What Are the Health Risks of Smoking vs. Obesity?

Smoking during pregnancy can negatively affect an unborn child.

• Smokers have a greater risk of dying from various cancers such as lung, throat, mouth, bladder, and esophagus than non-smokers.
• Smokers also have a greater risk of heart attack, respiratory illness (emphysema, COPD, pneumonia), high blood pressure, stroke, heart disease, peripheral vascular disease, and aortic aneurysms. Smoking while pregnant can increase the risk of low birth weight.
• Obesity is itself a long-term disease and a health epidemic in the U.S. A person who is obese has a BMI (body mass index) greater than 30. A person is morbidly obese with a BMI of 40 or more.
• Obesity can increase a person's risk of developing high blood pressure, diabetes, heart attack, stroke, sleep apnea, osteoarthritis, and depression.
• The rate of childhood obesity, while still high, may no longer be on the rise.
• Smoking cessation programs can help a person quit smoking. Methods to help with smoking cessation include nicotine replacement therapy (gum, patch, lozenges, inhaler, or nasal spray), medications, and counseling.
• Treatment for obesity involves weight loss. In general, eating less and exercising more is the safest path to losing weight and a diet and exercise plan is essential. Medical treatment for obesity may involve medications or surgery.
• Quitting smoking allows the lungs to begin to heal and can decrease the risk of developing many cancers. Statistics show people who quit smoking before the age of 50 cut their risk of dying in the next 15 years in half.
• Obesity can become a lifelong health condition for many people. Obese patients should be monitored for complications such as diabetes, hypertension, and heart disease.

Cigarette smoking is a leading contributor to death and illness among Americans.

Significantly fewer than half of all American adults smoke. Slightly more men smoke than women. Hispanics and Asian Americans smoke less than whites or African Americans. Fewer than one-third of people ages 25 to 44 are current smokers.

Since 1964, when the Surgeon General issued the first report outlining the health dangers of smoking, the prevalence of smoking has dropped among adults. The incidence of lung cancer, chronic bronchitis, and emphysema would become significantly less common if people would stop smoking.

Compared to a nonsmoker, a smoker faces these risks:

• fourteen times greater risk of dying from cancer of the lung, throat, or mouth;
• four times greater risk of dying from cancer of the esophagus;
• two times greater risk of dying from a heart attack; and
• two times greater risk of dying from cancer of the bladder.

Use of other tobacco products such as pipes, cigars, and snuff is less common; however, the health effects of these products are similar to those of cigarettes -- particularly their association with cancers of the mouth, throat, and esophagus.

Increasing attention has been devoted to publicizing the dangers of second-hand (environmental) smoke, the association between tobacco marketing and initiation of smoking among youth, and the development of strategies and medications to help smokers quit. According to the CDC, about 126 million non-smoking Americans are exposed to secondhand smoke and put at risk for tobacco-related problems such as lung cancer, heart disease, and respiratory infections. In addition, a new problem termed "third-hand smoke" has been recently investigated. Cigarette smoke-generated carcinogens lodge in clothing, carpets, drapes, and other materials and can be absorbed through human skin, especially that of children and infants. These carcinogens can also be ingested and inhaled in dust.

Cigarette smoking has been linked strongly to the following illnesses:

• heart disease
• stroke
• hypertension (high blood pressure)
• other diseases of blood vessels (such as poor circulation in the legs) and aortic aneurysms (potentially life-threatening disruptions in the wall of the aorta)
• respiratory illness, including the following:
  • lung cancer
  • emphysema
  • bronchitis
  • pneumonia
• cancers, including:
  • lip or mouth
  • pharynx or larynx (voice box)
  • esophagus (food pipe)
  • stomach
  • pancreas
  • kidney
  • urinary bladder
  • cervix
  • ovary
• peptic ulcer disease
• burns

The foods we eat every day contribute to our well-being. Foods provide us with the nutrients we need for healthy bodies and the calories we need for energy. If we take in more calories than we burn, the extra food turns into fat and is stored in our bodies. If we overeat regularly, we gain weight, and if we continue to gain weight, we may become obese.

Obesity results from the accumulation of excess fat in the body. Obesity is considered a chronic (long-term) disease, like high blood pressure or diabetes. It has many serious long-term consequences for your health, and it is a leading cause of preventable deaths in the United States (with tobacco use and high blood pressure). Obesity is defined as having a body mass index (BMI) greater than 30. The BMI is a measure of your weight relative to your height.

