The Coulds and Shoulds of Control

Before we start, don’t miss this important and timely message for parents.

Portion control is all-important, and can be practiced both at home and out in the world, although public venues are more difficult to navigate. For this and other reasons, there is some sentiment for banning “all-you-can-eat” restaurants.

Objections multiply quickly: Economically disadvantaged customers like a place that encourages eating as much as a stomach can hold, and if they slip a few items into a baggie in a pocket, so much the better. This practice might promote obesity, or it might prevent starvation. Besides, someone with a serious eating disorder does not need an all-you-can-eat place to go wild in. That person is quite capable of “sneaking away with strangers’ leftovers” in a regular restaurant.

The contrarians

There are other possible takes on the question. Do these establishments induce overeating? If they do, so what? So does heartbreak, and you can’t outlaw that. As for the argument that an all-you-can-eat format is socially offensive to restrained eaters, let them go eat in some restrained place. These are the thoughts of a great many Americans, along with the freedom arguments. Customers should be allowed to buy any legal substance that someone wants to sell them, and sellers should be allowed to offer any legal product for sale.

Should any ruling body have the power to decree, “There shall be no fixed-price, all-you-can-eat restaurants”? Designating exactly what kinds of eating establishments may exist, and where, could set America’s foot on a slippery slope and lead to such outcomes as the government infringing on business and restraining trade.

Two U.S. longitudinal studies, conducted in Massachusetts and California, respectively, found that smoking bans in cities were supported by the population over time, and showed that these actions increase the cessation attempts and the number of people who actually quit smoking.

Such research findings encourage hope to spring eternal. Anything that works against smoking, we want to adapt somehow to the exhausting effort to reverse the obesity epidemic. Age restrictions on food are almost non-existent. The struggle to limit the amount and type of advertising aimed at children has been difficult enough. Trying to stop corporations from selling food to minors seems a very quixotic ambition. Sugar-sweetened beverages (SSBs) seemed like a good place to start, and that idea has made progress.

The American Academy of Pediatrics and the American Heart Association recently issued a joint statement calling SSBs a “grave threat” to the health of children. They want stricter chains on advertising and, writes Emma Betuel, to “change the social context in which products are sold.” Betuel writes,

The policy recommendations argue that the government should make it more expensive for companies to market to kids by not allowing them to deduct costs associated with advertising as business operating expenses… They also recommend excise taxes on added sugar that would raise the price of soda. Excise taxes are already used on cigarettes…

Research from Berkeley, CA, is said to find a 52 percent decrease in soda consumption since taxing began. Following the example of nicotine extirpation, they want sodas out of hospitals. The professional organizations want the hospitals to grasp the reins of leadership, as they did with the smoking issue. Hospitals led the way to changed social norms once, and they can do it again.

Your responses and feedback are welcome!

Source: “Lost,” TheSunMagazine.org, June 2017
Source: “Tobacco smoking: From ‘glamour’ to ‘stigma’. A comprehensive review,” Wiley.com, 10/09/15
Source: “In ‘Landmark’ Move, Scientists Say It’s Time to Treat Soda Like Cigarettes,” Inverse.com, 03/26/19
Photo credit: Quinn Dombrowski on Visualhunt/CC BY-SA

The Big Three — More Similarities and Differences

Nicotine, alcohol, and… calories? Yes, it looks like overeating is as much a threat as drinking and smoking to Americans’ personal health and the national budget. Can the methods used to fight any one of them cross over and be useful in the other battles?

In 2009, the Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration authority over tobacco products. The Act banned sales to minors, and cut down the likelihood of unauthorized sales by removing cigarette vending machines from all but adults-only venues.

It also forbade the sale of packs of less than 20 cigarettes; sponsorship of sports and other social and cultural events; free samples; and the distribution of any tobacco-branded promotional items. There were also several other provisions, but these most directly affected consumers.

The built environment

As we have seen, hospitals were early adapters in the movement to vanquish smoking, or to at least make it expensive, shameful, and inconvenient enough to convince smokers to slow down a bit. They got rid of cigarette machines and indoor smoking sanctuaries, and they don’t exactly love it when smokers congregate around the entrances, either. Incidentally, since cigarette machines disappeared from hospitals, some retailers, like the CVS chain, have voluntarily removed cigarettes from their shelves.

