Pat Hartman | Childhood Obesity News

The Non-Equivalency of Smoking and Overeating

Pat Hartman March 25, 2019 No Comments

In the national effort to reduce smoking, stigmatization plays an important role. But a nicotine habit, even an addiction, is qualitatively different from a state of being, like obesity. Smoking is something a person does, rather than something they are. Sure, somebody who smokes is a smoker, but that is seen as an extra thing added on, like aftermarket wheel rims, instead of an essential component of personhood.

A smoker is criticized for something she does; an obese person is taken down for something she is, which is a different proposition. Expecting someone to stop doing something is quite different from asking a person to stop being something. It is also the reason why stigmatization is unable to play as large a role in stemming the obesity epidemic as it does in slowing down the rate of smoking.

Crucial differences

Someone who is shamed into quitting tobacco is congratulated and celebrated, and the love is relatively easy to earn. All this individual has to do is continue not smoking, and with the extra advantage of being able to set up a lifestyle that avoids contact with tobacco and with other smokers. A person who is shamed into losing weight does not collect the same reward of brownie points, but at the same time, faces a much harder road. No one can shift to a lifestyle that excludes food and people who eat.

Smoking cessation benefits others in tangible, identifiable ways — releasing less pollution into the air and fewer cigarette butts onto the streets. It is more difficult to point to environmental benefits from weight loss, because the fat person himself is considered to be the blot on the landscape.

Smoking cessation has emotional, tangible benefits for others. For instance, it helps the quitter live longer, to care for and be available to family members, which is a help to them. Many ex-smokers are appreciated for that in an ongoing fashion, like yearly no-smoking “birthdays.” Weight loss achieves those same ends, yet, for some reason, it is more difficult to grant weight losers the acclaim they deserve while moving forward through life.

Essential differences

Although social opprobrium has been partly responsible for the decrease of smoking, there is a deep-seated reason why it can’t work the same way against the obesity epidemic. There is an obvious and distinctive difference between being shamed for smoking and being shamed over obesity. Generally, the people shamed for smoking are grownups. A child smoker is unlikely to be shamed, because if a child is smoking at all, it’s likely in a family and a culture where kids smoking is no big deal.

A grownup smoker has a history of life experience, and may have faced criticism and opposition for other choices. A certain amount of hard shell has built up around that person’s psyche. An adult probably has a job, which adds a layer of self-justification, as in, “Hey, I’m making a good salary. If I want to spend my money on cigarettes, how is that your business?”

A 5-year-old “fatty,” mercilessly teased by peers and picked on by family members, is a different case. That little self is barely formed, vulnerable, soft, and defenseless. Relentless negativity finds fertile ground in which to cultivate depression, self-loathing, and a body image that might be even worse than reality. In this morass of ugliness, problems like exercise avoidance and maladaptive eating patterns are unlikely to be addressed. That person grows up accumulating additional bad experiences related to obesity.

As time goes on, the person carries around more and more emotional baggage, along with a slicker ability to rationalize the very behaviors that cause the problem. And no matter how much pain has built up, and regardless of how much more is added to the pile, a thick skin may also be growing — a coating of indifference that looks like a bad attitude, one that says, “If you can’t love me as I am, just go to hell.”

Fat-shaming is worse than wrong — it’s useless

The message for normal-weight people is, good luck trying to shame an obese grownup. She has heard it all before, and learned to “stuff” that pain along with everything else. He has had a lifetime to prepare all the necessary rationalizations, and to develop all the reactive hostility needed to completely ignore the shamer.

The number of people who have lost significant weight to please another human is vanishingly small. Sure, we should avoid fat-shaming because it is unkind and hurtful. But an even more excellent reason is the ruthlessly pragmatic one — it doesn’t work.

Your responses and feedback are welcome!

Photo credit: Julie Facine on Visualhunt/CC BY-SA

Smokers and the Obese — More Similarities and Differences

Pat Hartman March 22, 2019 2 Comments

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,” TandFOnline.com, June 2017
Photo credit: Greg Parish on Visualhunt/CC BY

Smoking, Overeating, and Stigmatization — Roots and Effectiveness

Pat Hartman March 21, 2019 No Comments

In the previous post, Childhood Obesity News talked about the relative destructiveness of smoking stigma versus weight stigma, and about how negative attitudes are acted out against individuals, and received by them. Also interesting is the question of why people spend so much energy attempting to modify others others’ behavior.