Obesity is an epidemic in the United States and in other developed countries. More than two-thirds of Americans are overweight, including at least one in five children. Nearly one-third are obese. Obesity is on the rise in our society because food is abundant and most of us are employed in positions that require little to no physical activity. On the bright side, recent data suggest that childhood obesity, while still high, may no longer be on the rise.

Smoking

Signs and symptoms of cigarette smoking are frequently obvious even to a casual observer. Besides the confirmatory evidence (a person actually smoking a cigarette in public view), nicotine-stained fingers and teeth, the characteristic smell of smoke-impregnated clothing and household items, the chronic "smokers cough," the gravelly voice, and often the visible pack of cigarettes and lighter in a person's pocket or purse are signs and symptoms that a person smokes. However, new (teenage) smokers or "infrequent" smokers may exhibit few or none of these signs and symptoms. In addition, many teens will try to "cover up" any evidence of cigarette use for any number of reasons (for example, the legality regarding their age and the purchase of cigarettes or their parents forbid smoking).

Signs and symptoms of tobacco related diseases often depend on the specific illnesses they cause. (There are many other symptoms of tobacco-related diseases, and those listed here are simply examples.)

• Shortness of breath may be a sign of emphysema or heart disease.
• Chest pain may signal angina pectoris caused by insufficient blood flow to the heart or a heart attack.
• Difficulty swallowing, or persistent hoarseness, may signal a cancer in the mouth or larynx.
• Painless bloody urination may signal bladder cancer.
• The presence of any of the following common symptoms associated with tobacco use should prompt a visit to the doctor or hospital's emergency department:
  • chest pain
  • shortness of breath
  • persistent cough
  • coughing up blood
  • frequent colds and upper respiratory infections
  • persistent hoarseness
  • difficulty or pain on swallowing
  • change in exercise capacity
  • sudden weakness on one side of the face or body; or difficulty speaking
  • leg pain while walking that goes away when at rest
  • unexplained weight loss
  • persistent abdominal pain
  • blood in the urine

Obesity

Obesity increases your risk of many other diseases and health problems, including the following:

• Heart disease
• Diabetes
• High blood pressure
• Stroke
• Osteoarthritis (especially knee and hip joint pain, and lower back pain)
• Gout
• Gallstones
• Lung disease
• Insomnia from sleep apnea (snoring)
• Fungal rashes in skin folds
• Colon cancer
• Endometrial cancer
• Depression
• Dementia

Depression may be one of the most common effects of obesity. Many obese people suffer emotional distress. Because of the emphasis on physical appearance in our culture, which equates slimness with beauty, obese people may feel unattractive. They also are subjected to prejudice, ridicule, and discrimination, which may make them feel ashamed or rejected.

Obesity is also a major risk factor for the development of diabetes mellitus. The good news is that this may be preventable. In clinical studies, patients who were at a high risk of developing diabetes decreased their risk by almost 60% with less than 10% weight loss in three years.

Appearance and weight alone are subjective and do not provide enough information for an accurate clinical obesity diagnosis. Healthcare professionals have a number of tools and formulas to calculate whether someone is classified as obese.

Weight-to-Height Tables

These tables give general ranges of healthy weights and overweight for adult height. The tables do not take into account individual conditions. For one thing, they do not distinguish fat from muscle, water, or bone. They are much less helpful than body mass index in identifying risk of health problems related to weight.

Body Fat Percentage

Many health professionals agree that percentage of body weight that is fat is a good marker of obesity. Men with more than 25% fat and women with more than 32% fat are considered obese.

Body fat percentage is difficult to measure accurately, however. Special equipment is needed that is not found at most medical offices. The methods used at health clubs and weight-loss programs may not be accurate if not done properly. Inexpensive scales for home use that estimate body fat are now widely available. They may not be entirely accurate but are generally consistent, so they may be used over time to track one's progress.

Waist measurement is also an important factor. People with apple or pot belly shapes, who tend to put on weight around their waist, have a higher risk of obesity-related health problems. This includes women with a waist measurement of greater than 35 inches and men with a waist measurement of greater than 40 inches.

Body Mass Index

A measure called the body mass index (BMI) is used to assess your weight relative to your height. It is defined as weight in kilograms divided by height in meters squared (kg/m2). It can also be calculated for weight in pounds and height in inches.

Body mass index is closely related to body fat percentage but is much easier to measure. Therefore, it is used by many primary-care providers to identify obesity. The greater your BMI, the higher your risk of developing health problems related to excess weight.

To calculate your body mass index, follow these steps:

• Multiply your weight in pounds by 705.
• Then divide by your height in inches.
• Divide this by your height in inches again.

What does BMI tell you?

