Sedentary Behavior, Moral Norms, and Health Outcomes

Sedentary Behavior, Moral Norms, and Health Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sedentary Behavior, Moral Norms, and Health Outcomes Uzair Jamil, Joshua Pearce This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8542989/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Americans have shifted the cultural view of sloth and laziness from the historical and moral frameworks to the point that 90% of American believe that laziness is a form of “self care” and 25% of Americans are physically inactive, which is well known to cause a litany of personal and public health problems. This study aims to quantify the health impacts associated with the decline of structured moral and social norms that historically discouraged inactivity. Trends in religiosity in the U.S. are analyzed, focusing on the relationship between religious adherence and lifestyle changes with the impact on obesity, diabetes and musculoskeletal disorders. To help overcome some compounding factors, a comparative analysis is also used for the obesity rates in the top 10 countries with predominantly religious populations. The results suggest a compelling association between declining religiosity and increasing rates of obesity, diabetes, and musculoskeletal disorders in the U.S. As religious affiliation, particularly Christianity, declined from 87% in 1990 to 63% in 2022, obesity rates surged from 12% to 42% The findings suggest that as religiosity declines, sedentary lifestyles and their associated health burdens rise, underscoring the need for interventions that foster discipline and accountability — traits traditionally reinforced by religious, cultural and community institutions. sloth religiosity public health obesity diabetes religion sin Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The United States is home to three predominant religions: Christianity, Judaism, and Islam (PRRI 2021), all of which incorporate moral codes governing behavior, responsibility, and self-regulation. In Judeo-Christian traditions, sin is characterized as actions or behaviors that deviate from the divine intentions for human life (Timpe 2021 ). Similarly, Islam emphasizes the avoidance of sin, viewing it as a transgression against God that must be strictly avoided (Usmani 2015 ). Within Christianity, the "seven deadly sins" are identified as particularly egregious vices: pride, greed, wrath, envy, lust, gluttony, and sloth” (Lyman 1989 ; Tucker 2015 ). Beyond their spiritual implications, the concept of sin may also offer tangible public health benefits, which have only recently have been considered in a more holistic view of public health. For instance, prior studies have highlighted a significant association between the decline in religiosity and discourse on sin in the U.S. and the rise of behaviors such as gluttony, accompanied by increasing obesity rates and related health issues (Jamil and Pearce 2025 ; Pearce 2024 ). Among the seven deadly sins, persistent inactivity and neglect of responsibilities have historically been discouraged across many moral and philosophical traditions (Sunshine 2018 ). Rooted in religious teachings, sloth was viewed as a moral failing that not only disrupted an individual's relationship with God, but also hindered his or her contributions to society. Sloth also known as acedia or accidia has deep historical roots (Wenzel 2017 ). In certain theological interpretations, inactivity is framed in strongly moralized language. In Christianity sloth is the culpable lack of physical or spiritual effort; laziness regarding one’s grave responsibilities to God, oneself, or others. In the Catholic tradition, sloth transcends mere laziness such that it “goes so far as to refuse the joy that comes from God and to be repelled by divine goodness” (U.S. Catholic Church 1997 ). Considered a deadly sin, sloth thus catalyzes other sins and further what Christian’s consider immoral behavior. Conversely, in Islam, laziness itself is not inherently considered a sin; however, acting on laziness in a way that leads to the violation of Shari'ah commandments is deemed haram or impermissible (IslamQA 2019 ; Sufyan 2012 ). It has been reported that Prophet Muhammad specifically sought refuge from sloth, emphasizing its undesirable nature within Islamic teachings (Daily Health Online 2025 ). Over time, however, as religiosity has declined in the U.S. (Pew Research Center 2022), the perception of sloth has shifted from a sin to a normalized behavior in secular contexts. This transition has coincided with the rise of modern lifestyles characterized by convenience and inactivity. Physical inactivity outside of work varies by race, and location in the United States as non-hispanic asian and white adults had the lowest inactivity rates, while higher prevalence was observed among non-hispanic black, American indian/alaska native, and hispanic populations (CDC 2024c ). Geographic disparities were evident, with the South having the highest inactivity rates, while the West had the lowest (CDC 2024c ). Colorado reported the lowest prevalence (17.7%), whereas Puerto Rico had the highest (49.4%). Several states, particularly in the South and Midwest, had inactivity rates exceeding 30% as can be seen in Fig. 1 (CDC 2024c ). This has recently been accelerated due to the shift towards remote work or work from home, which has significantly contributed to an environment that encourages inactivity (de Oliveira da Silva Scaranni et al. 2023 ). With more employees working from home, minimal in-office attendance has become the norm; for instance, recent data from the U.S. government shows that only 6% of federal employees show up to work full time in the office (King 2024 ). During the COVID-19 pandemic, remote teachers' physical inactivity were linked to poor health, reduced quality of life, anxiety, and sadness (de Lima et al. 2024 ). Similarly, students are attending fewer in-person classes (Paul Basken 2023 ), as virtual learning platforms gain prominence, reducing opportunities for physical activity (Chu and Li 2022 ), that traditionally come with commuting or campus-based education. This transition aligns with the broader "convenience culture," where the growing reliance on door-delivery services for groceries, meals, and household items, combined with advancements in automation (Willie et al. 2024 ). For instance, the U.S. online food delivery market is anticipated to generate USD $ 429.9 billion in revenue by 2025, up from USD $ 66.18 billion in 2017, with an estimated annual growth rate of 6.99% from 2025 to 2029 (Statista 2025 ). By 2029, the market volume is projected to reach USD $ 563.4 billion, reflecting the continued expansion of digital food services (Statista 2025 ). Furthermore, sedentary entertainment options, such as endless streaming platforms and immersive gaming experiences, have replaced more active recreational activities, reinforcing a lifestyle characterized by prolonged periods of inactivity (Kwok et al. 2021 ). Again the average American spends over 7 hours on screens being sedentary every day (Duarte 2024 ). This largely sedentary lifestyle has shifted the cultural view of sloth and laziness from the historical and religious views. For example, La-Z-boy furniture manufacture sponsored a survey that found nearly 90% of American believe that laziness is a form of “self care” (La-Z-Boy 2024).This overall perception shift has all led to a reduced amount of