Why do many Americans want to see, among their compatriots, an end to both smoking and compulsive overeating? There are personal reasons, but a lot of it is altruistic. The main ideas here are: A) some diseases don’t really need to happen and B) let’s figure out how to prevent those. As it turns out, this involves changing human nature, one human at a time, a process also known as therapy.

The object is to help people stop behaving in harmful ways. But why do some of our fellow humans think that condemnation might be an effective way to motivate people to quit their cherished habits? Experience repeatedly shows that the opposite is true. Before we ask whether shame has helped to reduce smoking, first we need to look at how the circumstances in America have evolved. The AMA Journal of Ethics says,

In the 50 years since the 1964 Surgeon General’s report, Smoking and Health, US adult smoking rates have fallen from 43 percent to 18 percent…

Although smokers lost ground in proportion to the population as a whole, in absolute terms their numbers have gone up. Compared to 20 years ago, they are a smaller percentage but a larger number overall. But because of how statistics work, it can be said that smoking has decreased. The extent to which stigmatization is responsible is impossible to tell. A case has been made that for smokers who don’t quit, it’s not always, or exclusively, physical addiction.

In the course of examining anti‐smoking pressure in Western countries, three researchers learned that when people cling to tobacco, it’s not just addiction, but much more akin to self-medication. They call tobacco “a somewhat usual drug in environments in which humans need to concentrate and reason, as in education and work settings.” (It could be thought of as a focus aid, and with a much gentler stimulant effect, for people who can’t get Adderall.)

Moreover, tobacco does not bring on the psychological twists or adverse behavioral effects that other drugs are known for, and the cognitive effects are important reinforcers. They say it is…

[…] the only drug that can be consumed throughout one’s daily life without harming their routine activities, such as work and study, and may even generate positive effects for such purposes.

A lot of those attributes are shared by eating. People want to do it while they study; it calms them down and gives them energy; helps with reasoning and concentration by nourishing the brain; is compatible with many other simultaneous activities; and usually is not psychoactive.

An interesting study of New York City smokers looked at their “perceived devaluation, perceived differential treatment due to smoking, social withdrawal from nonsmokers, and concealment of smoking status.”

The results suggest that the stigmatization of smokers is a potentially powerful and unrecognized force, one that may have counterproductive consequences.

If success were measured by making people feel bad about themselves, vilification could be said to do a good job. In 2014, Penn State researchers wondered how aware smokers are of negative stereotypes, and how much they care. From a meta-analysis of 30 previous studies, they learned that smokers describe themselves as pathetic outcasts, lowlifes, and bad people.

Being treated like lepers causes some smokers to internalize that dynamic and feel like lepers. They feel guilt, shame, embarrassment, and hopelessness. If they try to quit, and fail, that makes everything worse. So far, all these things could also be said of obese people. On the other hand, warned the researchers, some smokers…

[…] resisted internalizing the stigma by adopting a defensive strategy also employed by other marginalized groups such as those with a mental illness or with weight problems…

Your responses and feedback are welcome!

Source: “Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care,” AMA-Assn.org, May 2017
Source: “Tobacco smoking: From ‘glamour’ to ‘stigma’. A comprehensive review,” Wiley.com, 10/09/15
Source: “Stigma and Smoking: The Consequences of Our Good Intentions,” ResearchGate.net, December 2009
Source: “Smoking stigma can backfire, hurt efforts to quit,” FredHutch.org, 11/02/15
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Smoking and Overeating — When Society Fights Back With Scorn

Pat Hartman March 20, 2019 No Comments

One interesting question is whether weight stigma is the equivalent of smoking stigma. The answer depends on whom you ask, and what area of human activity is being looked at. Smokers and obese people both face opposition to their lifestyles, no matter how involuntary their conditions might be. In both cases, two major dynamics are at work — morality and methodology.

Designated villains

When challenged to rid itself of harmful behavior, society has always had its ways. In the oldest of old days, a wrongdoer might be ostracized for a certain time. Everybody would just ignore the person and pretend that he or she wasn’t there. For repeat offenses, the response would escalate to banishment from the village. There was no big city to run away to, and the nearest settlement hated strangers. Painful starvation and lonely death were real possibilities. The incentives to conform were strong.

