nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, September 16, 2010

Fewer People Smoke. Great. But It's Caused More Obesity. Not So Great.

The research community has known for decades that people who quit smoking are likely to gain weight.

Suggested Article Title:  The Unintended Consequences of One-Dimensional Public Policy

An opinion piece in the Wall Street Journal (Sep 7)  talks about broad public policy consequences.  If government and commercial organizations address unequal pay for women by promoting opportunities and education about the workplance and pitfalls in career management, things happen.  I've read several articles recently about (1) average higher incomes in over 30 single females than over 30 single males, (2) college enrollment and graduation rates higher in women than in men, and (3) more PhD's in 2009 in women than in men.  Many medical schools now have more women than men students.  My undergraduate college is approaching 60% women.

None of which is necessarily bad, but it was not the original intent of the policies to reach beyond equity.

The unintended consequences of public policy emerge routinely in many fields:  illegal immigration, which everybody is upset about, has been falling for the last two years.  Why?  Well, the economy stinks; why would they want to?  No jobs.

But this is a medical blog.  And public health policy has  unintended consequences, too.  As the op-ed says,
And then there is the anti-smoking effort that has become something of a national norm. Smoking is now banned in most public places, especially the workplace. A Chinese researcher has found that during the period from 1998 to 2006 such policies on the job have led to more in obesity among workers. 
Feng Liu of Shanighai University of Finance and Economics studied responses from 227,000 American workers and found that on average, nonsmokers had a Body Mass Index 1.8 points higher than smokers and a probability of obesity almost 10% higher. The study also reported that smokers had a BMI 3.6 points lower and were almost 20% less likely to be obese.
Smoking causes an estimated 443,000 deaths a year in the U.S. through increased likelihood of heart and lung diseases and cancer. Obesity is thought to be a large cause of heart disease, diabetes and some cancers, although the research has not been as developed in associating it with an estimated number of deaths.

I'm not surprised by these results.  You can criticize the study's method (self-reporting), but in my clinical experience, most quitters gain anywhere from a few pounds to several dozen pounds. 

Single-focus public policy always overlooks human nature: that we are dealing with a complex interplay of motivations and incentives.

Does this mean we should back off on smoking regulations?  Of course not, but improving that public health hazard has led to worsening of another.  Hence, we are seeing policy efforts to deal with obesity by calorie labelling, restrictions on fast food restaurants, school menu changes, promotion of fruit and vegetable consumption, etc. 

I'm OK with health education efforts, but think laws and regulations to restrict choice will fail (remember Prohibition?)

Ask yourself this:  what unintended consequences will be created when we begin to lower obesity?  Are we just playing Whack-A-Mole?

Doc D

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