Democracy Dies in Darkness

Health-science

You’re heavy, and your doctor makes you feel bad about it. That’s not good.

By Marlene Cimons

August 13, 2017 at 7:06 AM

(iStock)

Virtual reality — in which people wearing headsets and other equipment experience computer-generated environments as if they were real — is helping obesity researchers better understand people's responses to their personal genetic information.

"It's important to put people in a setting that is as close to real life as possible," says Susan Persky, a scientist with the National Human Genome Research Institute's social and behavioral research branch. "For example, you really will feel much more like you are in a doctor's office. You feel present within the system. At the same time, we control everything."

Persky and her colleagues have conducted several studies using VR to gauge how obese individuals react in clinical settings and at other sites when presented with genetic information about their weight.

In one, she found that telling overweight women about the likely genetic basis for their obesity reduced the women's feelings that they were blamed for their weight. Other research has found that women who feel stigmatized by their doctors may avoid medical treatment to the detriment of their health.

The scientists recruited 200 women unhappy about their weight and gave them a 10-minute "appointment" with a virtual doctor. The virtual clinician gave each woman one of four presentations. One stressed genetic factors, delivered in a supportive style. A second also emphasized genomics, but it was given in a directive, "doctor-knows-best" manner. A third was supportive but focused only on personal behavior. The fourth stressed behavior but in a directive manner.

Not surprisingly, the volunteers liked the supportive virtual clinician best, especially when the doctor also offered genetic information, saying this approach made them feel less stigmatized and better about themselves. "People feel less blame when doctors talk about genetic factors," Persky says. "In obesity, we find this idea of genetic predisposition resonates with people."

Researchers also looked at guilt among overweight mothers of 4- and 5-year-old children, providing information about the influence of lifestyle to one group and the effects of genetic factors and lifestyle to a second group. Mothers told about genetic factors felt guiltier than the others, presumably because they felt they were passing obesity along to their offspring.

The parents then were asked to select a meal for their children from a virtual food buffet offering choices that were more healthy (grilled chicken, steamed carrots, peas and green beans) and less healthy (chicken nuggets, macaroni and cheese).

Why use a virtual buffet rather than a real one? "It's an assessment of actual parent behavior that can be measured in the controlled, sterile lab, while it actually looks and feels like a real-world environment where parents actually make feeding choices," Persky says.

Mothers who chose the healthier options felt less guilt afterward about the possibility of passing down genetic obesity risk factors to their children, even those in the group who weren't explicitly told about genetic influences, according to the study. "Most parents have some sense that there are genetic factors involved in weight," Persky says. "This isn't a totally new concept for them."

The findings suggest that parents are inclined to change how they feed their children — thus feeling less guilt about passing on their genetic risks — while still reluctant to change their own eating behavior. "Parents are often willing to do things for their children that they wouldn't do for themselves," Persky says.

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