Vanity vs. Gluttony: Competing Christian Discourses on Personal Health

Abstract

Three focus groups with adult Christians explored the ways that Christians give religious meaning to their physical health experiences through communication. Participants described thoughts on the link between faith and health and expressed their personal values. Christians spoke about both personal beliefs and interpersonal interactions. Personal beliefs were characterized by a sense that God calls one to be healthy; a response to this call—particularly through exercise—can demonstrate personal values of obedience and self-discipline. Interpersonally, failure to respond to this call and express these values was addressed through confession or confrontation. Discursive tensions arose concerning how to discern the spiritual motives or character of a person given their health behaviors or appearance. Implications for tailored health messages are discussed.

Keywords:

• Religion
• Health
• Values
• Dialectics
• Exercise

Obesity rates in the United States are at all-time high levels, with 32.2% of adult men and 35.5% of adult women classified as obese (i.e., BMI≥30; National Institutes of Health, 2010). Obesity often co-occurs with negative health outcomes, like hypertension, heart disease, and Type II diabetes (Flegal, Carroll, Ogden, & Curtin, 2010). Counterintuitively, given biblical passages that encourage care of one's physical body (e.g., 1 Corinthians 6:19–20), Christian religiosity (i.e., attendance at a Christian church, affiliation with a Christian denomination, or considering Christianity a salient part of everyday life) is positively associated with high rates of obesity (Ferraro, 1998; Kim, Sobal, & Wethington, 2003). Affiliation with organized religion is common in the United States, with more than two-thirds (78%) of US adults considering themselves Christians (Pew Forum on Religion & Public Life, 2008). Physical activity is one way to combat obesity and associated negative health outcomes (Slentz et al., 2004). Thus, promoting physical activity among Christians is a worthwhile goal that requires effective health messages.

In order to create effective persuasive health messages for this group, the complex relationship between religiosity and health outcomes must be understood from the perspective of the religious audience. From that foundation, practitioners can develop messages that persuade religious individuals to adopt (and to maintain) physically active lifestyles (Kreuter, Lukwago, Bucholtz, Clark, & Sanders-Thompson, 2003). Intervention messages must draw on the ways that faith communities talk about and give meaning to health issues, like exercise, to create a uniquely communicative approach to designing persuasive health messages for this population (Baxter, 2011). Atkin (2001) draws on decades of theoretical and empirical literature to argue that tailored intervention messages are more effective at modifying attitudes and ultimately leading to behavior change. Thus, the current study provides formative data about how Christian communication about health in general, and exercise in particular, expresses personal values; these data can be used to develop tailored campaigns about exercise for Christians.

Relevant Literature

Consistent exercise can facilitate weight reduction, which may decrease the risk of other obesity-related health issues, such as diabetes (Slentz et al., 2004). Increasing exercise among obese individuals is relevant for Christians because there is a positive relationship between obesity and Christian religiosity (Ferraro, 1998). In a nationally representative survey study, Ferraro (1998) found that the following religious variables were positively associated with obesity: considering religion a salient part of everyday life, affiliation with Baptist denominations, and frequent Christian church attendance. Kim et al.'s (2003) national survey also showed a positive association between religious affiliation, obesity, and gender, such that Conservative Protestant men had significantly higher BMIs than those who reported no religious affiliation.

Given this association between obesity and Christian religiosity, a number of studies have targeted the issue of overweight/obesity in Christian churches through interventions that aim to increase exercise. Some interventions have successfully increased physical activity among members of traditionally black churches using the church as a community organization through which to disseminate general (non Bible-based) health information (for an overview, see Campbell et al., 2007). Other faith-based weight loss interventions developed intervention messages that highlighted the connection between one's faith and one's health (e.g., Wilcox et al., 2007). For other health issues, campaigns used Bible-based messages and found them to be more effective than non-Bible-based messages at producing attitude and behavior change in religious audiences (Fitzgibbon et al., 2005; Holt et al., 2009).

Another way to target health messages to Christians is to create messages matched to their personal values. This can be an effective intervention strategy for this population for two reasons. First, people are inclined to achieve and to maintain consistency between their values and their actions (Bardi & Schwartz, 2003; Rokeach, 1973). Second, personal values are likely to be shared by Christians (Brown, 1987) because religious groups share beliefs that drive personal values (Miller, 2002).

Personal values are also relevant to intervention design because they are related to attitudes toward health behaviors and can guide successful message design (Atkin, 2001). According to the functional approach to attitudes, the expression of personal values is one reason that people hold attitudes (Katz, 1960). Personal values are relatively enduring, abstract beliefs about achieving desirable end-states, such as success or health (Schwartz, 1992). Value-expressive attitudes communicate personal values that clarify one's self-image and, at the same time, craft one's self-image (Katz, 1960). Thus, value-expressive attitudes are attitudes that reflect a person's self-image and a person's most fundamental life goals.

