Similarities and Differences of Three Public Threats    

When we talk about correcting societal problems via governmental interventions, two different layers of argument need to be dealt with. First, is it justifiable under the Constitution, and the generally understood rules of human decency? In other words, should it be done? Some political philosophies hold that very little should be done by the government, and they have their reasons.

Then, there is the pragmatic side. Can it be done, and if it can, does it work? Sometimes the thing backfires. When a program is mandated in public schools for almost 20 years, and affects millions of kids, and then turns out to be worse than nothing, attention must be paid. It is the sort of outcome that we can’t afford too many of.

Troublesome trio

Childhood Obesity News has looked at several ways in which smoking resembles compulsive overeating. Cigarettes are clearly addictive, and that perverse attachment becomes the main reason to continue smoking, according to the authors of a paper on glamorization and stigmatization.

They also maintain that easy availability reinforces the behavior, along with positive mental and emotional associations. Those motivating factors are tangled up with a belief that to quit smoking is extremely difficult.

Various foods seem to have distinct addictive qualities, or maybe the addiction should be qualified as behavioral, but either way, it turns out that an inability to adopt a reasonable eating pattern looks exactly like addiction, and certainly many patients describe it that way.

Alcohol can also be wildly addictive, and its consumption is another activity that society tries to repress in different places, at random times, and with varying degrees of success. Easy availability is quite frequently a factor in overuse. In any part of the globe it is usually possible to procure alcohol, or cigarettes, or too much of the wrong kinds of food. Very often, people are lucky enough to have access to any two of them, or even all three.

Dangerous bonding

We learn from advertisements that people smoke while enjoying pleasant or exciting life experiences. Having been hypnotized into believing that a good time is deficient without nicotine, when a positive moment takes place, the person lights a cigarette to make the experience complete. That smoking episode melds with the boat ride or the amusement park excursion to form a happy memory, and the next cigarette brings back the happy memory, and so on, ad infinitum.

In endless combinations, liquor and fun go together, until one day they don’t anymore. More than the other two, food is notorious for being purposefully associated with all kinds of good times, from childhood birthday celebrations to religious feast days to the pie-eating contest at the county fair. At emotionally fraught family gatherings, overeating is the whole point. In the realm of positive mental and emotional associations, all three bad habits are capable of forming self-reinforcing loops.

Similar, but not the same

But the vices have their differences. The authors of the paper say,

For instance, it appears that there is no evidence of a safe level of consuming tobacco cigarettes or other types of tobacco products, and this applies equally for intermittent, occasional or light use. This differentiates tobacco from alcohol, for which there is a serious scientific debate about its moderate use, which would not be associated with bad health effects.

Of course, for an alcoholic there is no safe level of alcohol. With food, there definitely is a safe level, and a necessary level. A person can live without smoking or drinking, but not without eating. This is no excuse for the vast amount of overeating that goes on, and perhaps indicates that interventions successful against smoking or drinking are futile when faced with compulsive overeating.

Your responses and feedback are welcome!

Source: “Tobacco smoking: From ‘glamour’ to ‘stigma’. A comprehensive review,” Wiley.com, 10/09/15
Photo credit: Vivien Rolfe/Biology Open Educational Resources on Visualhunt/CC BY-SA

Smoking and Obesity — Uncle Sam to the Rescue?

Smoking and unnecessary eating have in common the pitch used to sell them: “You Deserve This.” Because you are an exceptional person, because you work hard without complaint, and endure what Shakespeare called the “slings and arrows of outrageous fortune,” you are entitled to a whiskey, a steak, a baked potato with sour cream, and a cigar. But here is a hot tip backed up by centuries of philosophy: Thinking about what is deserved is not a healthful path, and has potent consequences.

In tackling the childhood obesity epidemic, Dr. Pretlow sees two main needs: 1) get obese kids un-addicted from highly palatable foods, and 2) prevent healthy kids from becoming addicted to start with. It is useful to examine the methods that have been used to decrease cigarette smoking, to see if they might be transferable. But first, what is the rationale for government involvement in either smoking or the eating patterns that lead to obesity?

As the theory goes, everyone is potentially affected by secondhand smoke, which is especially bad for babies, the elderly, sick people, and anyone whose breathing apparatus is already compromised. Smoking is harmful to the individual, no question. It is also hazardous, in less obvious and less immediate ways, for everyone. This would include peripheral dangers like forest fires, and houses burning down.