Nowadays, society has to cope with smokers and compulsive overeaters whose very existence some folks find unbearable. An offender is banished in symbolic ways; she or he is recategorized, deprecated, removed from consideration as a worthy human. On moral grounds, the zeitgeist seems to feel equally justified in denouncing smokers and the obese. Some factions are quite punitive toward them.

Three shades of degradation

There is a hierarchy of socially acceptable addictions. When it comes to compulsive overeating, “society” is basically schizophrenic. On the one hand, it allows every possible thing to encourage eating and lots of it, at all times and places. Consumption is joviality and bonhomie, mixed in with precious family and cultural values, and a whole slew of other emotional baggage. At the same time, the end results of all that consumption, the lumpy carcasses and broken bathroom scales, are mocked.

In the mid-range of acceptability, alcohol is king. Millions of people are enslaved by it, at a monumental social cost, yet somehow the appetite for it never seems to slacken. Alcohol, while not always totally acceptable, is tolerated. People who like to drink tend to congregate, while non-drinkers may hang out with other non-drinkers, or not hang out at all.

On the social acceptability scale, smoking is definitely the lowest. For a while now, it has been politically correct to dump on smokers. They are the one category of humanity it is perfectly okay to despise. The critics of obesity, although not shy about expressing to the world the depth of their scorn, are still a bit more reserved, at least for the present. At least, among grownups. But not even all grownups.

Methodology

The practice of stigmatization has so many facets, only a couple of them are mentioned here. Obese people are encouraged to make spectacles of themselves on TV, where they are looked down on both for being fat, and for floundering around under stage lights, sweating for the camera.

We mentioned that “society” now finds it easy to blame and hate smokers, even to the point of directly confronting and denouncing them. Anti-smokers who are less brave will make their point by uttering little coughs in the direction of the smoker.

Although there are some startling exceptions, even those who vehemently object to smokers are not as likely to give an overweight person a hard time, in public, in a demonstrative way. The aggressions tend to be of the indirect variety, like taking pictures of a large person to send to friends. Usually, dislike of the obese, at least among grownups, is expressed with a bit of discretion.

Your responses and feedback are welcome!

Photo credit: David Peterson on Visualhunt/CC BY

Smoking, Overeating, and Official Disapproval

Pat Hartman March 19, 2019 No Comments

Why should “society” care if people use tobacco? There are many reasons. It annoys nearby people — which is also true of certain colognes, but no one has found a way to outlaw those yet. On the “serious as a heart attack” side, tobacco use has been linked to cancer of at least a dozen crucial body parts.

Obesity shares the notoriety of being associated with a plethora of diseases, or as the pros call them, morbidities. A morbidity is as bad as it sounds, a condition that either kills you or makes you wish you were dead.

Smoking and obesity are responsible for tragedy on the both the micro and macro scale. They are not alike in every way, but in enough ways that anyone interested in controlling obesity will look to the anti-smoking movement for advice — although maybe not vice versa.

Lots of people either lived through the days of ubiquitous smoking, or have seen them depicted in Mad Men or some other TV show. In elementary school, teachers smoked in the teachers’ lounge. Smoking in movie theaters, college classrooms, and hospitals was taken for granted. Every restaurant table was equipped with an ashtray, and every restaurant gave away matchbooks that advertised the business, because matches were something that everybody needed.

When people visited the homes of relatives and friends, permission to smoke was expected, and only a very ungracious hostess would fail to provide at least one ashtray. It wasn’t a big deal. Smoking was widely perceived as stylish, cool, and even sexy — but that is well-documented elsewhere.

Now, practitioners of the vice, exiled from the comfort and companionship found within walls, can be seen standing huddled in the rain, trying to keep their cigarettes lit. What happened? Taxes happened, along with consequent disgruntlement in some places when the authorities failed to use the revenues as promised. Laws have been made to free the air of smoke, not only indoors, but within X number of feet from entrances and windows.

In the workplace, smokers pay more for health insurance, and apparently, some employers can even refuse to hire them. The situation is the same for overweight and obese employees. In either case, the company may or may not offer various health-enhancing measures to help out.

The laws vary from state to state, so an employer needs to be cognizant of the local situation. In 29 states, just smoking alone is not a good enough reason to refuse to hire a person. But even so, there are all kinds of side rules and exceptions depending on the total number of employees, or the probable safety risk posed by smoking in that particular setting, or what the union negotiates. It gets complicated, because if smoking is an addiction, then it’s a disability, and Americans with disabilities should not be discriminated against.

