Abstract
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The value of genetic
test feedback for common conditions is widely debated. This is principally
because of the lack of impact on behaviour change of feedback for genes with
small effect sizes, but also because of concern about the risks of fatalistic
responses to positive test results or false reassurance from negative
results. This thesis describes research using feedback for one gene, FTO,
implicated in the development of obesity, as a model to investigate
motivational and emotional reactions to testing for genetic susceptibility.
It comprises a series of six studies examining the benefits and harms
associated with genetic test feedback. They incorporated a mixture of
qualitative and quantitative methodologies, used hypothetical and real
genetic feedback, and tested predominantly normal-weight students and
overweight/and obese individuals from a web panel. Fatalism or false
reassurance in response to FTO genetic test feedback was not observed in any
of the studies. Genetic test feedback was consistently perceived as
motivating, and negative emotional effects of a higher-risk FTO gene result
were minimal. Overweight and obese individuals found the test result helpful
for alleviating guilt and stigma; although in response to an unexpected
lower-risk genetic test result, some were disappointed. University is
notoriously a life stage with risk of weight gain but not all students gain
weight. One study examined associations between genetic risk status and
weight gain, and found that students with at least one higher-risk allele
were more likely to gain weight. The final study was a randomised controlled
trial examining the effect of giving FTO feedback alongside simple weight
control advice to first year students. Short-term (one month) results showed
that weight control intentions were significantly higher in those randomised
to receive FTO feedback and weight control advice than weight control advice
alone, but there was no effect on weight or reported behaviour change.
Although the studies in this thesis had many limitations, the findings
indicate that people are unlikely to misinterpret or overstate the impact of
genetic test results, at least in the context of a single gene implicated in
a multifactorial condition. However, effects on behaviour remained elusive.
This indicates the need for future research to learn how to harness the
potential of genetic information to promote personalised prevention.
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