In response to my recent post about how unlikely significant long-term weight loss is, someone on Facebook posted the following:
“If most people who try to quit smoking fail, does that mean doctors shouldn’t advise their patients to quit?”
This a a common argument that comes up every time I talk about the failure rate of dieting. I have to assume that it’s made by people who really haven’t thought this through. So today I thought this would be a good time to re-post this, as a public service to anyone who thinks comparing being fat and smoking makes even the tiniest bit of sense:
First, this is not an apt comparison. Smoking is a single specific behavior – every smoker smokes. Being fat is a body size, being listed as “overw*ight” or “ob*se” (terms that were literally invented to medicalize and pathologize fat bodies) 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 as there is in smoking.
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 (and there is no evidence to suggest a similar “rebound” affect in smoking.)
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. Since we know that smoking is unhealthy (and that every cigarette not smoked makes someone healthier whether they relapse or not) recommending quitting is statistically the best possible recommendation.
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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Dances With Fat 
There’s one other difference.
Fat people do not harm my health by being fat in my presence.
I once took a temp job in an office where everyone smoked. I went in at 8 in the morning, feeling fine. By noon, I had developed a full-blown case of bronchitis (confirmed by a doctor that very afternoon, when I went in for urgent care, because I COULD NOT BREATHE). I had to quit that assignment, tell my temp agency to ONLY assign smokers to that company, and spend significant amount of time off, recovering.
Oddly enough, no matter how many fat co-workers I’ve had at once, how fat they were, nor how closely we worked together, have I ever had problems breathing or otherwise living, just from being around them.
I had a comment disappear. Spammed? Or automoderated?
People say, “Why don’t they just lose weight?” As if it’s some instantaneous thing they can “just” do.
You can “just” quit smoking, going cold turkey. It’s REALLY hard, but it can be done. However, short of lopping off body parts, no human being can “just” lose weight.
People talk about “exercising just the smallest amount of will-power.” NO. It’s not just the smallest amount of will-power. It is HUGE. And it is FOREVER.
There are many successful interventions for smoking, with long-term success. For dieting, however, you have to exercise will-power to stick to starving yourself and/or overexercising ALL day long, EVERY day, and YOU’RE STILL FAT. It takes months or even years to lose enough weight for people to stop saying, “Just lose the weight, (insert insult here).” And that whole time, you’re feeling miserable, both physically and mentally.
There is still the belief that fat people are lazy overeaters. There doesn’t seem to be an easy way to kill that belief.
Here is one of the other MAJOR differences between smoking and weight loss:
Smoking is an option. It is not a survival necessity. I have never smoked. I never even tried it, because being stuck in the family car when my dad would light one up made me determined that I had no desire to do that to myself or to my own children. I’ve gone 56 years so far without a cigarette, or cigar, or pipe, or any other tobacco product, and I’ve done just fine without them.
A person can forego smoking completely, or quit cold-turkey. Without any regards whatsoever to the effects on health, smoking is a choice a person makes.
Eating, on the other hand, is not optional. We cannot quit food completely, not if we wish to continue living. Our bodies require energy to continue functioning, and our bodies’ source of that energy is the food we eat. Once we have depleted our body’s fat reserves, the next step in maintaining sufficient energy to continue body function is to begin reabsorbing muscle tissue. Sooner or later, there will no longer be enough left to draw upon and our body shuts down from starvation.
People, if you’re reading this blog because you’re a sizeist and you think you’re gonna “gotcha” Regan with some Clever Retort, don’t bother. She’s been doing this a long time, she’s heard all of the dumb arguments, and she can destroy them in her sleep by now.
Ragen. Stupid autocorrect.
Yeah, that’s why I like reading her hate mail page, sometimes. It’s fun to watch her take them on.
True that! I don’t see how the sizeists think that they can beat Ragen in a war of words.
Thank you, again, Ms. Ragen… so many issues you’ve addressed over time–inpressive… I find your site to be a great Library of good answers/retorts to stupid questions/comments regarding size/weight-related subject matters… very thankful to have stumbled upon your blogsite… 🙂
It drives me nuts when people compare being fat to smoking.
My main retort is “Well if they are the same, why is there no such thing as second and third hand fatness? There is second and third hand smoke and those contain extremely harmful to a person.”
My mother smoked while pregnant with me and we found out some 20 odd years later that is why I was premature and was born with damaged lungs, which only got worse because a good chunk of my family smokes, and doesn’t care if I am coughing so hard I gag or in some cases vomit.
My doctor is amazed I am not sicker then I am given the amount of second and third hand smoke I am exposed to. The worst I have had is croup, H1N1, H1N2, and bronchitis which I just got over.
(original post eaten; Cliff’s Notes version ahoy)
It’s only in our messed up body-moralizing culture anyone would even *try* to compare a fat person with a harmful voluntary behavior, because it’s ridiculous to compare a human being to an action. “We have the right to legislate fat people’s lives because smoking!” is just as transparent an excuse as, “I abuse you out of compassion because I care about your health!” and “Oh, my aching tax dollars!” They all boil down to size bigots not liking to look at fat bodies and scraping for some way to burden the owners of those bodies with removing themselves from their entitled lines of sight.
That said, there’s plenty of room to compare the diet industry and the tobacco industry, as both thrive on beating down potential customers’ self-esteem to sell them products that have a good chance of damaging their health or even killing them, but I don’t see the diet industry getting seriously investigated in my lifetime. They’ve been made of Teflon for years.
I had a doctor once ask me to “set a goal” of losing 5 lbs by a certain date. I responded that I couldn’t do that. I could set a goal of following a diet for X days. I could set a goal of following a certain exercise routine for X days. I could even set a goal of keeping a food log for X days. But losing 5 lbs isn’t an action, it is a result. If I could just lose 5 lbs anytime I felt like it, I wouldn’t be seeing her. And after that, I stopped seeing her.