In a Christian population, there are likely some shared values (Miller, 2002), which may be expressed through attitudes toward particular health behaviors (Katz, 1960). Recent work with value-expressive attitudes has shown that attitudes are, indeed, related to personal values and that health messages matched to audiences’ values are more effective at changing attitudes than health messages that are not matched to audiences’ values (Hullett, 2004; Hullett & Boster, 2001). Thus, the link between personal values and health (and health maintenance behaviors like exercise) among Christians may help explain the relationship between religiosity and obesity, and it should be observable in Christian communication about health and exercise.

The Revised Relational Dialectics Theory, or RDT 2.0 (Baxter, 2011) provides a communicative lens for identifying competing discourses that constitute lived reality for individuals. Individuals constitute lived reality through assigning meaning to various aspects of life through shared communicative interactions with others. Meaning, then, is “located in the ‘between’—that is, in the interplay between competing discourses” (Baxter, 2011, p. 12). It is through this lens that talk about personal values and attitudes toward health, among a Christian sample, is explored.

Observing the interplay between competing discourses can help illuminate meaning-making in health contexts. It is a particularly useful lens for health research because the same material health event may signify different things to different people as a result of the discourses they are exposed to and engage in (Baxter, 2011). For example, one person diagnosed with breast cancer may interpret it as a loss of womanhood, whereas another may interpret it as a punishment for sin. In a similar way, there may be varied ways that Christians ascribe meaning to health and health maintenance behaviors such as exercise, and these meanings should be evident in Christian discourse about health and exercise.

Analyzing discursive interaction also illuminates the expression of personal values through communication, as well as the tensions that arise from those values. As Baxter, Hirokawa, Lowe, Nathan, and Pearce (2004) noted, “communication always implicates tracings of unified-yet-competing values, orientations, and perspectives” (p. 230). Indeed, in a study of pregnant mothers’ discourse about drinking alcohol during pregnancy, Baxter et al. (2004) found that pregnant mothers’ discourse reflected a tension between personal values of individual freedom and of responsibility to family. Similarly, Christian discourse regarding the relationship between personal values and exercise attitudes may contain important points of tension.

Given the need to address the positive relationship between religiosity and obesity among Christians in the US (Kim et al., 2003) and given the positive effects of exercise on weight maintenance and reduction (Slentz et al., 2004), this study seeks to understand Christians’ perspectives on the relationship between their religious beliefs and their exercise attitudes within the broader context of the faith–health relationship. Given the relationship between personal values and attitudes (Hullett & Boster, 2001; Katz, 1960) and the tensions that may be present in discourse about health beliefs and personal values (Baxter et al., 2004), the following research questions are posed:

RQ1: How will Christians describe the relationship between their personal faith and health?

RQ2: How will Christians’ personal values be expressed in discourse about Christian faith and health?

RQ3: What are the competing discourses in Christian talk about health?

Method

Sampling and Participants

To recruit participants, I contacted a ministry leader at a Midwestern non-denominational Christian church of approximately 2,500 members. According to a church elder1 I spoke with, this church is not affiliated with any larger church network, denomination, or hierarchy—it is completely independent.

The ministry leader I contacted allowed me to recruit participants from ongoing small group Bible studies. These small group Bible studies were designed for Christians in their 30s and above. Thus, the participants in the focus groups reflect that age demographic. During Fall 2009, I visited these small groups and told them that the purpose of my study was to examine the link between Christian faith and health; interested group members provided their contact information and I scheduled focus groups based on their availability.

Three two-hour focus groups were conducted in a meeting room at the church from which the participants were recruited; a total of N=16 church members participated in the groups. Conducting the focus groups at the participants’ church likely made religion more salient, thus the results should be considered with this caveat in mind. The first focus group included five participants, the second group included eight participants, and the final group included three participants. Among the participants, there was one white man and one African American woman; the remaining participants were white women. Additional demographic data were not recorded.

At the start of the focus groups, each participant completed an informed consent form. At the end, participants entered to win $25 gift cards to a local grocery store as an incentive; two participants in each focus group received gift cards. As a trained focus-group moderator, I moderated each focus group. The group interactions were audio-recorded, and a research assistant took notes on the proceedings to provide transcribers with additional information that helped the transcribers accurately attribute quotes to specific participants.

Instrumentation

I began each focus group by personally identifying as a Christian and frequent attendee at the church where the focus groups took place. This identification allowed me to have greater authenticity with the group members. My experience as a Christian and attendee at that church also helped me to be familiar with religious terms, phrases, and other meaning-making sensibilities common to these participants so that follow-up and probing questions could be usefully incorporated into the focus group interactions. My role as the moderator was to facilitate discussion, so I asked brief open-ended questions and allowed dialogue to unfold. My interjections were limited to follow-up questions to clarify or probe more deeply into participants’ statements. The moderator guide (see Appendix) used short, open-ended questions to guide participants through conversations about the relationship between faith and health with a focus on exercise.

Coding Procedure

Three research assistants transcribed the focus groups’ discussions from the audio files. No identifying information was included in the transcriptions. Participants’ turns were unitized as one complete thought, regardless of the length and regardless of the number of sentences. As sometimes happens during focus groups, some of the turns were interrupted with quick interjections or backchannel responses from other participants, such as “Amen” or “Right.” These interjections were not counted as separate thoughts, but were included as part of the main thought from the interrupted participant.

