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In a letter to The Guardian newspaper artist and pro-tobacco campaigner David Hockney suggests that there could be a link between not smoking and being obese or having diabetes.

Is there a link between the decline of smoking and the rise of obesity and diabetes?

...

Some people might be much better off smoking instead of nibbling.

Is there any evidence that smoking can prevent obesity or diabetes?

  • I think I'd better leave this one to someone else; the sheer audacity of the claim - particularly as it relates to diabetes - staggers me, and I fear I would stoop to calling this Hockney guy some names I shouldn't. – Oddthinking May 4 '12 at 11:27
  • @YannisRizos see this discussion on notability - meta.skeptics.stackexchange.com/questions/1125/… – Tom77 May 4 '12 at 12:00
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    I've heard (independent of this letter) claims that smoking suppresses appetite, and that people who stop smoking put on weight. – Andrew Grimm May 4 '12 at 14:03
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    This is like saying more people die in Car accidents than die from falling off of buildings so instead of driving to work you should climb from building to building. – Chad May 4 '12 at 17:59
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    Sure. You often die of lung cancer or a heart attack or stroke before the diabetes kicks in. – user3344 May 4 '12 at 18:47
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This has to be one of the most pathetic attempts to earn money I can imagine - ignoring all of the evidence and actually recommending smoking? That is bat!@#$ crazy.

Comparing the Risks

Let's look at the mortality rates. (I've limited myself to just the evidence in the UK, because that is where this <expletive> lives.)

  • 70-75 thousand people in the UK with diabetes die every year... not of diabetes... with diabetes. [Source]

  • 34 thousand people in the UK die of obesity. [Source] No doubt, there is overlap with the above figures.

  • Compare that to the 100 thousand people in the UK dying of smoking every year. [Source]

The whole idea of putting yourself at risk of smoking-related deaths to avoid obesity and diabetic mortality is in-f!@#ing-sane. Why not douse yourself in petrol and set fire to yourself to avoid the risk of frostbite?

Positive Correlation - Diabetes

Even that is assuming, of course, that smokers genuinely have reduced the risk of diabetes.

But that's not the case! For diabetes, the association goes the other way.

Results The search yielded 25 prospective cohort studies (N = 1.2 million participants) that reported 45 844 incident cases of diabetes during a study follow-up period ranging from 5 to 30 years. Of the 25 studies, 24 reported adjusted RRs greater than 1 (range for all studies, 0.82-3.74). The pooled adjusted RR was 1.44 (95% confidence interval [CI], 1.31-1.58). Results were consistent and statistically significant in all subgroups. The risk of diabetes was greater for heavy smokers (≥20 cigarettes/day; RR, 1.61; 95% CI, 1.43-1.80) than for lighter smokers (RR,1.29; 95% CI, 1.13-1.48) and lower for former smokers (RR, 1.23; 95% CI, 1.14-1.33) compared with active smokers, consistent with a dose-response phenomenon.

Conclusion Active smoking is associated with an increased risk of type 2 diabetes. Future research should attempt to establish whether this association is causal and to clarify its mechanisms.

Smokers are more likely to get diabetes. This idiotic risk reduction technique won't get you out of the frying pan into the fire - it will leave you in the frying pan and the fire!

Negative Correlation - Obesity

For obesity, I have to accept that there is an association between obesity and never smoking:

Overweight and obesity were more prevalent among never smokers than among current smokers in all occupational classes and among both never smokers and smokers in the lower occupational classes.

(Note: I couldn't find a measure of statistical significance of this anywhere - I expected it in Figure 1 or Table 2.)

Of course, this was the line in the study that the media, such as the BBC latched on to, even as they reminded people:

Prof Johan Mackenbach from the Erasmus Medical Centre in Rotterdam welcomed the study but added: "It is important not to forget that smoking is a much stronger risk factor for mortality than most other risk factors, including obesity."

In fact, the same data set supports the idea that any upside to be being smoker is outweighed by the downsides:

Conclusions Among both women and men, never smokers had much better survival rates than smokers in all social positions.

Conclusions

This crap hits a trigger button for me, and makes me angry. Giving people false information about life decisions that kill 100,000 people a year is obnoxious, callous and unethical.

Even if you assume the inverse relationship between obesity and smoking is causal, smoking to prevent obesity is putting you in a higher-risk category, and so is counter-productive.

Smoking to prevent diabetes is even more nuts. It doesn't reduce the risk, it is associated with a higher risk.

First, give up the cigarettes. Then, work on your weight. Then, work out how we can retain freedom of speech and yet get guys like this to shut up.

  • 1
    "how we can retain freedom of speech and yet get guys like this to shut up" - make them personally responsible for the consequences of their free speech. They can say what they want, but go to jail if harm comes to people. Simple! – Sklivvz May 5 '12 at 21:58
  • @Sklivvz On the other hand, Hockney will face the consequences of his own advice as he is a smoker. And part of his broader argument is that the state should not coerce people into doing things that only harm themselves. On the other hand again, he offers bad advice. – matt_black Mar 3 '13 at 21:06
  • @matt: (I'm assuming there a missing negation in the 2nd sentence somewhere.) By your argument, Hockney is only facing the consequences of his smoking, not of his negligence with the lives of others. He is taking an action that harms others, which seems in the bailiwick of the legal system to try to stop (notwithstanding, as I mentioned, the desire to maintain freedom of speech for those who actually need it for good.) – Oddthinking Mar 3 '13 at 22:26
  • @Oddthinking correct on missing negation. States shouldn't force people to be healthy. I sympathise with Hockney on that, not on promoting bad advice. – matt_black Mar 4 '13 at 0:10
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    @Benjol If we reduce the harms of smoking to an economic evaluation, smoking is a big positive to society. The taxes raised vastly exceed healthcare cost and they die young, saving society a vast expense on pensions. – matt_black Jun 14 '13 at 23:29
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This article basically says that you need to be careful when you quit smoking not to allow yourself to gain weight.

However there is nothing that says that you can lose weight by smoking. In fact:

University of Kansas researchers found in a 2006 study that heavy smokers tend to exercise less, eat in front of the television more often and frequent restaurants that serve high-calorie food much more often than nonsmokers, suggesting heavy smoking often occurs alongside a package of unhealthy behaviors that can lead to obesity.

Source

So while quitting can lead to weight gain(it did for me), resuming smoking is unlikely to take those pounds back off. But diet changes and exercise will. Smoking is never going to make you healthier even if it causes you to lose weight.

Even the article I found that said it might help said this:

Heavy smokers are believed to burn up to 200 additional calories each day as a result of this.

1 pound requires 3500 calories of burn. So if you need to lose 10 pound smoking will take heavy smoking for 175 weeks. That is over 3 years.

With the damage that it does to your body you are better off spending a half an hour a day doing a slow run(12 minute mile) and gaining benefits of that which include a greater calorie burn than best case smoking, than you are taking smoking back up.

And the reasons given for smoking helping to lose weight: Smoking damages your body cause it to malfunction. source

  • 3
    Chad, please cite the peer reviewed studies themselves instead of some questionable news article about them. – Sam I Am May 4 '12 at 20:19

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