Smoking and Overeating — Big and Bad

We are looking at the similarities between two public health menaces, nicotine and the overconsumption of food, that threaten to bring on an obesity epidemic, the combined weight of which could knock the planet off its axis. (Just kidding. Or not.)

As killers, smoking and obesity both have a lot of patience, and will prolong the torture for years before finally finishing off the victim. Paradoxically, that is a good thing, because the time span gives a person many opportunities to get off a bad track and onto a better one. It means that, as causes of death, both are preventable.

Both cost a lot of money. According to the McKinsey Global Institute,

Obesity costs the global economy about $2 trillion annually or 2.8% of global GDP, which is comparable to the costs of smoking or of armed violence, war, and terrorism combined.

The financial argument is certainly valid, as medical bills cost society an enormous amount. The illnesses of people who don’t receive assistance from government funds cost society a lot, too, because they go bankrupt and are no longer good consumers, so everyone else gets poorer, except the insurance corporations.

A Canadian study calculated the amount that could be saved by implementing tobacco policy interventions, noting that “these numbers pale relative to the projected costs for medical care, productivity losses, and the cost of premature deaths if the obesity epidemic is not controlled.”

Both smoking and overconsumption can be annoying to live with. A housemate who smokes will stink the place up so everybody’s clothes smell funky. Cigarettes will fall out of ashtrays and leave burn scars on the credenza. A compulsively overeating housemate might leave the kitchen in a mess. Other residents might find blocks of cheese hidden in bizarre places.

Obesity can afflict the body with systemic inflammation, and so can smoking. Teenagers, who are convinced of their own invincibility, find it very difficult to internalize warnings about the danger of either nicotine or obesogenic eating patterns. And if they do worry about excessive weight gain, it tends to become a different and separate problem.

Another similarity is that large numbers of experts consider them both to be addictions. Massive industries have grown up around both smoking cessation and the curbing of compulsive overeating. The other side of that coin is the splendid growth of voluntary association in the quest for health, typified by such organizations as the no-cost 12-Step programs.

Devotion to smoking and overeating are so similar, they often replace one another. The overall stats since the 1950s show that smoking has decreased, while obesity grows and grows to where an actual one-third of Americans are classified as obese. Some people are able to curb their recreational eating only by smoking, which keeps hunger at bay and fills some kind of metaphysical void. The sad truth is that many people who quit smoking will take up eating instead, and put on multiple unnecessary pounds.

In his “Fighting Obesity: What We Learned From The Battle On Smoking,” Tom Fudge included several narratives from people who quit smoking and gained problematic amounts of weight. One reason is that the taste buds, long bludgeoned into passivity by heat and harsh chemicals, begin to regain their powers.

The journalist quoted Dr. Ken Fujioka, director of the Scripps Clinic Center for
Weight Management:

When you stop smoking cigarettes, two things happen. One is that most people eat about 225 calories more a day. But the other thing they do is, they actually burn less calories when they come off of cigarettes. So they burn 15 percent less, which is very significant.

Virginia Slims, anyone?

Your responses and feedback are welcome!

Source: “Obesity in America,” ASMBS.org, October 2018
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
Photo credit: reXraXon on Visualhunt/CC BY

Public Health Menaces — Smoking and Overeating

Overeating and smoking are both deemed maladaptive attempts to cope with the stress of life. We mentioned a few ways in which smoking and overeating resemble each other; for instance, both cause insurance problems, and both can sometimes be moderated with drugs. Also, both habits are deplored by large segments of society. Because much of the lure of substances originates in the tricky human psyche, they share several other similarities which we will explore.

Physiological evidence that a cigarette helps a person relax is missing, but a lot of people do not feel like they are really taking a break unless it includes the tobacco incineration ritual. For problem eaters, this translates into the mindset cultivated by such ad slogans as “You deserve a break today.” By smoking, or by ingesting a bagful of junk food, a person is both pampering himself or herself and collecting the just reward that is due for putting up with all the aggro the world insists on dishing out.

Renowned late-night talk show guest and former addict Alexander King described something he witnessed during a stint in federal rehab. In an adjoining cell, a fellow junkie knelt next to the bed, eyes reverently shut, miming the actions of tying off his arm and injecting heroin in the crook of his arm with an imaginary syringe. That visual haunted King for the rest of his life.

The motions, the rituals, are important (more to some than to others). For an eater, there might be a special magic in applying the chocolate nut butter to the bread with artistic swirls. Compulsive overeating might be largely a behavioral disorder, and cognitive behavioral therapy is employed to address it. On a mundane level, people need something to do with their hands, an object to hold and manipulate, like a cigarette or a glass, or a toothpick. Pipe smokers get to fiddle endlessly with their paraphernalia.

A hospital patient once told Dr. Pretlow how much the daily visits of the volunteers meant.

She said that the hand-to-mouth movement of unwrapping the candy bars and moving them back and forth to her mouth replaced what she missed from smoking, as well as the biting, chewing, and swallowing of the candy bars.