Media campaigns about the dangers of smoking have been produced for various audiences, most importantly kids. As for commercial media, we used to see doctors and nurses (or “doctors” and “nurses”) making their pitch for tobacco. Print media ads featured famous actors. Here is some history:

In 1971, the U.S. banned broadcast advertising of tobacco products. Smoking within TV dramas immediately dropped by 70 percent. The tobacco companies then returned to systematic product placement campaigns in Hollywood, affecting hundreds of mainstream movies.

The 1998 Master Settlement Agreement between state attorneys general and domestic tobacco companies prohibited tobacco product placement in entertainment accessible to kids. Despite this legally-binding agreement, however, on-screen smoking climbed…

Obviously, it would be impossible for authority to ban eating in movies or on television, whether kids are likely to be watching or not. Could the law forbid depiction of certain kinds of products, like doughnuts or sugar-sweetened beverages? Not without monumental legal battles.

Your responses and feedback are welcome!

Source: “Can Employers Refuse to Hire Smokers?,” HRDefenseBlog, 09/04/18
Source: “Tobacco’s history in Hollywood,” UCSF.edu
Photo credit: Anton Raath (Fugue) on Visualhunt/CC BY-SA

Smoking, Overeating, and Breaking Up Their Powerful Coalition

Pat Hartman March 18, 2019 No Comments

Childhood Obesity News has been comparing tobacco use and/or addiction to food overconsumption and/or addiction. It is hoped that methods successful in one area can be used to also tackle the other. As we recently mentioned, there seems to be little hope of working on just one of those two problems, because it will pop up again disguised as the other.

The key elements of tobacco control are clinical intervention and management, educational strategies, regulatory efforts, economic approaches, and “the combination of all of these into comprehensive programs that address multiple facets of the environment simultaneously.”

As a smoking prevention or intervention method, counseling by physicians is the best. But it is only one “prong,” not a full solution. Alone, physician counseling cannot vanquish the broad cultural acceptability of tobacco, or the various pressures and triggers that cue a person to shake a cigarette from the pack.

What’s going on?

When researchers look at changes in the prevalence of smoking, the number of quit attempts, and the successes, “no single component of the comprehensive programs can account for all of the significant changes.” Not surprisingly, we see that the multifactorial problem of widespread obesity needs a multifactorial solution.

Some things work, sometimes, for some people. Educational interventions and strategies are delivered via school programs and public service announcements, the mass media, and counter-marketing, and through parents and community programs. But why has counseling for smoking cessation historically been more successful than obesity counseling?

It gets complicated. Under the increasingly labyrinthine and underfunded medical care system, doctors can find it difficult to be reimbursed for their time and skills. But does that position need to be filled by a credentialed physician? Isn’t it possible that counseling could be as effectively delivered by nurses, physicians’ assistants, pharmacists, or even artificial intelligence speaking through devices?

Sounds like a winner

The Health Impact of Smoking and Obesity and What to Do About It, from the University of Toronto Press, wants professionals to know that the evidence for tobacco interventions is “extensive and compelling.” This meta study of meta studies is meant to be the ultimate authority:

Fortunately, extensive summaries have recently been completed that expertly review the current evidence on tobacco control strategies, sometimes incorporating dozens or even hundreds of studies. Our approach here is to compare and collate all of this work and offer a state-of-the-art review of reviews.

An entire chapter is devoted to “10 Lessons from the Tobacco Wars,” with “summaries of all of the interventions — the good, the less proven, and the unproven.” The book’s third section is mainly concerned with drawing parallels and showing that the strategies used to reduce environmental smoke (and cut down the number of smoking deaths) can be adapted to the struggle against the obesity epidemic.

In addressing health care issues, the importance of building coalitions and alliances is emphasized. A warning is issued that “there are still large gaps in understanding the individual and combined roles of diet, exercise, and counseling in different settings.”

Your responses and feedback are welcome!

Source: “Possible lessons from the tobacco experience for obesity control,” OUP.com, April 2003
Source: “The Health Impact of Smoking and Obesity and What to Do About It,” JSTOR.org, 2007
Photo credit: Sergio Santos on Foter.com/CC BY

Smoking and Eating Disorders — Their Strange Relationship

Pat Hartman March 15, 2019 No Comments

Smoking prevalence and eating disorders are intertwined in the human psyche. Plenty of scientists have noticed this, and done some exploration, but conclusions about the relationship are far from solid. A multi-author meta-analysis with ties to 15 institutions wanted to determine exactly how prevalent smoking is among people with eating disorders (ED), as compared to the general population. Idle curiosity was not the motive. Together, the two lifestyles add up to one big problem, namely, an important public health issue.

