07/08/2014 06:01 EDT | Updated 09/08/2014 05:59 EDT

Obesity Is Not the New Tobacco

There are those who say obesity is the new tobacco. It's not.

I understand the argument. While tobacco companies and others like asbestos producers have long gathered top prizes for most toxic products sold, most hospital patients created, most lives shortened prematurely, obesity is becoming one of our greatest killers. Even in poorer countries, the diseases of obesity -- diabetes, heart disease, stroke -- are rapidly moving up the rankings, becoming bigger causes of death and disability than the old classics: AIDS, malaria, tuberculosis, the diseases of undernutrition.

But the refrain that obesity is the new tobacco ignores the fact that tobacco is still the new tobacco.

Those of us living in comfortable countries like the United States and Canada often have the comfortable feeling that the tobacco problem has been licked. Smoking in the U.S. is down to fewer than one in five adults and the numbers look even better in Canada. That's still a sizable number of people putting their health at risk, but it's nothing compared to the hazy decades of the past when nearly half of adults smoked.

It's been a long time already since someone's cigarette smoke trail ruined my restaurant dinner, since going to a bar meant coming home reeking of tobacco exhaust. Sure, youth are still being coaxed into smoking with chocolate-flavoured cigarillos, older adults are still finding the deadly results of smoking on their lung x-rays. But there is a general feeling that the tobacco companies have been beaten and the public health has won.

In much of the world though, smoking, among men at least, is still in its wild west days. Sixty percent of Chinese men smoke (and that's a lot of men), 70% of Russian men. Countries like Chile have more tobacco gender equality with as many as 35% of women smoking compared to over 40% for men.

How big is the problem still? The World Health Organization estimates that over 500 million of those of us alive today will be killed by tobacco.

There are some positive stories. Uruguay has seen an impressive drop in lighting up, usually credited to strong laws that wrestled tobacco to the ground. Ethiopians have never really taken up the habit and have stunningly low rates of tobacco abuse. Hardly anyone in the Sri Lanka smokes either, or so the statistics say.

But it's not time to put tobacco in the "done" pile in order to focus on unhealthy eating and the global weight gain that has resulted. The kinds of diseases that have become the world's biggest killers are products of unhealthy eating and of smoking, and both of those problems require similar approaches.

Those approaches, for unhealthy eating in particular, can be a real challenge, because they bang hard against the reactor core of our economic system -- consumption. Consumption and lots of it. Like tobacco, the fight for healthy eating will challenge the heart of what companies do: sell as much as they can. And it will need to challenge the marketing that seeks to get children and adults hooked on unhealthy products. As with tobacco, that's how the public health will win.

So let's not declare obesity the new public health enemy number one, not while tobacco continues to steal so many lives. Obesity is not the new tobacco, it's just tobacco's new partner-in-crime. And both are unfortunately going to need a little law and order to stop.


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