The data were analyzed using thematic analysis. Thematic analysis is “a method for identifying, analyzing, and reporting patterns (themes) within data” (Braun & Clarke, 2006, p. 79). The procedure for thematic analysis suggested by Braun and Clark (2006) was followed. First, I familiarized myself with the data. Then, I generated initial codes that reflected interesting features of the data corresponding to the description of the relationship between faith and health, the expression of values and attitudes through communication, and the discursive tensions present in the discourse. Next, I grouped codes into potential themes. Themes “capture something important about the data in relationship to the research question” (Braun & Clarke, 2006, p. 82). I used RQ1 as a basis from which to identify themes and sub-themes; then I examined the subthemes for evidence of values (RQ2) and discursive tensions (RQ3). Finally, I reviewed and revised the themes and their labels to ensure that they presented a clear, thorough, and accurate picture of the data.

After I identified and revised the themes, another coder used the coding scheme to code the transcripts and verify the coding scheme. In addition, the second coder identified negative cases (i.e., responses that did not fit into a theme identified by the researcher) in the transcripts. The second coder and I discussed differences in coding and negative cases; these issues were resolved. After discussing and resolving specific cases, the organization—but not the content—of themes and subthemes was modified.

Finally, I gave all participants the opportunity to provide feedback. Three of the participants—one from each group—responded, and I conducted member-checking with them. I spoke in-person with one participant, by phone with another, and via e-mail with another. I gave each participant a copy of a full report of the themes found in the groups, direct quotes representing those themes, and my interpretation of those themes. Then I asked for feedback concerning the accuracy of my representation and interpretation of participants’ comments. Each of the participants felt strongly that the themes were not only an accurate reflection of their groups’ discussions, but also a thorough reflection—correctly capturing the range of topics and positions covered in the groups.

Results

For the purposes of presenting the results, each participant has been given a pseudonym. In group 1, participants were Mary, Patricia, Linda, Barbara, and Elizabeth. In group 2, participants were Jennifer, Susan, Margaret, Joe, Lisa, Nancy, Karen, and Betty. In group 3, participants were Helen, Sandra, and Donna.

Research question 1 asked how participants would describe the connection between their personal faith and health. Research questions 2 and 3 concern the nature of these descriptions in terms of their value content and discursive tensions, respectively. Thus, the themes capture the description of the relationship between faith and health, and the interpretation of the themes highlights the personal values and discursive tensions present in these descriptions.

Main Theme 1: Articulating Personal Beliefs and Giving Meaning to Personal Experiences

The comments in this theme describe how each person interprets Christian teachings or Scripture about health and/or gives Christian religious meaning to his/her health experiences (RQ1). Subthemes within this theme include believing that one's body is composed of both flesh and spirit, obeying God's call to be healthy, developing self-discipline through exercise, praying for physical healing, and prioritizing spiritual versus physical activities. Three salient values (RQ2) within this theme include faith/devotion, obedience, and self-discipline (Schwartz, 1992) and are discussed in subthemes 1B, 1C, and ID. Finally, discursive tensions (RQ3) were observed in subthemes 1B, 1C, and 1D, where the line between God's and the individual's responsibility for personal health was blurred and contested, and where participants struggled with how to give meaning to external appearances that may indicate particular internal states. Finally, subtheme 1E presents the strongest tension in the focus group discourses: given a belief that health can be spiritualized to some degree, how does one prioritize the physical alongside the spiritual?

Subtheme 1A: Believing the body is both flesh and spirit. That the body of a Christian is composed of both flesh and spirit is a common Christian belief (see Matthew 26:41, Romans 8:5–6, and Galatians 5:17, ESV), and was one way that participants spoke about the faith-health relationship (RQ1). Sandra explained, “Our body is part of us and the Holy Spirit resides in this body.” Furthermore, the spirit—or spiritual portion of the individual (i.e., the Holy Spirit)—is considered good, and the flesh—or the human portion of the person—is often considered bad (e.g., Galatians 6:8). As participants spoke about this dualism of spirit and flesh in the body, they noted that Western strands of Christianity often divorce the body from the spirit or sublimate bodily concerns to spiritual concerns. As Sandra noted, “It's weird because it's almost like we've divorced our bodies from the Church. You know you don't hear much about gluttony in the Church.” Donna spoke about the idea that “culture” (or secular influences outside of the church) emphasizes the body, so churches are reluctant to engage in discourse about the body because they desire to stay discursively and ideologically distinct from “culture.” She said, “I think that maybe Churches are kind of afraid to bring in the body or health/nutrition part because it's so overdone in culture.”

Interestingly, there are significant discursive differences between the terms “flesh” and “physical.” To speak about one's physical body is completely different from speaking about “the flesh.” The “flesh” discursively represents those aspects of human experience that are opposed to spiritual goodness, i.e., the “flesh” is always bad. The “flesh” is where sin resides, because it is believed to be the receptacle of original sin passed down from Adam and Eve (Genesis 3). Thus, the “flesh” is a metaphor for a sinful human nature, whereas the “physical” body is simply a tangible part of human experience.