• Normal weight = 18.5-24.9
• Overweight = 25.0-29.9
• Obese = 30 or greater
• Morbidly obese = 40 or greater

To calculate your body mass index on the Internet, fill in your height and weight at the web site of the government's National Heart, Lung, and Blood Institute's Obesity Education Initiative.

Smoking

Smoking is recognized as a medical diagnosis called Tobacco Use Disorder.

Doctors should ask people about tobacco use at every visit and provide counseling about quitting.

Most people who smoke admit doing so, in part because smoking carries less social stigma than use of other substances, such as alcohol or illicit drugs. Smokers should not underestimate how much they smoke and for what length of time (for example, a pack a day since age 16), as this information helps the doctor understand the risk for tobacco-related disease.

Children from smoking households are more likely to begin smoking than children from nonsmoking households.

• Much attention has been focused on the influence of tobacco company advertising on encouraging young people to smoke.
• Although cigarette commercials have been banned from television for over 30 years, tobacco products remain among the most heavily marketed products. According to the American Lung Association, the tobacco industry spent an estimated $12.49 billion on advertising in 2006. Some states place restrictions on the type and locations of tobacco advertising, and legislation enacted in 2009 gave the U.S. FDA strong authority to regulate tobacco products. The FDA requires prominent health warnings on all cigarette packaging and advertisements in the United States.
  • Studies have shown that youth are particularly susceptible to tobacco marketing campaigns.
  • In the past, cigarette use by actors in popular films was a means to portray smoking as sophisticated and glamorous.
  • Although denied by tobacco companies, the use of cartoon animals and the like in advertising campaigns appeals to youngsters.
  • Counter-advertising by various antismoking advocacy groups may provide some balance, but their advertising budgets pale beside those of tobacco companies.
  • Schools generally provide education on the use of tobacco, alcohol, and other substances, but their impact is unclear.
  • Increasing the taxes on cigarettes, and hence their price, has been shown to reduce tobacco consumption, especially among adolescents.

Obesity

Weight gain occurs when you eat more calories than your body uses up. If the food you eat provides more calories than your body needs, the excess is converted to fat. Initially, fat cells increase in size. When they can no longer expand, they increase in number. If you lose weight, the size of the fat cells decreases, but the number of cells does not.

• Obesity, however, has many causes. The reasons for the imbalance between calorie intake and consumption vary by individual. Your age, gender, genes, psychological makeup, socioeconomic, and environmental factors all may contribute.
  • Genes: Your genes may play a role in efficiency of metabolism and storage and distribution of body fat.
  • Family lifestyle: Obesity tends to run in families. This is caused both by genes and by shared diet and lifestyle habits. If one of your parents is obese, you have a higher risk of being obese.
  • Emotions: Some people overeat because of depression, hopelessness, anger, boredom, and many other reasons that have nothing to do with hunger. This doesn't mean that overweight and obese people have more emotional problems than other people. It just means that their feelings influence their eating habits, causing them to overeat.
  • Environmental factors: The most important environmental factor is lifestyle. Your eating habits and activity level are partly learned from the people around you. Overeating and sedentary habits (inactivity) are the most important risk factors for obesity.
  • Socioeconomic factors: Do you live in a neighborhood where it is save to exercise outdoors? Are there supermarket with fresh foods in your neighborhood?
  • Sex: Men have more muscle than women, on average. Because muscle burns more calories than other types of tissue, men use more calories than women, even at rest. Thus, women are more likely than men to gain weight with the same calorie intake.
  • Age: People tend to lose muscle and gain fat as they age. Their metabolism also slows somewhat. Both of these lower their calorie requirements.
  • Pregnancy: Women tend to weigh an average of 4-6 pounds more after a pregnancy than they did before the pregnancy. This can compound with each pregnancy.
• Certain medical conditions and medications can cause or promote obesity, although these are much less common causes of obesity than overeating and inactivity. Some examples of these are as follows:
  • Cushing syndrome
  • Depression
  • Certain medications (examples are steroids, antidepressants, birth control pills)
  • Prader-Willi syndrome
  • Polycystic ovarian syndrome
• Obesity can be associated with other eating disorders, such as binge eating or bulimia.
• The distribution of your body fat also plays a role in determining your risk of obesity-related health problems. There are at least two different kinds of body fat. Studies conducted in Scandinavia have shown that excess body fat distributed around the waist (apple-shaped figure, intra-abdominal fat) carries more risk than fat distributed on the hips and thighs (pear-shaped figure, fat under the skin).

Smoking

Treating tobacco involves helping the individual successfully stop smoking. This often requires integrated steps.