It is harder to make a case for any universal harm caused by some people being obese. The demonstrable damage to the common good is mostly financial, which counts for a lot — but, at least, gas station storage tanks don’t blow up when they walk by.

One report on the food industry’s social responsibility said,

Not everyone has the same nutritional needs; there is no food-related equivalent to the harm people may encounter from secondhand smoke; no research has shown that foods have physically addictive properties, much less that food companies manipulate their addictive content to encourage dependence, as was the case with the tobacco companies.

Not much there to work with. Some analysts feel the strongest parallel between smoking and obesity is probably the corporate exposure to liability litigation and legislative actions. Government-imposed fines, and compensation awarded to the families of dead victims, are both expensive.

While the food industry does not mind paying for the services of high-powered lawyers it would still, like anyone else, prefer not to. The authors of this paper noted that consequently, in the United States,

Some of the most important advances in public health in recent times (e.g., the reduction in smoking) have resulted from new legislation, heightened regulatory enforcement, litigation, or a combination of these three factors.

Within living memory, people could smoke in hospitals, college classrooms, and restaurants. Intensive media attention began to shape public opinion. The government stepped in very heavy-handedly, banning the advertising of tobacco in many contexts. A gradual dawn of awareness let to a smoking ban inside virtually all buildings, and in entire sections of cities.

What would it take to get such decisive action on problem foods? That is, as the old saying goes, a whole different kettle of fish. Tobacco is, after all, just one plant, and nicotine is just one chemical. By focusing efforts on the science of one plant and its most prominent toxin, parameters were neatly drawn.

Food, on the other hand, comes in thousands of varieties and combinations. Every attempt to regulate a basic substance like, for instance, sugar, has always faced numerous and vociferous objections. When the debate turns to more complicated ingredients, the logistical problems multiply exponentially.

Is there a path through the wilderness?

Your responses and feedback are welcome!

Source: “The Foodservice Industry’s Social Responsibility Regarding the Obesity Epidemic, Part I:,” FIU.edu, 2010
Photo credit: Hello Turkey Toe on Visualhunt/CC BY

Smoking, Overeating, Other Bad Habits, and the Government

The McKinsey Global Institute decided to count the many ways in which the obesity epidemic is believed to be vulnerable to pressure. Some of the methods were instrumental in cutting down tobacco use, although that does not necessarily guarantee that they are adaptable. Here is the scope:

Working in conjunction with policy advisers, population health academics, and individuals from companies, and drawing on an extensive review of research, we have identified 74 intervention levers that are being discussed or piloted around the world. The 74 intervention levers fall broadly into 18 groups.

The 18 groups are:

1. Active transport
2. Incentives offered by health-care payors
3. Healthy meals
4. Reduction of high-calorie food and drink availability
5. Calorie and nutritional labeling
6. Media restrictions
7. Parental education
8. Pharmaceuticals
9. Portion control
10. Price promotions
11. Public-health campaigns
12. Reformulation
13. School curriculum
14. Subsidies
15. Taxes and prices
16. Surgery
17. Urban environment
18. Weight-management programs
19. Workplace wellness

A lot of things need to be done, with limited resources. Of all proposed social engineering schemes, most are never funded. Somebody has to perform triage to separate the viable ideas from the ones that don’t seem to have a chance. No matter what the bureaucrats do, a faction of the public will be mad at them.

Don’t tread on my coiled tape measure

Americans are particularly touchy about some areas of life. A morbidly obese person might wish he could be on “The Biggest Loser” TV show. Or she may not want to discuss her weight with anyone. The point being, nobody wants to be forced into taking either of those courses. What some call intervention, others call interference.

Like it or not, government is capable of either supporting or quashing activity. But as we have seen, not everything that can be done, should be done. The government, although professedly well-meaning, is in the compulsion business. So, discussions can become contentious.

A good laugh, or maybe cry

On the local, state, and federal levels, governments do a lot of things that touch upon obesity in some way. Here is a small but bizarre example from one state whose House of Delegates set out to pass a clean water bill. The West Virginia Manufacturers Association strongly objected to any tightening of standards. Journalist Erin Beck wrote,

They argue that the EPA encourages states to incorporate state-specific science, and that because West Virginians are heavier, their bodies can handle more pollutants, and that because they drink less water, they are less exposed to the pollutants.

