Today is Mother’s Day, the day we set aside to think about and honor our mothers, and to let them know how much we appreciate their love and devotion. Two days from now, May 11, marks the 45th anniversary of my own mother’s death. I miss her still. I regard it as one of the tragedies of my life that just on the verge of forming an adult relationship with my mother, I lost the opportunity forever. I thought I’d take this occasion to share some personal reflections on this experience.
My mother died of a stroke at the age of 52. She had been ill for a couple of years – of heart failure, we now know – but not in our wildest nightmares did we imagine she was dying.
It was a devastating blow to my family. Two of my three siblings were still living at home, and my father (a great father but, like most men of his generation, not such a good mother) was at a loss as to how to cope with his new situation. My 16-year-old sister, overwhelmed by grief, sprinted through what remained of her high school career, graduating a semester early to evade my father’s efforts to burden her with running the household. My 11-year-old brother was unceremoniously packed off to a boarding school where he was lonely and miserable. My 20-year-old sister and I must have been lonely and miserable, too, because we both married within a few months; my marriage lasted but hers didn’t. My profound feeling of vulnerability (how could it be so easy to die?) led to a bad case of hypochondria that persisted for several years.
Our family had lost its compass. Overnight, we were transformed from a close, happy family into a seriously dysfunctional one. All my mother’s children, in one way or another, have carried the scars of her loss into our adulthood.
My mother was not a smoker, but any woman who smokes greatly elevates her risk of sharing my mother’s fate and dying prematurely. Half of all smokers die of a smoking-related disease, many of them in middle-age. Female smokers, on average, lose more than 14 precious years of life.
Female smokers are twice as likely to develop heart disease as women who have never smoked. Smoking is also associated with cerebrovascular disease, especially in young age groups – a risk that is greatly elevated in oral contraceptive users. Almost all lung cancer is caused by smoking, and lung cancer (not breast cancer, as many would guess) is the biggest cancer killer of women.
One woman in five still smokes. The fact that that woman is a mom surrounded by people who love and depend on her, who think she’s the most important person in the world, won’t protect her if she keeps on smoking. Quitting at any age, on the other hand, produces huge health benefits. Honor your mother, love your kids, and help yourself to a long and healthy life by resolving to quit today.
Today – May 1, 2010 – my home state of Michigan becomes smoke-free, joining 38 other states that have already enacted some version of this policy.* Fittingly, the new measure is named for the late Dr. Ron Davis, a tireless supporter of this legislation and a friend to all who care about the public health. Rest in peace, Ron. For me, as for most nonsmokers, this change is cause to celebrate. Starting today, the wait staff of my favorite pizza parlor can go to work every day without being exposed to environmental tobacco smoke as an unavoidable condition of employment. Starting today, I can bring my grandchildren in for a grilled cheese sandwich without worrying about the short- and long-term health effects of just breathing the air around them.
But nonsmokers aren’t the only ones with reason to cheer. If you’re a smoker who’s trying to quit, the new law is your friend. By breaking up the strong association between smoking and alcohol consumption, it ensures that just being in a bar will no longer be a potent cue for smoking. It’s an especially happy development for “weekend smokers” (mostly women) who rarely smoke except in bars, and who now are less likely to progress to regular smoking as a result of intermittent exposure to nicotine. Likewise, recent quitters, their resolve softened by alcohol, will be less likely to be seduced into relapse by seeing others light up and smelling cigarette smoke.
Although confirmed smokers may be less enthusiastic, they, too, stand to benefit from this ban. If you’re a smoker who likes to gather with friends at Happy Hour or drop in for a nightcap but dreads braving the elements just to satisfy the need for nicotine, here is yet another good reason to stop smoking and start living.
Interestingly, even in the context of Michigan’s tattered economy, the above-mentioned pizza parlor has recently undergone remodeling, including installation of a beautiful new polished hardwood bar, and seriously upgraded its menu. Could it be because the place can no longer get away with being just the smoker’s last remaining refuge? Whatever, a good thing just got better.
