Sizism and Healthism: Some Perspective

I talked a little bit about healthism at the end of a recent post, linking to JoannaDeadWinter, who clarified her position a bit in comments. I wanted to talk some more about it.

I think that health should not be a moral imperative. People get to prioritize their health as well as prioritize certain aspects of their health over others. People should not have to deal with busybodies asking them about their health issues. I remember when I was a child, after being indoctrinated at school, I started nagging a particular adult to quit smoking. I was a little jerk.

My impression is that smoking is probably the most stigmatized health condition or behavior besides fatness. But fatness still seems to be much more stigmatized than smoking. A recent article by Daniel Engber (often an ally for fat people, although not wholly on board with Fat Acceptance) had this to say about attitudes toward obesity and smoking:

Which is a more serious problem for America, smoking or overeating? According to a Gallup poll released this week, 67 percent of the nation’s adults think of cigarettes as an “extremely serious” or “very serious” social problem, compared with 81 percent who say the same for obesity. Gallup first started asking this question in 2003, and now, for the first time, respondents have shown that they’re more worried about jiggly thighs than blackened lungs.

The shift in public opinion suggests a dangerous and unintended consequence of the war on obesity. Years of epidemiological work have shown that smoking is far worse for your health than being fat. So much worse, in fact, that any suggestion to the contrary should be taken as a sign that our priorities are getting all mixed up.

I’m surprised that as recently as 2003, people were saying that smoking was the bigger problem. Especially since there’s been little to no increase in obesity rates since then.

Estimates of avoidable deaths reflect this difference in the odds: According to the U.S. Centers for Disease Control and Prevention, smoking accounts for an excess mortality of more than 400,000 Americans every year, compared to just 112,000 for obesity. That’s despite the fact that there are many more fat Americans—obesity rates are now 50 percent higher than smoking rates.

These numbers are just for the extremes. Even at the shallow end of the pool, smokers are at greater risk. If we limit the analysis to light tobacco users—those who consume a handful of cigarettes per day—then the relative risk of mortality turns up at 1.5, roughly the same as it would be for people with full-blown obesity. What about the folks who aren’t huge but merely overweight? CDC research suggests they have a relative risk of less than 1, in which case carrying a bit of extra weight could even provide some kind of protective effect on your health.

(I’m a little amused by the full-blown obesity emphasis/phrasing.)

And here’s why I consider Daniel Engber an ally:

It’s remarkable, when you think about it, that the war on smoking has been as successful as it has been, considering all the superficial excuses there are to maintain the habit. Nicotine is addictive in a way that food, as a category, isn’t. Smoking is less shameful for most people than overeating, and it keeps you thin. There’s evidence that it prevents teenagers from getting acne—one recent study found a dose-dependent, inverse relationship with cigarette consumption among a sample of 27,000 soldiers in the Israeli army—and that men who quit smoking experience rapid drops in testosterone. In other words (as we all suspected) tobacco use can improve your social status.

The fact that we’ve managed to cut smoking rates in spite of these factors doesn’t make tobacco any less of a scourge, or obesity any more dangerous in comparison. If anything, the paradox suggests that stigma is not in itself a solution to social ills. If Americans are more worried about obesity than smoking, it’s because they’ve let the shame of being fat cloud their judgment with second-hand smoke.

If there’s one thing that Fat Acceptance and the Rudd Center, anti-obesity people and HAES proponents and self-described “bad fatties” should all be able to agree on, it’s that stigma is never helpful. And even though, as I said before, I think that smoking is probably the most stigmatized health-related thing other than fatness, there has never been the kind of character assassination of smokers that there has been for fat people. The stigma seems to center more on the behavior than on the person. Smoking itself is thought of as gross, but smokers aren’t thought of as lazy or greedy or unclean or linked to any of the seven deadly sins. (They may be smelly, though…)

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