False Comparisons of Smoking and Obesity

Old Man Lighting a PipeAnalogies 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

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November 13, 2022

3 Responses to “False Comparisons of Smoking and Obesity”

  1. November 13, 2022 at 8:15 am, Al Lewis said:

    There are other differences too. Smoking/vaping, of course, is a personal chocie that the average teenager already knows is addictive.

    Whereas someone can think they are eating healthy food (like many heavily sweetened breakfast cereals marketed as healthy) but be misguided by “Big Food.”

    And of course while there are genetic predispositions to both, folks such as myself who have a tendency towards addiction know not to get started on an addictive substance. There is no concpet of “not getting started” on food.

    So I am one of those antismokers who does stigmatize smokers as having made a bad personal choice…but quite the opposite re obesity, where the only fault to be ascribed is to the food industry and the government.

  2. November 13, 2022 at 9:52 am, Allen Browne said:

    One more big difference: eating is healthy and necessary – smoking is not healthy and not necessary!


  3. November 16, 2022 at 2:34 pm, Skip Murray said:

    Hi Al Lewis!

    Life is full of opportunities to make bad choices. I think that the consequences we suffer from bad choices are all the punishment we should endure. It’s my hope that we find it in our hearts to stop stigmatizing those whose choices we disapprove of.

    As a child, I was subjected to unbelievable amounts of abuse by my father. My salvation was to have the most amazing grandpa a child could ever hope for. I had my first cigarette in 1969 at the age of 10. I wasn’t rebelling or experimenting. I wanted to be like my grandpa, who smoked. My first cigarette was the one I stole from his pack and smoked behind his barn. By high school, I was smoking 2 packs a day. And it took me until 2015 to quit smoking.

    Yes, I made a bad choice when I was 10. And once addicted to smoking, it wasn’t a choice like some people think it is. I used to abuse alcohol and drugs when I was a teen and managed to walk away from them, but not smoking.

    As someone who has a tendency towards addiction, I’m guessing you know how hurtful stigma can be. I believe the first step to helping people never smoke and stop if they do smoke is to treat them with compassion, kindness, and respect.
    Wishing you well,