I have been asked by the editor to comment, as a Christian medical practitioner, on gluttony and obesity from a medical perspective. I have agreed, with some trepidation, since the topic of people’s weight is a sensitive issue and I certainly do not want to contribute to any “fat shaming” or the labelling of people as “sinful” based on their dimensions!
Gluttony is a very old-fashioned word. It was one of the old Roman church’s “seven deadly sins”, as originally listed by Pope Gregory I, in the sixth century.
As a reminder, the seven “deadly” sins were Pride, Greed, Lust, Envy, Gluttony, Wrath and Sloth. It is not for me to discuss the status of these sins as “deadly” or otherwise but Scripture confirms that all of these characteristics of a human being are sinful.
The seven deadly sins are an interesting list. It is noteworthy that these seven sins have, in the 21st century, become one virtue followed by six medical conditions!
Pride is the 21st century virtue, pride is being encouraged for all, raise your self-esteem is almost a mantra of the age.
Gluttony has not had such a good press, the word even sounds unpleasant, perhaps it has its origin in onomatopoeic imitation of the noisy gulping of food?
Gluttony has been simply defined as habitually eating and drinking too much, perhaps with the added feature of eating for the enjoyment of eating.
The most obvious physical consequence of eating and drinking more than we need is becoming overweight. I must note here though, that gluttons are not necessarily overweight. People can eat to excess intermittently, such that they are gluttons at times and then fast to prevent weight gain.
I would observe that two of the other “deadly” sins play an important role in promoting obesity in our culture. These sins are sloth and greed.
Gluttony means eating excessively and sloth means that the excess we have eaten is not worked off. Sloth means that we do not take the exercise that would promote better health. Another major contributor to obesity is greed. Not, in this instance, the greed of the individual but rather corporate greed. Corporate greed that promotes foods that are bad for us, corporate greed that promotes quantities of food that are bad for us and corporate greed that sells harmful and addictive products like tobacco, alcohol, high calorie drinks, and, perhaps all too soon, commercial promotion of cannabis.
Being overweight changes into “obesity” once the weight you carry becomes hazardous for your health.
The original data on the relationship between weight and life expectancy came from actuarial tables developed by life insurance companies. Obviously, insurance companies care very much about life expectancy as they want to collect premiums for as long as possible. They are very keen to identify any factors that might predict early death, and, in the case of health insurers, to identify factors that predict ill health in the future.
The data they collected over very many years indicated that very overweight people had shorter lives than those of “average” weight.
Weight by itself is not a very sensitive indicator of life expectancy because sex, height and ethnicity influence what ought to be a “normal” weight for an individual.
In order to allow, to some extent, for differences in build and gender, the Body Mass Index was developed in the 1980s.
This is calculated as your weight in Kilograms divided by your height in metres, squared.
BMI = Kg/m2
Ideal body weight is said to be a BMI of between 20 and 30. It must be noted that the number of adults in New Zealand with a BMI of under 25 is a definite minority.
It has been estimated that two thirds of New Zealand adults are overweight or obese.
The findings for the insurance companies and from other large scale surveys through the last century is that a BMI of greater than 40 is associated with a significant reduction in life expectancy. Some studies suggest, on average, a 15 year reduction in life expectancy for those who are very overweight. In addition to reduced life expectancy, if you are very overweight there are increased risks for diabetes, breathing problems, many types of cancer and heart disease.
It needs to be stressed that these statistics are from aggregated data and are true for large populations in a general sense. They may be applicable to us all as individuals.
Individual variation means that there are many examples of lean, fit people dying young and overweight folk surviving into grand old age but these examples “prove the rule”, as the saying goes.
Another caveat when interpreting and applying BMI data is ethnicity.
Most BMI calculators are based on a Caucasian population and may overestimate obesity in Maori or Pasifika and erroneously label some people of Asian ethnicity as underweight.
So, having noted some precautions with applying labels of obesity, we can nevertheless move on to considering the medical issues associated with being overweight.
Obesity is certainly becoming very widespread and the consequences of obesity are correspondingly more common.
Obesity has also become a marker of poverty, quite a contrast to the protein-calorie malnutrition that was seen amongst the poor in times past.
As mentioned above, a type of diabetes is associated with being overweight. This used to be called “maturity onset diabetes”, occurring in adults who had been overweight for some time. However, we are now seeing children as young as seven who, being very overweight, develop this type two diabetes.
Is obesity always the result of eating more than we need?
The short, brutal answer is, yes.
The older we get, the less we do, the less food we need.
So, in the very automated 21st century, a very small amount of food is enough to maintain us in healthy weight, especially as we get older. Exercise is not a great way to lose weight.
