Obesity is one of the great health issues of our time. The World Health Organization (WHO) is ringing alarm bells about a Global Obesity Epidemic in both developed and underdeveloped countries.
Obese people often suffer from cardiovascular disease, diabetes, arthritis, hypertension, strokes, certain forms of cancer, among other ailments. “If immediate action is not taken, millions will suffer from an array of serious health disorders,” warns the WHO.
What’s to be done? Obesity is a complex phenomenon with biological, psychological, and social causes.
Doctors agree that people should change their ‘lifestyle’, but most patients will not or cannot change. The alternatives to lifestyle change for morbidly obese people range from weight-loss drugs to bariatric surgery. One of the latest techniques is an American device which sucks stomach contents out through a permanently implanted tube so that only about one-third of the calories are absorbed by the body.
Clearly lifestyle change is far cheaper and safer. But why is it so hard? What’s the big deal about doing half an hour of exercise every day or skipping an extra pastry?
Changing established habits takes a lot of determination and effort. Besides, someone can have a lot of risk factors for cardiovascular disease and feel perfectly healthy, so that there is no short-term felt need to change one’s habits. So lifestyle change requires a long-term vision, grit and determination. These are not products that you can purchase in your neighbourhood pharmacy.
One reason why obesity and other lifestyle diseases are intractable is that we have forgotten the ancient wisdom about how to change habits. It can be summed up in a single word: virtue.
This is a word with a chequered past. As one wit asked, how did a word which originally meant the strength of men come to mean the purity of women?
But virtue is not only about this narrow dimension of human life; true virtue leads us to human “flourishing”. This is a healthy life in the broadest sense; it includes bodily health, but also mental and spiritual well-being.
Stephen Covey, the author of the international best-seller, The Seven Habits of Highly Effective People, has some good insights into virtue. He asks his readers to imagine their own funeral, and think about what they would like people to say about them. A person who has lived according to the “Golden Rule”, “whatever you wish that others would do to you, do also to them”, has flourished as a human being, since such a person will certainly mean a lot for other people. In other words, virtue aims at making the story of our life, in which we are both author and protagonist, a beautiful story.
Habits that allow us to do good are called virtues. As American philosopher Alasdair MacIntyre states in his book Dependent Rational Animals, “In order to flourish, we need both those virtues that enable us to function as independent and accountable practical reasoners and those virtues that enable us to acknowledge the nature and extent of our dependence on others.” It is only when we are independent, accountable, and recognise our dependence on others, that we are able to do good to others in a stable way.
Virtue ethics claims to be making explicit something that is already implicit in human nature. There is a rich tradition in the West of teaching virtue ethics through the writings of Aristotle and St Thomas Aquinas. More recently management gurus like Stephen Covey and Alexandre Havard have struck a chord with their readers by repackaging the ideas of these philosophers.
How does one apply virtue ethics? The whole process should be accompanied by the greatest possible respect for the individual’s freedom to act, since virtues are only virtues when they are freely assumed.
But respect for freedom does not imply that growing in virtue is a solitary process. On the contrary, it is very important to have the support of family and friends. Interaction with others stimulates a persistent attention to improvement in virtue, and will help to overcome the inevitable difficulties.
Virtue ethics and lifestyle change
How can virtue ethics support lifestyle change? The connection is clear: lifestyle change requires willpower to change behaviour; virtues are just this capacity to act well.
Some people have lifestyles which need psychiatric help, not just a perusal of Aristotle. But even for them, virtue ethics can be valuable. The strong point of virtue ethics is that it allows people to focus on the big picture of their whole life story, and to see psychological problems as only one aspect of their lives. The psychological problem ceases to have ‘centre stage’.
Say that you have an eReader with four buttons (up, down, left, right). Unfortunately, one of the programs on the eReader has malfunctioned, perhaps because you pressed the buttons too hard. Learning about how the buttons and the programs work will prevent problems in the future. Ringing a friend to fix the stalled program in the eReader is still a good idea. In the same way, virtue ethics teaches us to use the ‘buttons’ of our human nature well. This will certainly be helpful, even though specific problems may call for a specific treatment.
How does virtue relate to health?
Within the framework of virtue ethics, bodily health is only one part of human flourishing which must be balanced against other needs. For instance, a person might want to go and exercise every day in order to keep in optimal shape, but that might conflict with his family life. The demands of bodily health are not absolute, but a virtuous person should certainly take them into account as one of the ‘goods’ that contribute to his flourishing, and the flourishing of the people around him.
Becoming a virtuous person is itself an important part of what flourishing consists of: virtue is its own reward. In this sense, lifestyle change is not only an opportunity to lose weight, but also to become a more virtuous person, an improved person. Hence the idea of virtue can therefore become a powerful motivating force for implementing lifestyle change.
Lifestyle change becomes an opportunity to grow towards human fulfilment, which may be accompanied by struggle, frustration and pain, but achieving all-round health will eventually also become pleasurable and easy.
Within this framework, it is easy to see why obesity solutions like AspireAssist will ultimately fail. One critical doctor commented, “It doesn’t do anything to make someone change their relationship with food. Once you put this in someone, they’re never going to want it taken out.” In other words, the technology does not help the patient acquire virtue and is not aimed at holistic human flourishing. In order to deal with the global obesity crisis, what the World Health Organisation needs to do is promote virtue, along with healthy eating and exercise.
Daan van Schalkwijk writes from Amsterdam. He teaches statistics and biology at Amsterdam University College, and is the director of Leidenhoven College, a collegeate hall of residence in Amsterdam. The author would like to thank Jan and Jetske van der Greef, Yan Schoën, and Herman van Wietmarschen for their useful input.