In other segments of the built environment, in structures and outdoor areas, sensitivity and vulnerability are the indices. Since everyone is to some extent touched by secondhand smoke, and by the customary offensive litter that marks smoking oases, arguments of sensitivity and vulnerability are easy to put forth. Ordinances decree where people can smoke, and fines are levied if the ordinances are disobeyed.

Restrictions have been instituted in some places and tried in others. Cities have implemented comprehensive smoking bans. Sometimes, desired limits cannot be drawn for various reasons. In some instances, rules can be made, but might not do any good.

Banning fast food establishments near schools seems futile when the roach coach can pull right up to the curb next to the playground. And imagine the sighs of frustration when parents realize that the school holds bake sales, and “soccer snacks” are available at sports events. Comprehensive smoking bans have been implemented in cities.

The culture of eating in public

By way of contrast, eating in public is permitted almost anywhere, and in many places, encouraged. In some places, it’s the whole point. Whether at a drag race, an amusement park, or a lush patio café, eating in front of tout le monde is almost universally accepted.

Public eating used to be the exclusive privilege of the most abject slum-dwellers. Given a choice, people chose not to, and with the streets full of horse droppings, who could fault them? Members of the middle class often had only one good outfit, and dry cleaning was not yet invented. They could not risk spilling sauce on their only presentable clothing. The upper class were like, “Dine in the common roadway? Without wine, without serviettes, without attendants? Sir, have you taken leave of your senses? Are you perhaps barking mad?”

Maybe, in certain times and places, compassion has been a motive to stifle public consumption. Someone nearby might be very hungry, and watching a stranger enjoy a meal would cause that person more pain, so showing off one’s good fortune would be rude. Or maybe people with food were careful to conceal the fact, realizing that those who had none just might grab it from them.

Things are different now. For whatever reasons, eating anywhere and everywhere is what we do, and that surely contributes to the obesity epidemic. What are the chances of reversing this trend? “Slim to none, and Slim left town.”

Your responses and feedback are welcome!

Source: “Family Smoking Prevention and Tobacco Control Act — An Overview,” FDA.gov
Photo credit: Peter Lindberg on Visualhunt/CC BY

Can Tobacco Suppression Be a Model?

Smoking, drinking, and compulsive eating cause a lot of havoc in society. If people did not do those things, it would be better for everyone. Sometimes, we ask the government to step in and exert some muscle.

Going after certain businesses has often been a government concern. Zoning is a serious deterrent. A liquor store may not be too close to a school or a church, and neither may a lot of other things. A tobacco product billboard has to stand at least 1,000 feet from a playground.

Locations are judged to be more or less sensitive; the populations that are served (or targeted, depending on who’s talking) are deemed more or less vulnerable. Control is easiest to exert over institutions that depend on government funding, like hospitals.

Hospitals contain large numbers of the undeniably vulnerable. Patients are sick already, and don’t need any exacerbating factors to pile on. One historian says of the old days,

If you wanted to smoke in your hospital bed it was allowed. In fact, a lot of people resisted making hospitals non-smoking because of the challenge of getting sick people outside to enjoy a cigarette, which is kind of ironic.

An episode of the painstakingly accurate 1960s TV series Mad Men portrayed the Don Draper character in a hospital waiting room with a cigarette machine. Some people alive today might be amazed to know that Americans used to smoke in airports, college classrooms, doctors’ waiting rooms, just about everywhere.

An online nurses’ forum asked for reminiscences about the bad old days. One nurse recalled pharmacy carts fitted out with ashtrays, for nurses to use as they passed out meds. Another respondent contributes that in 1977, “everyone smoked in the hospital”:

I know they were still smoking in nursing station in early 80s, late 80s it became a no no. At first hospitals made special smoking areas on each floor, then smoking was limited to one special area in bldg like section of cafeteria., then came complete ban in early 90s.

Another recalls how, when the ban descended, staff members had to go outside for their tobacco breaks, while patients with their doctor’s permission could still smoke in certain indoor areas.

