Smoking, Obesity and Disease Culpability

While hard-hitting public health campaigns to discourage smoking have proven effective, there is collateral damage to the mental and emotional well-being of a particular group: lung cancer patients. Stigma comes in three varieties: anticipated, enacted, and internalized. Very ill people spend most of their time at home or in medical care settings, so while they may fear being treated with prejudice, that anticipation rarely comes to fruition simply because they don’t get out much.

But internalized stigma — the guilt, the regret, the self-blame — those negative emotions move in and make themselves more at home with every passing month of disability. The authors of a recent paper say:

Stigma is associated with a number of deleterious psychosocial and medical outcomes in lung cancer patients, including delayed diagnoses, poor quality of life, and poor patient-clinician communication. Although there has been limited investigation of stigma and long-term outcomes, stigma may have clear downstream effects, such as reduced treatment adherence and heightened psychosocial distress.

The part about “delayed diagnoses” means that sometimes cancer is not discovered in a timely fashion because people delay in going to the doctor. Why? Because, on the social respectability scale, lung cancer is about as popular as leprosy. Some people would rather die than be scolded, or pitied as fools.

That is where the “reduced treatment adherence” part of the equation kicks in. When a 350-pound patient stops at the desk for a return appointment card, and the receptionist gives her the stink-eye, will that patient return in three months to be weighed and dissed again? Maybe; maybe not. So, more deaths occur.

Fun fact: between 15 and 25 percent of people who contract lung cancer never smoked, but they are afraid of the stigma too. They assume that others have a low opinion of them, and too often they are correct. When smoking stigma blossoms into lung cancer stigma, the consequences can be severe. In a profession whose prime directive is “First, do no harm,” attitude is the number one area to check.

What hangs people up is a psychological quirk known as disease culpability. It’s the concept of being at cause for one’s own illness, and despite the irrationality, non-smokers suffer from it too. Some lung cancer patients perceive themselves as targets of victim-blaming, whether or not there is any factual basis for it.

Feeling guilty about having cancer is another thing that causes needless fatalities. The same authors say,

Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma.

It is sad that lung cancer stigma even affects the amount of financial and institutional resources allocated to defeat the disease. When grant dollars are up for grabs, the negativity seeps in. Somehow, the message is conveyed that “Nobody cares about lung cancer.”

It is easy to see why regular people and even some professionals might have a cold attitude; something like, “Why bother? He brought it on himself; he probably won’t quit smoking anyway; there are better uses for my skills and empathy.” It’s a raw deal all the way around.

Your responses and feedback are welcome!

Source: “Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use,”, June 2017
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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.
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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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