PSYCH OLOGI CAL EX PLO RATION

The Role of Religious Leaders in Promoting HealthyHabits in Religious Institutions

Mark H. Anshel • Mitchell Smith

� Springer Science+Business Media New York 2013

Abstract The growing obesity epidemic in the West, in general, and the USA, in par-

ticular, is resulting in deteriorating health, premature and avoidable onset of disease, and

excessive health care costs. The religious community is not immune to these societal

conditions. Changing health behavior in the community requires both input from indi-

viduals who possess knowledge and credibility and a receptive audience. One group of

individuals who may be uniquely positioned to promote community change but have been

virtually ignored in the applied health and consulting psychology literature is religious

leaders. These individuals possess extraordinary credibility and influence in promoting

healthy behaviors by virtue of their association with time-honored religious traditions and

the status which this affords them—as well as their communication skills, powers of

persuasion, a weekly (captive) audience, mastery over religious texts that espouse the

virtues of healthy living, and the ability to anchor health-related actions and rituals in a

person’s values and spirituality. This article focuses on ways in which religious leaders

might promote healthy habits among their congregants. By addressing matters of health,

nutrition, and fitness from the pulpit and in congregational programs, as well as by visibly

adopting the tenets of a healthier lifestyle, clergy can deliver an important message

regarding the need for healthy living. Through such actions, religious leaders can be

effective agents in promoting critical change in these areas.

Keywords Physical activity � Exercise � Wellness � Health behavior � Religious

institutions � Religious leaders

The relationship between religious practice, spirituality, and health is well-entrenched in

the literature (Koenig 1999, 2008; Koenig et al. 2001; Levin 2001). Individuals who

M. H. Anshel (&)Departments of Health and Human Performance and Psychology, Middle Tennessee State University,Box 96, Murfreesboro, TN 37132, USAe-mail: Mark.Anshel@mtsu.edu

M. SmithFlorida Atlantic University, Boca Raton, FL 33431, USA

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practice a religious or spiritual lifestyle, particularly if they attend weekly services, often

experience superior health outcomes, as opposed to their non-religious counterparts

(George et al. 2000; Levin 2001). Ellison and Levin (1998) concluded from their review of

related literature that individuals who regularly practiced their religion, such as attending

religious services, praying, or reading Scripture or other religious texts, experienced lower

blood pressure, were hospitalized less often, and suffered less depression than their

non-religious counterparts. In a Norwegian study, Sørensen et al. (2011) studied the

relationship between church attendance, representing religious activity, and blood pressure,

representing overall health. The results indicated that the variable used to measure reli-

gious activities (church time) was significantly related to the variable used to measure

health (blood pressure). In other words, persons who were ‘‘religiously active,’’ defined in

this study as church attendance, were healthier than those who were not religiously active.

More recently, Schlundt et al. (2008) examined the relationships of religious involve-

ment and affiliation (e.g., church attendance, importance of religion, religion as a source of

strength/comfort) with health behavior among 3,014 residents of Nashville, Tennessee

(USA), located in what is known as ‘‘the Bible belt.’’ After controlling for demographic

differences and individual differences in religious involvement, the researchers found a

positive association between religious involvement and ratings of overall health, fre-

quency, intensity, and duration of physical activity, healthy lifestyle behaviors, and healthy

eating behaviors. Individuals who reported more frequent and ongoing religious practices

and beliefs also reported more frequent incidence of healthy behaviors, including exercise

and more nutritious dietary practices.

In a related study of 13,179 people out of a sample of 22,341 (59 %) in the national

Health Interview Survey, Harrigan (2011) found that ‘‘people who prayed for their health

had a lifestyle that included many behaviors that have a potential to improve health’’

(p. 605). This finding might partially explain why religious activity is associated with

superior health indicators such as low blood pressure and lower plasma lipids. Other

studies, however, have indicated different behavior patterns among religious practitioners.

Koenig et al. (2001) concluded in their review of related literature that individuals who

engage in regular religious practices often experience health-related problems due to an

unhealthy lifestyle, including obesity, partially due to a lack of physical activity (Koenig

et al. 2001). For example, Cline and Ferraro (2006) have concluded that the Christian

community suffers from a severe obesity epidemic. Baptists, in particular, they claim, were

the most likely to be obese. Among this group, obesity cases increased from 24 to 30 %

from 1986 to 1994, with Baptist women more likely to be obese than their male coun-

terparts. Cline and Ferraro speculate a possible cause of obesity among Baptists and less

healthy, overindulgent eating patterns in the South, where many Baptists reside. The

researchers call for additional research to learn how denominations view overeating and

obesity, which, they claim, is a contradiction to their strong belief in scripture.

One group of individuals who have a strong influence on the behaviors of others,

particularly in regard to health behavior changes, is religious leaders. The strength of this

role, however, has been relatively neglected. Thus, the primary purposes of this article are:

(1) to highlight some current obstacles and inconsistencies regarding efforts to promote

more healthy habits among religious institutions, (2) to cite selected key passages from

major religious traditions which underscore the context for following patterns of health

behaviors, and (3) to suggest ways in which religious leaders can play an important role in

providing guidelines, counsel, motivation, and initiatives in the service of increased health

in the religious community.

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The Problem

The most recent research from the Centers for Disease Control and Prevention indicates

that one out of every three adults and one out of every six children in the USA are obese

(Flegal et al. 2010, Journal of the American Medical Association, cited by the US media,

http://www.foxnews.com/health/2012/01/17/cdc-1-in-3-adults-is-obese/, January 17, 2012).

