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Obesity Is Not Smoking – Period!



Hon. Sarah Hoffman, Minister of Health and Minister of Seniors, Alberta

Hon. Sarah Hoffman, Minister of Health and Minister of Seniors, Alberta

The recent appointment of the Hon. Sarah Hoffman (NDP) to the post of Health Minister in Alberta has (as expected) prompted a wide range of remarks regarding her suitability for the job – not because of her qualifications as an administrator (these are uncontested) – but her size!

In a slurry of comments ranging from misguided misogynistic remarks (sadly, including by members of the former government) to outright personal insults, the social media frenzy around this topic is anything but unexpected.

The general story line is that someone living with obesity, who is thus obviously “unhealthy”, is not qualified be a health minister.

Indeed, one letter writer in the Edmonton Journal likens putting someone living with obesity in this position, to appointing a health minister who smokes – a fatal (but common) misconception of what obesity actually is.

For one, smoking is a behaviour – living with obesity is not!

When you inhale the smoke of a cigarette you are doing something (a behaviour) – when you gain (or lose) weight, it is something your body does (whether you want it to or not).

This distinction is fundamental: when I stop smoking, I become a non-smoker – end of story!

When I try to lose weight, my body will do everything it possibly can to resist losing weight. My appetite will increase, my metabolic rate will slow down, my body temperature will decrease, my thyroid function will decrease, my sense of taste and smell will increase, as will my risk-taking behaviour and my susceptibilty to stress. All of these changes (often referred to as the “starvation response”) will work day-and-night to “sabotage” my efforts and in 95% of people who set out to lose weight, these mechanism will eventually win out – even years after starting on their diet.

Every person I know who has ever lost a considerable amount of weight and is keeping it off, describes this as a daily on-going struggle. They are well aware that even the slightest interruption to their routine, an illness, an injury, a new medication, even just relationship issues or financial stressors and – boom – their weight is back, whether they like it or not.

This is why the WHO, the FDA, the AMA and a growing number of health organisations around the world are now calling obesity a chronic disease, because sadly, we have yet to find a cure for this condition.

Despite what celebrity pundits and the weight-loss industry may want you to believe, there are no easy solutions and try as they may, most people with excess weight will have to fight hard simply not to get any heavier.

So for one, even if Sarah Hoffman wanted to lose a few pounds, the chances that she will keep them off on her own in the long term are slim (unless of course she happens to belong to the lucky 5%). If she is looking for medical treatment, even surgery, I wish her good luck trying to access those services here in Alberta – welcome to the waiting list!

The other assumption underlying the criticism of Minister Hoffman, is the notion that obesity is a direct reflection of someone’s health behaviours – i.e. eating too much junkfood or not exercising.

Believe me that I have seen many patients in my clinic, who rarely (if ever) touch junk food, who spend hours in the gym, and still weigh in at 350 lbs or more. There is (and has been for a long time) enough scientific evidence to support the fact that people vary remarkably in their susceptibility to weight gain (and weight loss). The amount of weight gained by eating exactly the same amount of excess calories can vary as much as 5-fold between individuals.

So for all we know, Sarah Hoffman (like most people living with excess weight) is already well-informed and concerned about her diet and I’d hardly be surprised if, despite her busy schedule, she does manage to squeeze in as much physical activity into her daily routine as she possibly can.

But, irrespective of all of the above, there are simply so many different causes of weight gain (from genetics, to mental health, to sleep deprivation, to stress, to eating norms and culture, adverse childhood experiences, to medications – even perhaps the bugs that happen to live in your gut), that judging someone about their health knowledge or behaviours by looking at their size is truly laughable.

Indeed, who better to have as a health minister, than someone living with a chronic disease?

Would anyone seriously object to Sarah Hoffman’s appointment as Health Minister, were she living with diabetes, chronic kidney failure, coronary artery disease, HIV/AIDS, depression or for that matter cancer (even lung cancer)?

The only real difference between obesity and any of the above conditions is that obesity is visible for anyone to see (and apparently fair game for anyone to comment on).

Whether or not Sarah Hoffman turns out to be a capable and competent health minister remains to be seen – I am certain that neither her success nor failure will have anything to do with her size.

