Smoking, Obesity, Stigma, and Collateral Damage

Our previous post looked at the limited efficacy of shaming in the banishment of tobacco, and the almost non-existent usefulness of shaming in the abolition of obesity. Stigmatization can have unintended consequences, some of them serious, like suffering and death. How so?

The most dramatic outcome is suicide. In response to being shamed, some people kill themselves. The irony here is that taking one’s own life is also a highly stigmatized activity, but the victim has the advantage of no longer being around to care.

Of course, staying alive and playing host to suicidal thinking is no fun either. When a person walks past the knife drawer and hears tiny voices calling “Come to us! We’re sharp! We can fix it!” that’s a miserable life, but such interior struggles usually remain private.

Dishonesty, intentional or inadvertent

A few years back, there was a telephone survey of smokers, and about 8 percent of the respondents said “they would never reveal their smoking habit to a health professional.” (Of course, it’s probably pretty obvious to any health professional worth her/his salt.) There is more:

Non‐disclosure of smoking was more common among respondents who perceived a high level of stigma related to smoking. This is in line with the large number of people who are receiving medical treatment for smoking and claim to have stopped, even when not having done so, as a way of not disappointing the health‐care team.

There was a call for “confirmation of self‐reported smoking cessation during treatment using biological measures,” which is the scholarly way of saying, “We need a test that will tell if these patients are lying.” Too often, self-reporting is inimical to the ends that are sought. Researchers need to know if the subjects are smoking or doing anything else that would be relevant to the study. Incomplete information makes the whole question moot. Doctors need to know what patients are taking in and putting out. Incomplete information could even cost lives.

We have seen that some lung cancer cases are not diagnosed soon enough because people are reluctant to face criticism from medical personnel, whether that fear is justified or not.

Others feel disease culpability too

The American Medical Association’s Journal of Ethics suggests that health care professionals are not alone in their potential ability to either damage or strengthen a patient’s psychological state. The responsibility to eliminate any vestige of lung cancer stigma rests also with hospital administrators, nonprofit organization leaders, government bodies, and of course patient advocates. They say…

[…] the ethical principle of respect for persons and appreciating the intrinsic value of each individual requires that those who are suffering from tobacco-related illnesses, such as lung cancer, be treated with equity and justice.

The same goes for all smokers who are looking for help, and — any alert reader knew this was coming — the same courtesy and compassion must be extended to the obese, who also tend to avoid medical exams, often to their own great harm, because of reluctance to encounter overweight stigma. Dr. Pretlow has written,

Being overweight carries a significant social stigma in most cultures, so that overweight kids typically are embarrassed to talk face-to-face about their weight. They suffer in silence.

But, being minors, the are still susceptible to being taken to doctors by grownups. Once they become grownups themselves they can exercise their prerogative of never going to a doctor at all, and just allow the continual worsening of whatever co-morbidities exist along with their obesity. And, sadly, avoiding medical professionals is exactly what some damaged people feel compelled to do.

Your responses and feedback are welcome!

Source: “Tobacco smoking: From ‘glamour’ to ‘stigma’. A comprehensive review,”, 10/09/15
Source: “Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care,”, May 2017
Photo credit: US Embassy New Zealand on Visualhunt/CC BY-ND

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Profiles: Kids Struggling with Weight

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

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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