physical activity in the U.S. with now 25.3% of Americans being physically inactive (CDC 2024c ). It is well established that lack of physical activity is contributes to increased obesity and heart disease (Koolhaas et al. 2017 ). Based on this information, this study aims to test the following hypothesis: the decline in religiosity has contributed to the normalization of sloth, leading to reduced physical activity and the public health consequences of increased obesity and heart disease diabetes and musculoskeletal disorders. To test the hypothesis, this study examines trends in religiosity in the United States, focusing on the relationship between declining religious adherence and lifestyle changes. Obesity is analyzed as a primary indicator of increasing sloth and sedentary behavior among U.S. citizens. Additionally, trends in diabetes and musculoskeletal disorders are investigated to further explore the health impacts of a sedentary lifestyle. To help overcome some compounding factors, a comparative analysis is also used for the obesity rates in the top 10 countries with predominantly religious populations— Niger, Bangladesh, Ethiopia, Malawi, Sri Lanka, Afghanistan, Comoros, Egypt, Laos, and Morocco. It is thus further hypothesized that these nations, due to their higher levels of religiosity, will exhibit lower obesity rates compared to the United States based on the mechanism where a population’s avoidance of sin protects public health. Methods In this study, a cross-sectional approach was employed to examine the relationship between religiosity and health outcomes, particularly focusing on obesity, musculoskeletal disorders, and diabetes prevalence. The analysis aimed to explore trends within the Christian population in the United States and compare them with global data on obesity rates in religious countries. To assess these health outcomes, both U.S.-specific data from government health agencies and international data from the World Health Organization were integrated. The study also utilized a correlation-based approach to analyze the potential links between higher religiosity and health conditions, drawing on extensive public health databases and survey reports. This comprehensive data integration allowed for a multidimensional perspective on how religious beliefs may intersect with physical health outcomes across different populations and regions. Christianity as well as the religiously unaffiliated population in the United States from 1990 to 2022 was analyzed using data from the General Social Survey (GSS) (Nadeem 2022 ). Obesity prevalence from 1991 to 1993 was acquired from Mokdad et al. (Mokdad et al. 1999 ), while from 1994 to 2018 was derived from the National Center for Health Statistics (Cheryl D. Fryar et al. 2021 ). The data for obesity for 2019 was acquired from the U.S. Centers for Disease Control and Prevention (CDC 2025), and for 2022 was acquired from Trust for America’s Health’s annual report (Farberman and Bright 2025 ). Additionally, musculoskeletal disorder statistics in the United States from 1990 to 2020 were obtained from data reported by Gill et al. (Gill et al. 2023 ). Data on diabetes prevalence was obtained from Mokdad et al. (Mokdad et al. 2000), Fang (Fang 2018), the National Diabetes Statistics Report published by the U.S. Centers for Disease Control and Prevention (CDC 2024b ), and Neupane et al. (Neupane et al. 2024 ). Information on religiosity, as of 2024, was obtained from a survey (Wilson 2024 ). Lastly, the obesity rates for the top religious countries were acquired from the World Health Organization (WHO) data (World Health Organization 2024 ). Results The results demonstrate a marked decline in the proportion of Christians in the U.S. population alongside a notable rise in obesity rates from 1990 to 2022, suggesting a potential link between decreasing religiosity and lifestyle changes characterized by increased sedentary behaviors. In 1990, the percentage of Christians was at its peak (87.1%) while the obesity rate was 12.0% Over the next three decades, a trend is observed with Christian affiliation decreasing steadily to 63.3% in 2022, while obesity rates climbed to 42.4%. It should be noted the relatively rapid incline in obesity statistics between 1993 and 1994 may be due to the different sources and methods of counting (1993 data is self-reported data on telephone, while 1994 data onwards was acquired via physical assessments). So, it is clear that Americans were underreporting their own obesity, which is what caused the sudden increase in 1994. After 1994 the data can be considered more reliable. What is clear from Fig. 2 is the parallel growth of the religiously unaffiliated (purple) and obesity (orange) lines; as the religiously unaffiliated climbed so did the obesity rate at roughly the same rate for more than 30 years. A similar trend is seen for diabetes (yellow lines) as well in Fig. 3 . With sedentary life style being adopted in the United States, the trends has been increasing with almost 10.3% people identified with the disease in 2001, while almost 13.2% persons identifying with type II diabetes in 2017 (CDC 2024a ). As per 2021 data, almost 38.4 million people of all ages in the United States had diabetes. From 2012 to 2022, the total prevalence of diabetes rose substantially by 18.6% in the U.S. (Neupane et al. 2024 ). As the number of Christians declined and the number of religiously unaffiliated increased there is also a clear rise in various types of musculoskeletal pain in the U.S. as shown in Fig. 4 . From 1990 to 2020, the number of years lived with disability (YLDs) due to musculoskeletal disorders in high-income North America increased by 103.0%, equivalent to 4,180,000 hours (Gill et al. 2023 ). According to the United States Bone and Joint Initiative (Nurudeen Tijani 2024 ), musculoskeletal conditions are now the leading cause of disability among adults, affecting one in two individuals (Nurudeen Tijani 2024 ). Additionally, one in three adults (approximately 101.3 million people) experience chronic neck and/or lower back pain (Nurudeen Tijani 2024 ). This rising trend in musculoskeletal disorders is projected to result in substantial increases in healthcare costs, as well as higher levels of pain, disability, and lost productivity (Nurudeen Tijani 2024 ). To provide a comparative perspective, obesity rates in Niger, Bangladesh, Ethiopia, Malawi, Sri Lanka, Afghanistan, Comoros, Egypt, Laos, and Morocco were examined alongside those of the United States. As can be seen by Fig. 5 , countries with high religiosity generally exhibit lower obesity rates, reflecting a potential correlation between religiosity and reduced sedentary behavior. Niger, with a religiosity rate of 99.7%, has an obesity rate of just 4.9% (World Health Organization 2024 ). Similarly, Bangladesh (99.5% religiosity) and Ethiopia (99.3% religiosity) report obesity rates of 5.4% and 1% (World Health Organization 2024 ), respectively. Malawi, Sri Lanka, and Laos, each with religiosity exceeding 97%, also display low obesity rates ranging from 5.6% to 9.6% (World Health Organization 2024 ). In contrast, Egypt and Morocco, despite having 97% religiosity, report higher obesity rates of 35.7% and 20%, respectively. These values, however, are still low when compared to the overall obesity rates in the much less religious U.S. These findings suggest a general trend where highly religious nations tend to have lower obesity prevalence, potentially indicating