According to the survey, the average body mass index (BMI) for men and women in the

US is 28.7. A BMI of 25 or greater is considered overweight, while a BMI of 30 or greater

is considered obese. The prevalence of people classified as overweight or obese is 69 % of

the population overall—74 % of men are overweight or obese, while 64 % of women are

overweight or obese. The prevalence of obesity in children is approximately 17 %. This

situation, according to the researchers, represents a deterioration of the public’s health,

including an increased rate of heart disease, hypertension (i.e., high blood pressure), type 2

diabetes, and, in the long term, shortened lifespan and a dramatic rise in health care costs

(Healthy People 2010).

The problem of poor health and lower quality of life can be explained by the lack of

exercise and poor dietary habits with approximately two-thirds of adults in the US being

overweight or obese (Walters and Byl 2008). Clearly, nutritional quality has deteriorated

due to over-consumption of soft drinks and high fat food. Research examining the effec-

tiveness of various types of interventions and strategies in addressing this problem suggests

that these programs can point to only partial success. One area that might offer greater

effectiveness at changing health behavior but has been neglected over the years is

addressing the habits and needs of the religious community.

Another obstacle to changing unhealthy habits in the religious community is the failure

to recognize that the reason to lose weight is less about improving physical attractiveness

and more about the undesirable consequences of excess weight on one’s health. In fact,

poor weight control, ostensibly due to the combination of insufficient physical activity and

excessive caloric intake, is actually a medical concern because it can seriously affect a

person’s short-term and long-term physical and mental health. The general quality of

health in the US (and other countries) has deteriorated in recent years, spearheaded by the

well-known obesity epidemic, resulting in dramatic concomitant cost increases (Healthy

People 2010). The overall health of our society, in general, and among the religious

community, in particular, is deteriorating, and the incidence of disease and costs to treat

obesity-related diseases is increasing substantially annually (Byl 2008). Thus, individuals

who engage in regular religious practices are not immune from health-related problems due

to an unhealthy lifestyle, primarily due to obesity and the lack of physical activity (Koenig

et al. 2001).

Cline and Ferraro (2006) have concluded that the Christian community, in particular,

suffers from a severe obesity epidemic. The authors speculate that a possible cause of

obesity in this group could be from less healthy eating patterns in the South, home to many

Baptists, and a lifestyle habit of physical inactivity. Even controlling for residency, Cline

and Ferraro contend that Baptist women are more likely to be obese than their male

counterparts. This trend could be related to the strong emphasis for Baptists to avoid

alcohol and tobacco, however, replacing these unhealthy habits with overeating. The

researchers call for additional research to learn how denominations view overeating and

obesity, which, they claim, is a contradiction to their strong belief in Scripture.

Nevertheless, according to Baumann (2008), as indicated earlier, most religious insti-

tutions do not appear to detect a problem with the excessive body weight of their members,

and clergy rarely address ways in which religious texts impel congregants to seek a

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healthier lifestyle. Koenig (2008) notes missed opportunities when it comes to overweight

or obese congregants. He feels that religious leaders do not sufficiently bring to bear

relevant religious teachings by addressing how congregants could be healthier and enjoy a

higher quality of life if they engaged in healthier habits. In addition, he asserts that

religious leaders ignore the medical consequences of maintaining unhealthy behavioral

patterns. Key among the possible causes of these undesirable habits is the propensity of

many people of faith to separate the physical from the spiritual world. In addition, some

individuals attribute control of one’s health, quality of life, and destiny to a higher power.

The result is the perception of reduced responsibility and consequences for habits that the

medical community would consider ‘‘unhealthy.’’

One unhealthy habit that is addressed by religious texts and related to poor weight

control is gluttony. Gluttony, often referred to as the etiology of obesity (Hill 2011), is

defined as excessive indulgence in food and drink and can lead to obesity. Hill makes the

distinction between being fat and being a glutton. While a person can behave gluttonously,

she contends, obese individuals are not inevitably gluttonous. The gluttonous person may

be perceived as unhealthy and may exhibit undesirable, even immoral behavioral patterns,

such as a lack of self-discipline, laziness, and a love of overindulgence.

Colbert (2002) contends, for instance, that Christians do not generally discuss gluttony

or other habits related to overeating because they do not think of themselves as gluttons or

overweight. Gluttony and overeating has been divorced from obesity in their minds so that

it becomes merely a health issue rather than a spiritual or moral one. He contends that

greed, gluttony, and overeating form the primary causes of obesity among people of faith.

While gluttony and overeating are primary causes of obesity among non-religious people,

as well, these eating habits are inconsistent with religious precepts. Thus, poor eating and

dietary habits should have meaning to individuals who attempt to live according to mes-

sages from their respective religious texts.

In addition, clergy may not address the issue of obesity because they do not want to risk

offending a significant number of their faithful members (Koenig 2005). One might also

argue that there is historically a strong association between religious community life and

food (e.g., church potluck dinners, cake and cookies after church, etc.). For some

denominations, ethnic foods are an integral part of their sense of identity (Colbert 2002).

An additional challenge in providing interventions that change health behavior, par-

ticularly for a certain segment of the population under discussion, is their firm belief that a

higher (spiritual) power is ‘‘in control’’ of their destiny, their health, and all other aspects of

life. Individuals whose faith entails the belief that a higher power is responsible for ‘‘all

things’’ may feel excused from taking personal responsibility for their unhealthy habits.

Hence, the task of persuading them to be more self-aware of their unhealthy habits and to

take control of their health by initiating so-called ‘‘healthy habits’’ may prove challenging

(Wallston et al. 1999). Low perceived self-control, also called self-determination (Ryan

and Deci 2007), may figure in one’s passive stance regarding one’s own health-related

actions and consequent outcomes from those actions.

