Obesity, Smoking, and Public Health

Public HealthIt seems like more and more often I’m seeing public health discussion in which fat is compared to smoking.  This is absolutely not an apt comparison and here is why.

The main difference is pretty simple.  Smoking in a behavior – every smoker smokes.  Being fat is a body size, being listed as “overweight” or “obese” in current medial science is a ratio of weight and height and it’s been changed over time, including at the request of companies that sell dieting.  Fat people are as varied in their habits and behaviors as any group of people who share one physical characteristic.

Now let’s talk about what a successful intervention looks like.  Smokers become non-smokers when they quit smoking – when they stop doing a single specific behavior. In order for  fat people to become not fat, they must change their body size.  There are no studies where more than a tiny fraction of fat people are able to become thin in the long term, with the behavioral solutions of “eat less and exercise more” failing just as often as what are considered fad diets.  Because being fat is a body size, not a behavior, there’s not a clear behavioral intervention.

For these reasons, even if someone believes that being fat requires public health intervention (and I don’t think it does) and even if someone believes that shaming smokers has been/is a good public health intervention (and I’m not suggesting that it is) they cannot logically draw the conclusion that shaming is an appropriate intervention for fat people.  Shaming smokers shames people for something that they do, shaming fat people shames them for who they are.  If smokers wish to avoid the shame and stigma they have the option to hide their behavior.  Fat people have no such option except to avoid ever going out in public.  It’s simply not the same thing.

Then there are issues with attempts and failures.  Even if we assume that smoking and weight loss have a similar failure rate (ie: the vast majority of people fail long term) the difference here is that a smoker is statistically healthier for every day they don’t smoke – even if they start smoking again.  Dieting does not work that way.  Each time we feed our body less food than it needs to survive in the hopes that it will eat itself and become smaller, we open ourselves up to health risks including those from weight cycling and from caloric deficit, as well as rebound weight gain.  If we think that being fat is unhealthy, then statistically a weight loss intervention is the worst possible recommendation since the majority of people who lose weight end up gaining it back plus more.

Smoking is causally related to health problems, obesity is correlationally related.  There is good research showing that quitting smoking improves health. In addition to a lack of evidence that significant long term weight loss is likely or even possible for most people, there is also no research showing that fat people who are able suppress their weight have health improvements because of the weight loss.  There is, in fact, research that suggests that they don’t.

Regardless of what you believe about smoking and “obesity”, they are simply not comparable from a public health perspective and continuing to treat them as if they are does a disservice to everyone involved.

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Published in: on January 17, 2014 at 10:45 am  Comments (45)  

45 CommentsLeave a comment

  1. Always amazing how much research people can choose to,ignore when a 60 billion dollar a year industry is on the line.

    • Amen. A thousand times over…

  2. On a sort of related, basic human decency front — I see a lot of nasty comments on obesity-related stories about how it’s OK to shame fat people because it’s OK to shame smokers. It’s not OK to shame smokers, either, regardless of these differences.

    • Yes!

      • Just what I was going to say. I am 100% anti-smoking, having lost 3 grandparents due to cigarette smoking. But I am also 100% anti-shaming, regardless of the target or motive.

  3. I really wish policing/shaming others would simply stop. Why is it that so many people think it’s ok to butt into someone else’s business? It’s bad enough when close friends and family do it, but in those situations a person can set up rules and boundaries which, if broken, changes the relationship. Random a-hole on the street policing another person is an arrogance that really needs to be checked. In my opinion.

    • One point is that there is causality between second-hand smoke and illness in others. That means that when someone is smoking around me, I am affected by it. This is not OK. I can, however, be fat right in someone else’s face, and it does nothing whatsoever to their health. I’m not policing someone else’s behavior, merely protecting my own health.

      • That doesn’t stop me from getting glares on the airplane though. :/

      • Yeah, I agree that it’s reasonable to restrict smoking in public places, or to ask people not to smoke around you. I don’t think it’s appropriate to shame someone for smoking, though. (There’s a difference between “Please put that out; I’m allergic.” and “Don’t you know that’s going to kill you?”

        • I thought saying your allergic to smoke was strange. Isn’t it normal to be allergic to gasoline fumes and pesticides?

          • There’s a difference between being sensitive to these things, and being allergic enough that it can cause an asthma attack, or worse. For me, being around cigarette smoke makes it physically difficult to breathe due to it causing my nasal and throat tissue to swell. People can definitely be allergic to these things, as weird as it seems.

        • I’m sorry – I don’t think I said that well. I didn’t mean to say that I thought shaming was OK. It’s not. I just meant the issues themselves were different.

  4. This is another one I’m printing out to save. I suppose it is sad that I feel the need to do this at the age of 51, but I’m happy that I have you and your wonderful readership of support.