Smokers must partner with their doctors, families, spouses, friends, even employers, to make quitting successful.

Quitting is not easy. Many smokers try to quit, but only a few succeed.

Treatment consists of two broad areas.

• The medical conditions caused by smoking - respiratory illness, heart disease, circulatory disease, cancer, ulcers - need to be treated. In addition to stopping smoking, any associated medical condition, if one is present, needs to be addressed by the patient's doctor. Smokers need to discuss treatments for their individual diagnosis with their doctor.
• The nicotine addiction also must be addressed and generally consists of a combination of the following:
  • Nicotine replacement therapy (gum, patch, lozenges, inhaler, or nasal spray): Some nicotine replacement products (gum, patches, and lozenges) are available over the counter, under several brand names, but are best used in conjunction with a doctor. Others (nasal sprays and inhalers) require a prescription. The non-prescription products are less expensive and work as well as the prescription products.
  • Varenicline (Chantix) is a prescription drug approved by the U.S. FDA to help adults quit smoking. Chantix acts on the nicotine receptors in the brain, stimulating these receptors and blocking the ability of nicotine to attach to these receptors. Chantix is taken seven days prior to the date an individual desires to quit smoking, and most people will keep taking Chantix for up to 12 weeks.
  • Group or behavioral counseling. The most successful quitting programs use combinations of drug treatment and counseling and have success rates of 5% after 1 year.
  • The prescription antidepressant bupropion (Zyban, Wellbutrin) has also been shown to help some people quit smoking.
• Smokers trying to quit need lots of support and encouragement to help handle the inevitable urges to light up.
• Doctors, although trained in the diagnosis and treatment of smoking-related illnesses, may be less comfortable in providing the counseling and drug treatment smokers need to quit.
• Call your local chapter of the American Lung Association for further advice about smoking cessation programs.

Other Treatments

Treatment of the many diseases and conditions associated with smoking is dependent upon the extent and severity of the condition. Treatments are numerous, varied and are best done in consultation with the individual's primary care physician and associated caregivers (for example, cardiologist, oncologist). Smoking cessation products are available (see medical treatment previously) for home use for people interested in quitting smoking.

Obesity

For most people who are overweight or obese, the safest and most effective way to lose weight is to eat less and exercise more. If you eat less and exercise more, you will lose weight. It is as simple as that. Any weight-loss program, including medical and surgical approaches, will also include decreasing caloric intake and exercise. There are no magic pills. Diets that sound too good to be true are just that.

By decreasing daily calorie intake by 500 calories or expending an extra 500 calories during exercise each day, you will lose about 1 pound per week.

Decreasing your calorie intake by 10 calories a day will equal 1 pound of weight loss after one year.

Any good diet plan will include exercise. It helps to increase metabolism and is one less opportunity to eat during the day. You should exercise for at least 30 minutes, five times a week. Regular exercise also helps your heart and lungs and lowers triglyceride levels that can cause heart disease. It also increases the HDL ("good cholesterol") levels. Even simple measures such as taking the stairs instead of the elevator and short walks eventually add up to a lot of calories burned. Commercial fitness programs such as Boot Camp can help you start or improve upon a fitness program.

Group support programs such as Weight Watchers or Take Off Pounds Sensibly, known as TOPS, provide peer support and promote healthy habits.

For those who don't have the time to make it to support groups, there are now many free or low-cost apps available for the iPhone, iPad, or Android, which help determine and track calories, nutrition, and calorie expenditure. Try LoseIt!, Weight Watchers Mobile, Restaurant Nutrition, 40:30:30, Diet Point, Noom Weight Loss Coach, FitBit, Fooducate, Diet Assistance, Calorie Counter PRO MyNet Diary, Amwell, MyFitnessPal, or 7-Minute Workout.

Of special interest to women who have gained weight after having a baby is the fact that breastfeeding helps you shed some extra pounds. Besides the positive effects for the baby, breastfeeding burns approximately 500 extra calories each day.

Medical Treatment

Medical treatment of obesity focuses on lifestyle changes such as eating less and increasing activity level. There are medications that can promote weight loss, although they work only in conjunction with eating less and exercising more.

Most medications that promote weight loss work by suppressing the appetite. Some medications used in the past have been shown to be unsafe and are no longer available. The newer appetite-suppressing medications are thought to be safe, but they do have side effects and may interact with certain other drugs. They are used only under the supervision of a health-care professional.

Some weight-loss products are known to be dangerous. The safety of others is in question. This includes certain prescription and over-the-counter drugs and herbal supplements. Avoid them.