The extent to which persons feel that a higher power is responsible for their health can

be objectively measured. Wallston et al. (1999) developed and validated the God Locus ofControl Scale (GLHCS) that determines the extent to which people of faith perceive a

superior entity (e.g., God) as the determinant of their health and quality of life. Sample

items of the GLHCS include ‘‘God is directly responsible for my [condition] getting worse

or better’’ and ‘‘God is in control of my [condition].’’ The researchers suggest that indi-

viduals with a ‘‘strong’’ external God locus of control may feel less likely to take

responsibility for their actions, such as engaging in unhealthy habits and experiencing the

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long-term consequent health problems of obesity and disease. Ostensibly, then, high

externals (on the GLHCS) may find that strong religious faith actually impedes their sense

of self-control and responsibility in maintaining healthy habits.

Wallston et al. (1999) claim it is important to determine the extent to which religious

practices and beliefs dictate the person’s health-related behavior patterns. Ostensibly,

persons who surrender control of their health to a higher authority may result in a less

healthy lifestyle (i.e., ‘‘God is in control’’), as opposed to individuals who feel more

personally responsible for their long-term health as part of their religious commitment.

This may partially explain the challenge in changing health behavior by persons with

strong religious convictions. Wallston et al. found that people who rated religion as more

important, who reported being more active in their practice of religion, or who scored high

for religious coping scored higher on the GLHCS.

Religious leaders might exercise potentially strong influence over individuals who fail

to take personal responsibility for their health and to care for their ‘‘temple’’ (Byl 2008).

Religious leaders might also advocate various forms of physical activity (i.e., exercise,

sport) and dietary habits for improving and maintaining good health among people of faith.

Whether religious leaders perceive their role as facilitators of healthy behavioral patterns is

speculative, they share the common theme that maintaining a healthy lifestyle is God’s

will.

Selected Scriptural Passages Related to Health

Most religious traditions are replete with scriptural passages promoting healthy habits and

self-control, and cautioning against over-indulgence is replete in various religious texts.

Many faiths offer moral and practical guidance concerning ways to attain and maintain

proper physical, mental, emotional, and spiritual health. While particulars vary from one

religion to the next, they share the common goal of helping to ensure that maintaining a

healthy lifestyle is God’s will (Levin 2001). Having been created in the image of God,

individuals are admonished to take care of their body, especially in order to maintain good

health, and to stave off illness, lethargy, and premature death. Perhaps the most common

health-related theme generated from scripture is moderation.

One of the earliest Scriptural texts dealing with matters of moderation is the reference to

the stubborn and rebellious son, whose disobedience of his parents is thought to lead him to

gluttony and drunkenness (Deuteronomy 21:20). The Biblical mandate that the towns-

people should stone such an individual to death and that all take note may appear

excessive. As such, it offers a reminder of the need to deliver proper discipline and

instruction of the young in providing values that insure healthy and properly balanced

living.

Notable among these teachings and cautionary words include warnings against gluttony,

an object of disdain in many faiths. The Bible, which condemns overindulgence in many

things, including food, says in Proverbs 23: 20–21: ‘‘Do not be among those who… drinktoo much wine, or with those who gorge themselves on meat. For the drunkard and theglutton will become poor, and grogginess will clothe them in rags.’’

The post-Biblical text Mishnah Avot, the so-called ‘‘Sayings of the Fathers,’’ includes

the words of the 2nd century sage Shimon Ben Zoma: ‘‘Who is a hero? He who conquers

his appetites’’ (4:1). Along these lines, the Wisdom of Ben Sira, one of the Books of the

Apocrypha notes: If you are sitting at a grand table, do not lick your lips and exclaim

‘‘What a spread!’’ ‘‘Do not reach for everything you see or jostle your fellow-guest; judge

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his feelings by your own and always behave considerately. If you are dining in a large

company, do not reach out your hand before others. A man of good upbringing is content

with little, and he is not short of breath when he goes to bed. The post-Biblical material

found in the Talmud exhorts in one passage, ‘‘Do not get drunk, and you will not sin’’

(Babylonian Talmud Tractate Brachot, 29b)

The doctrines of many faiths offer moral and practical guidance concerning ways to

attain and maintain good physical, mental, emotional, and spiritual health. While the

particulars vary among the various religions, they share the common goal of helping to

ensure that the adherents of each tradition followed by people of faith live a long and

productive life (Levin 2001). Young and Koopsen (2005) cite texts which view human

beings as having been created in the image of God and as such are consequently

admonished to take care of their body. And while individuals have free will to accept or

reject the teachings of their faith, it is inconsistent with the principles of their faith to

maintain unhealthy habits that will lead to illness, disease, lack of energy, and a shortened

life.

Hillel took his disciples to task for failing to recognize the proper care of the body as

an important religious precept (Leviticus Rabbah 24:3). A century later, the apostle Paul

similarly challenged the dualistic (Greek) thinking of the Christians of Corinth who

separated their physical bodies from a spiritual life, telling them that how they treated

their bodies mattered on the spiritual as well as the physical level and that they were not

owners, but stewards of their bodies. In many ways, contemporaries may have fallen into

a similar trap and perhaps that same dualism continues to plague individuals in the

twenty-first century (Koenig 1999). Thus, clergy might draw on scripture to drive home

the point that overeating and maintaining an unhealthy lifestyle are inconsistent with the

teachings of religion, for instance, from (1 Corinthians 6:19–20): ‘‘Do you not know that

your body is a temple of the Holy Spirit, who is in you, whom you have received from

God? You are not your own; you were bought at a price. Therefore honor God with your

body.’’