* In this post I’ve chosen to focus on bars and restaurants, the biggie for most of us, but note that Michigan’s new law, with a few exemptions, prohibits smoking in all enclosed, indoor workplaces.
If you’re a smoker who’s ever expressed concern about gaining weight if you quit, you may have encountered the “rule of thirds” somewhere along the line. The smoking cessation rule of thirds says, essentially, that around a third of quitters gain weight, a third remain the same, and a third actually lose weight.
This pat formula cropped up a few decades ago and no one can say exactly where it came from. Presumably the first person to utter these words meant well and hoped to encourage his (her?) smoking patients to overcome their reluctance to quit because they feared gaining weight. After all, what could be more reassuring than the idea that your chance of gaining weight is only a little over 30% – with an equally good chance that you’ll actually lose weight?
Only one problem: It simply isn’t true. There is no scientific evidence whatsoever to support this breakdown and plenty to refute it. Only a few quitters completely avoid weight gain and even fewer actually lose weight. And I’m convinced that many of those who lose weight have cessation-emergent depression and concomitant loss of appetite, a poor tradeoff! Yet somewhere along the line the rule of thirds became so entrenched that now, even when its “untruthiness” is pretty widely recognized in the research community, it still turns up occasionally, like a bad penny.
What’s wrong with a little white lie if it has the desired effect?
Plenty, in my opinion. Because weight gain often begins as early as the first week after quitting, this particular piece of disinformation is likely to convince women, before their attempt to quit has even gotten off the ground, that they’re in the unlucky third, that they’ve lost the lottery. It’s hard to think of a better formula for early relapse!
The precise distribution of weight gain after quitting is not easy to specify because of methodological issues (e.g., how long after quitting do you measure? how do you factor in normal weight gain over time in nonsmokers? etc.). Based on my own reading of the literature, however, I have developed my own algorithm that I think is a lot closer to the truth:
What does this mean for you? Readers of Life After Cigarettes or of this blog will be well aware of my conviction that it is likely, by definition, that you will be among the large majority of women smokers who do not gain weight in amounts that will require a new wardrobe or increase your health risk when you quit.
The other thing to remember is that whether you will be among those who gain weight in disproportionate amounts is not entirely a matter of chance. There are risk factors for large weight gain, including a history of binge-eating, a personal or family history of large weight gain after previous quit attempts, and a tendency towards depression-induced eating. Having one or more risk factors for excessive weight gain does not mean you shouldn’t quit smoking! It does mean that you should consider taking precautionary measures to counteract these propensities (e.g., using smoking cessation medications that minimize weight gain, such as nicotine replacement therapy or Zyban; reviewing your nutritional and exercise patterns with an eye to identifying realistic changes you can make) and be prepared to seek professional help if weight gain after quitting gets out of hand. Whatever you do, please don’t quit quitting!
Today’s blog post honors Dr. Jean Kilbourne and her work in publicizing the effects of advertising on women and girls. Over the course of her long career as an author, public speaker, media critic, and documentary filmmaker, she has helped us all see what was hidden in plain sight – that Madison Avenue not only sells us consumer goods but, in her words, “changes the way we think and feel.” Much of her work has focused on ads for cigarettes, alcohol, and food using marketing ploys that objectify the female body and glorify a grotesque degree of thinness in ways that encourage self-hatred, eating disorders, and addiction. If her ideas do not sound all that surprising to you, it’s because her original perceptions have now become mainstream.
Many of her insights were rooted in her own early experiences. Born in 1943, she began smoking and drinking in her early teens to cope with her grief at her mother’s death and as an expression of her rebellious nature. Despite these distractions, she was able to maintain good grades in school and went on to graduate from Wellesley, later earning a doctorate in education from Boston University. She then spent three years working in Europe, first for the BBC and then for a French film company. It was in 1968 that she began looking critically at advertisements aimed at women and connecting the dots. Eventually, she concluded that the images of liberation and female beauty portrayed in the media were dangerously deceptive and decided that exposing these untruths would be her life’s work.
