A co-author of a book used for a required fitness class at UNC-Chapel Hill defends the book, which has been criticized for referring to cancer and diabetes as “diseases of choice.”
Ron Hager, an associate professor of exercise sciences at Brigham Young University, is the co-author with Barbara Lockhart of “21st Century Wellness.” The book is used as part of the one-credit hour Lifetime Fitness class, which is required for all UNC undergraduates. About 5,000 students a year take the UNC course, which includes physical activity as well as online content about health, fitness and nutrition.
Hager said in an email that the intent of the book is to promote an active and healthy lifestyle. He said he and Lockhart “really are trying to make a difference for the better.”
“One of the overriding purposes of our text is to encourage and empower individuals to take responsibility for their own good health through the everyday choices they make,” he wrote. “We focus on helping individuals gain a perspective of inherent self-worth that can motivate them to make the best choices and optimize their potential for a healthy and long life (compression of morbidity) especially when combined with solid health related information supported by research.”
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He said some of the criticisms do not consider the full breadth of the text. Hager said he too had struggled with the concept of “diseases of choice.”
“I seriously doubt anyone would say they choose cancer or heart disease or type 2 diabetes, etc.,” Hager’s email said. “But without question, choices can and do have consequences and there is ample evidence of various kinds ... that show certain behaviors within our control can contribute to increased risk of disease, and not at a minuscule level.”
Hager said the American Cancer Society estimates that one-third of all cancer deaths are related to exposure to tobacco products and another one-third are attributable to diet, physical inactivity and obesity. He said there are also genetic causes of diseases such as cancer.
A former student in the UNC class, Skye Golann, criticized the textbook, which he said put an extreme emphasis on personal responsibility for health, without enough exploration of societal factors for bad health, such as poverty and lack of access to medicine.
Hager also took issue with a News & Observer report’s characterization of the book’s description of a theory by psychotherapist and Holocaust survivor Victor Frankl. About Frankl, the book says: “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.”
“There is no mention of some kind of inner strength,” Hager said in his email. “What is mentioned is that a sense of inherent self-worth can be a source of strength or motivation that can help those struggling, in this case in concentration campus but also for anyone.”
Another point criticized in the book is the assertion, “When obsessed with weight, many if not most women and some men have become habitual dieters.”
Though some have viewed the statement as sexist, Hager said it is backed up by research.
“There is solid survey data that suggest that people (more women than men) go from one diet fad to another with limited success and that of those who are obsessively concerned about body weight, size, shape, etc., seek quick fixes,” Hager said.
The book and its accompanying online educational modules are used by a number of universities. Sold by an Indianapolis-based company called Perceivant, the courseware is sold at 14 universities, including Arizona State, Ohio State, Kennesaw State and Brigham Young universities.
UNC officials said the Lifetime Fitness class replaced the university’s previous traditional physical education classes, which only had a sports class component. The new class is aimed at giving students more information about how to live a healthy lifestyle.