Perhaps it will take a Health Minister living with obesity, to finally create a health system, where people living with obesity are treated with compassion and respect and, most importantly, can find the help and treatments that they need.

@DrSharma
Edmonton, AB

81 Comments

  1. Great, great essay!! Thanks so much for writing it!

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    • Dr. Sharma: PLEASE submit this letter to the Edmonton Journal. A rebuttal is very much needed.

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    • This is the last form of prejudice that “seems” to be popular. People who would never tell a racist/sexist joke STILL think it is acceptable to make fun of another human being for a physical condition that for the most part is NOT THEIR FAULT! I applaud the writer of the article!
      And YES I am obese, and know a lot about the physical and emotional pain it causes me. I am fortunate that most of the people I surround myself with love me as I am. I struggle to do the same.
      Thanks for the article.

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      • being fat is always your fault. eat less. move more.

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      • What I find especially funny is that, just as some straights and Christians think they’re oppressed based on their chosen lifestyle, I’ve met thin people who say they’re constantly attacked and belittled for their size too. Yeah, how about no? Unless you are transparent or translucent, it doesn’t happen. Or to the extent it does, it’s not universal and you will get plenty of positive reinforcements to overcome it.

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    • thamk you for this
      You have captured what I feel and get judged on everyday

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    • Thank you so much for a powerful article. Overweight/obesity is a multifactorial condition that goes beyond the simplistic understanding of the many causes of obesity. Unfortunately, even health care professionals lack the understanding of the causes and treatments. Bravo to you for educating them.

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    • What a load of horseshit. You call yourself a doctor. There is no obesity without overeating, period. Your body does not defy physics.

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  2. Obesity is not a disease, it is a series of bad decisions that eventually leads to excess body fat. You can’t be a victim of obesity because the problem AND solution are presented to us every day in every grocery store. As a Doctor you should be encouraging healthy eating, not the victim mentality. But I guess there is no money to be made in common sense for you.

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    • By that argument most cancers are not diseases nor is coronary artery disease – sad to say, it is this sort of simplistic thinking about obesity that has gotten us nowhere.

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      • Her argument is sound, doc…and I agree whole-heartedly, Debbie. I’m a healthcare professional, as well, and the thing with many cancers, and CAD, is that they are often linked, if not directly caused, by a series of poor lifestyle decisions, just like obesity. And you know this very well, sir. I’m not into shaming my patients, but I’m also not going to support their poor choices, and although some of my patients don’t like to hear that they need to lose weight to facilitate their rehabilitation, most of them know and accept this even before I tell them. Whether obesity is a “disease”, or not, is semantics, and is simply dancing around an issue that needs direct attention. The bigger problem these days, is that the poor choices of parents are now rubbing off and creating obese children, as well. So…is obesity in children a disease too, Dr., or poor choices?

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      • I think you are a bit disingenuous in some of what you say. I accept your point that weight is not entirely determined by your own choices, just like getting coronary heart disease is a combination of genetics, lifestyle, environmental factors, luck. The key distinction seems to me to be TO WHAT EXTENT obesity is to due with your lifestyle, not whether it is. Most reasonable people will accept your points that not everyone can just hop on an exercise bike and choose not be obese any more. And undoubtedly there will be a percentage of the population who are genetically predisposed to obesity. It is important to remove the stigma associating being overweight with being lazy for these reasons. Nonetheless, it is obviously not helpful to just suggest that all obesity be classed as a chronic disease about which the sufferer can do nothing. It is still important to emphasise that your weight will tend to be very much a product of your lifestyle choices – maybe less important to emphasise this point to the chronically obese, but to wider society this message is important in reducing obesity!

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        • Who says that having a chronic disease means you can do nothing about it – patients live with and manage a wide range of chronic diseases all the time. The word “chronic” does not imply that you cannot do anything about it – it only means that there is no cure and that whatever treatment works (diet, exercise, yoga, meditation, mindfulness, drugs, surgery) have to be used in the long term – when the “treatment” stops, the disease comes back – that’s all.

