On October 10, 2000, two days before her seventeenth birthday, Ria Hickerton was pronounced dead upon arrival at Wexford Hospital.
It had been an otherwise typical Tuesday. She had said goodbye to her friends after school and jogged to the local library, where she worked part-time as a library assistant. For once, the weatherman had correctly predicted rain, and droplets had just begun to strike the sidewalk when she entered the building.
Within a few hours, the rain would stop and so would her heart. Her death was a thunderbolt to the close-knit community: as a member of the Leamington Swim Club, Ria had been active, and by all accounts, in perfect health. She had no history of diabetes, heart disease, or fainting; in fact, when she was first discovered slumped over the help desk, a coworker thought she was sleeping.
On the other side of the world, Elizabeth Boham was a medical student in residency at Albany Medical College. At age 30, she’d already earned an undergraduate degree in nutritional biochemistry from Cornell University, as well as a graduate degree and Registered Dietitian credential through Columbia University. Her ultimate passion, however, was disease prevention, and according to friends and family, Elizabeth practiced what she preached: she was careful with her diet, prioritized regular exercise, and her weight was within the “normal” range for a healthy, active female. But one morning, while practicing a breast self-exam as part of her training, Elizabeth felt a massive lump.
Sitting on the examination table, she felt her heart stop and restart with a frantic beating that drowned out the noise of the bustling hospital. Immediately, she checked a second time…then a third, and a fourth, and a fifth, until she had managed to convince herself that it was not—it could not be—cancer. After all, she had devoted her life to both the practice and study of cancer prevention. No one in her family had any history of the disease, Elizabeth reasoned. Surely it was something else that another doctor could properly identify.
Elizabeth was eventually diagnosed with a 1.7-centimeter triple negative aggressive breast cancer: in layman’s terms, this meant that common treatments, such as hormone therapy and targeting drugs, would be ineffective[1]. Almost overnight, Elizabeth was stripped of her white coat and placed in a blue hospital gown. The shock of this diagnosis, along with the accompanying stress of treatment and recovery, would send her into three years of depression.
At first glance, Elizabeth and Ria may not have had much in common. But to those who knew them best, both women were exceptions to an unwritten rule: that by doing the right things, and not doing the wrong things, one can effectively “earn” one’s well-being.
Health, at least in the United States, is accepted as undeniably hard work. As one fitness guru declares, “There is no getting around it...being fit and healthy—and staying that way—requires discipline and dedication”[2].
Indeed, while not all of us may have the time or ability to exercise, we respect those individuals who diet, work out, and will eventually (at least in theory) outlive us. We admire their self-control, commitment, and assiduity. Perhaps, somewhere deep inside, we resent the intensity with which they approach their work as it makes us.By comparison, we feel less diligent, less focused, and certainly less deserving of the benefits that come with a “healthy body.”
Such discontentment is never more apparent than in the first week of January. With each new year, we resolve to improve ourselves by eating better, working harder, and going to the gym more often. Even as our initial determination fades, our conversations and portrayals of toned, sculpted bodies serve to either motivate or shame our waning self-discipline.
Various January covers for STRONG, Fitness, and Men’s Health magazines.
A mere glance at the magazines lining the grocery checkout aisle provides ample proof of our obsession with what we perceive as “health.” Grinning, glistening figures, typically wearing nothing more than bathing suits, invite shoppers to “shift” their “Xmas bellies.” On one cover for Men’s Health, a bolded headline screams, “Get Back in Shape! Drop Two Waist Sizes and Build Strength and Size”[3].
Research—and personal experience—shows that most resolutions will fail by the first week of February[4]. And yet, the focus on weight loss, especially as it pertains to health and , well-being, and other lofty goals, persists throughout the year as depicted on the March and April covers below:
[Image result for fitness health magazine,Image result for foods to live longer magazine]
Gemma Atkinson, actress and author of The Ultimate Body Plan: Get the Body You Love and Discover a Leaner, Fitter You, for the March 2019 cover of Health & Fitness. On the right, the April 2019 issue of EatingWell magazine.
