A sociological study on the topic posited that associations between obesity and faith may have to do with a prioritization of certain sins over others. Sociologists Krista Cline and Kenneth Ferraro noted that, in America, religions tend to focus on constraining sins such as smoking, drinking and promiscuity, while gluttony became a more acceptable vice to indulge in.
Dr. Keith Ayoob, director of the Nutrition Clinic at Albert Einstein College of Medicine, added that amid the atmosphere of restriction, food can also become "a legitimate, socially acceptable drug."
While the association between religiosity and obesity was strong in the study, both Feinstein and diet experts warned against concluding that religious affiliation definitely causes obesity. More likely, there are other factors, such as the health attitudes and lifestyle choices discussed above, that are associated with both religious faith and the tendency to overeat.
One such mediating factor may have been where participants were living. The southeastern part of the United States, often referred to as the Bible Belt, has the highest concentration of religious populations and also contains some of the states with the highest prevalence of obesity.
While Feinstein's study draws on populations from around the country (Alabama, Minnesota, Illinois, and California), researchers did not control for location and, hence, it may have been that the Alabama participants skewed the association by having large populations of overweight and highly religious participants.
Whether religious faith was predisposing church-goers towards mid-life obesity or other factors associated with religious involvement were controlling the association, Feinstein pointed out that anti-obesity initiatives may do well to have specific outreach to religious populations.
Anecdotally, "faith-based" exercise programs have had success in religious communities heavily burdened with obesity and co-morbid conditions such as diabetes and heart disease. For instance, one Los Angeles-based program had elderly black women pair scripture readings, group prayer and exercise education with much success.
"Religion can be a tool we can use for those at risk," said Ayoob. "This study may be a wake-up call that we need to use religious ideas to convey health messages that mean something to people [of faith]. Make diet and exercise an extension of their religious dedication."