal attributions. Moreover, mediation and path analyses highlight the double-edged nature of genetic attributions-they simultaneously reduce people's perception of the perpetrator's sense of control while increasing people's tendencies to attribute the cause to internal factors and to expect the perpetrator to reoffend. These countervailing relations, in turn, predict sentencing in opposite directions, although no overall differences in sentencing or ultimate verdicts were found.

Genetic causal attributions for weight status and weight loss during a behavioral weight gain prevention intervention

PURPOSE

Emerging evidence suggests that attributing one's weight to genetics may contribute to the adoption of obesogenic behaviors. We investigated whether weight-related genetic attributions were associated with weight change during a weight gain prevention intervention.

METHODS

Participants (n = 185) were from a randomized clinical trial of a digital health weight gain prevention intervention for black women ages 25-44 years with body mass index 25.0-34.9 kg/m(2). Weight-related genetic attributions (weight status attribution and weight loss attributions) were measured at baseline and 12 months.

RESULTS

Among intervention participants, high genetic attribution for weight loss was associated with greater weight loss at 12 months (-2.7 vs. 0.5 kg) and 18 months (-3.0 vs. 0.9 kg). Among usual-care participants, high genetic attribution for weight status was associated with greater 18-month weight gain (2.9 vs. 0.3 kg). The intervention reduced the likelihood of high genetic attribution for weight loss at 12 months (P = 0.05). Change in the likelihood of genetic attribution was not associated with weight change over 12 months.

CONCLUSION

Impact of genetic attributions on weight differs for those enrolled and not enrolled in an intervention. However, weight gain prevention intervention may reduce genetic attribution for weight loss.Genet Med 18 5, 476-482.