Smoking Positivity?

What, if anything, should we as a society or individuals do about individual habits that negatively impact health? Is it any of our business if it only affects individuals? Should it be the business of health professionals? Should we treat all habits that negatively affect health the same? Here are some things to consider.

1. Behaviors that affect our health
2. Shaming or making fun of health-related behaviors
3. Negative consequences of (2)

Virtually everyone has poor habits. The problem with some of those poor habits is that they have negative health consequences. The social science is by no means complete, but both shaming and making fun of others’ bad habits tends to produce the opposite of the intended effect – they tend to increase the unhealthy behavior in question.?

Recently, more and more articles and books are about “fat positivity.” This recognizes that all body shapes and sizes should not only not stigmatized but that “it’s fine to be fat.” Tara Gilibert, a literary agent tweeted that she wants “Fat girl stories where their weight is not the plot.” The idea is for fat people, particularly women, to feel good about themselves and, for everyone else, to stop fat shaming them. In fact, there are numerous studies that show that the stress from being fat shamed causes people to eat more and gain more weight. One study put part of the blame on physicians, where people in six different countries reported experiencing “weight stigma from doctors.”

And yet, the list of diseases from the CDC associated with overweight and obesity includes Type 2 diabetes, coronary heart disease, stroke, gallbladder disease and problems with physical functioning. But all of these diseases have one thing in common: they are not external to the individual. With the exception of sitting next to an obese person in a cramped airline seat, they only affect the individual and their choices.

If we are going to accept fat as an individual choice that neither doctors (nor anyone else) should try to address to prevent disease, then what about other individual choices that affect health? How about smoking?

Compared to the 42% of Americans that are obese, only 10.3% (34 million) smoke. Nevertheless, it is the leading cause of preventable deaths in the U.S. It primarily affects the individual smoker as smoking is banned in almost every indoor public place. The Wall Street Journal reported a UCLA study that showed that stigmatizing smokers had the exact same effect as fat shaming: it increased their urge to smoke. Should there be a movement for “smoking positivity?”

The same thing has been found about drinking alcohol. As long as you are not driving and endangering others, the health effects are only on the individual. And yet, they are shamed, including one mother who felt shamed every time she showed up on social media as a mom who drinks. People who drink also tend to drink more when faced with abuse.?

Those are three behaviors that lead to poor health consequences but there are certainly others like being a workaholic (associated with depression, anxiety, sleep disorders) or being sedentary (increases in all-cause mortality).

There’s another side to these issues as well, population risk versus personal risk. Some smokers may live to a ripe old age. So might obese people and people who drink alcohol. “How much” matters as, for example, people with extremely high BMI’s have much higher risks. Severe obesity can shorten a person’s life by 10 years – equivalent to the effects of lifelong smoking.

Nevertheless, the way we treat others’ health behaviors is likely to be a topic of public debate for some time and one outcome might be to bring us to a more tolerant society – live and let live (the Dutch proverb), or live and let die (the James Bond movie). Maybe it will simply be to follow the Christian proverb, “Let he who is without sin, cast the first stone.”

Finally, is any of this right? Shouldn’t we put people’s health first? I don’t know at this point.

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