Though the physical body is part of the human experience, it is also subject to God's control, and tensions concerning the balance between personal or divine control over the physical body ran through much of the discourse in these groups. This tension echoes work with the spiritual health locus of control (Holt, Clark, Kreuter, & Rubio, 2003) that examines how religious individuals ascribe responsibility for health issues: either to God or to themselves in partnership with God. The next sub-theme deals with this tension.

Subtheme 1B: Praying for healing from God. An interesting space to examine the relationship between personal responsibility and God's ability to alter human existence is in the phenomenon of faith and prayer. Prayer is initiated by an individual in the hopes that it may influence God's actions or work in concert with them. Coupled with those prayers is the faith of the person praying them; faith not only that the prayer is effective, but also that God can answer such a prayer. Thus the faith and prayer phenomenon is an extremely complex and sophisticated way of blending the responsibility of the individual with the ultimate authority of God—essentially resolving a discursive tension (RQ3). Prayer and faith were often mentioned as vehicles for God's healing to occur. As Elizabeth said, “I believe that through faith that, you know, God will heal you.” Helen noted that prayer is often used as a resource for health issues, saying “you know most prayers are about health issues.” However, Sandra pointed out that belief in divine healing through faith and/or prayer can be taken to an extreme, and is part of a movement that is pejoratively termed the “health and wealth gospel” (Hunt, 2000). As Sandra explains:

There is in this [local] community a lot of teaching on this “health and wealth gospel.” So some people do think that healing came with the atonement, not just spiritual healing but physical healing was provided by Jesus on the cross, so everyone should be healed and if you're not [being healed] then you need to pray, you don't have enough faith. You know, it's your responsibility to claim and appropriate what God provided on the cross.

Though participants were careful not to align themselves with the so-called “health and wealth gospel,” they did often speak about God's ability to physically heal a person. Somewhat in tension with this belief that God heals the physical body is the belief and discussion of a personal responsibility to be obedient to God's call to be healthy.

Sub-theme 1C: Obeying God's call to be healthy. Obedience was a key value included in participants’ discourse about the relationship between faith and health (RQ2). Participants often alluded to a particular biblical passage which reads: “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” (1 Corinthians 6:19–20). Participants felt that this passage represented God's call for a Christian to care for his or her body, and spoke to a range of actions that have ramifications for one's physical body. As Donna said, “We're God's temple, so maybe if we care about God we should care about ourselves.” Mary specifically mentioned exercise as an activity that allows one to care for one's body, “When we talk about exercise and habits and such … many people believe that the body is the temple of Christ, and that they're to care for that.”

The idea of properly caring for the body as God's temple demonstrates that personal values such as living a spiritual life, being devout, and being obedient to God are expressed through communication about exercise attitudes (RQ2). As Joe described caring for the body as God's temple and part of his creation, he said “it isn't what you want to look like or how you want to feel, it's more: this is what would be pleasing before God.” Thus, attitudes about health maintenance were not based on physical appearance or even physical health, but, rather, they were based on pleasing God by being obedient to His call to care for the body as His temple.

In addition to direct references to the body as God's temple, and being obedient to care for it as such, participants generally expressed the idea that maintaining one's health is an expression of the personal value of obedience to God (RQ2). Obedience is a personal value and is considered a Christian virtue (2 Corinthians 10:5; Philippians 2:8). Specifically, participants expressed a belief that God calls Christians to live a healthy life. As Patricia said, “I do believe that that is a command from Him that we should be taking care of ourselves.” Along with being called to live a healthy life, many participants talked about God expecting them to be obedient to that call. Karen spoke about this, saying, “I have been looking at my future and trying to be healthy and stay healthy because I think that God does call on us to be healthy.”

Moving to an examination of the discursive tension in this subtheme (RQ3), the discourse of personal responsibility to be obedient to God was sometimes in tension with the discourse of God being willing or able to take care of a person (and his/her health) under any conditions. Sandra spoke about a tension between Christians who focus on personal responsibility to be obedient and Christians who prefer to rely on God for health maintenance: “It's like they [other Christians] don't want to take responsibility; they want to leave it all up to God … but I believe people have a responsibility for certain things and working in collaboration with God.”

The tension between relying on God to care for one's health and being personally responsible for obedience was succinctly expressed by Helen, “Well you can't just eat all you want and have all of these bad health habits and expect God to just erase it. He doesn't do that.” An exchange between Helen and Sandra expresses a similar sentiment:

Sandra: I mean God takes care of us but He's not going to allow us to abuse ourselves, I don't think He wants us to be …

Helen: We don't get to escape the consequences …

Sandra: Right.

Helen: We don't get to overeat and still be a size three.

Another personal value that was intertwined with the tension over responsibility for personal health was that of self-discipline.