• "Phen-fen" and Redux: These prescription drugs have been removed from the market in the United States and many other countries. They are linked to heart-valve problems and pulmonary hypertension. Pulmonary hypertension affects the blood vessels in the lungs and is often fatal.
• Ephedra: This natural substance is essentially an herbal phen-fen. It is the active ingredient in MaHuang and is used as a stimulant and appetite suppressant. Ephedra resembles the amphetamines -- the popular "diet drugs" that were banned in the 1970s -- in that it is highly addictive. Ephedra is often combined with caffeine and aspirin ("the Stack"), which increases the thermogenic (fat-burning) effect of ephedra. Ephedra increases the risk of high blood pressure, irregular heartbeat, insomnia, seizures, heart attack, stroke, and death. The FDA has recently banned ephedra because it has been linked to more than 100 deaths.
• Phenylpropanolamine (PPA) is often found in appetite suppressants as well as over-the-counter cough and cold remedies. The FDA has recommended that products containing PPA be removed from the market. Studies have suggested that this product is associated with an increased risk of hemorrhagic (bleeding) stroke in women.
• Sibutramine is an oral anorexiant that was removed from the U.S. market in 2010 due to the risk of serious adverse cardiovascular events.

Some people have tried combining more than one weight-loss drug or combining a weight-loss drug with other drugs for the purposes of losing weight. The safety and effectiveness of such drug "cocktails" is not known.

Surgery to correct obesity (known as bariatric surgery) is a solution for some obese people who cannot lose weight on their own or have severe obesity-related medical problems. Generally, surgery is recommended only for morbidly obese people (body mass index 40 or greater). This means men who are at least 100 pounds overweight and women who are at least 80 pounds overweight.

Surgery

The two types of bariatric surgery are malabsorptive and restrictive.

• Malabsorptive procedures decrease intestinal absorption of food by bypassing part of the digestive system. A greater proportion of food than usual passes through without being absorbed.
• Restrictive procedures decrease the amount of food that a person can take in by decreasing the size of the stomach.

Both surgical strategies entail changes in how food is processed in the body. While they are successful in helping some people lose weight, they also may cause cramps, diarrhea, and other unpleasant effects, as well as iron deficiency anemia.

Liposuction is purely a cosmetic procedure that removes fat cells but has no beneficial effects on health, such as heart disease and diabetes.

Vagal blockade involves surgically implanting a device that stimulates the abdominal vagal nerve, thereby sending signals to the brain that say you are full, which can reduce hunger. Short-term studies have shown modest weight loss (about 18 pounds). No long-term studies have been done yet, and some patients develop pain at the implantation site as well as nausea, vomiting, heartburn, and burping.

Smoking

For smokers, quality and length of life depends on the number and severity of smoking-associated illnesses they may develop and if they have other medical conditions such as diabetes or high blood pressure. Other lifestyle factors, for example, use of alcohol or other drugs also make a difference in long-term outcomes for smokers. For smokers who quit, projected health and life expectancy improve markedly at any age of life.

• Smokers who quit before age 50 years have half the risk of dying in the next 15 years compared with those who continue to smoke.
• Quitting smoking substantially decreases the risk of lung, larynx, esophageal, oral, pancreatic, bladder, and cervical cancers. For example, 10 years after quitting, an ex-smoker has lower risk of lung cancer compared to a continuing smoker. Continued smoking abstinence continues to lower the risk.
• Quitting lowers the risk for other major diseases including coronary heart disease and cardiovascular disease. The increased risk of coronary heart disease halves after 1 year of abstinence. After 15 years, the risk of coronary heart disease approximates that of someone who never smoked.
• Women who stop smoking before pregnancy, or during the first 3 or 4 months of pregnancy, reduce their risk of having a low birth weight baby to that of women who never smoked.
• The health benefits of quitting far exceed any risks from the average 5-pound weight gain that may follow quitting.

Obesity

For most people, obesity becomes a lifelong struggle. Obesity is caused by multiple factors, and although the principle of decreased caloric intake and increase in exercise is a relatively simple concept, there are many underlying reasons that lead to obesity in an individual. Treatment, therefore, has to take all of this into consideration.

If you are obese, you should have a primary-care physician who follows you closely and monitors you for the known complications of obesity such as diabetes, hypertension, and heart disease. The following are additional indications to see a health-care provider:

• If you are overweight or obese and don't know how to lose weight
• If you are concerned about the effects of a weight-loss diet or increased physical activity on your other medical problems
• If you are unsuccessful at losing weight on your own
• If you are concerned about the safety of your weight-loss method