September 2005 Article of the Month
Popkess-Vawter, S., Yoder, E. and Gajewski, B. "The role of spirituality in holistic weight management." Clinical Nursing Research 14, no. 2 (May 2005): 158-174.
SUMMARY: The authors describe at the outset the "obesity epidemic" which is the context for their study: "More than 64% of the adults in the U.S. are overweight, with 15% to 25% obesity prevalence in 50 states compared to only 4 states in 1991." They assert, "Failure to help people sustain healthy weights may be partly due to health care professionals' not addressing the psychological, sociocultural, and spiritual influences of weight gain" [p. 159]. This is a descriptive, feasibility study of 34 adults (out of a convenience sample of 104) who had received health care from the principal investigator. Sue Popkess-Vawter (a practicing clinical nurse specialist as well as a professor at the School of Nursing, University of Kansas Medical Center), had generally observed in her practice:
The authors note that their theoretical perspective is rooted in Aaron T. Beck's cognitive theory, particularly that "when people assess underlying personal beliefs and cognitions that lead to negative emotions and actions, they can learn to reevaluate and challenge basic assumptions about their self worth" [p. 163]. With this in mind, Popkess-Vawter and her colleagues believe that their findings may support the "cognitive restructuring strategies" of spiritual nurturance and spiritual coping as clinical interventions.
Spiritual nurturance--practicing daily interconnections with self, others, nature, and a Higher Power--is aimed at expanding inner reserves to "buildup resistance" to negative cognitions. Spiritual coping is cognitive restructuring aimed at tapping into inner reserves as a source of guidance and strength when confronted with negative situations and thoughts. [p. 163]They state in the discussion of their findings:
Spiritual intervention strategies are needed to support spiritual nurturance and spiritual coping and to dispel any biases that self-care for the mind, body, and spirit is selfish and self-serving. ...Negative emotions (anger, resentment, feelings of abandonment, loneliness, fear) originating from negative beliefs and negative cognitions can potentially be corrected using spiritual cognitive restructuring strategies, which can bolster cognitive cognitions of self-esteem and quality of life. [p. 171]However, the authors do caution against the practical application of such cognitive restructuring strategies with weight management patients until further research is conducted. In the meantime, they suggest to nurses that they "can follow Nightingale's general directive...to use spirituality as a potent source of healing. Asking about, listening to, and supporting patients' spiritual beliefs generally can promote wellness" [p. 172].
BRIEF COMMENT: This article presents a constructive association between spirituality and healthy weight management, in terms of the reports of participants as well as the authors' theoretical take on the potential place of spirituality in cognitive restructuring strategies. As such, this research may be an affirmative invitation for chaplains to become more involved in clinical programs and studies regarding weight management, ranging from diet modification to (increasingly popular) bariatric surgery. Research on the relationship of spirituality/religion to weight management remains scarce and could benefit from the practical perspective of chaplains on the range of ways that religion may play out in the lives of people with weight management issues. For example, a patient may find in religious teachings strong motivation to care for her body as the "temple of the soul" or as the vehicle for work in the world. Certainly, some formal religious dietary regulations may promote healthy eating. This would be in line with the sense of this month's article. However, a patient may also struggle with religiously-based guilt about his excessive weight, may come to come to identify himself as a "glutton," and may resort to unhealthy behaviors to purge himself of his sinfulness. (As a chaplain myself, I have encountered this in a number of patients.) A patient may also have conflicted feelings about the role of food in her religious social life, such as the place of "church suppers" and eating as part of a "fellowship hour" after worship when food becomes rather ironically mixed with the very settings to which the patient looks for social support. The relationship between spirituality/religion and weight management seems complex but also quite investigable, since some outcomes could be easily measured and since patients' self-reports about their motivation and experience may be especially valuable. The subject appears also be well suited for interventional studies, and that is said to be the immediate plan for the principal investigator in this case [see p. 172]. Future studies, however, will likely benefit from more recently developed measures of spirituality and from a variety of population samples representing different religious traditions.
Suggestions for the Use of the Article for Discussion in CPE:
This month's study is a good example of a research approach that combines qualitative and quantitative methodologies, and students may see how each yields insights that might go undiscovered if only one of the methodologies had been employed. Students new to research could be challenged to think about each methodology's potential for insights and for blind spots. Also, students may wish to discuss the authors' ideas about interventions, especially "spiritual nurturance" and its possible relationship to pastoral interventions. Of course, the article could easily open a general discussion of the role of spirituality/religion in weight management and the place of food and eating in religious traditions. [Note: (added 2/12/07]: see also the February 2007 Article-of-the-Month for material on spirituality and eating disorders.]
Other Items of Interest:
I. For a brief review of older studies on the relationship between religion and weight management, see the section on Weight Control (pp. 364-366) in Koenig, H. G., McCullough, M. E. and Larson, D. B., eds., Handbook of Religion and Health. (New York: Oxford University Press, 2001).
II. In April 2003, Dr. Kenneth F. Ferraro, PhD, Professor of Sociology and Director of the Center on Aging and the Life Course at Purdue University, spoke on "Research in Spirituality and Obesity" at a conference on Integrating Research on Spirituality and Health and Well-Being into Service Delivery that was held at the National Institutes of Health in Bethesda, Maryland. A transcript of that presentation was subsequently posted on the website the principal sponsor of the conference, the International Center for the Integration of Health and Spirituality. The ICIHS has since dissolved, but Dr. Ferraro has granted permission to the Research Network to post the original transcript, which is available by clicking HERE. He is also the author of "Firm Believers? Religion, Body Weight, and Well-Being," Review of Religious Research 39 (1998): 224-244. NOTE [added 2/11/07]: See also: Cline, K. M. C. and Ferraro, K. F., "Does Religion Increase the Prevalence and Incidence of Obesity in Adulthood?" noted in item VI, below.
III. Two recent studies may be of special interest. They predate this month's featured article but are not noted in it.
IV. Myers, R. M., Ostlie-Olson, M. and Cook, C. L. "Spiritual and emotional needs of bariatric patients." Critical Care Nurse 24, no. 5 (October 2004): 14 and 16. [This is a Letter to the Editor from Chaplain Russell Myers, et al., offering practical advice on the subject in light of experience at a hospital in St. Paul, MN.]
V. For more on Paloutzian & Ellison's Spirituality Well-Being Scale, used in this month's featured study, see the March 2004 Article-of-the-Month page.]
VI. Other recent articles:
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