reduced sedentary lifestyles (World Health Organization 2024 ). The data highlights a potential association between the decline in religious observance, which traditionally discourages inactivity-related behaviors, and the rising prevalence of obesity, diabetes, and musculoskeletal irregularities — key indicators of sedentary lifestyles. Discussion Previous studies have shown that overweight children were found to spend significantly more time in passive activities, whereas non-overweight children were generally more engaged in active behaviors (Kreuser et al. 2013 ). According to Reddon et al., the global rise in obesity is largely driven by significant societal and environmental changes, including increased caloric consumption and reduced physical activity (Reddon et al. 2018 ). Exercise is commonly recommended for managing both type 1 and type 2 diabetes (Peirce 1999 ). Many experts regard physical activity as a crucial component of diabetes care (Clark 2000 ). Furthermore, regular exercise plays a vital role in preventing the onset of type 2 diabetes, particularly among individuals at heightened risk, and contributes to alleviating the global burden associated with this condition (Peirce 1999 ). Engaging in progressive resistance training enhances muscular strength and leads to modest reductions in glycosylated hemoglobin, which are clinically significant for individuals with type 2 diabetes (Irvine and Taylor 2009 ). Overall, physical activity is fundamental in both the prevention and management of obesity and diabetes (Voulgari et al. 2013 ). Structure belief systems often promote discipline (Rayani et al. 2024 ), accountability (Shahul Hameed 2021 ), and active participation (Quran Explorer 2022 ),and religious individuals often exhibit better health outcomes compared to their non-religious peers (George et al. 2000 ). Activities such as fasting instill self-control and mindfulness (Dermawan 2018 ). Additionally, physical activity is frequently incorporated into religious observances, such as walking to places of worship, participating in pilgrimages, or engaging in specific movements during prayers. These practices not only cultivate spiritual well-being, but also contribute to healthier lifestyles, offering a counterbalance to sedentary behaviors commonly observed in modern societies. Persistent inactivity extends beyond individual choice, representing a societal issue with critical public health implications as seen in this study. The increasing prevalence of sedentary lifestyles and associated health challenges, such as obesity and diabetes, underscores systemic shifts that go beyond individual behavior. Religious beliefs can therefore have a positive impact on individuals' lives, extending beyond spiritual outcomes to enhance physical health. This study has several limitations that warrant consideration. One major limitation is the complexity of isolating religion as the sole factor influencing obesity and other indicators of sloth. The United States, for example, is a wealthy nation with widespread availability of calorie-dense, processed foods (Sifferlin 2015 ), and a culture that often prioritizes convenience over physical activity (Steven Lewis and Charles H. Hennekens 2025). These factors contribute significantly to obesity rates (Sifferlin 2015 ) and sedentary lifestyles, independent of religiosity. Therefore, it is challenging to disentangle the influence of declining religious practices from other socioeconomic and cultural variables that shape health behaviors. Future research should consider conducting a community trial as an experimental study to assess the direct impact of interventions targeting sedentary behavior and lifestyle choices (DiPietro 2010 ). Alternatively, a cohort study could be implemented as an observational approach to examine long-term associations between religiosity, physical activity, and health outcomes (DiPietro 2010 ). A well-designed experiment to assess the impact of sloth on well-being would involve selecting participants with comparable dietary habits to control for physical health factors and similar social structures to account for mental health influences. The study would include both highly religious and non-religious individuals, ensuring that all participants share similar baseline characteristics. A multicultural sample would be incorporated to minimize genetic predispositions to conditions associated with inactivity. By monitoring both groups over time, the study would evaluate differences in obesity rates, musculoskeletal disorders, and other health outcomes linked to sedentary behavior. Another limitation is the availability and scope of data. While this study draws on reliable sources for trends in religiosity, obesity, and other health markers, the data are limited in scope and do not account for potential confounders such as regional variations (such as shown in the map of Fig. 1 ), socioeconomic disparities, or access to healthcare. Future research should aim to collect more granular data, ideally at the community or individual level, to better understand the relationship between religious participation and health outcomes. Furthermore, future studies could adopt design studies to track religiosity, lifestyle factors, and health outcomes over time in diverse populations. Experimental studies or interventions promoting specific religious practices, such as fasting or community activities, could also help isolate their effects on physical health. By combining such approaches with broader datasets and advanced statistical modeling, researchers can further refine the understanding of how religion—or its absence—affects public health. Conclusions The results of this study suggest a compelling association between declining religiosity and increasing rates of obesity, diabetes, and musculoskeletal disorders in the United States. As religious affiliation, particularly Christianity, declined from 87.1% in 1990 to 63.3% in 2022, obesity rates surged from 12.0% to 42.4% over the same period, highlighting a potential link between reduced religious engagement and lifestyle changes characterized by greater physical inactivity. A similar trend is evident for diabetes, with prevalence rising from 10.3% in 2001 to 13.2% in 2017, reaching 38.4 million cases in 2021. From 2012 to 2022, the total prevalence of diabetes increased by 18.6%. Likewise, musculoskeletal disorders have become the leading cause of disability, with the YLDs due to these conditions in high-income North America rising by 103.0% from 1990 to 2020, equivalent to 4,180,000 lost hours. Currently, one in two adults suffers from a musculoskeletal condition, and one in three (101.3 million people) experiences chronic neck and/or lower back pain, leading to increased healthcare costs and lost productivity. These results can be explained by a mechanism where unreligious no longer enjoyed the health protections associated with behavioral norms that discouraged prolonged inactivity. Beyond its direct health implications, sloth appears to perpetuate other self-destructive tendencies, notably gluttony, which exacerbates obesity-related illnesses and disability. This pattern is not only evident in the U.S. but also in global comparisons, where highly religious nations tend to exhibit lower obesity rates, potentially reflecting more active and disciplined lifestyles. Niger, with a religiosity rate of 99.7%, has an obesity rate of just 4.9%, while Bangladesh (99.5%) and Ethiopia (99.3%) report obesity rates of 5.4% and 1%, respectively. Countries such as Malawi, Sri Lanka, and Laos, each with religiosity exceeding 97%, display similarly low obesity rates ranging from 5.6% to 9.6%. These findings suggest that as religiosity declines, sedentary lifestyles and their associated health burdens rise, underscoring the need for interventions that foster discipline, accountability, and community engagement—traits traditionally reinforced by religious participation. These public health issues, closely tied to sedentary behaviors, underscore the broader consequences of this shift and highlight the potential benefits of revisiting the moral framework that once discouraged prolonged inactivity. Declarations Author Contribution Conceptualization, J.M.P.; methodology, U.J. and J.M.P.; validation, U.J. and J.M.P..; formal analysis, U.J. and J.M.P.; investigation, U.J.; resources, J.M.P.; data curation, U.J.; writing—original draft preparation, U.J. and J.M.P.; writing—review and editing, U.J. and J.M.P.; visualization, U.J.; supervision, J.M.P.; project administration, J.M.P.; funding acquisition, J.M.P. Acknowledgement This work was supported by the Thompson Endowment. Data Availability Data will be made available upon request. References CDC. (2024a, May 22). National Diabetes Statistics Report (Appendix A: Detailed Tables). Diabetes . https://www.cdc.gov/diabetes/php/data-research/appendix.html. Accessed 23 January 2025 CDC. (2024b, July 23). 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Education and Human Development Journal , 9 (2), 153–162. https://doi.org/10.33086/ehdj.v9i3.6379 Reddon, H., Patel, Y., Turcotte, M., Pigeyre, M., & Meyre, D. (2018). Revisiting the evolutionary origins of obesity: lazy versus peppy-thrifty genotype hypothesis. Obesity Reviews , 19 (11), 1525–1543. https://doi.org/10.1111/obr.12742 Shahul Hameed. (2021, September 2). Accountability and the Day of Judgment. IslamOnline . https://islamonline.net/en/accountability-and-the-day-of-judgment/. Accessed 24 January 2025 Sifferlin, A. (2015, June 30). This Kind of Food Is Why America Is So Fat, Study Says. TIME . https://time.com/3941710/this-kind-of-food-is-why-america-is-so-fat-study-says/. Accessed 24 January 2025 Statista. (2025). Online Food Delivery - US | Statista Market Forecast. Statista . https://www.statista.com/outlook/emo/online-food-delivery/united-states. Accessed 29 January 2025 Steven Lewis & Charles H. Hennekens. (2025). Sobering Statistics on Physical Inactivity in the U.S. http://www.fau.edu/newsdesk/articles/Physical Inactivity-AJM.php. Accessed 24 January 2025 Sufyan. (2012, May 29). The Definition of Haram and How the Haram is Determined. SeekersGuidance . https://seekersguidance.org/answers/general-counsel/the-definition-of-haram-and-how-the-haram-is-determined/. Accessed 24 January 2025 Sunshine, G. (2018, May 8). Sloth: Avoiding Our Responsibilities. Breakpoint . https://www.breakpoint.org/sloth-avoiding-our-responsibilities/. Accessed 24 January 2025 Timpe, K. (2021). Sin in Christian Thought. http://seop.illc.uva.nl/entries/sin-christian/. Accessed 19 March 2024 Tucker, S. R. (2015). The Virtues and Vices in the Arts : A Sourcebook, 1–302. https://www.torrossa.com/it/resources/an/5262284. Accessed 19 March 2024 U.S. Catholic Church. (1997). Catechism of the Catholic Church, 2nd Edition. https://usccb.cld.bz/Catechism-of-the-Catholic-Church/. Accessed 24 January 2025 Usmani, M. M. T. (2015). Ijtihād: Concepts and Queries. Journal of Islamic Sciences , 3 (1). https://www.academia.edu/download/37778385/Ijtihad__Concept_and_Queries.pdf. Accessed 11 August 2024 Voulgari, C., Pagoni, S., Vinik, A., & Poirier, P. (2013). Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism , 62 (5), 609–621. https://doi.org/10.1016/j.metabol.2012.09.005 Wenzel, S. (2017). The Sin of Sloth: Acedia in Medieval Thought and Literature . UNC Press Books. Willie, M. M., Maqbool, M., & Qadir, A. (2024). From click to calories: Navigating the impact of food delivery apps on obesity. Open Health , 5 (1). https://doi.org/10.1515/ohe-2023-0022 Wilson, D. (2024, April 7). World’s Most (And Least) Religious Countries, 2024. CEOWORLD magazine . https://ceoworld.biz/2024/04/08/worlds-most-and-least-religious-countries-2024/. Accessed 13 October 2024 World Health Organization. (2024). Obesity Rates by Country 2024. https://worldpopulationreview.com/country-rankings/obesity-rates-by-country. Accessed 23 January 2025 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8542989","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583097711,"identity":"b74ede7f-7014-4cc9-be81-9759370824c1","order_by":0,"name":"Uzair Jamil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoElEQVRIiWNgGAWjYFCCAwwMCQU2JGsxSCPZJoPDpCg+ePjphgcG5xM3HG9g/PCDKC0HjpndSDC4nbjhzAFmyR7itByAaNl2I4GNgYc4Lce/AbWcA2th/EOcljMgWw6AtTATZYvkgTNlQC3JxvvPHGyWliFGC9+N49tu/qiwk53Z3nzw4xtitDBIHICxGBuI0sDAwE+swlEwCkbBKBi5AAA4dTzfzZ9z6gAAAABJRU5ErkJggg==","orcid":"","institution":"Western University","correspondingAuthor":true,"prefix":"","firstName":"Uzair","middleName":"","lastName":"Jamil","suffix":""},{"id":583097712,"identity":"c89e86ba-4eca-41c1-904d-8d0f744e4f00","order_by":1,"name":"Joshua Pearce","email":"","orcid":"","institution":"Western University","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Pearce","suffix":""}],"badges":[],"createdAt":"2026-01-07 15:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8542989/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8542989/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101698641,"identity":"30b4b46f-bb36-4e46-8ea9-ca12bed2abc7","added_by":"auto","created_at":"2026-02-02 17:35:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":193599,"visible":true,"origin":"","legend":"\u003cp\u003eAdult physical inactivity outside of work in different states in the U.S. (CDC 2024c).\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8542989/v1/33a3ea717e1a7b38312d740a.png"},{"id":101698645,"identity":"33efacdb-000a-4230-832f-1d7fadd9a400","added_by":"auto","created_at":"2026-02-02 17:35:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":60485,"visible":true,"origin":"","legend":"\u003cp\u003eTrends indicating a decline in Christianity alongside a corresponding rise in non-religious population and obesity rates, suggesting an association with increased sedentary behaviors in the United States.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8542989/v1/1e7de9e40257909182fe7030.png"},{"id":101698642,"identity":"94295077-9bd7-42a7-80a2-4a6125e6abaa","added_by":"auto","created_at":"2026-02-02 17:35:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":61728,"visible":true,"origin":"","legend":"\u003cp\u003eTrends indicating a decline in Christianity alongside a corresponding rise in non-religious population and diabetes, suggesting an association with increased inactivity in the United States.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8542989/v1/4187765bfe2a726a3d5419d0.png"},{"id":101698644,"identity":"b39e8df7-e83d-471a-8abc-cd352a2cd38e","added_by":"auto","created_at":"2026-02-02 17:35:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":216926,"visible":true,"origin":"","legend":"\u003cp\u003eTrends for various types of musculoskeletal pains in the United States with data extracted from (Nurudeen Tijani 2024) and percentage of Christians and religiously unaffiliated population.