Even today, though many are aware of how the tobacco and advertising industries’ efforts to sell cigarettes to women may contribute to poor body image, the full extent of the link between smoking and eating disorders remains underappreciated. Smoking is over-represented among women with diagnosable and subclinical eating disorders. (Indeed, I have often thought that smoking – thanks at least in part to clever advertising that has persuaded so many girls and women it’s an effective way to control weight – should be considered a “compensatory behavior,” along with purging, fasting, and excessive exercise, in diagnosing bulimia and binge-eating disorder.) Credit to Dr. Kilbourne for recognizing the connection between these two serious health hazards and the insidious way in which they have been used to “feed” one another, to the detriment of physical and mental health.
Dr. Kilbourne could have pursued a standard academic career, churning out grant applications and scientific publications. Instead, she has chosen to dedicate her speaking skills and wit to a one-woman crusade for media literacy, raising our consciousness so that we see our everyday environment in a new light. For more information about Dr. Kilbourne and her current projects, visit her website at www.jeankilbourne.com.
It tastes good and lifts our spirits. It comforts us and quells our appetite. Yet we know it’s bad for us and sometimes suspect we may be addicted to it.
I’m talking about sugar – and the love-hate relationship many women have with it. Unfortunately for many of us, Mother Nature didn’t provide us with brakes when it comes to consuming sugar. In the wild, it’s probably a good thing to eat your fill of that berry bush because it may be awhile before you encounter another one. But we’ve become so good at refining and producing the stuff that it’s now freely available to us in virtually unlimited amounts. So we eat…and eat and eat, despite the fact that it’s loaded with empty calories (bad for our waistlines), promotes tooth decay (bad for our looks), and raises triglycerides and releases free radicals (bad for our health). In large amounts it increases insulin levels and in some individuals leads to insulin resistance and eventually Type 2 diabetes.
Three hundred years ago, the average American consumed around four pounds of sugar per year, if that. Today, it’s estimated that we eat 90-180 pounds per year. Much of it is consumed in the form of sugar added to our coffee or in soft drinks, fruit juices, sports drinks, and desserts. But because sugar, in addition to being a sweetening agent, has other properties useful in food-processing (it cuts acidity, increases shelf life, adds bulk and texture, prevents clumping, moisturizes, changes the boiling point of water, caramelizes/browns, and promotes fermentation), it’s also found in foods you might never think of as sources of sugar – tomato-based products, bologna, pretzels, cheese spread, and Worcestershire sauce, to name a few.
You don’t have to be a smoker to love sugar but it helps. In a laboratory study we conducted nearly two decades ago, we found that significantly more smokers than nonsmokers preferred higher sucrose concentrations. And we know that when smokers quit, they tend to eat more – which, for those with a sweet tooth, means more sugar.
The link between smoking and sugar dates back at least to the 17th century, when they were obtained in the West Indies to satisfy the growing demand for both in Europe, in exchange for West Africans sold into slavery – the notorious Triangle Trade. This shameful chapter marks a low point in the shared history of sugar and tobacco, but the two are paired in other ways as well. For many of us, for example, candy cigarettes were our first introduction to “smoking.”
The problem is not sugar per se – as noted above, a little of it is a good thing. It provides a quick boost of energy. It helps the medicine go down. But we’re now in a situation of “too much of a good thing” – and that’s a bad thing. So how can you avoid excessive sugar intake when you quit? Here are a few tips.
Some years ago, after I had given a talk to a group of psychologists on weight concerns as a barrier to quitting smoking, an attractive young woman from the audience approached me to say that in the South American country where she had grown up (I can’t remember which one it was), she had never heard that smoking suppresses weight. Indeed, she hadn’t even put two and two together when she stopped smoking – and gained ten pounds! She was genuinely surprised at the content of my talk.