For most Americans, choices relating to food and fitness will remain heavily imbued with moral significance. Take, for example, the marketing of food products. In 2014, The National featured an article titled “Seven Deadly Foods You Need to Avoid,” in which the author compared refined white flour, diet soda, and hydrogenated oils to the seven deadly sins, a group of vices within Christian teachings which, when combined with their unwholesome confederates, constitute a multitude of culinary abominations[5]. After all, if certain foods are good for you, then it’s not a far stretch to say that other foods must be bad. Along with traditional carrot sticks and celery stalks, “Skinny Sticks,” “Thinables,” and “Real Thin” popcorn are a few notable examples of “snacking [that] you can feel good about.” On the other side of the scale, Kraft Dinners, DOVE chocolates, and fast food chains, such as Wendy’s and McDonald’s, invite consumers to [Image result for magnum seven deadly sins] “indulge” on their greasy, guilty pleasures.
Shown below: Advertisement for new menu selections at The Green Turtle, a sports bar franchise.
[Image result for food guilt advertising]
Somehow, we’ve convinced ourselves that healthy eating is black and white. In the process, we’ve also come to believe that our diet, by association, can make us either “virtuous” or “sinful”[6]. Just as children can be “bad” for hitting a sibling or lying to a parent, adults may describe themselves as “bad” for eating a midnight snack. With increasing access to information regarding food, nutrition, and the obesity crisis, our accountability is only increasing.
For most of us, guilt, fear, and shame aren’t words that we would immediately associate with food, but in March 2019, a survey from OnePoll found that Americans “feel guilt about 29 percent of the food they eat on average”[7]. It doesn’t stop there: in terms of physical activity, popular culture also equates exercise with “goodness”.
Three hundred years ago, it may have been common practice to attend church on Sunday: according to the National Library of Congress, an estimated 75 to 80 percent of the population attended churches between 1700 and 1740. Today, many Americans approach their gyms with the same devotion. In an article for The Atlantic, writer Zan Romanoff describes how her experience at SoulCycle (a popular indoor-cycling fitness company) “mimics the form of traditional religious services” by “[painting] its room with mantras that…subsume new riders into a collective ‘we’ that ‘aspires to inspire’” by “‘find[ing] freedom in our sprints’.” Much like churches appoint pastors and priests to guide their congregation through religious services, SoulCycle assigns instructors, men and women who provide proper form and lead routines for the masses, who gym-goers “revere as gurus.”
[Image result for soulcycle class picture]
Above: Empty pews bicycles in a SoulCycle classroom. [Image result for corepower yoga classes]
Shown above: Mission statement taken directly from the SoulCycle website.
Left: A CorePower yoga class. According to its website, CorePower consists of over 200 studios nationwide. Its goal: to “show the world the incredible life-changing things that happen when you root an intensely physical workout in the mindfulness of yoga.”
Rather than focusing solely on the outward physical appearance, SoulCycle promotes the belief that fitness is a “gateway” to a “larger and more lasting state of happiness and fulfillment.” However, its message is far from unique. Whether through CrossFit’s relentless message of blood, sweat, and toil, or in CorePower’s simple directive to “live your power,” one promise endures: “Your body will get smaller, your world will get bigger, and your life will get better, but only through rigorous, sweaty work”[8].
A motivational poster taken from PFITblog.com. Steve and Bonnie Pfiester are self-professing Christians who run Max Fitness and BCx Boot Camp™ in Vero Beach, Florida. The Pfiesters offer 30 days of “Daily Fitness Devotionals”, each of which tie around a daily Bible verse and fitness goal[9].
At some point in our history, working out became a goal as worthwhile as saving money , eating healthy, orand learning a new skill. While it’s true that losing weight is hard work, the implications of food and exercise on one’s outward appearance directly translate to virtues of discipline, serenity, and self-control. If exercise and weight are linked to being a good person, or at the very least, to “a person who does the ‘right’ thing”, it is unsurprising that failing to exercise as much as you “should” can become a source of guilt[10].