    Thank you.

    • Not sad that you need to… happy that you have affirmation that helps. :)

  5. Excellent points. It’s not as if anyone can just say, “Oh, you’re right. I’m sorry I’ve been choosing this ‘fat’ lifestyle… I’ll deflate myself, now.”

    Not that I believe in shaming smokers, either… yes, it’s a behavior, but you also wouldn’t yell at meth addict to quit being addicted, right this minute, either.

    • Hm. Are you sure that isn’t what farts are for??? ;)

      • I don’t know, but I do know I’m totally going to start using it that way:

        “Did you fart?”

        “Nope. I did deflate a bit, though. Needed to lose some weight.”
        :D

  6. Thank you, thank you, THANK YOU. I cannot emphasize how much I hate the (frequent) comparisons between smoking and being fat, and you’ve eloquently laid out exactly why. I could choose to use cigarettes (I don’t), and I could choose to discard them. I cannot choose to discard my body. It is not a Pretender shell.

    Also, not only do healthists treat smokers far more compassionately than they treat fat people, they *laud* smokers if they get the side effect of weight loss (oh, the healthists will trip over themselves to deny they do this, but I have personally heard them congratulate people for losing weight on cigarettes and suggest cigarettes as a weight loss tool). So they’re not fooling me with this one any more than when they interrupt a fat person’s workout to tell her she’s going to die if she doesn’t start exercising.

  7. I think the other really big factor here is that the behavior of smoking demonstrably harms non-smokers. I have asthma, and my son has serious asthma. Being in a setting where smoking is allowed can result in a visit to the ER for us. Meanwhile, unless you believe BS studies about contagious fat, my fat body existing doesn’t harm anyone else.

    • Absolutely right! And in spite of what its detractors say, the tobacco control industry has long been primarily focused on the effects of second hand smoke, at least in terms of legislation and regulation.

  8. Hi Ragen,
    This is my first time commenting, but I love stopping by your blog. I myself am not fat, but equality and acceptance for everyone is important to me, so your message resonates with me! I am currently in grad school to be an epidemiologist, and it might also be encouraging for you to know that they DO teach that it’s behaviors that are a risk factor/determinant of health, and that obesity, if anything, appears to be correlated with chronic disease, not causative. So public health practitioners that blame obesity are simply displaying academic dishonesty/laziness, or personal bias. Keep it up! We need to build a culture where we marginalize no one, for any reason at all. Thanks for your part in that.

    • Your comment made my day. I’m happy to hear that this is understood and being taught.

  9. The other thing that people forget when they draw these asinine parallels is that a supposed “skinny” lifestyle and appearance has long been held up as the ideal for everyone in (modern, American) society. Smoking used to be as well, and to some extent it still is. A skinny body and a pack of smokes were two things that you needed to go along, get along, and be thought of as “normal.” The ad world told us so, (complete with doctors endorsing cigarettes!) and to eschew tobacco was to risk being branded as unsociable and/or Puritanical.

    The mockery and shaming sometimes directed against smokers starting in my childhood years was, to some extent, a major break with previous societal norms.

    But except in the paranoid fantasies of Susan Powter and her ilk, we’re not currently living in a culture where fat bodies are loved and elevated as a societal ideal. Hell, even in candy and fast food ads, everyone we see chowing down has a nice, skinny body. [rolleyes]

    • You also needed to have a martini in hand to really look cool and sophisticated!

      • Ooh… I love a good Martini. New plan: I’m buying for us all. Just as soon as I finish turning the compost, getting the groceries and picking up that used toaster oven that I just found on craigslist. I’ll get my better half to whip us up some canapes, too. Black tie optional. ;)

  10. Dear Chastain

    Thanks for your great articles. Predictably since Christmas in UK the usual articles touting ‘novel’ ways to lose weight have been in the media. One article by a doctor espoused that being overweight increases cancer risk as well as diabetes. I’d be grateful if you could look at this research and examine how reliable it is.

    Best Regards
    Stephanie Marcou
    Sent using BlackBerry® from Orange

    • Just curious – are you a very good friend who calls Ragen by her last name as an inside joke? I don’t want to assume that you don’t know her first name necessarily, but it is unusual to call a woman by her last name to her face unless you know her well. (And why IS that, I wonder?)

      • Glad I’m not the only one who sensed that the Troll is strong with this one….

        • It does sound like she’s wanting someone to read information and process it for her…

          Hrrrrmmmm….

    • Well, when I was at my fattest, I dated this loser who was a Cancer. I’d say that was a pretty big risk. (Not as big as the asshat who followed, though.)