Subtheme 1D: Developing self-discipline through exercise. Exercise was discussed as a behavior that demonstrates how a person might take responsibility for his/her health (RQ1). It was also discussed as a way to obey God's call to be healthy (RQ2). Some participants noted that exercise has spiritual meaning by providing an opportunity for spiritual growth in the form of developing a specific spiritual gift, i.e., self-discipline. Self-control, or self-discipline, is a personal value and is identified in the Bible as a gift of the Holy Spirit (Galatians 5:22). Discourse describing how a health experience can help a person develop such a value shows the intermingling of religious beliefs and personal values, and how personal values are expressed in communication about health (RQ2). A number of the participants saw a link between spiritual disciplines and physical disciplines, and noted that the discipline required to maintain a healthy life should be considered a spiritual discipline for two reasons. First, there may be spiritual motivation for exercising, which spiritualizes the activity. One example comes from Margaret:

I've started back on the treadmill and God has shown me that being on the treadmill is kind of like my Christian walk … God just shows me that so many times it's not about hitting my goal, but praying for people and getting me to the next mile.

Second, they felt that consistent commitment to exercise requires a person to rely on God for help in developing such discipline. Elizabeth spoke about her recent diabetes diagnosis, saying “I need to pray to God to be disciplined to do the things I'm supposed to be doing to keep myself healthy.” Lisa summed up this subtheme, saying, “it all takes the same thing: discipline and following Christ consistently … it's just the discipline of obeying what God tells us daily.”

The subtheme of developing the spiritual gift of self-discipline through exercise represents the tension between the discourse of valuing inward states (i.e., discipline and/or obedience) and the discourse of valuing external states as evidence of such inward states (i.e., the shape or size of a person's body) (RQ3). Some participants talked about how this is an area of a person's life where lack of self-control is physically evident, in the form of excess weight. Thus, even though many participants spoke about exercise as something that can be considered in terms of inward states, regardless of physical outcomes, they still placed value on the visible physical effects of such inward states like discipline or obedience. Mary spoke about this tension in terms of interpreting the actions of church leadership:

I think it [living a healthy lifestyle] is [a spiritual discipline] … I don't know if it's a prejudice I have or if it's just my own issue, but I've been in churches in the past where the leadership of the church is extremely overweight—that bothers me. Because that is like an outward sign of lack of discipline and those men are supposed to be our leaders.

Thus, discourses of valuing inward or outward expressions of certain personal values (e.g., self-discipline) are often in tension with one another. However, for participants like Mary, these discourses were not competing, but were two ways to give meaning to the same experience, i.e., external indicators allowing a person to discern inward states. Regardless of whether a person values inward or outward expressions of personal values, the choice to express a value like obedience or self-discipline through an activity like exercise presents its own tensions.

Subtheme 1E: Prioritizing spiritual vs. physical activities. This subtheme reflected one of the most important tensions in the focus-group discussions: if faced with a choice between physical and spiritual exercise, which one should a good Christian choose? Which position on exercise best expresses the personal values of a Christian? Sometimes participants, like Mary, had straightforward opinions about this choice: “I think if you quit going to church so you can get your jog in that might be a problem.” Sandra offered a more thorough discussion of this theme. She pointed to tensions between Christian values (e.g., obedience, a spiritual life) and the values in what she called “our culture” (e.g., vanity) and her comments reflected tensions between secular and religious discourses; she said:

I think that's our culture though. You [are familiar with] Christians [who], if they have to choose between spending time with God and exercise, they'll pick exercise. So I've always thought, “You know, I'm going to choose God.” It seems like it's set up as a choice because you've [only] got so much spare time. But then you find some people who, in this culture you know the body is idolized, and so it's like you're walking this line between where you want to take care of your body, but you don't want to spend too much time.

The following exchange illustrates a similar tension between caring for one's body as the temple of God and becoming vain or prideful through that pursuit as a result of exercise developing physical beauty:

Helen: I think it is that thing about the vanity and all of that stuff. You're afraid that maybe you're going to get too caught up in the flesh because if you start looking really good then … Well because then you get attention and vanity.

Sandra: I disagree with that, you can take care of yourself to the point of being beautiful and there is nothing wrong with that. You can separate the vanity from just looking good and feeling good.

Helen: I'm just saying when you are looking good and feeling good that's a motivation to start thinking vain thoughts and …

Sandra: But people look at you when you're F-A-T too, so I'm just saying that it's okay. It's a teeter-totter. I don't agree with what you said at all.

These discourses reflect participants’ inferences about others’ personal motives for engaging in exercise. Such motives may be considered “righteous” (e.g., developing self-discipline, being obedient) or “unrighteous” (e.g., wanting personal attention or a positive public image). For the Christians in these groups, it was important to distinguish which motives drive exercise for themselves and others. And, as discussed above, there are competing discourses with respect to how to identify a person's motives—either through external or internal indicators (RQ3).

Thus, a tension arises for Christians who realize that—regardless of which discourse of motive identification they endorse—their external appearance will be considered an indicator of their ability to be obedient to God's call to care for one's body as His temple (RQ3). External appearances can lead to one of two attributions that Christians in the focus groups wanted to avoid and those attributions represent discourses on unrighteousness. Exercise behavior can lead to attributions that a Christian is vain or prideful, that s/he values preserving his/her public image and seeking recognition, and is unrighteous. On the other hand, lack of exercise behavior, and subsequent excess weight gain, can lead to attributions that a Christian is gluttonous, does not value obedience, self-discipline, or devotion to God, and is unrighteous. Thus, discourses about external indicators of internal states crucially shape Christians’ attitudes toward exercise, largely because the internal state of a person (i.e., righteousness) is held in such high esteem within this community.