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8542989/v1/caed568f5b9fa2779c0fb2e8.png"},{"id":101698643,"identity":"e046a083-e202-4e91-b68a-77b11c28f3c7","added_by":"auto","created_at":"2026-02-02 17:35:39","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":61251,"visible":true,"origin":"","legend":"\u003cp\u003eReligiosity level and obesity rates of the top 10 religious countries in the world and a comparison to the United States.\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8542989/v1/fcf71b26de2ea65f98cb7ec2.png"},{"id":108803684,"identity":"c5b55dac-478c-47ae-9800-fa3763d7a87e","added_by":"auto","created_at":"2026-05-08 15:03:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":729557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8542989/v1/d0b87ba8-36a7-4870-896f-d75ee0f18b44.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sedentary Behavior, Moral Norms, and Health Outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe United States is home to three predominant religions: Christianity, Judaism, and Islam (PRRI 2021), all of which incorporate moral codes governing behavior, responsibility, and self-regulation. In Judeo-Christian traditions, sin is characterized as actions or behaviors that deviate from the divine intentions for human life (Timpe \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Similarly, Islam emphasizes the avoidance of sin, viewing it as a transgression against God that must be strictly avoided (Usmani \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Within Christianity, the \"seven deadly sins\" are identified as particularly egregious vices: pride, greed, wrath, envy, lust, gluttony, and sloth\u0026rdquo; (Lyman \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Tucker \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Beyond their spiritual implications, the concept of sin may also offer tangible public health benefits, which have only recently have been considered in a more holistic view of public health. For instance, prior studies have highlighted a significant association between the decline in religiosity and discourse on sin in the U.S. and the rise of behaviors such as gluttony, accompanied by increasing obesity rates and related health issues (Jamil and Pearce \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Pearce \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong the seven deadly sins, persistent inactivity and neglect of responsibilities have historically been discouraged across many moral and philosophical traditions (Sunshine \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Rooted in religious teachings, sloth was viewed as a moral failing that not only disrupted an individual's relationship with God, but also hindered his or her contributions to society. Sloth also known as acedia or accidia has deep historical roots (Wenzel \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In certain theological interpretations, inactivity is framed in strongly moralized language. In Christianity sloth is the culpable lack of physical or spiritual effort; laziness regarding one\u0026rsquo;s grave responsibilities to God, oneself, or others. In the Catholic tradition, sloth transcends mere laziness such that it \u0026ldquo;goes so far as to refuse the joy that comes from God and to be repelled by divine goodness\u0026rdquo; (U.S. Catholic Church \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). Considered a deadly sin, sloth thus catalyzes other sins and further what Christian\u0026rsquo;s consider immoral behavior. Conversely, in Islam, laziness itself is not inherently considered a sin; however, acting on laziness in a way that leads to the violation of Shari'ah commandments is deemed haram or impermissible (IslamQA \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sufyan \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). It has been reported that Prophet Muhammad specifically sought refuge from sloth, emphasizing its undesirable nature within Islamic teachings (Daily Health Online \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOver time, however, as religiosity has declined in the U.S. (Pew Research Center 2022), the perception of sloth has shifted from a sin to a normalized behavior in secular contexts. This transition has coincided with the rise of modern lifestyles characterized by convenience and inactivity. Physical inactivity outside of work varies by race, and location in the United States as non-hispanic asian and white adults had the lowest inactivity rates, while higher prevalence was observed among non-hispanic black, American indian/alaska native, and hispanic populations (CDC \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024c\u003c/span\u003e). Geographic disparities were evident, with the South having the highest inactivity rates, while the West had the lowest (CDC \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024c\u003c/span\u003e). Colorado reported the lowest prevalence (17.7%), whereas Puerto Rico had the highest (49.4%). Several states, particularly in the South and Midwest, had inactivity rates exceeding 30% as can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e (CDC \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024c\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis has recently been accelerated due to the shift towards remote work or work from home, which has significantly contributed to an environment that encourages inactivity (de Oliveira da Silva Scaranni et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). With more employees working from home, minimal in-office attendance has become the norm; for instance, recent data from the U.S. government shows that only 6% of federal employees show up to work full time in the office (King \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). During the COVID-19 pandemic, remote teachers' physical inactivity were linked to poor health, reduced quality of life, anxiety, and sadness (de Lima et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Similarly, students are attending fewer in-person classes (Paul Basken \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), as virtual learning platforms gain prominence, reducing opportunities for physical activity (Chu and Li \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), that traditionally come with commuting or campus-based education. This transition aligns with the broader \"convenience culture,\" where the growing reliance on door-delivery services for groceries, meals, and household items, combined with advancements in automation (Willie et al. \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). For instance, the U.S. online food delivery market is anticipated to generate USD \u003cspan\u003e$\u003c/span\u003e429.9\u0026nbsp;billion in revenue by 2025, up from USD \u003cspan\u003e$\u003c/span\u003e66.18\u0026nbsp;billion in 2017, with an estimated annual growth rate of 6.99% from 2025 to 2029 (Statista \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). By 2029, the market volume is projected to reach USD \u003cspan\u003e$\u003c/span\u003e563.4\u0026nbsp;billion, reflecting the continued expansion of digital food services (Statista \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Furthermore, sedentary entertainment options, such as endless streaming platforms and immersive gaming experiences, have replaced more active recreational activities, reinforcing a lifestyle characterized by prolonged periods of inactivity (Kwok et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Again