Wednesday, November 16, 2011

Fat people - welcome to our world

In a recent Time Magazine online article, "Let’s Stop Being Passive About Fighting Obesity: It's time to embrace the same tactics that worked against smoking," public health writer Shannon Brownlee drew comparisons between smoking and obesity, calling for public health (and the public) to start treating fat people like smokers. I responded in the comments, but felt it was worth posting here, as well:

The author says, "The war on smoking worked because it made smoking shameful and the public health measures needed to fight it permissible."

In fact, the war on smoking was most successful from 1950 (when the link to lung cancer was found) through the 1980's - when public health focused on education and information, not the "shaming" of smokers. The smoking rate dropped dramatically from 44% to 26% (from 1950 to 1990.) The greatest advances in the mid to late 1980's - nicotine gum approved by the FDA, first city bans smoking in restaurants in 1987, nicotine compared to heroin (without any actual studies to support it), had very little impact in the following decade. The research on second-hand smoke came out in the 1990's, which was gleefully used to change a war against the negative health effects of smoking (to HELP smokers improve their health) into a war AGAINST smokers. The smoking rate at that time was 25%. Since the war on smoking turned from education and encouragement to a war on smokers and making smoking "shameful," the smoking rate has decreased only 5% in those 20 years (1990 to present) and has even ticked back up from 19% to 20% in the past couple of years.

The war on smoking worked for 40 years because it focused on education, developing tools for smokers to quit (finding them safer alternatives) and helping get smokers access to those tools. It relied on sound science and a true dedication to improving public health by empowering people - not controlling human behavior.

Since the late 1980's, public health has turned from trying to help smokers to battling "Big Evil Tobacco" - regardless of the health effects. The discovery that nicotine is addictive turned nicotine and addiction into the evil of smoking, rather than the health effects of inhaling toxic smoke. The science shows that not all tobacco use is equally hazardous - modern smokeless tobacco and e-cigarettes have been shown to be 99% safer than smoking, but since the anti-tobacco groups want everyone to quit, they feel justified in letting smokers think they may as well smoke, so they don't just switch to safer options. The insistence on absolute abstinence from all nicotine use, even if it has extremely low health risks, angering smokers and tobacco users by treating them as less than human, applying punitive charges, taxes and policies to smokers - all while isolating them and ostracizing them - has created a backlash.

Additionally, using junk science to justify these actions (claiming taxes, graphic labels, bans and nicotine products work, when real scientific research proves they don't or claiming smokeless products like snus, dissolvable tobacco or e-cigarettes are just as dangerous as smoking when they are 99% less of a health risk) has created distrust and animosity of public health groups. Not to mention revelations that tobacco taxes - having been raised over 2,000% in some places since 1990, because proponents claimed for every 10% taxes were raised overall smoking rates would fall 4% (yet the smoking rate has only fallen 5% overall in the same time period) - are being relied upon to balance state budgets and pay tobacco control executive salaries, which seems to be a huge conflict of interest in actually wanting to END smoking.

Is this really the model you want to apply to fighting obesity?

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