It seems like more and more often I’m seeing public health discussion in which fat is compared to smoking. This is absolutely not an apt comparison and here is why.
The main difference is pretty simple. Smoking in a behavior – every smoker smokes. Being fat is a body size, being listed as “overweight” or “obese” in current medial science is a ratio of weight and height and it’s been changed over time, including at the request of companies that sell dieting. Fat people are as varied in their habits and behaviors as any group of people who share one physical characteristic.
Now let’s talk about what a successful intervention looks like. Smokers become non-smokers when they quit smoking – when they stop doing a single specific behavior. In order for fat people to become not fat, they must change their body size. There are no studies where more than a tiny fraction of fat people are able to become thin in the long term, with the behavioral solutions of “eat less and exercise more” failing just as often as what are considered fad diets. Because being fat is a body size, not a behavior, there’s not a clear behavioral intervention.
For these reasons, even if someone believes that being fat requires public health intervention (and I don’t think it does) and even if someone believes that shaming smokers has been/is a good public health intervention (and I’m not suggesting that it is) they cannot logically draw the conclusion that shaming is an appropriate intervention for fat people. Shaming smokers shames people for something that they do, shaming fat people shames them for who they are. If smokers wish to avoid the shame and stigma they have the option to hide their behavior. Fat people have no such option except to avoid ever going out in public. It’s simply not the same thing.
Then there are issues with attempts and failures. Even if we assume that smoking and weight loss have a similar failure rate (ie: the vast majority of people fail long term) the difference here is that a smoker is statistically healthier for every day they don’t smoke – even if they start smoking again. Dieting does not work that way. Each time we feed our body less food than it needs to survive in the hopes that it will eat itself and become smaller, we open ourselves up to health risks including those from weight cycling and from caloric deficit, as well as rebound weight gain. If we think that being fat is unhealthy, then statistically a weight loss intervention is the worst possible recommendation since the majority of people who lose weight end up gaining it back plus more.
Smoking is causally related to health problems, obesity is correlationally related. There is good research showing that quitting smoking improves health. In addition to a lack of evidence that significant long term weight loss is likely or even possible for most people, there is also no research showing that fat people who are able suppress their weight have health improvements because of the weight loss. There is, in fact, research that suggests that they don’t.
Regardless of what you believe about smoking and “obesity”, they are simply not comparable from a public health perspective and continuing to treat them as if they are does a disservice to everyone involved.
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