Unfortunately, our wonderful bodies are extremely efficient and, if you continue to eat at your usual level, you have to spend a very, very long time exercising in order to reduce weight significantly.
It has been noted that exercising through dinner time (and exercising instead of eating dinner!) might be a more effective plan for weight loss through exercise. The only really effective way to lose weight is to eat less than you need, in a sustainable manner.
What about metabolic problems and hormonal problems that cause obesity? It cannot all be due to eating more than we need, can it?
An underactive thyroid gland promotes weight gain by turning down your metabolic rate. And, if we do not also turn down our calorie intake, we will gain weight. It must be emphasized that weight gain by itself is not usually due to isolated thyroid gland failure. If your thyroid stops working there will be lots of other symptoms like cold intolerance, constipation, anaemia, skin and hair changes, even changes in mood and thinking may occur. An underactive thyroid is easily diagnosed and treated. A normal thyroid test means that taking extra thyroid hormone can be hazardous. Too much thyroid hormone in the body, although promoting weight loss, also promotes muscle atrophy, rapid heart rate and even cardiac arrhythmias. Please avoid taking extra thyroid hormone if your thyroid function tests are normal.
There are some, rare, genetic disorders associated with marked obesity from infancy. For example; Prader-Willi Syndrome, occurring in perhaps 1 in 25,000 children.
The reason that a child with Prader-Willi Syndrome is overweight is that they have an uncontrolled appetite, an appetite unrelated to what they need. They eat much more than they need in a compulsive fashion, because they seem to lack the normal “satiety” signaling system. (“satiety” meaning the sensation that one has eaten enough.)
These disorders obviously account for a tiny proportion of obese children and adults in society. They do however shed some light on the mechanisms whereby some of us get an “I’m full” signal when we have had enough and the rest of us think we have had enough when we are full to bursting or the plate is empty or there are no seconds left.
A child with a genetic lack of satiety is not being a glutton when they eat too much. They have no internal way of knowing what “enough” looks or feels like.
Such a child needs an external mechanism to control calorie intake. It may well be that many obese people need an external signal in order to know when to stop eating. So they are arguably not being gluttons when they eat too much.
To underscore the truth of the claim that obesity is always the consequence of eating more than we need, it might be helpful to have a brief look at weight loss strategies that work.
Weight Watchers, the Keto diet, the Paleo diet, the Atkins diet, the Zone diet, the cabbage soup diet, the Israeli Army diet, Jenny Craig, bariatric surgery and appetite suppressants, all help some people, for some period of time.
They all result in weight loss, if strictly adhered to. Because we will all lose weight if we eat less than we need. We will gain weight if we eat more that we need. If we eat exactly what we need, our weight will not change.
We can decrease what we eat. If we can do this, we will lose weight.
If all obesity is caused by eating too much, are all overweight people gluttons?
I do not think so.
There are many factors that govern what we eat. We might get comfort from food, we may lack an internal “calorie counter”, we may be hungry all the time when we are sad or anxious. We may need to eat to prevent low blood sugar symptoms, we can be influenced by family, friends, our up-bringing and bombarded by messages about what to eat and how to reward ourselves. Many people who are overweight do not seek out large portions or exotic foods. Overweight people get just as hungry as skinny people, in fact, probably more so.
And, as noted previously, some gluttons, who live to eat and who worship food, are not overweight.
So, how do we as Christians deal with our weight issues?
I would suggest a balanced diet that is low in overall calories. Extreme diets tend not to be sustainable, some people can manage Keto for quite a while but the question always arises, how can this become a healthy “business as usual” lifestyle? And if it cannot become a sustainable life style, we end up with cyclic weight loss and then regaining even more than we had lost.
A sustainable low calorie diet that can be incorporated into daily life is more likely to provide long-term benefit. But, as the vast weight loss industry has shown over the last 60 years with literally countless “diets” being promoted, sustained weight loss and maintenance of healthy body weight is very difficult for many of us.
Self-control is a real challenge in our high calorie, rich food-as-reward culture.
Galatians 5:22-23, “But the fruit of the Spirit is Love, Joy, Peace, Patience, Kindness, Goodness, Faithfulness and Self-control, against such things there is no Law.”
All of these gifts of the Spirit are antidotes to the deadly sins listed above. Self-control is what we need to look after our bodies as temples of the Holy Spirit, self-control is what we need to combat our own desires and to resist the pressures of our “Super-Size Me” society.
Dr Hans Snoek is a member of the Reformed Church in Wellington and a medical doctor in general practice.
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