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          • Absolutely, I manage the shit out of my chronic pain condition and add everything to my management plan that my doctor thinks will help. Fine, obesity is a chronic disease but it too can be managed. I let myself get lazy on my meds because everything hurt and irritated my condition. But I made a conscious choice in December and dropped 40 pounds in the next 3.5 months. Weight can be lost, but the chronic aspect of that is making sure you keep it off!

      • Are you delibiritley being dense? There’s no coming back from cancer or coronary artery disease without medical intervention. You can cure your own obesity by eating less and moving more.

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    • Obesity is definitely a disease. It may have a non drug “Cure” but it is quitw predictable given the obesogenic dietary advice (low fat, carbaholism), the formulation of modern process food and the false promise of the fitness industry. Sweden has turned the obesity epidemic around (along with IHD mortality) with LCHF.

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    • DEBBIE – actually OBESITY is now classified as a disease. Being obese can be acquired by something as simple as having to take Prednisone for Asthma – and many other medications. I hope to enlighten you that judging someone by size that they must have done something is sheer ignorance. The DIET industry makes so much money on it, because DIETS do NOT “work”.
      I personally have struggled with weight for more than 40 years, the ONLY thing that has had any appreciable help is MEDICATION for my
      medical issues – and movement. It took me 2 YEARS to loose 50 pounds and I have kept most of it off, but as my medical problem is “progressive” it is a horrible feeling of failure. I am STILL about 100 pounds “overweight” and live with that everyday. I can assure you – that if you wore a 100 pound packsack on your back – and tried to do what you normally do every day, YOU would do anything to loose that weight. I CARRY a 100 POUND weight with me – PLUS I get INSULTED by ignorant people on a regular basis.
      I Hope you can take what I have said and really feel what it is LIKE to be overweight. I doubt ANYONE chooses it!

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      • I absolutely agree. At my heaviest I was close to 400lbs. I have pretty much lived on a 1200-1500 calorie max most of my adult life. However since the age of 19 when my auto-immune disease kicked into high gear I have been on prednisone/prednisolone. My Dr’s gave me a choice, I could live and be fat, or I could stop taking the pred, lose weight and quite possibly die. So the best I could hope for was to not gain too much. Most people have no idea what it’s like to publicly shamed for something you can’t control. On the rare occasion I would go out with friends to celebrate, god forbid I ordered dessert once a year – because someone would always have to make the comment, “should you really be eating that?”. I pretty much became a recluse because I was tired of the comments. I was a professional at work, I take pride in my appearance at whatever size. I wasn’t something that rolled out of bed that you’d find in the Walmart-world pics. Yet people barely treated you as if you were human.

        Finally I was able to get on a new experimental drug that allowed me to come off pred. and I have deflated like a balloon. I am now at 170lbs and carry about 30lbs of extra skin which is itself a whole nother bag of fun.

        Most of the obese adults I know, especially women know more about health and diet than the skinnies out there. They know because they have been on every diet ever made. For everyone who thinks people should be reminded of their physical size through comments, regardless of how well-meaning. Stop it. You have no idea what battle that person is facing. They see their size every time they face a mirror, every time they zip up their pants or go shopping.

        They. Know.

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        • Prednisone doesn’t make you fat, it makes you feel hungry, and you eat, making yourself fat. More excuses…

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        • Thank you for your post! Congratulations on winning your battle. I struggle with mine everyday. Even when the weight is under control – I struggle to keep it that way! And every time I have a new leg surgery or go on iboverin and interferon I gain weight back.
          My Momis in a wheel chair because of her MS – people look
          At her and automatically think it is because she is over weight! Which is not true, years ago a top MS Doctor put her on steroids so she get her eyesight and use of her legs back. She gained back her eyesight and 70 lbs in 90 days. She took herself of the steroids as the side effect in a small percentage of people was weight gain. She has not recovered the use of her legs and has not been able to shed the weight! I try not to judge people for their looks I wish others would do the same!
          Walk a day in my or my moms shoes!

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    • I totally agree…if obesity is disease, it is a totally preventable disease. Stop eating crap and get moving.

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    • Sorry, but you are wrong.

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  3. “When you inhale the smoke of a cigarette you are doing something (a behaviour) – when you gain (or lose) weight, it is something your body does (whether you want it to or not).”