This woman held a doctorate in psychology. She was neither stupid nor ignorant. But somehow the tobacco companies had failed to find her and warn her, in their own special way, about the dire consequences of quitting. Given the efficiency with which they have managed to spread the word both at home and abroad, it’s hard to see how she could have escaped their notice! But because no one had managed to frame the issue as a choice between being beauty-queen gorgeous, movie-star sexy, and fashion-model slim, on the one hand, and not smoking, on the other, she just up and quit. As for the ten-pound weight gain, she had no idea it had anything to do with quitting, so she just sucked it up and kept moving. After all, “así es la vida” – such is life.
Even if it were possible, I’m certainly not advocating keeping women in the dark about this effect of smoking—any more than I’d favor not telling you that smoking ages your skin, hoarsens your voice, defeminizes your body shape, yellows your teeth, fouls your breath, and burns your clothes. But the tobacco companies go far beyond educating women about the weight-suppressing effects of their product, scaring them with the specter of out-of-control weight gain if they quit and pushing thinness as a cultural value. Somehow they never get to the other part of the message, the part about the other effects of smoking upon appearance, all of them undesirable.
Public health campaigns have done a great job of emphasizing the health hazards of smoking, but less has been said about its detrimental effects on appearance. Absent that information, you only know half the story – the half the tobacco industry wants you to hear.
Most people’s lists of life-changing books focus on great works of literature, philosophy, and religion. Prominent on mine is Sarah Susanka’s The Not So Big House. Susanka popularized the notion that when it comes to living spaces, bigger is not necessarily better, and showed the world how to put it into practice. She convinced us we didn’t need to duplicate functions or devote a lot of space to rooms that are almost never used. She suggested that we spend our housing budget on quality, not quantity. Calculate the amount of square footage you can afford, then spend the same amount of money on a smaller amount of space, making it as appealing to the eye and nourishing to the soul as you can.
It occurred to me that these principles for how we live could be adapted to how we eat, and that they might be especially relevant for people who have quit smoking or are about to do so. After all, smoking suppresses appetite; when nicotine is removed from your life, appetite increases. Although some of the typical increase in weight after quitting comes from changes in metabolism and blood volume, most of it comes from increases in food intake. So at a time when you probably need to eat a little less to maintain weight, you are likely to eat a little more instead. This isn’t a failure of the will, it’s the triumph of physiology.
Dieting doesn’t usually work; or it works for awhile and then it doesn’t, because it’s hard and unpleasant to live in a state of perpetual deprivation, especially at a time when you’re also absorbing the loss of your cigarettes.
But there’s a fair amount of wiggle room between dieting and supersizing – and even between dieting and eating till you’re “full,” as many of us have been taught to do. In nutrition, as in architecture, if we can improve the experience by using high quality ingredients and then taking time to savor the results, we can eat a little bit less and enjoy it more. We can leave a little on our plate and still feel satisfied. We can reframe our thinking about what constitutes “enough.”
As little as 100 fewer calories per day can make a difference. Here are a few clues that will tell you you’re on the right track with your food choices:
Too expensive? A few Americans are so close to the margin that there is no elasticity in their food budgets, but most of us can pay a little more for good food if that’s what we prioritize. Divert the money you used to spend on cigarettes to upgrading your fare and regard it as an investment in looking and feeling your best.
My diatribes about tobacco advertising often focus on its role in promoting nicotine’s weight-suppressing effects (and probably in encouraging our strong preference for slimness as well). Like all successful seducers, however, the tobacco industry has more than one arrow in its quiver. In this post I’d like to talk about smoking as a symbol of women’s rights and the way in which the purveyors of tobacco have capitalized on it.