Even for special occasions, disengaging from such behavior comes with a sense of shame and weakness. As explained by Jennifer Still for Healthyish, “cheat days” serve as “naughty loopholes” in the “health and wellness law of dietary restraint”—and God forbid that you eat without self-regulation. Jillian Michaels, a well-known fitness guru and television personality from the show The Biggest Loser, recommends eating “intelligently” by “sticking to three meals and one snack per day, and fasting for at least 12 hours overnight”[11]. Self-discipline and motivation, while required for any grueling task, are presumed to be absent in those who choose—or fail—to embrace a “fitter” lifestyle.
[Image result for exercise discipline] [Image result for exercise discipline]
Various “Fitspiration” posters from the web.[CAT3]
How has wellness evolved into a series of commandments with tasks that either make or break the moral code? The answer may lie further back in our history than one would expect. Oliver Burkeman, a writer for The Guardian, points out that hard work and self-denial are two traditional American values that were instrumental in establishing our government, medical system, and more recently, the fitness industry.
What’s interesting to note is that Burkeman is not a health writer or fitness guru. In fact, his words first appeared in a commentary on the Protestant Work Ethic, a controversial social phenomenon first characterized by German economist Max Weber. In his book, The Protestant Ethic and the Spirit of Capitalism, Weber claimed that the Protestant values of hard work and diligence led to the emergence of modern capitalism. Simply put, the Protestant work ethic was characterized by active contribution to the community as well as a staunch dedication to self-improvement: two features which led early businessmen to earn money, invest it, and see areceive return, but without indulging in its profit[12].
When it came to dietfood and drink, one subgroup of Protestants was especially disciplined. Named after John Calvin, a French theologian and statesman, the Calvinists were marked by a belief in predestination, or the doctrine that God has “eternally chosen those whom [He] intends to save”[13]. In other words, there is no way to earn one’s place in Heaven. God alone knows who is saved from eternal damnation and who isn’t. However, since evidence of salvation includes a “life of systematic and unemotional good works…and self-control,” many of Calvin’s followers suggested that a “moral life” could prove that a person was (probably) one of the chosen few[14].
It’s not hard to see how such thinking might have unleashed a revolution. While Weber’s hypothesis remains wildly controversial, it’s true that Calvinists were marked by their discipline and personal responsibility. According to an article from The Presbyterian Outlook, the main aim of eating to early Calvinists was “to sustain people so that they may give thanks to God and serve him through earthly labor”[15]. In his sermons on Ephesians, one of the Apostle Paul’s letters to the early church, John Calvin wrote that the “lawful use” of wine, water, bread and “other viands” was to “feed ourselves…according to the need of our infirmity, and to sustain us so in life that we may not live idly, but that first of all we may do homage to him of whom we hold our life.” (sic)
It's important to note that Perhaps it is no coincidence then that the religious traditions of early American settlers were of a Calvinist background. As members of a “varied group of religious reformers who....shared a common Calvinist theology and common criticisms of the Anglican Church,” Puritans believed that God made each person a steward of His earth[16]. Men and women were meant to devote their lives to God by working hard to care for each other, as well as the nourishment of their own bodies.
Today, it’s evident how Calvinist attitudes have shaped our views on food and exercise. Health personalities like Doctor Oz and Deepak Chopra may be far from their more pious precursors, but their underlying message echoes the same call to uncompromising devotion. Some notable headlines and book titles include:
This Is Your Do-Over: The 7 Secrets to Losing Weight, Living Longer, and Getting a Second Chance at the Life [CAT4] You Want by Michael F. Roizen, foreword by Dr. Oz
The Vice Busting Diet: A 12-Week Plan to Break Your Worst Food Habits and Change Your Life Forever, written by Julia Griggs Havey and promoted by Dr. Oz as a source of “insights into how we can join her in gaining wellness through healthy weight control”
Perfect Weight: The Complete Mind/Body Program for Achieving and Maintaining Your Ideal Weight by Deepak Chopra
What are You Hungry For?: The Chopra Solution to Permanent Weight Loss, Well-being, and Lightness of Soul
Words such as “second chances,” “vice,” “perfect,” and “soul” are charged with religious connotations. Although the pursuit of health may not be recognized as an organized religion, for those among Oz’s and Chopra’s target audiences, it is much more than a hobby. Exercise and diet are steps along the path to Enlightenment, two ways in which one can attain a higher, purer, way of life and reach some sort of Enlightenment.