    And your body is not you?

    Obesity and smoking are harmful addictions. Both the obese and the smokers have failed to figure out how to overcome their addictions.

    The health minister is an administrative position, not a health counseling position. On the other hand, the health minister is also a figurehead. In that capacity, the selection of the health minister is counterproductive.

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    • Sorry, there is a big difference between what you do and what your body does – there is only so much of physiology that you can willingly control (just try slowing down your breathing to 12 breathes a minute for the next hour or so).

      To equate obesity with addiction is a gross oversimplification of the problem (not that addictions are by any means simple). While food or eating addiction may well be a problem for some people, causes of obesity are far more diverse than simply addiction.

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      • I agree with those who question your medical credentials. Perhaps you are a doctor of sociology and not MD? Splitting the human into twain with the body being like a runaway horse, uncontrollable and wild, is stupidity and pure non-science. Using an autonomic system example like breathing indicates an attempt to deceive.

        Is the body not controlled by what the mind decides to purchase and place into the body’s hand to shove into the body’s mouth?

        That was one of the will-power exercises I developed to help me stop smoking. I stopped buying cartons of cigs and was forced to pay full price per pak. Then I would stop myself from lighting it & place the cigarette back in the pak until the reflex action (that wild uncontrollable horse) again put it back in my mouth. Put it back twice and I had earned the smoke. Then I stopped buying paks of cigs and whenever the body overwhelmed my will, I was forced to ask someone on the street. My mind made the rules that my body was forced to follow.

        Same with eating. As a young adult I became very ill from a lousy lifestyle. Stopping sugary food intake and eating better changed my life. Again, I am now in poverty and am forced to choose carefully what to eat.

        I discovered that it is cheaper to eat Real Foods than not. Processed foods are specifically designed to encourage and stimulate appetite, causing over-eating. By simply avoiding processed over-salted, over-sugared, unhealthy-fat-filled foods, and going for a daily walk, I lost 25lbs with no effort, no counting calories, and no strenuous exercise.

        My ‘uncontrollable body'(snark) still shoves the yummy fats into my mouth, but Olive Oil and Coconut Oil are Real Foods and essential fats and not JUNKFOOD. They satisfy and sustain and do not stimulate appetite. Chocolate made with 75% cocoa satisfies whatever candy urges that come.

        So the excuse that poor folks are forced to eat “cheap” fattening foods is another Social Science generated lie. What poor people need most is shopping and cooking lessons which should be provided by Ministries of Health.

        This idea that folks can choose what they want to eat is a Corporate lie that has led us astray from our grandmothers’ wisdom and made us into JUNK consumers. The solution is a responsible activist Health Authority that can set a healthy example for citizens.

        Being healthy does not come naturally in the human-constructed world in the 21st century. We need to again LEARN how.

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    • Implying that our new Minister of Health will be counterproductive to health policies is absurd. There is no evidence that people with obesity are less intelligent or competent than others. Considering that almost 2 million Albertans have overweight and obesity, this comment would imply that more than half of Alberta’s population would be incompetent and has somehow lost their will power to manage their weight. It is absurd.

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    • Get her a gym membership and a personal trainer and make some progress toward being a suitable representative of health. Stop saying she’s a victim! She should give her wishbone a rest (I wish I wasn’t fat) and work her backbone.

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  4. Thank you for this! I was dismayed and frustrated with the online commentary regarding Ms. Hoffman’s weight and her ability to do her job. This piece is a nice counterpoint to all the misinformation out there,

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  5. I quit smoking almost 30 years ago – and compared to my struggle with my weight, that was reallllllly easy!

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  6. Dr. Sharma, you are a horrible doctor if you really believe this and should never give weight counseling ever.

    As a formerly obese person, now 23 BMI for 6 years with no gain back, you simply are part of the problem. People didn’t start to get obese in alarming numbers in 80’s on because of any factor beyond eating too much and moving too little.

    NONE of your patients violate the laws of thermodynamics, they just want you to give them easy excuses. You should lose your license to practice.

    I should add since getting in shape, my BP is down from borderline hypertensive to athletic, my knee pain is completely gone, my stamina is greatly improved, and my sleep apnea gone.