Maimonides, the medieval philosopher and physician, wrote: ‘‘If a man would take care

of his body as he takes care of the animal he rides on, he would be spared many serious

ailments.’’ In another passage, he wrote, ‘‘The moderate eater enjoys healthy sleep; he rises

early, feeling refreshed. But sleeplessness, indigestion and colic are the lot of the glutton.

One should eat only when justified by a feeling of hunger, when the stomach is clear and

the mouth possesses sufficient saliva. Then one is really hungry…. If one feels hungry he

should wait a little, as occasionally one is led to feel so by a deceptive hunger’’ (The

Preservation of Youth, Chapter 31, vs. 12–15, 18–20).

As Koenig (1999) notes, when we begin to perceive of our body in a manner consistent

with these teachings, regarding God, we begin to make different decisions that affect our

physical health. The failure to offer proper stewardship of our bodies, leading to obesity or

other unhealthy habits, is clearly a matter worthy of clergy bringing to the attention of their

congregants.

Linking Physical Activity, Health, and Religion

In her book, Greater Health God’s Way, Omartian (1996) cites scripture that lends cre-

dence to the Lord’s expectation that humans should maintain a healthy lifestyle. Unhealthy

habits are contrary to the basic principles of the New Testament, what she calls ‘‘words of

truth.’’ At the heart of her message, however, Omartian places responsibility for one’s

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health with the individual, as God intended, she contends. For example, she claims that

‘‘the biggest problem with excess weight is not whether God still loves you. He does, and

so do other people. Nor is the biggest problem whether you look good in your clothes. The

most important thing is whether you’re going to be incapacitated by fat-related diseases

and die prematurely’’ (pp. 89–90). Omartian provides guidelines, nutritious food recipes,

and daily rituals for a healthy lifestyle related to exercise and nutrition in support of

Scripture and living a life consistent with the value of faith.

In their edited book, Christian paths to health and wellness, Walters and Byl (2008)

examined proper exercise, nutrition, and ways to maintain a healthy lifestyle interspersed

with religious text. The first two chapters reflect heavily on Scriptural passages that pro-

mote living a life consistent with one’s values, including health and faith, and provide a

spiritual framework for supporting and maintaining healthy habits. In describing the focus

of their book, the editors link religious teaching with healthy living: ‘‘This book is about

knowing God and yourself and about how you can enjoy and care for the world God has

placed you in; it’s about knowing ‘that you yourselves are God’s temple and that God’s

Spirit lives in you (1 Corinthians 3:16).’’’ It is apparent, then, that religious beliefs and

practice are intrinsic to a healthy lifestyle. Religious leaders have an opportunity to become

the catalyst that helps members of their respective institutions to create a climate of healthy

behavioral patterns as an intrinsic part of religious and spiritual practice.

Koenig (1999) and Levin (2001) are among those proclaiming that all religions

encourage healthy living and discourage any habit or activity harmful to the human body.

Furthermore, the health-related benefits of following these tenets have been documented in

recent studies (e.g., Burazeri and Goda 2008; Schlundt et al. 2008). Others have decried the

failure of many people of faith to follow the teachings of their faith which would result in

improved energy and a higher quality of life while serving the Lord or a higher power (e.g.,

Baptist Messenger, January 31, 2008). Bearing in mind the numerous calls from the sacred

literature to avoid gluttony and practice self-discipline, religious leaders have a clear

opportunity to help their congregants embrace healthier behaviors as an intrinsic part of

their religious life.

The Role of Religious Affiliation in Promoting Healthy Lifestyle Choices

Several factors have been shown to help explain the influence of religious practice on

quality of health. This is particularly important in making the case for greater involvement

by religious leaders in promoting healthy habits in the religious community. One of these

factors is increased social support (e.g., religious leaders, family, congregation member-

ship). Surrounding oneself with individuals who provide support, understanding, and

motivation is referred to as the buffering hypothesis (Kinney et al. 2003). Individuals with a

strong social support system are healthier and suffer from less mental illness and disease

(Commerford and Reznikoff 1996). Religious institutions provide an important role as part

of a person’s social support network by increasing a sense of belonging and sharing with

other members’ beliefs and group-held norms about proper health-related behavior patterns

(Koenig 1999). The influence of social support on maintaining a healthy lifestyle as a

function of religious beliefs and practices remains an area meriting future research.

The results of other studies have indicated that those who practice their faith tend to

engage in fewer unhealthy behaviors because of scriptural teachings (e.g., see Koenig et al.

2001, for a review). This is partly because virtually all religions extol the virtues of healthy

habits, and sometimes urge followers to practice behavior patterns that promote good

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health and energy, and prevent disease and premature death. In addition, religiosity

empowers some individuals to take personal responsibility for their health, experiencing

reduced frequency and intensity of perceived stress, using effective, spiritually based

coping skills, and maintaining positive emotions to maintain good mental health (Koenig

1999). In his study of the religious elderly, Musick (1996) found that frequent participation

in devotional activities is significantly and positively related to perceived good health. One

possible explanation for these favorable effects is that ‘‘people involved in a religious

practice enjoy increased social support that has been increasingly recognized as playing a

significant role in mental and physical health’’ (Jones 2004, p. 318).

Strategies of Religious Leaders to Promote Healthy Habits

Perhaps aside from a person’s physician or health care provider, the one community

member who has the greatest influence on another person’s thoughts, emotions, and

behaviors is a person’s spiritual leader (Toh and Tan 1997). Religious leaders bring to the

situation of health behavior change their status and standing in the community, the proper

level of credibility, supportive Scriptural and other religious texts, history of a long-term

relationship with the individual that nurtures trust and respect, and communication skills

needed to influence desirable changes in health behavioral habits.