The authors started out knowing already that “Cigarette smoking is associated with severe mental illness including schizophrenia and bipolar disorder, and with morbidity and mortality.” But what about eating disorders? They wrote,

There appears to be a longstanding belief that nicotine suppresses appetite, and smoking has been shown to increase resting metabolic rate, which is why smoking is used for weight control. In individuals with ED, the perceived benefits of nicotine for weight-control and temporary stress reduction may outweigh any concerns about the long-term harms of smoking.

But… this holds true only if they have one of two specific problems, and not the third:

People with binge eating disorder and bulimia nervosa are significantly more likely to be life-time smokers than healthy controls, which is not the case for anorexia nervosa.

Isn’t that odd, or at the very least, counterintuitive? Because out in the world, AN patients get up to some pretty desperate tricks just to shrink a few more fat cells. It seems like it would be the most natural thing in the world, for anorexics to turn to smoking. Yet, apparently they do not. Concerning this and other matters, the paper reiterates a useful concept that is not heard often enough: “The relationship… appears to be complex.”

But wait! Another study, very close in time, contradicted that one. According to the Department of Psychiatry at the University of North Carolina…

[…] subjects with eating disorders of any type, including anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder, had increased rates of smoking and higher nicotine dependence compared to controls.

That is what it says, “disorders of any type, including anorexia nervosa.” This is why there are lots of laboratories and lots of trials, so results can be checked again and again. The big takeaway from this study was that tobacco use and eating disorders do not just happen to coincide once in a while, but hang out together on a fairly regular basis.

Unless the patient’s smoking and eating problems are treated comprehensively and simultaneously, failure can be predicted. Serious rehab costs a king’s ransom. It is said that “many” treatment programs offer support to those with co-occurring conditions, but that may be overly optimistic. For most Americans, the more pressing question is whether an insurance plan offers the same support.

The news gets even worse. The “smoke your way to slimness” trope appears to be based on a false belief. This paper says,

The idea that cigarette smoking is helpful in controlling body weight has been part of popular culture for many decades, dating back to 1930s advertisements that suggested women could smoke to help curb cravings for sweets.

Michelle Lippy of EatingDisorderHope.com offers a handy checklist for the person who is trying hard to quit cigarettes without bringing in overeating as a replacement. The name of the game is mindfulness. Interrogate yourself like a concerned friend or a skillful therapist, and figure out what the real problem is. Try some of the other suggestions on the page. None of them could possibly hurt.

Your responses and feedback are welcome!

Source: “The association between smoking prevalence and eating disorders: a systematic review and meta-analysis,” SGUL.AC.UK, May 2016
Source: “When Cigarette Smoking is Used as an Appetite Suppressant,” EatingDisorderHope.com, 05/07/17
Source: “How to Avoid Falling into Using Food to Replace Tobacco,” EatingDisorderHope.com
Photo credit: Photos by Chloe Muro on Visualhunt/CC BY-ND

Smoking and Eating Disorders — It’s Complicated

Pat Hartman March 14, 2019 No Comments

A few years ago, a study set out to observe the relationship between smoking cessation treatment and binge eating. Previous research had discovered that…

[…] both smoking and binge eating modulate negative affect, so it is possible that in the absence of smoking, some individuals begin binge eating in an attempt to regulate negative emotions.

To put it another way, people overeat and/or smoke to move their emotional states away from stress and toward comfort. And why not? Even an amoeba knows to recoil from pain, and for all we know, it might yearn to go to the amoeba equivalent of a beach and enjoy the amoeba equivalent of a Mai Tai.

The study indicated that among people in a quit-smoking program, binge eaters were less likely than normal eaters to abandon nicotine. A non-binge-eater was an impressive three times as likely to successfully quit smoking. So far, sounds like common sense — but the picture becomes complicated.

