In the Cook Islands, four out of five people are not just fat, but obese. It wasn’t always this way. The introduction of a Western diet after World War II has a lot to do with it. Still, obesity is a massive crisis for those people — and, according to The Atlantic, one Cook Islands doctor successfully employs a radical method to fight it: Shaming. Excerpt:

Shame and ridicule are actually common ways to regulate behavior in small Pacific Island communities. He regularly said to his patients, “There is something wrong in a place where the parents are so fat and the children so skinny.” He started monitoring what parents gave children for school lunch and posting it on the government notice board for everyone to see, and laugh at. Pretty soon shamed parents fed their children baked uto (sprouted coconut) instead of packaged instant noodles. This also meant that the parents ate the same healthier cooked food, and in smaller portions.

Many mothers in the Cook Islands feed their babies a bottle of warm water with two teaspoons of sugar, a path to diabetes. Dr. Thein refused to treat the infants or mothers if they fed the baby sugar water instead of breast milk or formula. He also made jokes about the “ugly babies” fed on sugar water bottles. His litany of shaming jokes was just part of how he operated.

In terms of exercise, he encouraged it but mostly he modeled it. Every morning and every evening he would walk around the island with his wife at a brisk pace. He stopped and visited as he walked, often asking, “What are you having for dinner?” He might then mention how canned corned beef causes premature ejaculation, to huge eruptions of laughter. Then he would continue walking.

He used these tactics implicitly, not just with obesity, but with all health care. When a married man came in with a sexually transmitted disease, he refused to treat the man until the man returned with all the partners that he had slept with. Despite his shame, the man had no choice but to bring all the women in for treatment too. He allowed the teenagers, embarrassed about sex, to come to his home in the safety of the dark to request condoms.

Shaming isn’t the only thing this doctor does, as the article explains, but it is, I would suppose, the one we would find most controversial. The author says that the doctor knew that research shows education won’t get you very far, because people may know the facts, but exempt themselves from the conclusions. The doctor also knew the culture and psychology of this society, which is why he chose the approach he did. Says the writer:

Before we make blanket assumptions about what is or is not a proper approach to obesity, we must consider that cultural context can make all the difference.

I have been exercising faithfully for a month now, because I was, frankly, ashamed of myself when I went to the doctor about my persistent sinus infection, and learned that I had gained 15 pounds in as many weeks (it started in France, unsurprisingly). As soon as I recovered from the sinus infection, I got back on my elliptical trainer, and have been working hard at it. I’m getting results. In my case, it was all about shame — shame that I had become so undisciplined, and was unable to wear some of my clothes. It wasn’t that I thought, “Oh, I need to work on this for my health.” It was that the discovery that I had gained so much weight made me ashamed that I had been so indulgent with food, and so lax about exercise. I regarded this as a moral failure, and have been working to correct it.

Shame has also worked for me in other areas. In the sacrament of confession over the years, I have grown weary of having to bring up the same sins with my confessor. There have been times when I’ve been tempted by this or that persistent sin, and I’ve thought, “Do you really want to do this? Do you really want to have to tell Father that you’ve fallen again?” And the thought of having to admit the same failure to my priest gave me the strength to resist it. It’s not that my confessors over the years have been condemning of me, but rather that the process of accountability — of having to stand before someone else and admit my failures — provided what has been for me a healthy sense of shame. If you take the Church’s teaching on the Eucharist seriously, you cannot receive it with serious unconfessed sin on your conscience. And if you take the Eucharist seriously, you cannot long stay away from it without damaging your soul and your relationship to God. So you have to man up and face your sin squarely, and tell your confessor about it. And you have to keep telling him about it every time you do the same thing.

As I’ve said, I have found over the years that simply being ashamed to come to confession with the same sins has been a strong prompt toward overcoming them. Shame, of course, can be a tremendously destructive thing, no question about it. But not always. In my case, at least, my psychology was strongly shaped by the values of a shame/honor culture — which is partly to do with my father’s values, and partly to do with old-fashioned Southern culture — and that really drives a lot of my moral behavior and conduct, even in relatively petty matters.

Here’s another example of shame working in a positive way. A friend told me the other day that many years ago, when she was a small child, she was playing on the sidewalk with another friend, and she used a racial epithet. An older (white) woman heard this, and admonished her thus: “That’s so common” — which is to say, in the usage of that era, “trashy,” “base.” Notice what happened here. The older woman appealed to the child’s sense of shame, saying, basically, “Aren’t you ashamed to have descended by your conduct to the lowest levels?” The older woman didn’t correct the child by telling her she was morally wrong, though the older woman no doubt believed she was. She played off her sense of shame. I got that a lot in my childhood, when being corrected by other adults for an infraction — lines like, “Your mama and daddy raised you to be better than that!” That’s pretty common here, in fact, and I never really thought about how interwoven into our moral culture down South a sense of personal honor and self-respect is.

When one shows bad manners, it is thought to be a sign of either gross ignorance or, more often, bad character. The thought is that a person uses good manners and courtesy not only as a matter of respect for others, but as a matter of respect for oneself. The thing you don’t want to be is “common,” though that term is antique today. No matter how poor you are, good manners elevate you; no matter how rich you are, poor manners degrade you. All of this depends on a shame/honor sense within culture. I’m not sure how much of that survives today, to be honest.

Anyway, my point here is not to recommend shame for the sake of personal and social improvement. We can all point to examples of shame as a terrifically destructive thing. But we should be careful not to condemn it entirely. It can work for the good, and does at certain times, in certain places.