      • “‘Novel’ ways to lose weight.” So… read War and Peace while walking the treadmill, or what? :p

  11. I used to work for a company involved in tobacco control and no matter what people who are against limiting smoking say, shaming smokers has never been part of the MO of the tobacco control industry (which is very small, and we all knew each other). Shaming Big Tobacco, yes, but not individual smokers. I say never, but there probably were times when smokers were shamed; however, it was far, FAR from the standard practice. Tobacco, and especially cigarettes, are highly addictive (and made more so by the tobacco companies themselves) and VERY difficult to quit using, and to shame people for being addicted is not useful.

    • I’m glad someone mentioned this. Any shaming of smokers has almost always been indirect product of the assault on their habit.

      Some of it’s the product of the way smoking is described. Hence the need to soften the blow by its ‘addiction’. Nope.

      Negativity is potent, it has an overspill. A direct assault on bodies is inherently destructive. The only upside is it will wake a lot more fat people up a lot quicker than a smoke break.

      • “Wake fat people up”…?

        Wake them up to what exactly? And in what way?

  12. I can speak from experience that any type of shaming never works. When I was a smoker in college and for a little bit afterwards, whenever someone gave me grief about it, I just wanted to smoke more with the thought “Eff them!” I didn’t quit until the day I decided I didn’t feel like doing it any longer. Had nothing to do with anyone else, the research or the health risks. I just didn’t feel like smoking anymore.

    Kinda the same when someone tries to fat shame me. Just makes me angry and it is completely counter-productive. And I don’t have a gallbladder (removed in my 20s) because of dieting and weight-cycling. Forcing people to go on restrictive diets does have consequences even if they aren’t immediately seen. I feel for all those people shamed into weight loss surgeries that have been more deleterious for their health than the weight ever was.

  13. What we shouldn’t be doing is trying to make shaming anyone a normality. We shouldn’t be picking and choosing who to shame and who we shouldn’t because it just proves that no one really cares abou t the livelihood of others, only our selfish ideologies as human beings to make ourselves feel comfortable in our judgmental spaces. I also dislike how fat people are the scapegoat for every thing, like really? That’s ridiculous, seems like people are trying to find any excuse to justify their fatphobia and bigotry.

  14. Reblogged this on Sly Fawkes and commented:
    First of all, amen and hallelujiah!
    Second, although I quit smoking in 2006 after smoking about a pack a week (Yes, a week, not a day) for a total of 20 years, I am not one of those sanctimonious ex-smokers. I think that the fact that the company where I work deprived smokers of their area by the dock and now forces them to go out to the sidewalk to smoke like pariahs is uncivilized.
    Second, the approximately 25 pounds that I lost when I first started exercising again a year and a half ago came back. I’m not certain of the exact reasons. It could be that when my knee became so terribly inflamed because of having to climb four flights of stairs up and down several times in the night when the elevators where I work were down, it was hard for me to do any extra exercise. Or, it could be that my body just wants to be at this weight.
    Long term weight loss has never worked for me, and I’m not going to try to force it to.

    • Smoking is DISGUSTING. It makes me cough, it makes me gag. I risk secondhand and thirdhand effects whenever ANYONE who smokes is around me. Yes, third-hand smoking is a thing. If you can smell effects, then you can get cancer from the cigarettes. YOU SHOULD be exiled off property. DO not expect someone to risk NOT BREATHING so you can have your fix. It’s rediculous to compare it to being fat. Smoking kills both the smoker and anyone around the smoke and anyone who comes into contact with the smoker. Being fat only affects the person who is fat. AND it only affects that person because society says it is wrong.

      • But smoking is an addiction, often fostered when a person is in their teens or even younger. Tobacco products are deliberately designed to be that way, so it’s small wonder that so many people who try to quit will end up failing.

        Surely we can have smoke-free spaces without shaming addicts. Believe me, I don’t care for smoking, either, but as a fat person I’m wary of duplicating the language that’s used so frequently against people like myself. :(

  15. Something I’ve never seen anyone bring up is that there has been at least one documented death due to secondhand smoke. The first definite case was… would have been between 2005 and 2008, because I read the story at an old job. Was a restaurant or bar server with poorly controlled asthma, and working in a smoky environment triggered a lethal attack. I’m uncertain how many, if any, equally damning deaths have been recorded since.

    To the best of my knowledge, secondhand fat does not exist, and thus it has killed no-one.

    • I think secondhand fat is what the jerk who wrote the article about how hanging around fat people makes you fatter is afraid of. Those adipose cells just jump off our fat bodies and onto their skinny ones, turning them from svelte and beautiful nymphs into hideous obese blobs.
      I can’t remember who wrote that damn article, nor do I want to. I believe it originated in Shape magazine, and it was circulating around for a while a couple of years back.


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