the average American spends over 7 hours on screens being sedentary every day (Duarte \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This largely sedentary lifestyle has shifted the cultural view of sloth and laziness from the historical and religious views. For example, La-Z-boy furniture manufacture sponsored a survey that found nearly 90% of American believe that laziness is a form of \u0026ldquo;self care\u0026rdquo; (La-Z-Boy 2024).This overall perception shift has all led to a reduced amount of physical activity in the U.S. with now 25.3% of Americans being physically inactive (CDC \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024c\u003c/span\u003e). It is well established that lack of physical activity is contributes to increased obesity and heart disease (Koolhaas et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on this information, this study aims to test the following hypothesis: the decline in religiosity has contributed to the normalization of sloth, leading to reduced physical activity and the public health consequences of increased obesity and heart disease diabetes and musculoskeletal disorders. To test the hypothesis, this study examines trends in religiosity in the United States, focusing on the relationship between declining religious adherence and lifestyle changes. Obesity is analyzed as a primary indicator of increasing sloth and sedentary behavior among U.S. citizens. Additionally, trends in diabetes and musculoskeletal disorders are investigated to further explore the health impacts of a sedentary lifestyle. To help overcome some compounding factors, a comparative analysis is also used for the obesity rates in the top 10 countries with predominantly religious populations\u0026mdash; Niger, Bangladesh, Ethiopia, Malawi, Sri Lanka, Afghanistan, Comoros, Egypt, Laos, and Morocco. It is thus further hypothesized that these nations, due to their higher levels of religiosity, will exhibit lower obesity rates compared to the United States based on the mechanism where a population\u0026rsquo;s avoidance of sin protects public health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this study, a cross-sectional approach was employed to examine the relationship between religiosity and health outcomes, particularly focusing on obesity, musculoskeletal disorders, and diabetes prevalence. The analysis aimed to explore trends within the Christian population in the United States and compare them with global data on obesity rates in religious countries. To assess these health outcomes, both U.S.-specific data from government health agencies and international data from the World Health Organization were integrated. The study also utilized a correlation-based approach to analyze the potential links between higher religiosity and health conditions, drawing on extensive public health databases and survey reports. This comprehensive data integration allowed for a multidimensional perspective on how religious beliefs may intersect with physical health outcomes across different populations and regions.\u003c/p\u003e \u003cp\u003eChristianity as well as the religiously unaffiliated population in the United States from 1990 to 2022 was analyzed using data from the General Social Survey (GSS) (Nadeem \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Obesity prevalence from 1991 to 1993 was acquired from Mokdad et al. (Mokdad et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1999\u003c/span\u003e), while from 1994 to 2018 was derived from the National Center for Health Statistics (Cheryl D. Fryar et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The data for obesity for 2019 was acquired from the U.S. Centers for Disease Control and Prevention (CDC 2025), and for 2022 was acquired from Trust for America\u0026rsquo;s Health\u0026rsquo;s annual report (Farberman and Bright \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Additionally, musculoskeletal disorder statistics in the United States from 1990 to 2020 were obtained from data reported by Gill et al. (Gill et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Data on diabetes prevalence was obtained from Mokdad et al. (Mokdad et al. 2000), Fang (Fang 2018), the National Diabetes Statistics Report published by the U.S. Centers for Disease Control and Prevention (CDC \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024b\u003c/span\u003e), and Neupane et al. (Neupane et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Information on religiosity, as of 2024, was obtained from a survey (Wilson \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Lastly, the obesity rates for the top religious countries were acquired from the World Health Organization (WHO) data (World Health Organization \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results demonstrate a marked decline in the proportion of Christians in the U.S. population alongside a notable rise in obesity rates from 1990 to 2022, suggesting a potential link between decreasing religiosity and lifestyle changes characterized by increased sedentary behaviors. In 1990, the percentage of Christians was at its peak (87.1%) while the obesity rate was 12.0% Over the next three decades, a trend is observed with Christian affiliation decreasing steadily to 63.3% in 2022, while obesity rates climbed to 42.4%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIt should be noted the relatively rapid incline in obesity statistics between 1993 and 1994 may be due to the different sources and methods of counting (1993 data is self-reported data on telephone, while 1994 data onwards was acquired via physical assessments). So, it is clear that Americans were underreporting their own obesity, which is what caused the sudden increase in 1994. After 1994 the data can be considered more reliable. What is clear from Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e is the parallel growth of the religiously unaffiliated (purple) and obesity (orange) lines; as the religiously unaffiliated climbed so did the obesity rate at roughly the same rate for more than 30 years.\u003c/p\u003e \u003cp\u003eA similar trend is seen for diabetes (yellow lines) as well in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. With sedentary life style being adopted in the United States, the trends has been increasing with almost 10.3% people identified with the disease in 2001, while almost 13.2% persons identifying with type II diabetes in 2017 (CDC \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e). As per 2021 data, almost 38.4\u0026nbsp;million people of all ages in the United States had diabetes. From 2012 to 2022, the total prevalence of diabetes rose substantially by 18.6% in the U.S. (Neupane et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs the number of Christians declined and the number of religiously unaffiliated increased there is also a clear rise in various types of musculoskeletal pain in the U.S. as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. From 1990 to 2020, the number of years lived with disability (YLDs) due to musculoskeletal disorders in high-income North America increased by 103.0%, equivalent to 4,180,000 hours (Gill et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to the United States Bone and Joint Initiative (Nurudeen Tijani \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), musculoskeletal conditions are now the leading cause of disability among adults, affecting one in two individuals (Nurudeen