More than a decade following completion of the Human Genome Project there are high expectations that the provision of personalized genomic disease risk information to individuals will motivate risk-reducing lifestyle heath behavior changes [1
]. In this regard, it has been suggested that genomic information may be inherently more powerful relative to other types of non-genetic information, a notion commonly referred to as ‘genetic exceptionalism’ [3
]. In part, recent evidence of these high expectations for genomics can be seen in the current availability of direct-to-consumer (DTC) genomic testing for multiple markers conferring genetic risk for multiple common conditions. In this context, testing is initiated by and results are provided directly to individuals without the involvement of a health-care provider. It has been argued that this potentially empowers the individual consumer to make appropriate changes in risk-reducing lifestyle and other health behaviors.
In this article, we provide a brief overview of studies that have examined lifestyle behavioral responses to genetic testing. We define this to mean dietary behavior, physical activity and smoking, given that these represent the three main factors that increase risk for chronic diseases with the highest worldwide mortality rates (cardiovascular disease, cancer, chronic respiratory disease and Type 2 diabetes). As will be shown, we find only a few studies that have examined this issue, and that many of the studies that have been carried out have been limited in terms of design and sample size, and also tend to focus on monogenic conditions. Indeed, we know of only one study that has evaluated this issue in the context of multiplex testing for multiple genetic variations and risk for multiple common diseases [4
]. Also, of the studies that have been carried out, results generally show no positive (disappointingly) or negative effects of testing (e.g., increases in unhealthy behaviors in response to estimates of low genetic risk). These findings raise an important question: can direct access to personal genomic information be used in ways that will motivate positive lifestyle behavior change and thus benefit public health and lead to chronic disease prevention?
In anticipation of the wide availability of whole-genome sequencing and more comprehensive phenotyping of individuals [5
], careful consideration of this question is now more critical than ever. In addition, lifestyle behaviors deserve separate consideration from more ‘medical’ health behaviors for two reasons: first, there is existing evidence that medical health behaviors that require involvement of a healthcare provider (e.g., altering medications or clinical screening) are impacted quite differently than lifestyle behaviors in terms of response to genetic testing [4
]. Second, while best practice medical guidelines currently do not include recommendations for individuals found to be at increased or decreased risk based on genomic testing, there are clear public health goals for diet pattern, physical activity and smoking (i.e., for all individuals, see [101
]). As such, for providers and consumers alike, DTC genomic testing presents a clear opportunity for providing personalized health information that may motivate improvements in lifestyle behaviors, potentially leading to a reduction of disease morbidity and premature mortality [7
In the latter half of this article we propose several constructs that may be useful in guiding studies of, and the development of interventions for, positive lifestyle behavioral change in the context of personalized genomic risk testing. Furthermore, while simple communication of genomic information and disease susceptibility may be sufficient to catalyze lifestyle changes in some highly motivated groups of individuals, for others, additional strategies may be required. Thus, we conclude by suggesting some possible strategies for more novel means of communication of genomic information (e.g., in the context of social norm feedback) either alone or in combination with other promising interventions (e.g., real-time wireless health monitoring devices) in order to promote more widespread adoption of healthy behaviors.