When I accepted Smith College’s offer of admission in 1960, I don’t think I fully appreciated the company I’d be keeping. The ranks of my fellow alums include many illustrious advocates for and/or examples of female achievement—writers as diverse as Margaret (Gone with the Wind) Mitchell, tragic poet Sylvia Plath, and political humorist Molly Ivins; the redoubtable Julia Child; and feminist trailblazers Betty Friedan and Gloria Steinem, to name but a few.
I recently received the 100th anniversary issue of the Smith Alumnae Quarterly, featuring a decade-by-decade review of the college’s proud history of empowering women. Because of my interest in the history of tobacco use, I was particularly taken with an essay by Shirley Dlugasch Zussman of the Class of 1934. Zussman, a sex therapist living in New York, still active, still blogging at age 95, vividly evoked the heady sense of emancipation she and her classmates experienced: “World War I had brought women out of the house to work in offices and factories and given them a new freedom. The harsh sexual repression of the Victorian age had begun to subside…. [The] students relished the new freedom women had. Smoking was common, its dangers still unknown.”
The tobacco industry probably did not invent the connection between smoking and women’s emancipation, any more then it invented nicotine’s weight-suppressing effects, but it was similarly quick to turn the connection to its own advantage. Lucky Strike enjoyed remarkable success in expanding the women’s market by persuading a group of debutantes to smoke as they walked in the 1929 Easter Parade in New York, billing cigarettes as “torches of liberty” and lending a new air of respectability to smoking in public. By the time Shirley Zussman and her classmates arrived in Northampton, MA in the fall of 1930 to begin their freshman year, smoking among women had become commonplace on college campuses as well as in other settings.
In 1963 the so-called “second wave” of feminism was sparked by the publication of Betty Friedan’s The Feminine Mystique. Three years later the National Organization for Women (NOW) was formed, and in the early ‘70s, Gloria Steinem became the founding editor of Ms. magazine. It was during this era that the Virginia Slims brand was launched, using the same twin themes of liberation and weight control that had worked so well for Lucky Strikes in the ‘20s. Images of sleek, glamorous women succeeding in business and social settings were served up to the catchy tune of “You’ve come a long way, baby.”
One big difference from the college days of Shirley Zussman: By now the health hazards of smoking had been well publicized. You might think the women’s movement, committed as it was to protecting the health of women, would have confronted the tobacco industry—but you would be wrong. Sadly, by advertising in women’s magazines, contributing to women’s causes, and sponsoring women’s sports events, Big Tobacco was able to fend off most potential opposition, and by and large the risks of smoking were downplayed in the pages of Ms.
The introduction of “women’s cigarettes” saw an alarming uptick in smoking initiation by 14-17 year old girls, running counter to the steady overall decline in smoking in the U.S. beginning in the early ‘60s. Thus were excess numbers of young women in the generation just behind mine lured into tobacco addiction.
Emancipation? Liberation? Or clever manipulation by people who have their own bottom lines and not your best interests at heart? You be the judge.
You saw it on webmd.com – you know, the folks who pride themselves on “bring[ing] you the most objective, trustworthy, and accurate health information on the web. “ Cutting salt, shouts the headline, is “as good as quitting smoking.” “Half a teaspoon less salt a day,” they continue, “would prevent 92,000 deaths, 99,000 heart attacks, 66,000 strokes.”
Hmmm, you may be asking yourself, which is easier? Quit smoking, or eat a little less salt each day? Well, duh.
Because smoking is widely known as the single biggest preventable cause of morbidity and mortality, it seems to be the health hazard to beat if you want to make a splash in the news. (I recently blogged about obesity, another condition that has vied with smoking for the role of number one health villain.)
What is wrong with this picture? (And c’mon, deep down you know you can’t balance out the risks from smoking by blocking half the holes in your salt shaker.)