Tijani \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Additionally, one in three adults (approximately 101.3\u0026nbsp;million people) experience chronic neck and/or lower back pain (Nurudeen Tijani \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This rising trend in musculoskeletal disorders is projected to result in substantial increases in healthcare costs, as well as higher levels of pain, disability, and lost productivity (Nurudeen Tijani \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo provide a comparative perspective, obesity rates in Niger, Bangladesh, Ethiopia, Malawi, Sri Lanka, Afghanistan, Comoros, Egypt, Laos, and Morocco were examined alongside those of the United States. As can be seen by Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, countries with high religiosity generally exhibit lower obesity rates, reflecting a potential correlation between religiosity and reduced sedentary behavior. Niger, with a religiosity rate of 99.7%, has an obesity rate of just 4.9% (World Health Organization \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Similarly, Bangladesh (99.5% religiosity) and Ethiopia (99.3% religiosity) report obesity rates of 5.4% and 1% (World Health Organization \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), respectively. Malawi, Sri Lanka, and Laos, each with religiosity exceeding 97%, also display low obesity rates ranging from 5.6% to 9.6% (World Health Organization \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In contrast, Egypt and Morocco, despite having 97% religiosity, report higher obesity rates of 35.7% and 20%, respectively. These values, however, are still low when compared to the overall obesity rates in the much less religious U.S. These findings suggest a general trend where highly religious nations tend to have lower obesity prevalence, potentially indicating reduced sedentary lifestyles (World Health Organization \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe data highlights a potential association between the decline in religious observance, which traditionally discourages inactivity-related behaviors, and the rising prevalence of obesity, diabetes, and musculoskeletal irregularities \u0026mdash; key indicators of sedentary lifestyles.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious studies have shown that overweight children were found to spend significantly more time in passive activities, whereas non-overweight children were generally more engaged in active behaviors (Kreuser et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). According to Reddon et al., the global rise in obesity is largely driven by significant societal and environmental changes, including increased caloric consumption and reduced physical activity (Reddon et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eExercise is commonly recommended for managing both type 1 and type 2 diabetes (Peirce \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Many experts regard physical activity as a crucial component of diabetes care (Clark \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Furthermore, regular exercise plays a vital role in preventing the onset of type 2 diabetes, particularly among individuals at heightened risk, and contributes to alleviating the global burden associated with this condition (Peirce \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Engaging in progressive resistance training enhances muscular strength and leads to modest reductions in glycosylated hemoglobin, which are clinically significant for individuals with type 2 diabetes (Irvine and Taylor \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Overall, physical activity is fundamental in both the prevention and management of obesity and diabetes (Voulgari et al. \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStructure belief systems often promote discipline (Rayani et al. \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), accountability (Shahul Hameed \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and active participation (Quran Explorer \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e),and religious individuals often exhibit better health outcomes compared to their non-religious peers (George et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Activities such as fasting instill self-control and mindfulness (Dermawan \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Additionally, physical activity is frequently incorporated into religious observances, such as walking to places of worship, participating in pilgrimages, or engaging in specific movements during prayers. These practices not only cultivate spiritual well-being, but also contribute to healthier lifestyles, offering a counterbalance to sedentary behaviors commonly observed in modern societies.\u003c/p\u003e \u003cp\u003ePersistent inactivity extends beyond individual choice, representing a societal issue with critical public health implications as seen in this study. The increasing prevalence of sedentary lifestyles and associated health challenges, such as obesity and diabetes, underscores systemic shifts that go beyond individual behavior. Religious beliefs can therefore have a positive impact on individuals' lives, extending beyond spiritual outcomes to enhance physical health.\u003c/p\u003e \u003cp\u003eThis study has several limitations that warrant consideration. One major limitation is the complexity of isolating religion as the sole factor influencing obesity and other indicators of sloth. The United States, for example, is a wealthy nation with widespread availability of calorie-dense, processed foods (Sifferlin \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), and a culture that often prioritizes convenience over physical activity (Steven Lewis and Charles H. Hennekens 2025). These factors contribute significantly to obesity rates (Sifferlin \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and sedentary lifestyles, independent of religiosity. Therefore, it is challenging to disentangle the influence of declining religious practices from other socioeconomic and cultural variables that shape health behaviors. Future research should consider conducting a community trial as an experimental study to assess the direct impact of interventions targeting sedentary behavior and lifestyle choices (DiPietro \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Alternatively, a cohort study could be implemented as an observational approach to examine long-term associations between religiosity, physical activity, and health outcomes (DiPietro \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). A well-designed experiment to assess the impact of sloth on well-being would involve selecting participants with comparable dietary habits to control for physical health factors and similar social structures to account for mental health influences. The study would include both highly religious and non-religious individuals, ensuring that all participants share similar baseline characteristics. A multicultural sample would be incorporated to minimize genetic predispositions to conditions associated with inactivity. By monitoring both groups over time, the study would evaluate differences in obesity rates, musculoskeletal disorders, and other health outcomes linked to sedentary behavior.