Smoking, Overeating, and Stigmatization — Roots and Effectiveness

In the previous post, Childhood Obesity News talked about the relative destructiveness of smoking stigma versus weight stigma, and about how negative attitudes are acted out against individuals, and received by them. Also interesting is the question of why people spend so much energy attempting to modify others others’ behavior.

Why do many Americans want to see, among their compatriots, an end to both smoking and compulsive overeating? There are personal reasons, but a lot of it is altruistic. The main ideas here are: A) some diseases don’t really need to happen and B) let’s figure out how to prevent those. As it turns out, this involves changing human nature, one human at a time, a process also known as therapy.

The object is to help people stop behaving in harmful ways. But why do some of our fellow humans think that condemnation might be an effective way to motivate people to quit their cherished habits? Experience repeatedly shows that the opposite is true. Before we ask whether shame has helped to reduce smoking, first we need to look at how the circumstances in America have evolved. The AMA Journal of Ethics says,

In the 50 years since the 1964 Surgeon General’s report, Smoking and Health, US adult smoking rates have fallen from 43 percent to 18 percent…

Although smokers lost ground in proportion to the population as a whole, in absolute terms their numbers have gone up. Compared to 20 years ago, they are a smaller percentage but a larger number overall. But because of how statistics work, it can be said that smoking has decreased. The extent to which stigmatization is responsible is impossible to tell. A case has been made that for smokers who don’t quit, it’s not always, or exclusively, physical addiction.

In the course of examining anti‐smoking pressure in Western countries, three researchers learned that when people cling to tobacco, it’s not just addiction, but much more akin to self-medication. They call tobacco “a somewhat usual drug in environments in which humans need to concentrate and reason, as in education and work settings.” (It could be thought of as a focus aid, and with a much gentler stimulant effect, for people who can’t get Adderall.)

Moreover, tobacco does not bring on the psychological twists or adverse behavioral effects that other drugs are known for, and the cognitive effects are important reinforcers. They say it is…

[…] the only drug that can be consumed throughout one’s daily life without harming their routine activities, such as work and study, and may even generate positive effects for such purposes.

A lot of those attributes are shared by eating. People want to do it while they study; it calms them down and gives them energy; helps with reasoning and concentration by nourishing the brain; is compatible with many other simultaneous activities; and usually is not psychoactive.

An interesting study of New York City smokers looked at their “perceived devaluation, perceived differential treatment due to smoking, social withdrawal from nonsmokers, and concealment of smoking status.”

The results suggest that the stigmatization of smokers is a potentially powerful and unrecognized force, one that may have counterproductive consequences.

If success were measured by making people feel bad about themselves, vilification could be said to do a good job. In 2014, Penn State researchers wondered how aware smokers are of negative stereotypes, and how much they care. From a meta-analysis of 30 previous studies, they learned that smokers describe themselves as pathetic outcasts, lowlifes, and bad people.

Being treated like lepers causes some smokers to internalize that dynamic and feel like lepers. They feel guilt, shame, embarrassment, and hopelessness. If they try to quit, and fail, that makes everything worse. So far, all these things could also be said of obese people. On the other hand, warned the researchers, some smokers…

[…] resisted internalizing the stigma by adopting a defensive strategy also employed by other marginalized groups such as those with a mental illness or with weight problems…

Your responses and feedback are welcome!

Source: “Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care,”, May 2017
Source: “Tobacco smoking: From ‘glamour’ to ‘stigma’. A comprehensive review,”, 10/09/15
Source: “Stigma and Smoking: The Consequences of Our Good Intentions,”, December 2009
Source: “Smoking stigma can backfire, hurt efforts to quit,”, 11/02/15
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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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