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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