Main Theme 2: Interpersonal Experiences with the Faith-Health Connection

Though some of the discussion in the focus groups reflected individual beliefs about the nature of the relationship between Christian faith and physical health, the participants also spoke about situations where these beliefs are enacted in interpersonal contexts (RQ1). Specifically, participants discussed personally confessing a lack of obedience or self-discipline to other Christians and confronting other Christians about their lack of obedience or self-discipline in this area. Within these sub-themes, the values of obedience and self-discipline re-appear, and additional values of honesty and politeness (Schwartz, 1992) are expressed in subthemes 2A and 2B (RQ2). Discursive tensions (RQ3) were not present in these sub-themes; this point is discussed in the conclusion section.

Subtheme 2A: Confessing a lack of obedience or faith. Along with expressing a belief that God has called Christians to care for their physical bodies and to have faith (often through prayer) in His ability to bring physical healing, the participants’ discourse reflected many instances of confessing shortcomings in this area (RQ1). For example, Patricia spoke about specific health-maintenance behaviors, “I know I'm guilty of, of not doing the exercise, and taking care of my body like I should and eating right.” Margaret expressed this shortcoming in starkly spiritual terms, “food is an issue in my life. I think I've come to a place where I recognize it as a lack of the fruit of the spirit. A lack of self-control in my heart and life.” Margaret not only spoke about her struggles with overeating as an example of lack of self-control but also of weak faith, or trust, in God: “I'm supposed to be trusting in [God], yet I went to the ice cream.” Sandra confessed, “I'm definitely guilty of not taking enough time to care for my body, but you know it's a balance.” Thus, in confessing a lack of discipline or obedience, the participants again framed their health experiences within personal values (RQ2).

Importantly, these acts of confession happened in the interpersonal context of a focus group, and indeed, among Protestant Christians confession is commonly enacted in interpersonal ways with other Christians rather than being kept between a parishioner and a priest—as in Catholicism—or between only the Christian and God. Often the continual act of confessing to another Christian within the context of a relationship is termed “accountability” or holding one another “accountable.” For example, Nancy said, “as Christians we should be in control and accountable to each other.” Participants agreed that health maintenance can be a part of an accountability dialogue, but should not be the only focus of it; Margaret explained: “accountability is good but I think if you are accountable in a relationship the food is just a side issue.” Accountability was described as a dialogue within a relationship where both confession and confrontation can occur.

Subtheme 2B: Confronting overweight Christians. Some participants discussed—tentatively—the potential need to “confront” overweight individuals within the church (RQ1). One striking comment about the need to confront an individual who is overweight came from Mary who compared being overweight with other forms of sinful behavior which would, presumably, be confronted:

We would never allow our minister to walk up in front of our congregation with a bottle of beer in his hand or a pornographic magazine but we let them walk up with 50–60 [extra] pounds, which is a symbol of gluttony.

Unlike Mary, most other participants broached the subject of potentially confronting an overweight person with more caveats. In particular, most participants spoke about the need to have “accountability” rather than confrontation; and almost always, participants stressed the need to enact that accountability with sincere love. Considering RQ2, this emphasis on speaking truth lovingly (Ephesians 4:15) reflects the values of honesty and politeness. For example, Margaret said, “God's given us permission to call our brother or our sister up and say, ya know, ‘how are things going?’ But doing it out of love is the biggest thing.” However, the definition of being loving or kind was not the same across all participants, as Mary noted: “if we see people doing destructive things to themselves … kindness isn't always saying it's okay.”

In addition to talking about the need to possibly confront overweight as a symptom of sin in a person's life, participants were also careful to note that this type of confrontation could have more negative than positive effects. In this case, the value of politeness seemed to take precedence over valuing honesty in an effort to avoid negative responses to confrontations. For example, Elizabeth said:

[Confronting someone about their weight] can sound like you're getting put down to the point where you say … “Why should I even bother?” You know, so people that are encouraging or trying to be encouraging need to be careful not to make the person feel like there's no hope.

Speaking about the same issue but within the context of a youth group (which may include children ages 11–18), Sandra said, “I think that maybe youth groups are afraid to bring that in because they don't want to add to that pressure.” Thus, even though many participants saw a need for confrontation alongside confession, there was hesitancy about how that might realistically be enacted.

Conclusions

Previous studies have established a link between obesity and general indicators of Christian religiosity such as Christian church attendance, affiliation with a Christian denomination, and the belief that Christianity is a salient aspect of one's everyday life (Ferraro, 1998; Kim et al., 2003). Yet, in the current study, Christians’ discourse reflected a belief that Christian teachings can and should be linked with health behaviors (e.g., exercise) that could prevent or reduce obesity. This seeming contradiction points to the importance of considering not just religious affiliations or behaviors such as church attendance, but also the personal values tied to religious beliefs and the ways those are expressed through Christian discourse.