First of all, according to the article, the “benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use….” The operative words here are “population-wide reductions.” Most Americans consume excessive salt (mostly not from the salt shaker or in cooking; nearly 77% of the salt in the American diet comes from processed foods), whereas the risk of smoking is largely confined to the 20% of Americans who smoke. Population-based estimates average out your risk with that of your nonsmoking next-door neighbor, but in fact, most of the risk of smoking (apart from the lesser though not negligible risks of passive smoking) accrues to those who smoke.
Another catch: The study cited was based on cardiovascular risk. But smoking entails substantial other risks as well. For starters, it causes cancer, remember?
An editorial accompanying the scientific report advocates federal regulations to compel food manufacturers to reduce the salt in processed food. Michael Pollan, author of several bestselling books on nutrition, would urge you to eat less processed food. Either strategy—or ideally, both—would undoubtedly have a great impact on the public health.
But shame on you, webmd.com, for implying that cutting salt intake will produce health benefits comparable to smoking cessation without stating explicitly that this does not apply to the individual smoker.
I have read many explanations for the so-called “obesity epidemic” in the U.S. The phenomenon is undoubtedly multifactorial, with the success of anti-smoking public health campaigns and consequent postcessation weight gain numbering among the culprits. Other possible contributors include the aging population and ethnic shifts that increase the representation of groups that place less cultural emphasis on thinness, to name a couple. Overeating, however, is clearly key.
The big question is not why increases in caloric intake lead to increases in weight but why here and why now? What has happened to our food supply and the way it is marketed, and why are we so receptive? David Kessler’s latest book, The End of Overeating: Taking Control of the Insatiable American Appetite (Rodale Press, 2009), is a brilliant account of how food manufacturers, restaurants, and the advertising industry have conspired to manipulate the salt, fat, and sugar content of foods, mouth feel, portion size, appearance, etc. to maximize availability and palatability. These products — often not food in the conventional sense — are designed and tested to coopt brain reward mechanisms evolved to help us survive under very different conditions. The result is what Kessler calls “conditioned hypereating.” There may once have been an advantage in eating all the berries on the bush but not in the context of perpetual overabundance. It’s a setup for addiction that some can resist but many cannot.
Unfortunately Kessler’s proposed solution – essentially behavior modification based on a perceptual shift combined with showing the food industry the error of its ways – is less compelling than his analysis of the problem. Kessler, you may recall, devoted much of his career as FDA Commissioner to exposing the tobacco industry’s malevolence, which he documented in a book tellingly entitled A Question of Intent: A Great American Battle with a Deadly Industry. As a researcher on smoking/nicotine addiction and author of a book intended to help women smokers who struggle to control weight and keep depression at bay when they quit, I kept asking myself why Kessler is so willing to give the food industry a pass. Does he think the intent of the food industry is less diabolical and profit-driven, even though The End of Overeating is rife with evidence to the contrary? I hope he is right that re-educating them will have a big impact (maybe they have learned something from watching the travails of the tobacco industry), but pardon my skepticism.
Lest anyone think we Americans have brought our troubles upon ourselves through laziness and lack of discipline, there are already signs that the “obesity epidemic” is turning into a pandemic, and why should anyone be surprised? The laws of human biology are not suspended at national borders, and though the U.S. may be at the bleeding edge, we live in a global culture. One further point: In raising concerns about obesity it is not my intent (nor do I think it is Kessler’s) to endorse the socially-engineered preference for thinness that propels so many, especially women, to self-hatred and/or undernutrition. The issue is obesity as a health problem. You know something’s amiss when ads aimed at diabetics, peddling products that make diabetes look like fun, become mainstream.
Cynthia S. Pomerleau, Ph.D., is currently research professor emerita in the University of Michigan Department of Psychiatry. From 1985 to 2009 she served as director of the Nicotine Research Laboratory, where much of her research focused on the impact of smoking on women. She is the author of more than a hundred articles and book chapters on smoking and a contributor to the 2001 Surgeon General’s Report on Women and Smoking.