The research team suspects that some people smoke to tamp down their binge-eating desires, and for them it works. Also, there is evidence that smoking cessation can turn a person into a binge eater, even if they formerly were not. These individuals will gain weight as a consequence. No surprise there. The paper also says,

[…] binge eating is likely to result in weight gain and weight gain may predict relapse for smoking…

This sounds exactly like a vicious cycle, and those are the kind that nobody wants. Getting back to the study itself, there were a couple of problems. First, it depended exclusively on self-reporting, which is always a weak spot. Second, the respondents were left to improvise their own definitions of “binge eating.” But here is the kicker:

[A]ll study participants were taking bupropion, a drug with appetite-reducing and antidepressant effects, which suggests that the rate of binge eating and weight gain observed in this sample may have been influenced somewhat by the medication.

Influenced somewhat? That is an understatement. Unless the specific point was to find out what bupropion does, it seems like the fact that all the subjects were on it should be an automatic disqualifier. But the study did bring up interesting points, and offered one recommendation with which a quarrel would be hard to pick:

Future smoking cessation studies should evaluate and track eating problems throughout the treatment.

In a study five years later, a team examined…

[…] eating disorder psychopathology and depressive symptoms by smoking status (never, former, or current smoker) in persons with binge eating disorder (BED) and bulimia nervosa.

Among the BED patients, the current smokers had more depressive symptoms than the former or never smokers. For the bulimia patients, it didn’t seem to make any difference, and there were “no differences in eating disorder psychopathology by smoking status in either the BED or BN groups.” The report also said,

There is evidence that a subset of individuals use smoking as an appetite and weight control method, and fear of weight gain is a frequently cited barrier to smoking cessation in both non-eating disorder and eating disorder samples.

Your responses and feedback are welcome!

Source: “Effect of Binge Eating on Treatment Outcomes for Smoking Cessation,” NIH.gov, 10/01/10
Source: “Smoking Status and Psychosocial Factors in Binge Eating Disorder and Bulimia Nervosa,” NIH.gov, 12/19/15
Photo credit: Faint Sanity on Visualhunt/CC BY

Smoking and Overeating — More Differences

Pat Hartman March 13, 2019 No Comments

Smoking has become surrounded by a lack of social tolerance that is certainly not matched by a matching intolerance for non-nutritious foods. In public places, smoking and eating are not treated the same. In an office setting, a proud new father can bring in cupcakes to be enjoyed right there on the spot, but he can’t hand out cigars to be smoked in the workplace. At the church breakfast, it is inappropriate to smoke, but very appropriate to eat strawberry shortcake. In fact, that’s the whole point, and nobody is going to censure the minister for having a second helping.

Psychotherapist David Porter cites a “lack of social support to cease smoking,” but that seems overstated. Today’s reality actually does supply incentive to quit, whether it’s from an insurance company charging a higher premium, a spouse having a meltdown, or the enforced absence of advertising for tobacco products.

Porter also points out that tobacco contains nicotine, a psychoactive central nervous system stimulant. However, while reports of psychoactive effects in food certainly exist (a dish called Pad Thai comes to mind), they are not universally convincing.

Although smoking may not be discouraged at every turn, all day long, there is certainly very little social encouragement of it. In either youth or age, the sight of someone being coaxed or coerced into smoking a cigarette is rare. Alcohol, on the other hand, sets up among its users a weird compulsion to form a tribe and insist that everyone join it. Drinkers can be real bullies about it, actually shaming and mocking others for not drinking. This rarely happens with nicotine or food.

When people fool themselves

As we have seen, food addiction is very easy to rationalize. In former days, smoking and absorbing nicotine through other delivery systems used to be a lot easier to justify. Advertisements assured us that doctors approved of it and even found reasons to recommend it. Today, dedicated smokers seem to have quieted down, and no longer make the effort to put in a good word for smoking. That ship has definitely sailed.

Whole generations of people were indoctrinated and conditioned to believe that “cigarette” and “relaxation” are synonyms. The proposition that smokers gotta smoke was not quite recognized as a right granted by Heaven, but it was negotiated into workers’ contracts. Each smoke break was a tiny license to cheat, an opportunity to gratify oneself while not making money for one’s employer. Even prisoners used to retain their smoking privileges.

Now, there is no right to smoke, but employers and penal institutions still must recognize the right to eat, and grant time and reasonable facilities for it. So, that is quite a big difference right there.

Another is the relative difficulty of making a case that obesity has any kind of widespread negative impact. On the contrary, obesity is a boon to clothing manufacturers, who can charge a lot for extra-large garments. Sure, a “passenger of size” can exasperate the flyer in the next seat, and even others on the plane.