Sadly, there has been an apparent paucity of conscious attempts by religious leaders to

view health behavior change among congregation members—and for themselves—as an

intrinsic part of their mission. While there has been a paucity of research explaining poor

health practices of religious leaders, there is no shortage of speculation concerning the

reasons that religious leaders do not ‘‘practice what they preach.’’ Authors (e.g., Ellison

and Levin 1998; Kelly and Huddy 1999; Koenig 1999, 2007, 2008) have speculated on the

likely causes of the religious leaders’ inattention and neglect toward being better ‘‘stewards

of their temple.’’ These include: (1) the propensity of religious leaders to exert time and

energy toward the spiritual comfort and counsel to others, while ignoring their own per-

sonal psychological and health-related needs; (2) a perceived lack of time to engage in

exercise and other healthy habits that require additional time and effort; (3) a strong belief

that our health is primarily under the influence of a higher power and that the primary

strategy for maintaining good health is prayer; (4) their lack of knowledge about the

physical and psychological benefits of improved fitness and nutrition (e.g., increased

energy, improved information processing, elevated mood state, reduced stress and anxi-

ety); (5) absence of a mentor and other colleagues who maintain healthy habits, including

regular exercise and other forms of physical activity; (6) lack of knowledge about the

proper ways to exercise or to practice proper nutrition; (7) the lack of social support in

which friends, colleagues, and family members fail to indicate—verbally (e.g., ‘‘Good to

see you exercising, Pastor/Rabbi/Father’’) or physically (e.g., exercising with the religious

leader or promoting proper eating habits)—their recognition and approval of the religious

leader’s demonstration of healthy habits; (8) their own stress levels that consume their

energy and leave little time and energy toward self-care; and (9) the ‘‘Superman Complex’’

in which the religious leader does not believe, or feels impervious to, the long-term

consequences of unhealthy habits. Empirical research to confirm these plausible expla-

nations is needed.

Along these lines, further research, perhaps using qualitative methods which allow for

in-depth interviews, is needed to ascertain the reasons religious leaders tend to refrain from

discussing health-related issues from Scripture and other religious texts as part of their

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sermons and religious institution programs. It is plausible to surmise that religious leaders,

themselves, maintain many unhealthy habits, are overweight, and perhaps most important,

do not want to insult and, perhaps lose, their congregants.

Selected theoretical frameworks have been developed that provide a structure for

wellness interventions in religious settings. One framework, called New Institutionalism

Theory (Powell and Dimaggio 1991), posits that religious congregations and groups should

share sites and collaborate with other congregations to discuss community needs and plan

programs to meet them (Wuthnow 2004). Religious groups and institutions should network

with other congregations to circulate information about intervention strategies (Powell and

Dimaggio 1991; Trinitapoli et al. 2009). According to Catanzaro et al. (2007), the leading

motivation for churches to embrace a health intervention is to learn about the success of

similar programs from clergy of other congregations.

Another applied approach to health behavior change in the religious community is the

Socio-Ecological model (Campbell et al. 2007). This model is relevant to church-based

health promotion because it reflects the complex nature of a church community. It

addresses many factors that can influence the success of a behavioral intervention in a

church setting. Churches inherently provide congregants with motivation and support

through fellow members, as well as improve psychological well-being for church attendees

that regularly engage in prayer and religious practices.

According to Campbell et al. (2007), factors that must be considered when planning an

intervention within a church community include the members’ intrapersonal characteris-

tics, interpersonal/social networks, and organizational policies within the participating

church. These considerations provide a framework to intervene with multiple levels of

influence on health behavior change. Campbell et al. (2007) provide several components of

change that are related to church-based health promotion programs.

The intrapersonal component consists of individual characteristics that influence health

behavior such as improving the congregant’s knowledge, attitudes, beliefs, affect, and past

experiences. The interpersonal/social interaction component consists of interpersonal and

group influences including formal and informal social networks and social support from

family, friends, and church members to support healthy behaviors. The organizationalpolicies and resources component consists of policies and organizational structures that

help promote and maintain recommended behaviors within the church.

Community and geographic resources consist of neighborhood, community, or gov-

ernmental resources, institutions, policies, or other activities that improve the suppor-

tiveness and availability of healthy options for church members.

In one wellness study conducted in a church setting, Cowart et al. (2010) combined

nutrition education and exercise intervention over 12 consecutive Saturdays, for 3 h each

day to reduce obesity. Meetings started with participants sharing success stories and

challenges detailing the previous week regarding healthy eating and exercise. Discussion

was followed by a 1.5-h fitness program which included educational reinforcement and

group exercise. A pre-intervention survey determined that over half the participants fell

into the ‘‘obese’’ category according to their Body Mass Index. The results revealed several

favorable changes in nutrition (e.g., reduced fried food cooking methods, increased con-

sumption of fresh foods and whole grains) and exercise habits (e.g., regularly scheduled

cardiovascular and resistance training). Respondents judged this intervention program as

very helpful in improving their awareness of nutritional decisions and exercise participa-

tion. Scripture or other religious text, which lends support to living a more active lifestyle

and more nutritious dietary habits, was not cited, however.

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The religious and theological training of clergypersons may prove vital in these ways:

(1) to help others identify their values (e.g., faith, health, integrity, family), (2) to deter-

mine the extent to which persons’ lifestyles are inconsistent with their deepest values and

beliefs, and (3) to provide incentive for changing unhealthy behavioral patterns. Drawing

on tradition and Scripture with people of faith can underscore the inconsistencies between

a person’s lifestyle habits and his or her deeply held values (Anshel 2008). Perhaps, then, it

is plausible to surmise that a strong religious faith, also called spiritual health (Holt and

McClure 2006), and a trusted religious leader to provide Scripture-based incentive to

change behavior may facilitate healthy lifestyle habits based on the individual’s embrace of

their respective religious traditions. This approach to health behavior change has been

surprisingly absent from the religion and health literature.

