Smoking, Overeating, and Breaking Up Their Powerful Coalition

Childhood Obesity News has been comparing tobacco use and/or addiction to food overconsumption and/or addiction. It is hoped that methods successful in one area can be used to also tackle the other. As we recently mentioned, there seems to be little hope of working on just one of those two problems, because it will pop up again disguised as the other.

The key elements of tobacco control are clinical intervention and management, educational strategies, regulatory efforts, economic approaches, and “the combination of all of these into comprehensive programs that address multiple facets of the environment simultaneously.”

As a smoking prevention or intervention method, counseling by physicians is the best. But it is only one “prong,” not a full solution. Alone, physician counseling cannot vanquish the broad cultural acceptability of tobacco, or the various pressures and triggers that cue a person to shake a cigarette from the pack.

What’s going on?

When researchers look at changes in the prevalence of smoking, the number of quit attempts, and the successes, “no single component of the comprehensive programs can account for all of the significant changes.” Not surprisingly, we see that the multifactorial problem of widespread obesity needs a multifactorial solution.

Some things work, sometimes, for some people. Educational interventions and strategies are delivered via school programs and public service announcements, the mass media, and counter-marketing, and through parents and community programs. But why has counseling for smoking cessation historically been more successful than obesity counseling?

It gets complicated. Under the increasingly labyrinthine and underfunded medical care system, doctors can find it difficult to be reimbursed for their time and skills. But does that position need to be filled by a credentialed physician? Isn’t it possible that counseling could be as effectively delivered by nurses, physicians’ assistants, pharmacists, or even artificial intelligence speaking through devices?

Sounds like a winner

The Health Impact of Smoking and Obesity and What to Do About It, from the University of Toronto Press, wants professionals to know that the evidence for tobacco interventions is “extensive and compelling.” This meta study of meta studies is meant to be the ultimate authority:

Fortunately, extensive summaries have recently been completed that expertly review the current evidence on tobacco control strategies, sometimes incorporating dozens or even hundreds of studies. Our approach here is to compare and collate all of this work and offer a state-of-the-art review of reviews.

An entire chapter is devoted to “10 Lessons from the Tobacco Wars,” with “summaries of all of the interventions — the good, the less proven, and the unproven.” The book’s third section is mainly concerned with drawing parallels and showing that the strategies used to reduce environmental smoke (and cut down the number of smoking deaths) can be adapted to the struggle against the obesity epidemic.

In addressing health care issues, the importance of building coalitions and alliances is emphasized. A warning is issued that “there are still large gaps in understanding the individual and combined roles of diet, exercise, and counseling in different settings.”

Your responses and feedback are welcome!

Source: “Possible lessons from the tobacco experience for obesity control,”, April 2003
Source: “The Health Impact of Smoking and Obesity and What to Do About It,”, 2007
Photo credit: Sergio Santos on BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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