But by and large, the people most affected by obese fellow humans are medical personnel. EMTs and nurses have to shift them onto stretchers and hospital beds. Surgeons have to figure out how to move layers of fat out of the way before starting a procedure. Except for the financials, and the setting of bad examples, it is not easy to argue that obesity really impacts the non-obese.

Your responses and feedback are welcome!

Source: “Tobacco Use Disorder DSM-5 305.1 (Z72.0) (F17.200),” Theravive.com
Photo credit: Chris Murtagh on Visualhunt/CC BY

Smoking and Overeating: The Differences

Pat Hartman March 12, 2019 No Comments

We have looked at some of the commonalities shared by smoking and overeating, in terms of both impact on the individual and societal reverberations. Many people support the idea of government action to resist the obesity epidemic, and are heartened by the incomplete but rather startling effectiveness of tobacco suppression. Professionals who deal with obesity are very interested in how people quit smoking, because therapeutic interventions found to be successful in that area might be transferrable.

In many ways, however, smoking and overeating are not alike. There is a major, inborn difference between tobacco inhalation and food ingestion. Small children are instinctively repelled by smoking, and teenagers generally have to force themselves through initial disgust. But generally, people do not need to train themselves to enjoy food. Right from Day One, beginning with sweet, warm milk, everybody likes to eat.

Another difference is that while “society” finds it easy to blame and hate smokers, on the food side we tend to direct animosity toward the manufacturers and advertisers who work so hard to make kids demand junk food. It seems that a large proportion of the public is offended when corporate interests mess with the vulnerable minds of children.

John Pierce is the behavioral epidemiologist who went to war against the goofily lovable (and thus child-friendly) advertising icon Joe Camel. He is in agreement with many others who call smoking reduction a gigantic public health success story, and recommends using its lessons as a playbook in the efforts to end obesity.

In the tobacco intervention sector, much energy is devoted to stopping teens from ever taking up the smoking habit. The authors of The Health Impact of Smoking and Obesity and What to Do About It suggest a parallel, and point out why no parallel can be exact:

The natural comparison is the prevention of weight gain in the first place, and especially in the context of children… Unlike using tobacco, healthy eating and physical activity are important to child development, making controlling weight more complicated.

An important difference that is named in “Possible lessons from the tobacco experience for obesity control” still holds true 15 years later:

Whereas pharmacotherapy is recommended for all users of tobacco regardless of amount smoked, the risks and benefits of pharmacotherapy for obesity are related to body mass index (BMI), so there is no comparable approach for obesity intervention.

Then, there is the huge, yawning difference that we hear echoed so often: People can live without nicotine, but they can’t live without food. Consequently, overeating requires a great deal more ingenuity to beat. Kicking an addiction has been compared to getting a divorce.

With alcohol, nicotine, heroin and many other substances, it’s like a divorce without kids. You can just say “We’re done” and never have to see the person again. But if you have procreated, you have to deal with shared custody and child support and holiday visits and mutual grandkids, and so on. You’re tied to your ex forever, and that’s how it is with food.

Your responses and feedback are welcome!

Source: “The Foodservice Industry’s Social Responsibility Regarding the Obesity Epidemic, Part I:,” FIU.edu, 2010
Source: “Fighting Obesity: What We Learned From The Battle On Smoking,” KPBS.org, 06/09/17
Source: “The Health Impact of Smoking and Obesity and What to Do About It,” JSTOR.org, 2007
Source: “Possible lessons from the tobacco experience for obesity control,” OUP.com, April 2003
Photo credit: Joe Haupt (France1978) on Visualhunt/CC BY

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Essential differences

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Smokers and the Obese — More Similarities and Differences

Why did you quit eating?

Comparisons don’t always count

Smoking, Overeating, and Stigmatization — Roots and Effectiveness

Smoking and Overeating — When Society Fights Back With Scorn

Designated villains

Three shades of degradation

Methodology

Smoking, Overeating, and Official Disapproval

Smoking, Overeating, and Breaking Up Their Powerful Coalition

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Smoking and Eating Disorders — Their Strange Relationship

Smoking and Eating Disorders — It’s Complicated

Smoking and Overeating — More Differences

When people fool themselves

Smoking and Overeating: The Differences

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

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