****
In the United States, people who eat well and exercise religiously are often in “good shape.” Nonetheless, numerous studies have shown that there is a significant link between genetics and disease. . According to one estimate from the National Institutes of Health, “about 25 percent of the variation in human life span” is determined by one’s DNA, but for the most part, health professionals and fitness fanatics alike are quick to point out that “there are no shortcuts when it comes to health”[17]. Much of the current “fitspiration” movement depends on the simple presumption that with enough hard work, anything—even cancer prevention—is possible. As one advertisement proclaims in bold white font in front of a grinning woman and her six pack, [Image result for want it? strong health heart mind FitnessPod] “Want It? Eat Right. Exercise. Sleep Enough.”
However, as Ria Hickerton’s death demonstrated to the entire fitness community, there are exceptions to those rules which reveal just how complicated health really is. No amount of exercise or healthy eating could have prevented the onset of Sudden Arrhythmia Death Syndrome, a genetic heart condition that resulted in the sudden death of a young, “apparently healthy” person[18].
The fact of the matter is, for much of our population, physical appearance is a poor indicator of happiness and longevity. According to a 2017 study from the Centers for Disease Control and Prevention, unintentional injury is the leading cause of death for individuals aged 1 to 44 years. Among ages 10 to 44, suicide is the second, with homicide being the third most common cause of death for ages 13 to 34. Surely even Dr. Oz would be hard pressed to prescribe “clean eating” as the solution, and yet, despite mounting evidence for a more complicated narrative of well-being, it remains that “effort is key”[19].
So, what does this mindset imply for people who have poor health, perhaps as a direct result of their own poor choices?
In the early 2000s, health professionals identified a trend that was quickly dubbed the “Obesity Epidemic.” Alarmed at the rate of increase in body mass, in 2001, then-Surgeon General Paul Ambrose wrote a “Call to Action to Prevent and Decrease Overweight and Obesity.” In the paper, Ambrose declared that “a healthy diet and regular physical activity”, as prescribed by the Dietary Guidelines for Americans, “should be promoted as the cornerstone of any prevention or treatment effort.”
With the help of media outlets, the “Call to Action” triggered nationwide panic. “Overweight and obesity” may not be infectious diseases, but according to the Nation’s Doctor, they had “reached epidemic proportions” and anyone, even one’s children, might be next.
I vividly recall the fear which washed over me when my third-grade gym class attended a meeting on obesity. In a hushed, somber tone, the speaker divulged that my classmates and I were young enough to “make a change.” While we still could, we needed to stay active, eat vegetables, and avoid junk food if we wanted to “grow up healthier” and be “able to pursue [our] dreams”[20].
As a teenager, this fear never went away. Instead, it faded to the back of my mind, where it subtly influenced other areas of life, expressing itself through compulsive exercise, calorie-counting, and, in my third year of high school, a restrictive eating disorder. Like so many of my peers, I just wanted to do the right thing. Perhaps more importantly, I wanted to look as good as everyone else.
Of course, the problem is not moving more and eating healthy. Plenty of research has shown the benefits of whole grains and regular exercise. Heart disease, asthma, and diabetes mellitus are few common diseases whose risks are greatly lowered with regular physical activity[21]. Despite this fact, our true issues stem from a long and complicated history through which we’ve come to associate weight and health with moral worth.
