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Some patients may share their concerns or worries that “family history” or “genes” prevent them from meeting their wellness goals and weight-loss goals. Some may even use that reasoning as a crutch.

As a primary care doctor, it’s important to sympathize with the concerns of patients while also explaining that genetic factors aren’t always the case for body composition. A succinct yet factual discussion on how genetics, medications, metabolism, and lifestyle choices can help your patients embark on a healthier path.

What Does Science Say?

As with many medical conditions, genes influence individual traits including our weight, said Eva Tseng, MD, MPH, associate professor of medicine at Johns Hopkins School of Medicine in Baltimore.

“Some people may have genes that make them more likely to gain weight easily while others may have genes that help them stay lean,” she said.

While genes can influence weight and obesity, they interact with other factors like what we eat, how we live, what our environment is like, stress levels, sleep, etc., Tseng said. “It’s the combination of all these influences that ultimately affects our weight.”

Does a Family History of Obesity Require Different Choices?

While identifying specific genes involved in influencing weight and eventually testing people for the presence of these genes may be possible in the future, current treatment of obesity is focused on lifestyle changes and sometimes the use of medications, said Tseng.

“We are not currently able to identify specific genes to tailor treatment based on a person’s genetic profile; however, we apply general guidelines about dietary changes and patterns and activity levels, all of which have been well-studied.”

How to Discuss the Subject

While having these discussions, it can be a good opportunity to discuss risk factors of obesity. She shared how patients may feel uncomfortable discussing their weight so bringing up other health conditions or risk factors such as high cholesterol, heart disease, high blood pressure, etc., can be a good way to open the conversation.

“People have their personal history or experiences with other family member’s health issues so this can be a good way to start the conversation,” Tseng said. For example, someone may bring up a relative’s history dealing with diabetes and a primary care doctor can use that to talk about the patient’s own risk for diabetes, including addressing overweight/obesity to lower that risk.

In addition, it could be helpful to use open-ended questions to start the conversation instead of simple yes or no questions, Tseng said.

Example questions are, “Can you tell me what you have noticed about weight patterns in your family?” or “How do you feel your family’s eating habits or lifestyle choices have influenced your weight?” 

Then, acknowledge and validate the experiences and feelings they share about their family history and weight with affirmations such as: “I appreciate your willingness to talk about this topic; it shows you are concerned about the patterns you have seen in your family.”

Diving Into Other Factors

As mentioned, when interacting with your patients, it’s essential to acknowledge and validate their concerns regarding weight and health. And when discussing the factors that cause obesity, introduce how several factors affect a person’s weight.

“Obesity is best understood as a complex, chronic disease influenced by a combination of genetics, endocrine/hormonal, pharmacologic, sociocultural, behavioral, and environmental factors,” said Sophia Ali, MD, an endocrinologist at the University of Maryland Center for Diabetes and Endocrinology and an assistant professor of medicine at the University of Maryland School of Medicine in Baltimore.

She also noted it can be beneficial to discuss how medications such as corticosteroids, certain antidepressants, and antipsychotics can contribute to weight gain, as can certain endocrine conditions like Cushing syndrome.

Additionally, share with your patients how social determinants of health, including food insecurity, limited access to healthy foods, and unsafe or inadequate environments for physical activity — play a substantial role in obesity prevalence and outcomes. “Emerging evidence also highlights the independent associations between insufficient sleep, chronic psychosocial stress, and increased obesity risk,” said Ali. “These factors may interact synergistically with genetic susceptibility, underscoring the importance of a comprehensive, individualized approach to obesity management.”