“… because West Virginians are heavier, their bodies can handle more pollutants.” Is that a breathtakingly original brand of stigmatization, or just plain cray-cray? Actually, the excuse seems too preposterous to even require refutation.

But just to satisfy the conventions of journalism, representation for another viewpoint was sought. Environmental health professor and cancer expert Michael McCawley argues that “any amount of a carcinogen can be cancer-causing, and that heavier bodies may already have other problems, like inflammation, that increase risk for cancer.”

This is serious, because if the state passes safer clean water rules, Dow Chemical threatens to pick up and leave, and go poison somebody else’s water.

Your responses and feedback are welcome!

Source: “Overcoming obesity: An initial economic analysis,” McKinsey.com, November 2014
Source: “House of Delegates passes bill without updated human health water quality standards,” Register-Herald.com, 03/05/19
Photo on Visualhunt

Smoking, Obesity, and Synergy

As Dr. Pretlow has discovered, when childhood obesity is addressed, information alone is not enough. In that instance, the patient also needs skills to resist cravings and redirect his or her own attention, among other things. And of course, before anyone can accomplish anything, they need motivation, which is not always easy to generate, capture and harness.

Many people also need support from others. When all is said and done, the bottom line is, potency lies in synergy, in the combination of two or more contributing dynamics.

So, on a small scale, healing is multifactorial. But what about the macrocosm? A few years ago, the McKinsey Global Institute issued a report which pointed out that education alone is not sufficient to change behavior on a large scale, either.

Shaming works — unless it doesn’t

In the public arena, what sometimes creates progress, to a certain extent, is education plus public shaming. This is where the power of influencers enters the picture. Voices are magnified by popularity or notoriety — anything that enhances the Q-score or high recognition factor. Whether or not they know what they are talking about, any celebrity can change the hearts and minds of the populace, and indeed some specialize in it.

They can persuasively convince people that, to quote the report, “addressing social norms together is a powerful change mechanism.” The authors offer the example of United Kingdom TV personality Esther Rantzen, who stirred up public concern about automotive safety, particularly for children. Consequently, child car seats were mandated by law. This is what being a “thought leader” is all about.

Also in the U.K., drunk drivers were shamed for playing recklessly with other people’s lives. Education is all well and good, but to clean out the barn, a pitchfork needs at least two prongs. The paper mentions other examples of PR strategies that combine factual education with sharp criticism meant to encourage self-reflection and behavioral change:

An Australian campaign to discourage speeding implied that men who speed lacked virility, which proved a highly effective message. Stop-smoking campaigns stigmatized smoking in the presence of children and helped to make smoking less socially acceptable.

Instead of shaming

Journalist Alasdair Wilkins, who lost 100 pounds in a year, told a panel of professionals that we all hear three clamorous voices: from society, from the people we know, and from ourselves. He expands on the point:

In my experience, the third is by far the loudest voice… The messaging about weight that obese people get from society at large, from the medical community, and from themselves is consistently negative.

This leaves the afflicted person having to count on friends and loved ones for positive messaging. Here is what a friend or loved on needs to do:

The best thing is to care about someone, not define them solely by weight, and to not see them predominantly as a medical condition or problem. You’re there to be supportive, if and when they want to work on improving their health.

If someone has set out and said, “I’m going to lose weight,” then the best thing you can do is provide unconditional support. Let the person trying to lose the weight set the terms of engagement.

In previous posts, Childhood Obesity News has already mentioned several arguments against shaming obese people in an attempt to “help,” and here is one more. The (STOP) Obesity Alliance says,

There is no evidence that stigmatizing overweight and obese individuals motivates them to lose weight. In fact, stigmatization may postpone and even prevent these individuals from getting treatments that could improve their health.

Your responses and feedback are welcome!

Source: “Overcoming obesity: An initial economic analysis,” McKinsey.com, November 2014
Source: “How Did Alasdair Wilkins Lose 100 lbs in a Year?,” Diatribe.org, 10/5/15
Source: “Strategies to Overcome and Prevent (STOP) Obesity Alliance,” Policy Recommendations
Photo credit: istolethetv on Visualhunt/CC BY