Because religious leaders possess the communication skills, knowledge of religious

texts, and trusting relationships with congregants, they are in a unique position to carry out

a health behavior program in their religious institutions. They should seek the assistance of

mental and physical health professionals and life skill coaches who would work with them

to plan, generate, and implement programs intended to favorably influence the health-

related attitudes and lifestyle of their congregants and advance the health of these members

and the community, in general.

As indicated earlier, many individuals who maintain poor eating habits and a lack of

physical activity justify their actions by claiming ‘‘it’s God’s plan.’’ Most religious leaders

consider such feelings a misunderstanding of God’s role in our life (Colbert 2002). They

contend that it is the responsibility of each individual to guard and protect their ‘‘temple’’

and live a life consistent with one’s values. Failure to maintain behavior patterns and habits

that are consistent with one’s values is called a disconnect (Anshel 2010).

Many religious leaders contend that individuals who attend church services are looking

for spiritual fulfillment, as opposed to physical benefits, and that enhancing one’s spiri-

tuality is the religious institution’s primary role (Levin 2001). It is plausible to surmise,

therefore, that some clergy are not comfortable espousing the need to maintain a healthy

lifestyle and do not view health-related messages as central to their mission. Religious

leaders need to address over-eating, over-indulgence, self-control, self-discipline, and

gluttony from the pulpit without fear of offense. Initiatives by religious leaders to

encourage congregants to make changes in their lifestyles might be seen as matters that

might ‘‘bring glory to God.’’ Thus, expanding the mission of religious institutions must

include improving health and well-being among members.

Part of the challenge of attaining the mission of promoting healthy habits among

congregants is in persuading clergy to embrace a healthy physical and spiritual lifestyle as

an integral part of their own religious practice. Religious leaders who extol the virtues of

health as supported by Scripture, themselves may fail to ‘‘practice what they preach’’ (e.g.,

lack of regular exercise, overeating, poor dietary choices, being obese). An important role

is to be found in the clergy offering his or her personal situation as a model of the desired

change.

There are several planned strategies that religious leaders can use to promote good

health among congregation members. Their primary strategy is to provide their congre-

gation with the Word of God, such as preaching expository sermons—a verse by verse

study of the Word (Bauman 2008). In Titus 2:1, for example, Paul instructs Titus to ‘‘teach

what is in accord with sound doctrine.’’ It is advisable that the religious leader become a

vocal proponent of living a life consistent with appropriate values such as faith, health,

family, generosity, and integrity.

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Many religious leaders contend that individuals who attend religious services are

looking for spiritual fulfillment, as opposed to physical benefits, and that enhancing one’s

spirituality is the religious institution’s primary role (Levin 2001). It is plausible to sur-

mise, therefore, that clergy are not comfortable espousing the need to maintain a healthy

lifestyle and do not view health-related messages as central to their mission. In addition,

perhaps clergy do not address the issue of obesity because they do not want to risk

offending a significant number of their faithful members. One might also argue that there is

historically a strong association between church community life and food (e.g., church

potluck dinners, cake and cookies after church, etc.). For some denominations ethnic foods

are an integral part of their sense of identity (Koenig 1999; Levin 2001). Thus, to

encourage religious leaders to address over-eating, over-indulgence, self-control, self-

discipline, and gluttony from the pulpit without fear of offending congregants is needed.

Part of this challenge is in persuading clergy to embrace the need to maintain healthy

habits as an integral part of their own religious practice and maintaining a spiritual

lifestyle.

Other approaches that religious leaders can use for developing healthier habits in the

religious community and which require future research include the following:

1. Sponsoring wellness programs and services in conjunction with local fitness and sports

facilities (clubs, YMCA, schools);

2. Building a church fitness room and purchasing exercise equipment;

3. Sponsoring exercise and health-related programs or organizations/clubs;

4. Hiring health-related experts (e.g., a personal trainer, a registered dietician, a spiritual

counselor, health psychologist) to provide instruction and to deal with resistance and

barriers for engaging in programs that will improve health and wellness;

5. Scheduling seminars or workshops that are directly linked to a wellness program and

Bible study linking scripture to living a healthy lifestyle;

6. Sponsoring counseling seminars that address serious—and common—psychopathol-

ogy such as eating disorders, low self-esteem, depression, lack of perceived control

over one’s life that reflects an absence of free will, and related self-destructive

behavior patterns and beliefs that will impede the development and adherence to

healthy habits;

7. Leading wellness seminars on maintaining a healthy lifestyle based on Scripture and

other religious texts is of particular importance;

8. Encouraging religious leaders to include more sermon material that extol the virtues of

a healthy lifestyle, particularly if evidence is provided by Scriptural texts; and

9. Generating a mentoring program that includes role models of congregants who have

been successful in developing and maintaining a healthy lifestyle and who can mentor

other congregants who seek to achieve improved fitness, nutrition, and other healthy

habits.

Conclusions

Ironically, prayer, meditation, reading the Bible, and the social interaction provided by

religious practice each promote good physical and mental well-being. Yet, the ways

religious practitioners celebrate their faith and the many religious activities that are rooted

in high fat food represents an inconsistency that religious leaders should address. Equally

important is to encourage religious leaders to promote, model, and encourage physical

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health as an important and integral part of a person’s spiritual well-being. As Levin (2001)

concludes, ‘‘All religions endorse the idea that we ought to take care of our bodies and not

act in ways that are reckless and endanger our health’’ (p. 41).