\u003c/p\u003e \u003cp\u003eAnother limitation is the availability and scope of data. While this study draws on reliable sources for trends in religiosity, obesity, and other health markers, the data are limited in scope and do not account for potential confounders such as regional variations (such as shown in the map of Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), socioeconomic disparities, or access to healthcare. Future research should aim to collect more granular data, ideally at the community or individual level, to better understand the relationship between religious participation and health outcomes. Furthermore, future studies could adopt design studies to track religiosity, lifestyle factors, and health outcomes over time in diverse populations. Experimental studies or interventions promoting specific religious practices, such as fasting or community activities, could also help isolate their effects on physical health. By combining such approaches with broader datasets and advanced statistical modeling, researchers can further refine the understanding of how religion\u0026mdash;or its absence\u0026mdash;affects public health.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of this study suggest a compelling association between declining religiosity and increasing rates of obesity, diabetes, and musculoskeletal disorders in the United States. As religious affiliation, particularly Christianity, declined from 87.1% in 1990 to 63.3% in 2022, obesity rates surged from 12.0% to 42.4% over the same period, highlighting a potential link between reduced religious engagement and lifestyle changes characterized by greater physical inactivity. A similar trend is evident for diabetes, with prevalence rising from 10.3% in 2001 to 13.2% in 2017, reaching 38.4\u0026nbsp;million cases in 2021. From 2012 to 2022, the total prevalence of diabetes increased by 18.6%. Likewise, musculoskeletal disorders have become the leading cause of disability, with the YLDs due to these conditions in high-income North America rising by 103.0% from 1990 to 2020, equivalent to 4,180,000 lost hours. Currently, one in two adults suffers from a musculoskeletal condition, and one in three (101.3\u0026nbsp;million people) experiences chronic neck and/or lower back pain, leading to increased healthcare costs and lost productivity. These results can be explained by a mechanism where unreligious no longer enjoyed the health protections associated with behavioral norms that discouraged prolonged inactivity. Beyond its direct health implications, sloth appears to perpetuate other self-destructive tendencies, notably gluttony, which exacerbates obesity-related illnesses and disability. This pattern is not only evident in the U.S. but also in global comparisons, where highly religious nations tend to exhibit lower obesity rates, potentially reflecting more active and disciplined lifestyles. Niger, with a religiosity rate of 99.7%, has an obesity rate of just 4.9%, while Bangladesh (99.5%) and Ethiopia (99.3%) report obesity rates of 5.4% and 1%, respectively. Countries such as Malawi, Sri Lanka, and Laos, each with religiosity exceeding 97%, display similarly low obesity rates ranging from 5.6% to 9.6%. These findings suggest that as religiosity declines, sedentary lifestyles and their associated health burdens rise, underscoring the need for interventions that foster discipline, accountability, and community engagement\u0026mdash;traits traditionally reinforced by religious participation. These public health issues, closely tied to sedentary behaviors, underscore the broader consequences of this shift and highlight the potential benefits of revisiting the moral framework that once discouraged prolonged inactivity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, J.M.P.; methodology, U.J. and J.M.P.; validation, U.J. and J.M.P..; formal analysis, U.J. and J.M.P.; investigation, U.J.; resources, J.M.P.; data curation, U.J.; writing\u0026mdash;original draft preparation, U.J. and J.M.P.; writing\u0026mdash;review and editing, U.J. and J.M.P.; visualization, U.J.; supervision, J.M.P.; project administration, J.M.P.; funding acquisition, J.M.P.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis work was supported by the Thompson Endowment.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData will be made available upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCDC. 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(2017). \u003cem\u003eThe Sin of Sloth: Acedia in Medieval Thought and Literature\u003c/em\u003e. UNC Press Books.\u003c/li\u003e\n\u003cli\u003eWillie, M. M., Maqbool, M., \u0026amp; Qadir, A. (2024). From click to calories: Navigating the impact of food delivery apps on obesity. \u003cem\u003eOpen Health\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(1). https://doi.org/10.1515/ohe-2023-0022\u003c/li\u003e\n\u003cli\u003eWilson, D. (2024, April 7). World\u0026rsquo;s Most (And Least) Religious Countries, 2024. \u003cem\u003eCEOWORLD magazine\u003c/em\u003e. https://ceoworld.biz/2024/04/08/worlds-most-and-least-religious-countries-2024/. Accessed 13 October 2024\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2024). Obesity Rates by Country 2024. https://worldpopulationreview.com/country-rankings/obesity-rates-by-country. Accessed 23 January 2025\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sloth, religiosity, public health, obesity, diabetes, religion, sin","lastPublishedDoi":"10.21203/rs.3.rs-8542989/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8542989/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAmericans have shifted the cultural view of sloth and laziness from the historical and moral frameworks to the point that 90% of American believe that laziness is a form of \u0026ldquo;self care\u0026rdquo; and 25% of Americans are physically inactive, which is well known to cause a litany of personal and public health problems. This study aims to quantify the health impacts associated with the decline of structured moral and social norms that historically discouraged inactivity. Trends in religiosity in the U.S. are analyzed, focusing on the relationship between religious adherence and lifestyle changes with the impact on obesity, diabetes and musculoskeletal disorders. To help overcome some compounding factors, a comparative analysis is also used for the obesity rates in the top 10 countries with predominantly religious populations. The results suggest a compelling association between declining religiosity and increasing rates of obesity, diabetes, and musculoskeletal disorders in the U.S. As religious affiliation, particularly Christianity, declined from 87% in 1990 to 63% in 2022, obesity rates surged from 12% to 42% The findings suggest that as religiosity declines, sedentary lifestyles and their associated health burdens rise, underscoring the need for interventions that foster discipline and accountability \u0026mdash; traits traditionally reinforced by religious, cultural and community institutions.\u003c/p\u003e","manuscriptTitle":"Sedentary Behavior, Moral Norms, and Health Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 17:35:29","doi":"10.21203/rs.3.rs-8542989/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c2959ab-0c8b-4fd7-88bb-76bc0636e23c","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-02T09:10:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 17:35:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8542989","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8542989","identity":"rs-8542989","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}