Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Why live longer?
- Martin J. Lyons (13 May 2006)
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Smokers are much less likely to be obese
- Jonathan Pinard (14 May 2006)
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Is obesity becoming the new smoking?
- Kostas Zacharias, Victoria Salem (14 May 2006)
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Must be "terminated" earlier
- Takeharu Koga, Atsushi Kawaguchi (15 May 2006)
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Re: Smokers are much less likely to be obese
- Richard Bartley (16 May 2006)
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The BMJ as an outlet for the pro-smoking lobby
- David F Marks (18 May 2006)
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Re: The BMJ as an outlet for the pro-smoking lobby
- Jonathan Pinard (22 May 2006)
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Re: Re: Smokers are much less likely to be obese
- Jonathan Pinard (22 May 2006)
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Re: Re: Re: Smokers are much less likely to be obese
- Richard Bartley (22 May 2006)
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The smoker's paradox - and then the reality
- Arun Natarajan (4 July 2006)
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A comprehensive anaysis could be performed with the available data.
- Dorairajan Kulandaivel (10 October 2006)
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Martin J. Lyons, Health Care Manager 99362
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The article makes me question what are the real issues that someone would have a self-distructive behavior. It would be my interest to know if there is a mind set for a passive suicide in the studied group? You have to give people a goal to live for, to change the self-distructive behavior studied by the researcher. Competing interests: None declared |
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Jonathan Pinard, Smokers Rights Group Director 11725
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Since the rate of obesity among the adult population is 23.5%, and the rate of obesity among smoking adults is 4.7%, it would appear that smokers are less likely to suffer from diseases associated with obesity. This could be a reason why the Surgeon General’s 2004 Report on Smoking cited a study that showed that in population studies smokers have lower blood pressure than non-smokers. The CDC was impressed enough with the Surgeon General’s remarks that Hypertension has since been excluded from their list of smoking related diseases. One of the study’s conclusions is that “…a high proportion of people who stop smoking have large and persistent weight gain” It would appear from this conclusion that smoking cessation may not be the right choice for every smoker and that quitting smoking can be, and is, harmful for a large number of people. Clearly the only way someone should decide whether they should quit smoking is to first consult with their personal physician to assess the potential net benefit to their health. jpinard@socialsmokers.org Competing interests: Executive Director of the New York Coalition of Social Smokers |
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Kostas Zacharias, Cardiology Registrar Barnet Hospital, Wellhouse Lane, Herts, EN5 3DJ, Victoria Salem
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We read with great interest the analysis of Healton et al. As the authors point out, smoking and obesity are public health priorities. However the public perception of these two risk factors varies greatly. The prevalence of smoking in western countries is on the decline thanks to no-small part the great investment in anti-smoking campaigns, advertising bans and availability of help for individuals who wish to give up. By contrast the prevalence of obesity is on a continuous rise and the public's perception of the problem is distorted. Various surveys have shown that the majority of patients do not recognise they are obese or do not recognise obesity in their children. In the modern era of political corectness, doctors find it difficult to breach the subject of obesity with patients. Moreover govermnents find it difficult to regulate the food industry. Finally the availability of organised health care services for people who wish to address their obesity remains limited. As the cardiometabolic syndrome is increasingly being recognised, a great deal of investment is needed in educating the medical profession and the general public alike on the dangers of obesity and inactivity. If the trend towards an obese population is not reversed, obesity will be the smoking of the 21st century. Competing interests: None declared |
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Takeharu Koga, Associate professor Kurume University School of Medicine, Department of Internal Medicine, Kurume, 830-0011 Japan, Atsushi Kawaguchi
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As Healton et al have demonstrated (1), major risk behaviors for chronic diseases tend to cluster, especially in lower socioeconomic groups. Since it is known that these risk behaviors are acquired as early as in their teens (2), it is essential for efficient modification of these risk behaviors to encompass components targeting young people, such as education and school-based programs (3). References 1. Healton CG, Vallone D, McCausland KL, Xiao H, Green MP. Smoking, obesity, and their co-occurrence in the United States: cross sectional analysis. BMJ 2006:bmj.38840.608704.80. 2. Lowry R, Kann L, Collins JL, Kolbe LJ. The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. Jama 1996;276(10): 792-7. 3. Carrel AL, Clark RR, Peterson SE, Nemeth BA, Sullivan J, Allen DB. Improvement of Fitness, Body Composition, and Insulin Sensitivity in Overweight Children in a School-Based Exercise Program: A Randomized, Controlled Study. Arch Pediatr Adolesc Med 2005;159(10):963-968. Competing interests: None declared |
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Richard Bartley, Physiotherapist Denbigh LL16 3ES
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"It would appear from this conclusion that smoking cessation may not be the right choice for every smoker and that quitting smoking can be, and is, harmful for a large number of people." Surely the process of giving up smoking also involves making fundamental changes to one's life style, such as taking up regular aerobic exercise and following a sensible, balanced diet. The net effect of addressing diet and exercise as well as smoking is to reduce the risk of cancer and heart disease, whether these potentially fatal diseases are caused by benzenes, nitrosamines and hydrogen cyanide from smoke, or atherosclerosis from excessive metabolically active fat as a consequence of poor diet and lack of exercise. Suggesting that a smoker should not give up because he or she may put on weight is just another lame excuse to promote the right of some selfish individuals to commit slow suicide and the concomitant manslaughter of non -smokers. Competing interests: None declared |
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David F Marks, Professor of Psychology City University London, EC1V 0HB