As indicated earlier, one plausible explanation for the lack of progress in the area of

religious leader involvement in health behavior change is that, for many individuals who

engage in religious practice, weight reduction is an appearance issue rather than a health

issue. Omartian (1996), in response to this misunderstanding, claims ‘‘The biggest problem

with excess weight is not whether God still loves you. He does, and so do other people. Nor

is the biggest problem whether you look good in your clothes. The most important thing is

whether you’re going to be incapacitated by fat-related diseases and die prematurely’’ (pp.

89–90). It is apparent, then, that the greatest challenge to changing unhealthy habits among

those who have a strong faith and engage in religious practice is to understand the balance

between two thought processes: surrendering one’s life to the Lord on one hand and

maintaining free will and living a life consistent with good health and longevity on the

other.

Religious leaders have a particularly strong influence on the behavior of members of

their religious institution and in the community, in general. Their willingness to pontificate

the virtues of a healthy lifestyle, especially if grounded in Scripture, can be a source of

promoting healthy habits and reducing health care costs. Many people of faith wrongly

compartmentalize, rather than integrate, their life into spiritual and physical domains.

Bridging the gap between spiritual and physical components of life may be an area of

needed intervention. Thus, identifying religious or spiritual faith as an important (core)

value, yet failing to sustain and cherish one’s body (or ‘‘temple’’) by maintaining healthy

habits, is experiencing a disconnect between one’s values and behaviors (Anshel 2010).

Given the short- and long-term consequences of continuing the unhealthy habit should

cause a person to conclude that this disconnect is unacceptable. According to Anshel’s

(2010) Disconnected Values Model, an action plan is then needed to overcome the dis-

connect and eventually to realign the person’s values (e.g., faith, health, family, integrity)

with desirable behavior patterns (e.g., regular physical activity, proper nutrition and sleep).

Too often, religious leaders extol the virtues of healthy habits (that are consistent with

Scripture) but fail to practice these habits (e.g., lack of regular exercise, improper dietary

habits, obesity), themselves. This is at odds with the expectation that clergy follow

Scriptural teaching for personal and professional guidance. As Levin (2001) recognizes,

‘‘while not all religiously affiliated people follow all of the health-related guidelines of

their particular faith, we can expect that, on average, people who report a religious identify

are more likely to follow the dictates of their religion than people who report no affiliation

at all’’ (p. 33).

In summary, religious leaders might consider initiating at least four strategies to

advance the need to improve healthy habits among their congregants: (1) be more active in

assisting their congregants to make better lifestyle choices as part of the religious insti-

tution’s mission, (2) initiate programs and skilled, qualified leadership that provide the

structure and opportunity to carry out healthy lifestyle choices, (3) communicate to

members, through newsletters, sermons, and small group discussion, Scriptural passages

with members that extol the virtues of healthy lifestyle choices, and (4) be models in

making maintaining improved, more desirable behavior patterns that are consistent with

verbal messages and reflect the benefits of leading a healthier lifestyle. As Omartian (1996)

contends, ‘‘The main reason to exercise is for your health. Without good health you cannot

do all the Lord has for you to do and you cannot be all the Lord wants you to be.’’ (p. 117).

Sadly, religious institutions have heretofore neglected or given insufficient attention to this

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issue and often support a culture of overeating and other unhealthy habits (Cline and

Ferraro 2006). Further research is warranted on the effectiveness of clergy interventions

designed to change congregant lifestyle choices and the resultant desired health outcomes,

including improved fitness and other health markers. As Omartian (1996) contends, ‘‘Do

not ask the Lord to guide your footsteps if you are unwilling to move your feet’’ (p. 104).

Greater effort must be directed toward using the pulpit as a means to communicate the

association between religious texts and maintaining a healthy lifestyle in the hope of

influencing congregant health behavior. Religious leaders have a unique opportunity to

promote community health and help others develop healthy (positive) habits, especially

those habits related to proper diet and nutrition, and various forms of physical activity. The

role of these religious leaders, however, has been virtually neglected in the area of com-

munity and institution health behavior change. It is imperative that religious leaders help

others take the initiative to begin and maintain healthy habits and avoid, what (Holt and

McClure 2006) call ‘‘that God can heal through prayer and strong faith, so there is no need

to seek medical attention…and the idea that illness is God’s punishment for sin’’ (p. 272).

As Kelly and Huddy (1999) have concluded in strong support of developing healthy habits

through the religious community, ‘‘Religious institutions have a responsibility to encour-

age stewardship of the human body by providing experiences and environments that enable

and promote health-enhancing behavior and discourage health endangering behavior’’

(p. 334). Empirical research on the effectiveness of these health behavior change inter-

ventions in the religious and spiritual community is very much needed.

References

Anshel, M. H. (2008). The disconnected values model: Intervention strategies for health behavior change.Journal of Clinical Sport Psychology, 2, 357–380.

Anshel, M. H. (2010). The disconnected values (intervention) model for promoting healthy habits in reli-gious institutions. Journal of Religion and Health, 49, 32–49.

Baptist Messenger. (2008) Baptists the fattest of the fat? Presented at the Baptist General Convention ofOklahoma, Oklahoma City, OK, January 31, 2008.

Baumann, R. (2008). The overweight church. March 27, 2008. www.ChristianWorldviewNetwork.com.Burazeri, G., & Goda, A. (2008). Religious observance and acute coronary syndrome in predominantly

Muslim Albania: A population-based case-control study in Tirana. Annals of Epidemiology, 18,937–945.

Byl, J. (2008). Valuing wellness. In P. Walters & J. Byl (Eds.), Christian paths to health and wellness (pp.3–12). Champaign, IL: Human Kinetics.