When the most recent edition of the Diagnostic and Statistical Manual was published, psychotherapist and drug and alcohol counselor David Porter summarized some points about Tobacco Use Disorder. Tobacco use has many features that make it an ideal addictor: “the behavioral reinforcement of the hand-to-mouth habit, lack of social support to cease smoking, the ease of access of tobacco products, and the cultural acceptance of tobacco products.” Tobacco and dangerous food also share the tendency of scientists to tinker with their composition, and make them more irresistible.

To be deprived of nicotine can cause a craving for the substance, along with irritability, annoyance, anxiety, and other unpleasant emotions. Many people are convinced that they are addicted to certain foods in the same way — although this possibility is hotly contended.

DSM-5 does not even accord food dependency the courtesy of calling it a substance abuse disorder. Nor does the industry bible specify Tobacco Use Disorder treatments. Porter’s account sounds oddly familiar, in fact just like the things that have been tried against food dependency:

There are a number of methods to attempt smoking cessation, some of which are evidenced based, others are lacking in empirical evidence for their efficacy, and may be ill advised. Methods that have been attempted include Hypnosis, Social support through smoking cessations self help groups, Exercise as an adjunct to relieve nicotine cravings, […] Cognitive Behavioral therapy.

The Centers for Disease Control compiled a best practice document for tobacco control, with the intention of providing a template for formulating guidelines, for use by state and local authorities and organizations when creating their various obesity control programs.

Your responses and feedback are welcome!

Source: “Tobacco Use Disorder DSM-5 305.1 (Z72.0) (F17.200)
Image by ConservativeMemes.com

Plenty of Pain to Go Around

The previous post introduced readers to Anne Lamott, self-taught expert on a lot of subjects, including eating disorders and addictions in general. She knows a lot about the plight of a child in a household ruled by alcoholism or any other life-warping secret.

In the field of helping obese children, professionals wish they could believe that all parents share a single, lofty goal: to support and nurture the child in every possible way. Sadly, a vast number of parents are simply not equipped for the task. This is particularly true when they happen to have caused the child’s problem in the first place — which opens up a lot of possibilities.

It hurts to contemplate this, but a woman might have a child on purpose, and prenatally assign that baby the job of convincing the baby’s father to propose marriage. A man facing an overseas assignment might purposely sabotage family planning efforts, to ensure that his wife is uncomfortably and unattractively pregnant while he is away.

All too often, a child is born into a scenario where she or he is expected to immediately start helping the parents in some way — by making their parents happy, by giving them stuff to brag about, or boosting their self-esteem, by lavishing unconditional love on Mommy and Daddy. Before a baby draws his or her first breath, a ton of expectations are laid on it.

Sex is one. If a boy was devoutly hoped for, but a girl arrived, or vice versa, that child starts off with a handicap from Day One. Or the kid comes out musical, instead of athletic, as the parent had hoped. Failure has a thousand categories, and to disappoint a grownup, or several grownups, is almost unavoidable.

The fancy blindfold

Lamott discusses how in a family with addiction to alcohol, hard drugs, rage, etc., the child is assigned one primary duty, which is pretending not to see. At a spiritual retreat  with Ram Dass (a cultural icon since the 1960s), Duncan Trussell, and other sages, Lamott described the alcoholic home, where for a child, survival depends on metaphorically “signing a contract.”

This is an unvoiced but necessary agreement to disregard the irregularities. If you notice the dysfunction, you will have feelings about it, which is tantamount to “wrecking everything for everyone.” Lamott writes,

If you’re paying attention in an alcoholic home, you’re seeing stuff that they can’t bear for you to see, or to even know… Their life depended on us agreeing not to see what was going on, and so it’s very very hard to trust the narration of your own life… You’ve been told that what you see is not actually going on. By extension, what you felt is not actually what you felt…

Threatened parents skillfully explain to children how and why they are not actually feeling anything. In fact, that goes both ways. Addicted parents are adept at convincing children that neither they nor the children feel what they obviously feel. They engage in the worst kind of “gaslighting,” which is making someone deny the evidence of their own senses. It’s no wonder kids react by “stuffing” their feelings, or express their chronic anxiety through displacement behaviors like crunching snacks between their teeth all day long.

Typically, the burden is not equally distributed. Often, a family assigns one child to shoulder the blame and be the Official Patient, which lets everyone else off the hook. In many cases, the designated sickie is the obese child. Lamott says,

It’s best for the child to think he or she is the problem. Then there is toxic hope, which is better than no hope at all, that if the child can do better or need less, the parents will be fine.

Your responses and feedback are welcome!

Source: “About Almost Everything,” PenguinRandomHouse.com
Source: “Anne Lamott Quotes,” Goodreads.com
Source: “Duncan Trussell Family Hour 301: Anne Lamott and Raghu Markus,” IHeart.com, 08/16/18
Photo credit: Lala Photography at JoLi Studios Colchester on Visualhunt/CC BY-SA