False Comparisons of Smoking and Obesity

Analogies are a powerful tool to build a story and persuade people to adopt a preferred course of action. When it comes to policies to reduce obesity, one of the most frequent analogies employed is tobacco policy. Earlier this year, Sarah Hill and colleagues made the case for health policy to align the regulation of tobacco with other unhealthy commodity industries. In this framework, ultra-processed food and alcohol line up with tobacco as targets for regulation. “Commercial determinants of health” is the label for their framework. It’s an appealing concept in some ways. But it rests on false comparisons between smoking and obesity.

Big Food as the Enemy

For any compelling narrative, we need a villian and the food industry fits neatly into that role for many food policy activists. Tobacco companies played that role perfectly. They sell a product that kills the people who use it and they resist regulation.

But it’s not such a tidy fit for the food industry. To be sure, the industry contributes to the problem of obesity. It profits from overconsumption of appealing products and fosters unhealthy patterns of eating by doing so. Nonetheless, the food industry meets a basic human need for food that’s affordable, convenient, and tasty. Depicting food as addictive or sugar as toxic pushes the comparison of food and tobacco industries toward the realm of fiction.

Failures of Regulation

Tobacco regulation has had some major successes, though much work remains to be done. Tobacco still kills more than eight million people every year.

By contrast, health policy has had little success in reducing the harm of obesity. Despite ambitious efforts in some places, obesity prevalence continues to rise. Folks tell us that we will have to wait a long time for these efforts to work, because it took decades for anti-smoking policies to bring improvements in health. But that’s not exactly true. Smoking prevalence plunged in the 1980s when smoking became impermissible in many public places. By the early 1990s, deaths from lung cancer began to fall.

Pitfalls in Tobacco Policy

We have reasons to believe the comparisons between smoking and obesity will undermine efforts to improve health more than they help. Skip Murray, an advocate for health, equity, and kindness, has personal experience with both tobacco and obesity. She tells us she has serious reservations with taking these comparisons too far:

“Using anti-tobacco strategies makes me uncomfortable. Because part of that strategy was to stigmatize people who smoke, to motivate them to quit smoking.

“While that worked for many rich, white people, it didn’t work so well with the groups who are now the folks with the highest rates of smoking.”

Food Is Different

Likewise, culinary nutritionist Linn Steward gives us another reason to think that approaching food policy in parallel with tobacco policy might lead us astray. She writes about the challenge of dietary guidance:

“The narrow focus positions pleasure against health. When there is no place for joy in a healthy eating pattern, folks will choose other options. Both FDA regulations and the DGA [Dietary Guidelines for Americans] are instruction manuals. Compliance is expected and enforced. We need a better approach.”

Yes. We need a better approach to food policy and dietary guidance. Smoking is very different from eating and false comparisons with obesity will not lead us to sound health policies. More often than not, it will reinforce our biased mental models.

Click here for Hill’s article on commercial determinants of health and here for more on biased mental models in obesity.

Old Man Lighting a Pipe, painting by Johann Carl Loth / Art Institute of Chicago

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

November 13, 2022