In the late 1980s and early 1990s, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) was gunning for hospitals, and they knew it. By the mid-90s, 96 percent of hospitals in America were in compliance with JCAHO’s rules, and some were even more stringent. Clamping down on hospitals led to an encouraging victory, the first industry-wide ban of workplace smoking, and the idea soon caught on in other businesses.

All these illustrations pertain to the question of junk food in hospitals, available to visitors and staff, and potentially available to patients, against doctors’ orders. Can fast food outlets be excluded from hospitals? Should they be? Or maybe from children’s hospitals only?

The tobacco industry has taken a hit, and laws pertaining to alcohol may be very strict indeed. But even though the overconsumption of food can have tragic consequences, is it likely to ever face the same sanctions as cigarettes and liquor?

Your responses and feedback are welcome!

Source: “Remember when you could smoke anywhere and everywhere?,” ChathamDailyNews.ca, 02/13/13
Source: “Drinking with Draper,” SeattleMet.com, 09/14/09
Source: “Hospital Smoking Bans and Their Impact,” NIH.gov, February 2004
Source: “Trivia: When was smoking banned in all US hospitals,” AllNurses.com, 01/20/02
Photo credit: Kai Schreiber (Genista) on Visualhunt/CC BY-SA

Winning Hearts and Minds

In the quest to reverse the global obesity epidemic, the McKinsey Global Institute listed 18 categories of potential intervention, including the public health campaign. Such campaigns are believed to have helped in the decrease of smoking.

The main thing these programs of persuasion have going for them is administrative muscle. When the government supports an idea, it has the power to spread the word through the school system, and through workplaces, and through the media. When public figures mess up, judges can compel them to make pubic service announcements denouncing drunk driving or whatever they got in trouble for.

But while actors, musicians and athletes may influence kids to clean up their act to a certain extent, the relatively few celebrities who deliver health messages are in danger of being hopelessly drowned out by the many who shill for irresponsible corporations, because that’s where the money is.

In terms of more definitive government action, sometimes stigmatization works, as this quotation shows:

Data from smokers in Korea show that guilty feelings were positively and directly related to behavioral intention. The more the participants felt guilty after seeing each announcement, the more likely they were to search for an anti‐smoking public service to help them quit, and the higher their intention to quit smoking.

Culture critic Jeva Lange notes that a study published by The Lancet found that a 2013 Centers for Disease Control public service ad probably caused 100,000 Americans to permanently quit smoking. (Not to bicker, but permanently is a long time, and only a few years have gone by since then.)

In the late 1990s, Lange was part of the young television audience, with whom a simple “smoking is harmful” message did not hit. In addition, the “smoking is not cool” script was less likely to reduce teen smoking than to inspire derisive laughter. This suggests that telling kids not to chow down on junk food because it’s lame, or uncool, or whatever current term applies, is probably ineffective.

Instead, Lange recalls, ads “began to take cues from horror films, using unnatural or murky lighting, distorted sounds, and jarring or disgusting images”:

Imagine the withered lungs of a smoker gasping on your television. Or what happens to blood when tobacco is inhaled. Or a more metaphorical horror — like a fish hook looped through a cheek, or a small demonic man yanking at a mouth. Whatever approach the ad took, it was bound to be deeply and weirdly and uniquely horrifying…

Lange found such messages to be the most terrifying aspect of network television, and affirms that they worked on her, because she has never once even tried a cigarette.

The flip side

Whether instinctively or thanks to adverse personal experience, many Americans are wired to automatically reject any governmental suggestion about how to conduct their personal lives. They tend to discount what they characterize as brainwashing and propaganda, and either ignore the message or actively rebel against it.

So, while a public health campaign might seem brilliant at its conception, the prospects are always iffy. Attempting to make overeating socially unacceptable, like smoking, seems like a good idea, but public relations experts do not always strike the right note. If just conveying the information, “junk food is bad,” were effective, that would be great. But kids have the evidence at hand (and in mouth) to disprove that claim. Who are you going to believe, some strange grownup on TV, or your own taste buds?

Your responses and feedback are welcome!

Source: “Tobacco smoking: From ‘glamour’ to ‘stigma…’,” Wiley.com, 10/09/15
Source: “Anti-smoking ads traumatized me for life,” TheWeek.com, 10/04/18
Photo credit: Jennifer Murawski on Visualhunt/CC BY