Just as early Calvinists relied on hard work and industry as signs of their salvation, today we use physical appearance to evaluate one’s place, or lack thereof, in the modern world. As shown through countless magazines, articles, and advertisements, there is a certain standard that we know to exist. For those who fail to meet it, judgement is swift. As described by Lindy West, a self-proclaimed “fat person,” “fatness is conflated with myriad moral failings: laziness, selfishness, ignorance, incompetence, whininess, lack of self-control,” and a “refusal to take responsibility for one’s choices”[22]. From my own experience, a lack of confidence and the fear of social isolation nearly destroyed my mental and physical wellbeing.
Could it be possible that our obsession with weight comes with a heavier price?
In some cases, negative attitudes towards size have even hindered and prevented overweight patients from receiving proper medical care. In a story covered by The New York Times, an urgent care physician attributed an obese patient’s shortness of breath to her weight. After an appointment with an obesity specialist at Georgetown University, the patient learned that she had life-threatening blood clots in her lungs. Another obese patient was told that her hip pain stemmed from her weight, when in fact she had progressive scoliosis (an abnormal curvature of the spine that is unrelated to obesity)[23]. Left untreated, this could lead to pain, permanent deformity, and organ damage.
There may be undeniable health risks associated with heavier patients. Physical examinations can be more challenging and time-consuming, while other procedures such as surgery and childbirth are often riddled with complications[24]. But our preoccupation with weight and health has made it nearly impossible for people, including medical professionals, to distinguish between the two. In an age where social awareness, diversity, and tolerance are hailed as the supposed crown jewels of American culture, the lasting stigma surrounding weight and wellness proves how concepts of vices and virtues remain.
Much has changed since the Puritans first arrived on American shores, but if one attitude prevails in the modern world, it is that hard work and diligence can earn good health. Regardless of how we painstakingly ascribe to the rules, we cannot expect our lives to go exactly as planned. Though we may choose to ignore it, the truth is that we have never—could never—control every aspect of well-being. This is the simple, infuriating, and liberating part of being human. There are innumerable factors at play in every individual, whether it’s genetics that results in the malformation of heart muscle, or an unknown combination of age, sex, and cell division that culminates in breast cancer. The only thing we can know for sure is that health is complicated, and by passing judgement on ourselves and others at face value, our ignorance is twofold.
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[1] Johns Hopkins Medicine, “Triple Negative Breast Cancer.”
[2] Jillian Michaels, “How to Quit Sabotaging Your Fitness Goals.”
[3] Men’s Health South Africa, January 2018 cover.
[4] Joseph Luciani, “Why 80 Percent of New Year's Resolutions Fail.”
[5] Laura Holland, “Seven Deadly Foods You Need to Avoid.”
[6] Julian Baggini, “Clean Eating and Dirty Burgers.”
[7] Max Knoblauch, “Americans Have The Most Food Guilt.”
[8] Zan Romanoff, “The Consumerist Church of Fitness Classes.”
[9] Bonnie Pfiester, “30 Days of Motivation.”
[10] Pirkko Markula, “Feeling Exercise Guilt?”
[11] Katherine Scott, “Biggest Loser Star's Controversial Grazing Stance.”
[12] Daniel Luzer, “The Protestant Work Ethic Is Real.”
[13] Encyclopædia Britannica, “Predestination.”
[14] Barbara Goodrich, “The Protestant/Calvinist Work Ethic,” section 3.
[15] Jonathan Bowdler, “The Joy of Calvin: Food and the Calvinist Culinary Ethos.”
[16] Christine Leigh Heyrman, “Puritanism and Predestination.”
[17] MedlinePlus Genetics, “Is Longevity Determined by Genetics?”
[18] SADS Foundation, “Warning Signs of SADS.”
[19] Oliver Burkeman, “The Protestant Work Ethic.”
[20] National Archives and Records Administration, “America's Move to Raise A Healthier Generation of Kids.”
[21] Darren E.R. Warburton, “Health Benefits of Physical Activity: the Evidence.”
[22] Lindy West, “Doctors Aren't Mean to Fat Patients.”
[23] Gina Kolata, “Why Do Obese Patients Get Worse Care?”
[24] “Overweight and Obesity.” National Heart Lung and Blood Institute, Risk Factors.