The relationship between Christian religiosity (both beliefs and behaviors) and health outcomes (such as obesity) is quite complex, and a focus on personal values helps to uncover how religious beliefs translate into health beliefs and behaviors. For example, a belief that exercise expresses selfish personal values or a belief that actively caring for one's personal health contradicts valuing faith in God and His ability to heal a person may lead Christians to avoid activities like exercise. It is possible that such values, as expressed in the discourses presented here, may contribute to physical inactivity and higher rates of obesity among Christians than among non-Christians. On the other hand, the Christians in this study expressed a sense that positive connections can be made between Christian beliefs, personal values, and preventative health behaviors such as exercise. In other words, they felt that although Christian norms can sometimes discourage a person from pursuing exercise because it seems to express selfish—rather than spiritual—values, Christian teachings can be effectively used to encourage physical exercise. The complexities of these discourses about Christian beliefs, values, and exercise, and their potential relationship with health behaviors, suggest that additional studies should examine this intersection to more fully understand and explain the nature of the relationship between Christianity and health outcomes such as obesity.

In the current study, Christians discussed their beliefs about the relationship between faith and health, and exercise in particular, in terms of their personal beliefs and interpersonal activities that reflect those beliefs (RQ1). Participants expressed a belief that the body is both flesh and spirit, and that God calls the Christian to care for that body. These beliefs were then discursively paired with personal values of obedience and self-discipline (RQ2). The values of obedience and self-discipline were expressed through communication in both positive and negative terms. In positive terms, participants felt that health maintenance behaviors can express and develop values like obedience and self-discipline. But in negative terms, or when those values were not consistently being expressed, participants turned their discourse to confession and confrontation in an effort to correct shortcomings in this area. Building from these links between personal values and health attitudes, four key discursive tensions were observed (RQ3).

First, there was a tension concerning responsibility for personal health. Participants saw a tension between personal responsibility and reliance on God for personal health. Second, there was a tension concerning valid indicators of personal values or motives. The discourses of external and internal indicators of motives presented tension with respect to discerning whether an activity is right or spiritual. Third, there was a tension concerning prioritizing or balancing of physical and spiritual health. In this case, participants expressed that choosing to exercise seemed to be choosing to ignore God, but this could not be reconciled with their belief that God had called them to care for their bodies. Fourth, there was a tension concerning discourses of unrighteousness with respect to exercise behavior. Participants communicated that pursuing exercise can be seen as a vain desire for physical attractiveness, whereas lack of exercise can be seen as lack of self-control or the presence of gluttony.

The discourses about how to identify internal states through external indicators, as well as the discourses concerning whether a person is righteous, reflect similar discursive tensions within broader Christian teaching. For example, Jesus often chastised the religious leaders of His day for paying attention to external indicators of religiosity while ignoring their own (and others’) motives for behavior (Matthew 23:25–26). On the other hand, Jesus tells His followers that a tree is known by its fruit; in other words, a good Christian will demonstrate external proof of his or her faith (Mark 6:43–45).

Thus, the discourses in the focus groups reflected broader tensions in Christian teaching, but participants expressed a desire—transcending this tension—to align their inner motives with external indicators in responding to God's call to care for their bodies. In other words, they wanted to express and develop their personal value of obedience as an internal state that may have external consequences. They seemed to feel that exercise could be thought of as a spiritual discipline, one that expresses Christian personal values such as obedience and self-discipline, but that current discourses about exercise—both within and outside the church—do not promote this type of thinking. Again, current discourses concerning the relationship between Christian beliefs and exercise may be influencing Christian health behaviors and contributing to the prevalence of obesity in these communities. However, messages to promote preventative health behaviors such as exercise may still be able to successfully use a religious framework to persuade religious audiences to adopt such behaviors. Indeed, participants in this study expressed a desire for new exercise messages that are presented using their language, rather than the “worldly” messages that tout exercise as a way to attain physical attractiveness.

Developing new messages about exercise using Christian meaning-making must be done in a way that also honors the discursive distinction between the “flesh” and the “physical” seen in subtheme 1A. Though Christians want messages that link the physical body with their spiritual beliefs, messages should not make the argument that one should no longer divorce the “flesh” from the spirit, because reconciling the spiritual nature (i.e., the spirit) with the sinful nature (i.e., the “flesh”) would not be consistent with the meaning-making sensibilities observed here. However, messages could successfully make the argument that the physical should not be divorced from the spiritual; and this argument would be consistent with the Christian discourse presented here. Therefore, a careful communication campaign should untangle the physical body from the concept of “the flesh” and argue for a greater connection between an individual's physical and spiritual components for the purpose of improving health.