Campbell, M. K., Hudson, M. A., Resnicow, K., Blakenely, N., Paxton, A., & Baskin, M. (2007). Church-based health promotion interventions: Evidence and lessons learned. The Annual Review of PublicHealth, 28, 213–234.

Catanzaro, A. M., Meador, K. G., Kuchibhatla, M., & Clipp, E. C. (2007). Congregational health ministry’s:A national study of pastors’ views. Public Health Nursing, 24, 6–17.

Cline, K. M. C., & Ferraro, K. F. (2006). Does religion increase the prevalence and incidence of obesity inadulthood? Journal for the Scientific Study of Religion, 45, 269–281.

Colbert, D. (2002). What would Jesus eat? The ultimate program for eating well, feeling great, and livinglonger. Nashville, TN: Thomas Nelson.

Commerford, M. C., & Reznikoff, M. (1996). Relationship of religion and perceived social support to self-esteem and depression in nursing home residents. Journal of Psychology, 130, 141–151.

Cowart, L. W., Biro, D. J., Wasserman, T., Stein, R. F., Reider, L. R., & Brown, B. (2010). Designing andpilot-testing a church-based community program to reduce obesity among African Americans. TheABNF Journal: Official Journal of the Association of Black Nursing Faculty in Higher Education, 21,4–10.

Ellison, C. G., & Levin, J. S. (1998). The religion-health connection: Evidence, theory, and future directions.Health Education & Behavior, 25, 700–720.

J Relig Health

123

Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Center for disease control. Journal of theAmerican Medical Association, 303, 235–241.

George, L. K., Larson, D. B., Koenig, H. G., & McCullough, M. E. (2000). Spirituality and health: What weknow, what we need to know. Journal of Social and Clinical Psychology, 19, 102–116.

Harrigan, J. T. (2011). Health promoting habits of people who pray for their health. Journal of Religion andHealth, 50, 602–607.

Healthy People 2010. (2000). U.S. Department of Health and Human Services. www.healthypeople.gov/HTML/Volume1.

Hill, S. E. (2011). Easting to excess: The meaning of gluttony and the fat body in the anxiety world. SantaBarbara, CA: Praeger.

Holt, C. L., & McClure, S. M. (2006). Perceptions of the religion-health connection among AfricanAmerican church members. Qualitative Health Research, 16, 268–281.

Jones, J. W. (2004). Religion, health, and the psychology of religion: How the research on religion andhealth helps us understand religion. Journal of Religion and Health, 43, 317–328.

Kelly, M. P., & Huddy, C. (1999). Keeping your temple clean: Health promotion and religious function.Journal of Religion and Health, 38, 333–340.

Kinney, A. Y., Bloor, L. E., Dudley, W. N., Millikan, R. C., Illikan, R. C., Marshall, E., et al. (2003). Rolesof religious involvement and social support in the risk of colon cancer among Blacks and Whites.American Journal of Epidemiology, 158, 1097–1107.

Koenig, H. G. (1999). The healing power of faith. New York: Touchstone.Koenig, H. G. (2007). Spirituality in patient care: Why, how, when, and what. Philadelphia: Templeton

Foundation Press.Koenig, H. G. (2008). Medicine, religion, & health: Where science & spirituality meet. West Cons-

hohocken, PA: Templeton Foundation Press.Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York:

Oxford University Press.Levin, J. (2001). God, faith, and health: Exploring the spirituality-healing connection. New York: Wiley.Musick, M. A. (1996). Religion and subjective health among black and white elders. Journal of Health and

Social Behavior, 37, 221–237.Omartian, S. (1996). Greater health God’s way. Eugene, OR: Harvest House Publisher.Powell, W. W., & DiMaggio, P. (1991). The new institutionalism in organizational analysis. Chicago:

University of Chicago Press.Ryan, R. M., & Deci, E. L. (2007). Active human nature: Self-determination theory and the promotion and

maintenance of sport, exercise, and health. In M. S. Hagger & N. Chatzisarantis (Eds.), Intrinsicmotivation and self-determination in exercise and sport (pp. 1–19). Champaign, IL: Human Kinetics.

Schlundt, D. G., Franklin, M. D., Patel, K., McClellan, L., Larson, C., Niebler, S., et al. (2008). Religiousaffiliation, health behaviors and outcomes: Nashville REACH 2010. American Journal of HealthBehavior, 32, 714–724.

Sørensen, T., Danbolt, L. J., Lien, L., Koenig, H. G., & Holmen, J. (2011). The relationship betweenreligious attendance and blood pressure: The Hunt Study, Norway. International Journal of Psychiatryin Medicine, 42, 13–28.

Toh, Y. M., & Tan, S. Y. (1997). The effectiveness of church-based lay counselors: A controlled outcomestudy. Journal of Psychology & Christianity, 16, 260–267.

Trinitapoli, J., Ellison, C., & Boardman, J. (2009). U.S. religious congregations and the sponsorship ofhealth-related programs. Social Science and Medicine, 68, 2231–2239.

Wallston, K. A., Malcarne, V. L., Flores, L., Hansdottir, I., Smith, C. A., Stein, M. J., et al. (1999). DoesGod determine your health? The God Locus of Health Control Scale. Cognitive Therapy and Research,23, 131–142.

Walters, P., & Byl, J. (Eds.). (2008). Christian paths to health and wellness. Champaign, IL: HumanKinetics.

Wuthnow, R. (2004). Saving America: Faith-based services and the future of civil society. Princeton, NJ:Princeton University Press.

Young, C., & Koopsen, C. (2005). Spirituality, health, and healing. Sudbury, MA: Jones & Bartlett.

J Relig Health

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