Textbook calls cancer a ‘disease of choice’ -- and it’s required reading for UNC students

Undergraduates at UNC are required to take a one credit hour course called Lifetime Fitness.
Undergraduates at UNC are required to take a one credit hour course called Lifetime Fitness. cseward@newsobserver.com

A textbook for a required fitness class at UNC-Chapel Hill calls cancer a disease of choice, describes a theory that Holocaust victims failed to tap into their inner strength and maintains that “many if not most women” who are obsessed with weight have become habitual dieters.

The online textbook, “21st Century Wellness,” also includes standard information about fitness, nutrition and health. It is read by students in a one-credit hour course called Lifetime Fitness, required of all undergraduates at UNC. Each year, nearly 5,000 undergraduates take the class, which is aimed at teaching students about healthy lifestyles while incorporating a physical activity such as tennis, soccer or running.

Skye Golann, who graduated from UNC in May, took the class in the fall of 2017. He made an A, and said he enjoyed the physical activity twice a week as part of the class.

But he said the online course reading materials were “beyond bad.” He said he would sometimes read his girlfriend passages of “the craziest thing I found in the book that week.”

Golann said the book gives short shrift to genetic or societal factors that affect people’s health — for example, a lack of access to health care and good nutrition for many lower-income people. “There’s an extreme emphasis on personal responsibility that pretty much explicitly blames people in poor health,” he said, “which I thought was very problematic.”

Calling cancer, diabetes and cardiovascular problems diseases of choice goes too far, Golann said.

“Who doesn’t know someone who is a survivor or someone who died of cancer?” Golann added. “I remember thinking about, reading it — we have a huge cancer hospital less than a mile away.”

Positive thinking and natural choices

The book was written by two professors of exercise science at Brigham Young University, including Barbara Lockhart, a former Olympic speedskater who has taught mind/body integration, according to biographical information of the authors. The book explores the power of positive thinking, traditional Chinese medicine and making natural choices about health, as opposed to “surgery, drugs, or other means to achieve your desired ends.”

Christopher Johnson, the developer of the online course as part of a company called Bearface Instructional Technologies, said the information was peer reviewed by professors across the nation and by UNC faculty before the course book adoption.

Johnson left the publisher’s parent company, Indianapolis-based Perceivant, last year and formed a new higher education technology startup. He acknowledged that there had been some negative feedback about some elements of the book, but said scientific evidence backs up information that personal choices such as smoking, drug use and poor nutrition create risk factors for disease.

“Nowhere do we make character judgments,” Johnson said. “In fact, one of the approaches of the book is to really help students understand to build a sense of intrinsic motivation, that they need to get their source of energy and value from within, and not to say, because you’re overweight you’re not a good person. ... In our society today, the diseases that kill most people — a vast majority are because of people’s behaviors.”

UNC adopted the online course materials a few years ago, said Darin Padua, chair of exercise and sport science, though the Lifetime Fitness course has been in existence for nearly 15 years.

Lifetime Fitness replaced the university’s required traditional physical activity courses. Padua said the change was made to give students more of an education on fitness and healthy living, as opposed to one standalone sports class that would be less likely to have a long-term benefit for students.

The course modules revolve around basic themes of how to have a healthy lifestyle, including cardiovascular fitness, muscles, endurance and strength, flexibility, nutrition and weight management, Padua said.

He said UNC seeks student reviews on its classes, and the strengths and weaknesses of how the content is presented.

“Each year we get feedback and we try to keep things updated as information changes,” Padua said, adding, “We work with the publishing group, Bearface, to make modifications on a regular basis.”

‘You’re going to definitely get criticisms’

“When you’re having over a thousand students through a course each year, you’re going to definitely get criticisms, and we take those very seriously because we want to make sure we’re providing the best educational content out there,” he said.

Padua said he wasn’t familiar with specific passages that the student critic mentioned and could not speak to them. But he said he would take a look at it.“Everyone realizes that there are a lot of factors that are related to disease, and it’s not a personal choice,” he added. “People have opportunities to maintain a healthy lifestyle but there are certain things that set people up to make that more difficult, for sure, based upon their surroundings and the environment and genetics.”