Limitations

The results of this study may be limited in a number of ways. Participants were speaking about their Christian perspectives on an issue while in a room at their own church filled with other Christian church members. Thus, the salience of their Christian identity was highlighted by both the location of the focus groups and the participants in them. Participants’ remarks may reflect the performance of the role of a “good Christian” in front of peers rather than authentic perspectives on this issue. This may have been particularly powerful in the discussions of confession and confrontation. Because these interpersonal activities are generally endorsed by Christians across contexts as “good” behaviors, there was likely pressure not to disagree with applying those behaviors to a health context. However, during the focus groups there were clear tensions and disagreements among participants, and during member-checking interviews, each participant highlighted the individual nature of this issue—noting that individuals arrive at their own interpretations of the relationship between faith and health and these interpretations vary widely. Still, the nature of the data collection in this study may have mitigated additional tensions or dissent. Future studies using in-depth individual interviews could provide an opportunity for Christians to express their thoughts on the subject with less potential social pressure to present a particular “good Christian” identity.

This study was limited by not measuring various factors, such as current weight, current health, or the frequency, duration, and intensity of exercise. Such health indicators likely play a role in people's attitudes toward, and engagement in, physical exercise. The influence of these factors was outside of the scope of this study. Future studies should include additional measures of these factors in order to determine how they may interact with personal values and religiosity to affect exercise attitudes and behaviors.

The sample in this study is limited in size, potential self-selection bias, and gender and ethnic diversity. Three focus groups is a small sample size, even for a study of this nature. In addition, the participants were unique in that they were active in Bible studies and were interested in talking about the connection between faith and health. Therefore, their responses may not be representative of the congregation from which they were sampled or from Christians generally. The study was also limited in gender and ethnic diversity. Though women outnumber men in all major Christian denominations (Kosmin & Keysar, 2009), the imbalance is not as striking as that found in the sample for this study. In terms of ethnic diversity, all participants except one were white (i.e., 93.8% were white). In comparison, the general population of US Protestants is also predominantly (74%) white, but includes a greater proportion of other races (i.e., Black, 16%; Hispanic, 5%; Asian, 1%; and other races or ethnicities, 3%) (Pew Forum on Religion and Public Life, 2008). Further, regardless of race, the sample in this study is not representative of Christians across denominations, and future studies should work to incorporate greater gender, ethnic, and denominational diversity.

Practical Applications

Findings from this study suggest that practitioners working to increase exercise activity among Christians should create messages about exercise that frame physical activity as a way to be obedient to God's call to care for one's body as God's temple. Importantly, this type of message transcends some key discursive tensions by making exercise a behavior that is not about losing weight, looking good, or avoiding gluttony. Instead, exercise is a behavior that allows a person to express one of his/her most highly endorsed values: obedience. This type of message might work to reinforce the link between the value of obedience and exercise attitudes that appeared in this Christian discourse. In addition, such messages may prompt the audience to alter their discourse about exercise, so that their communication more strongly expresses the connection between their personal values and exercise attitudes. Since meaning-making occurs through communication and shapes our material realities (Baxter, 2011), prompting new types of discourse about exercise is a useful communicative step toward improving the health of this community.

Future health communication interventions should continue to utilize Baxter's (2011) RDT 2.0 as a sensitizing lens through which to analyze and interpret current discourses surrounding the health issue of concern. This theory, and the use of thematic analysis, allows participants’ meanings to emerge from their discourse, which provides researchers with a rich picture of the ways that participants think and talk about the health issue. In particular, researchers interested in linking participants’ values to their health attitudes and behaviors are encouraged to first consider analyzing communication from the target population in order to become sensitized to the values that are already embedded in the discourse, as well as key discursive distinctions (e.g., “flesh” vs. physical). Additionally, this lens allows a researcher to uncover tensions that can be addressed or transcended, rather than ignored or reinforced, through intervention messaging.

Acknowledgments

For their valuable feedback on this manuscript, the author would like to thank the reviewers, Dr. Stafford (editor of this special issue), and Drs. Braithwaite, Bach, and Metts who provided feedback through the 2010 NCA Doctoral Honors Seminar. A previous version of this paper was presented at the NCA Annual Convention in Chicago, IL.

Additional information

Notes on contributors

Jenn Anderson

Jenn Anderson is a Doctoral Candidate at Michigan State University

Notes

1. Elders are the spiritual and structural leaders of the church as an organization. At this particular church, all elders are men, and are chosen for inclusion based on criteria outlined by the current elders.

Appendix 1. Moderator guide

1.	How might faith or religion affect someone's health?
2.	Can you describe a time when faith or religion had an impact on some health issue that you or someone you know went through? a. What aspect of faith/religion had an impact? b. How did it impact the health issue?
3.	Which health issues do you think are most likely to be affected by religion or religious beliefs? a. Why does religion, or why do religious beliefs, affect these health issues? b. How does religion, or how do religious beliefs, affect these health issues?
4.	Does faith, or religious belief, have any affect on exercising or dieting? a. If yes, how so? Or why? b. Do you think it should? Why or why not?
5.	Does your religious faith affect what you think about exercising or dieting? a. If yes, how so? Or why? b. Do you think it should? Why or why not? c. How does your own religious faith affect the way you think about any of the other health issues we just discussed?
6.	How might your religious faith affect the way you would deal with establishing a healthier lifestyle? a. Do you think it should? Why or why not? b. How does your own religious faith affect the way you deal with any of the other health issues we just discussed?