Smokers and the Obese — More Similarities and Differences

We have established that both smokers and obese people are often made to feel like pariahs, sometimes out of pure meanness. Other times, it’s because those who sincerely want to help believe that shaming effectively incentivizes behavioral change.

Well, does it? Does being ostracized and/or criticized lead people to abandon their harmful habits? How is a question like this answered? For one thing, the research has to depend on an enormous amount of self-reporting, which is the bugaboo of true science. Some people lie, or forget, and others just basically don’t know themselves well enough to make this kind of analysis.

An alternative to dependency on self-reporting would be continuous, lifelong surveillance, and even then, what looks like a cause-and-effect relationship might be just a coincidence. The only reliable way to know why people quit is to put them in cages and shock them with electricity every time they light up, until they stop smoking.

But we can’t do that. We have to ask them, “Why did you quit smoking?” The answer will inevitably be what is known in some circles as “anecdotal.” Anecdotal evidence is what real people report about their own experience, and is also abhorred by the scientific establishment.

Why did you quit eating?

In the realm of obesity, Childhood Obesity News has explored stigmatization and its effectiveness, and even quoted a handful of people, both famous and ordinary, who reacted to fat-shaming by actually losing weight. So, granted, some obese individuals have reacted to ignominy by turning their lives around. But overall, one conclusion that can be drawn is that obesity has increased, a lot. It would be inaccurate to claim that stigmatization “works.”

In fact, as we have seen, a vocal minority of obese people go the opposite way, and claim pride in their size. Some people are so constructed as to be impervious to stigma, and no amount of opprobrium from any source will make a dent in them, so fat-shamers might as well not waste their breath. Actually, indifference to criticism is a splendid survival trait, but clearly susceptible to being misapplied.

Comparisons don’t always count

There is an unfair difference between smokers and compulsive overeaters. A smoker, in theory and sometimes in practice, can become a non-smoker overnight. All they have to do is not smoke, and they are eligible for acceptance back into the human race. But an obese person can’t flip a switch. Even with the best intentions and flawless execution of them, that person remains stuck with being fat for quite some time.

It often happens that multi-factorialism figures in these discussions, and here it is again. A recent study found that “smoking stigma may be more acute if smokers are also members of other stigmatized groups, such as racial/ethnic minorities.” And of course, anyone who is both obese and a smoker, had better get used to being a target of scorn. The “Conclusions” paragraph says,

Smokers who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts, report a stronger intention to quit smoking in the future, and report use of e-cigarettes, suggesting that feelings of self-and felt-stigmatization are related to greater motivation to stop smoking.

Your responses and feedback are welcome!

Source: “Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use,”, June 2017
Photo credit: Greg Parish on Visualhunt/CC 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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