Online courseware is big business, and large publishing firms are racing to develop interactive materials to replace or supplement textbooks. Perceivant sells its health and fitness courseware to 14 universities, including Arizona State, Ohio State, Kennesaw State and Brigham Young universities. Its website includes a case study on UNC’s Lifetime Fitness class, and features the UNC logo along with those of other universities.

In a 2014 promotional video, Johnson said the firm wanted to grow revenue aggressively. That year, the company had $1 million in revenue but aimed for $36 million by this year, if it could spread the courses to 200 campuses. “Because faculty make the textbook adoption decision and students are required to make the purchase, we need to target the individual faculty who control the largest adoption programs,” he said in the video.

Not ‘one size fits all’

Joel Davis, director of collegiate partnerships at Perceivant, said the company has structured its contracts with authors to allow for customization based on each university’s needs. So, for example, at Kennesaw State in Georgia, the “21st Century Wellness” book was altered, with nine chapters written by the school’s own faculty and the other eight chapters from the original authors.

Davis said academic departments might view content and terminology differently.

“It’s not going to be a one size fits all,” Davis said. “Some people are going to not want this chapter but they’re going to want that chapter.”

Another advantage, Davis said, is that professors can monitor students’ engagement with the online class material and intervene if students appear to be in danger of failing. In UNC’s class, faculty can collect aggregated student data to see students’ fitness and learning outcomes.

The courses feature interactive elements, including a self assessment on fitness. Students can check their progress in the course, and they do the test at the end to see whether their fitness improved.

“It helps students understand, in a very personal way, how the academic content immediately impacted them,” Johnson said.

Johnson said the online course material is purchased for about $36 per student, much less than most textbooks. That includes the book, interactive software and other elements.

Golann said a required health class in college makes sense, and students want more information about mental health in particular. But UNC’s online course had the feel of a class outsourced to a private company. The content, he said, was not up to UNC’s standards.

“It is the only required textbook that every UNC student has to take,” he said. “At graduation, this is the only book that everyone’s supposedly read.”

Jane Stancill: 919-829-4559, @janestancill

Excerpts from ‘21st Century Wellness’

“While enduring the atrocities of the concentration camps in World War II, Victor Frankl developed his school of psychotherapy, which he called logotherapy. He realized deep down that his life had meaning no matter how inhumanely he was being treated by his captors. The people in the camps who did not tap into the strength that comes from recognizing their intrinsic worth succumbed to the brutality to which they were subjected. They gave up or felt they were not deserving of being treated better. After surviving the camps, Frankl taught that every life has meaning and it is up to each person to discover and believe in that meaning.”

“Physicists and biologists speak of coherence, the integration of vast amounts of complex activities within a system, whether the whole universe or the human being. We feel this phenomenon of coherence when our heart, mind and body are aligned. It gives us a feeling of wholeness, feeling connected within ourselves. This feeling can transcend to others, feeling a oneness with others, or even to the earth or the cosmos, feeling a oneness with life.”

“There are many hundreds of research studies that have been published on the health-related benefits of cardiorespiratory fitness and a physically active lifestyle. Most of these health benefits come in the form of reducing risk of chronic diseases that are both physical and mental in nature. Some experts have begun calling these diseases diseases of choice because how we choose to live, in large part, determines the risk of being diagnosed with disease like heart disease, cancer, dementia, and others.”

“The therapeutic versus eugenic argument can be applied to your choices for healthy living. Will you choose to take a natural approach to living a prudent lifestyle focusing on being physically active, eating well, getting enough sleep, avoiding tobacco and so forth? Will you choose to use options other than these natural paths such as surgery, drugs, or other means to achieve your desired ends? Our intent is to provide you not only with the knowledge but also the context for making these choices so that you are aware of the potential benefits or detrimental consequences of your choices.”

“Thinking positively about yourself and others and reducing negativity in your life will work like a magnet helping to attract more positive people and things into your life.”

“When obsessed with weight, many if not most women and some men have become habitual dieters. A restriction in the amount of food eaten may result in an immediate weight loss; however, it also puts the body into a ‘survival mode’ characterized by a reduction in metabolism.”

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