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Jonathan Pinard declares his competing interests are that he is Executive Director of the New York Coalition of Social Smokers. I would be interested to learn more about the funding of the New York Coalition of Social Smokers and its Executive Director. Does that funding possibly include direct or indirect support from the tobacco industry? If so, then then the publication of his response can be seen for what it is: tobacco industry propoganda. Smoking is a curse to all and sundry, active smokers and passive smokers alike. Is the BMJ a suitable forum for the expression of such views? Shouldn't the BMJ moderate responses to publications more rigorously than to allow space to such medieval views as those expressed by Mr Pinard and the New York Coalition of Social Smokers? Competing interests: None declared |
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Jonathan Pinard, Executive Director New York Coalition of Social Smokers 11725
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I am amazed that seemingly educated people still call for censorship of the opinions of others based solely on the fact that they disagree with those opinions. The New York Coalition of Social Smokers has never received funding directly or indirectly from any tobacco company. Since the corporations who seem to benefit the most from attempts by smokers to quit are Pharmaceutical Companies, can you sir say that you have never received compensation from them? I appreciate the fact that you chose not to address my comment on its merit. By your attempt to censor my opinion and question my motives you confirm that my argument is a valid one. Thank you. Competing interests: Executive Director of a Smokers Rights Group |
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Jonathan Pinard, Executive Director New York Coalition of Social Smokers 11725
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"Surely the process of giving up smoking also involves making fundamental changes to one's life style, such as taking up regular aerobic exercise and following a sensible, balanced diet." Unfortunately smokers are often advised to quit at all costs regardless of any potential impact on their physical or mental health. Taking up aerobic exercise and following a balanced diet is difficult even for an individual not making other dramatic changes to their lifestyle. My suggestion was that people should seek the advice of their personal physician before attempting to quit smoking, something that they are often told to do before starting an exercise regimen, if that advice seems irresponsible to you please explain why you think so. Competing interests: Smokers Rights Group Director |
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Richard Bartley, Physiotherapist Denbigh LL16 5ES
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I concur. Taking up advise from a physician before attempting to give up smoking makes sense. I can pretty much guess what advice most physicians will give. Competing interests: None declared |
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Arun Natarajan, DRWF Clinical Research Fellow Newcastle University, Newcastle upon Tyne
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Here is something to mull over - the smoker's paradox, which is the unexplained, better short-term survival of smokers after an acute myocardial infarction (1). The possible reasons for this are still being debated. Yes, good news indeed for smokers. But weight this against the bad news - smoking can aggravate and hasten the fearsome consequences of obesity, namely, myocardial infarction, stroke and peripheral vascular disease. In addition smoking directly causes lung cancer, gastrointestinal malignancies, impotence, chronic obstructive pulmonary disease and low birth weight and a host of other problems in pregnancy. Hence, making the right choice should not be difficult. "Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined" (2). I have personally dealt with individuals who felt that they could be harmed if they quit smoking. It was difficult to talk sense into their heads. It is indeed worrisome that a quarter of the sample of the American population in the study by Healton et al are obese. And if these obese individuals continue to smoke, they will end up pulling the carpet from under their own feet. References 1. Barbash GI, Reiner J, White HD, et al. Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: Mechanism of the ‘smoker’s paradox’ from the GUSTO-I trial, with angiographic insights. Global utilization of streptokinase and tissue- plasminogen activator for occluded coronary arteries. J Am Coll Cardiol 1995; 26: 1222–1229. 2. www.cancer.org. Competing interests: None declared |
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Dorairajan Kulandaivel, Dentist and Public Health professional. 3181
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Editor, This is with respect to the article analyzing the co-occurrence of smoking and obesity in the United States. Smoking and obesity are major public health issues faced by the world countries. It has become a major social problem and the funds spent by Governments to have a check on these issues are massive. This study attempts extraordinarily to bring about the relationship between not only the major issues like smoking and obesity but also goes a bit further to explore the underlying social factors influencing a person to be a smoker or to be obese. The prevalence of people who smoke and are obese in United States was found to be 9 million. Although this represents only about 4.7% of the total population, the stratification performed according to age yields very meaningful results. The authors could have potentially taken this analysis a bit further to observe the outcome of combination of the different study factors. For instance an analysis to include smokers, who are white, their educational status and income levels would have given a much more detailed view about the existing social and health conditions in different population groups. Although complex, this kind of data would have provided with more compelling information regarding actual effect of the different social and economic environment on one’s smoking or dietary behavior. Hence it would be prudent to undertake longitudinal studies to monitor the effects of smoking on a person’s health and the effect of diet related behavior on one’s smoking habits. This study is striving to bring about a new relationship between the two independent factors. But from the outlook, it appears to have a very weak association. This is further ascertained by the results when out of 23.5 % of the overall obese people and 22.7% of the overall smokers; only 4.7% of them were continuing with both behaviors. But the health effect on people who are both smokers and are obese is enormous. For instance the risk of cancer, premature ageing, myocardial infarction and even endometrial cancer have been analyzed and documented by various studies. The higher prevalence of smokers who are obese among the African- Americans raises a question whether there is any other external factors apart from socio-economic condition and educational status that is influencing the current observation. Hence a longitudinal study to follow up on the present result to observe the association between these two factors with other social and economic environment would give health care providers comparitively strong evidence to predict to a certain extent one’s health outcome given a person is both a smoker and is obese. Competing interests: None declared |
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