    Just by counting calories “doctor”.

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    • Congratulations on your weight loss. Now you need to work on reading comprehension skills. No where does he state that you shouldn’t council people on weight loss. The point of this post is that obesity is a complex metabolic disease that is not fully understood. When you quit smoking you’re cured. If you eat less and exercise the underlying metabolic reasons that predisposed you to obesity still exist and never go away, so the interventions for obesity need to be life long.

      Do you by chance know what the success rate of “calorie counting” is? If it were a drug it would never get health canada approval, put it that way. Please get off your high horse and stop stigmatizing people with one of the only chronic diseases that anyone can see with the naked eye

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      • LIAR! Mgm posted: “When you quit smoking you’re cured.” Quitting is just the first step. It can take a DECADE before the cravings disappear. Each day is a struggle with the beast within. The only solution is the same as for the “underlying metabolic reasons that predisposed you to obesity.”

        That is: PERMANENT LIFESTYLE CHANGES. The obese must, just like the smoker, make permanent changes to what they put into their mouths. If one is “predisposed” to storing fats, then one must necessarily permanently input less fattening foods. It’s not dieting; it’s Permanent Lifestyle Changes.

        Not only did I quit smoking, but I have made the choice to permanently change my food inputs because I became AWARE of how those choices affected my moods/personality/health. I have had to further refine those choices because of poverty, and discovered that eating ONLY REAL FOOD is CHEAPER and resulted in further weight loss.

        Suggesting that obesity is disconnected from personal choices is typical postmodern big “L” Leftist B.S.

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      • But how come it is a sudden epidemic? If these metabolic predispositions existed, how come it is sudden (the last 40 years)? What happened?

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    • Wow. That’s a lot of vitriol.

      Here are my bona fides: I have maintained 50 lbs of loss for 12 years. At my lowest plateau I was down 68 pounds — coincidentally, a 23 BMI, like you — but I have experienced a partial regain of 18 pounds after three surgeries, one on my foot, and the necessary cessation of running as my exercise of choice.

      Tabulafora, here are my thoughts. Weight-loss maintenance is much more complicated than just counting calories. I know because I do it, and I watch other smart, dedicated people fail at it and regain the weight they’ve lost. It makes me sad for them and pensive for myself.

      If you go a little deeper into this blog, you can read about solid, independent, empirical science that documents endocrine changes, changes in the microbiota of the gut, metabolic changes and other changes in weight-reduced people that make the maintenance of losses long term much more challenging than women’s and fitness magazines like to purport. Also more challenging that the National Weight Control Registry promotes — that’s a think tank that surveys weight-reduced people sight unseen on their behaviors (as opposed to conducting empirical research) and neglects to check up on its subjects to assure validity. (I’m on the NWCR, so I know.)

      I’d be willing to bet that in your private moments you are more circumspect than you come off here. Our society rewards people for promoting a simplistic answer to weight-loss that others can glom on to as “inspirational” and that allows trim people (whether reduced or naturally trim) to blame fat people entirely for their own circumstances. I call it cultural mythology, but it’s conveyed with almost a cultish pressure.

      Anyway, I’m going to tell you, because I know, that promoting the myth of “it’s easy” gets exhausting after a while, because it just isn’t true. I hope you never grow to regret what you have said here — maybe your body systems have some exceptional quality to them that will protect you, help you continue to maintain your losses in some simple way — but I’d bet money that someday you will regret what you have said here. Best of luck to you all the same.

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      • Very well said, DebraSY. I am amazed at the anger and moral superiority in many of these comments. Also the absolute refusal to examine their beliefs about the obese and consider that they are perhaps wrong. Here is a doctor, with the studies to back him up, being told his credentials are suspect and he’s wrong because what he is saying challenges their world view.

        What about thin people who are sedentary? Who eat crap on a regular basis but don’t gain weight? Where’s the anger at them for living unhealthy lifestyles? All medications and health conditions belong only to the obese apparently.

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      • Wow, when did we as a society decide that it was ok to become rude and mean to others?
        I quit smoking 28.5 years ago. For me, at that time, it was easy. That doesn’t mean it’s ok for me to shame others as what worked for me, may not work for others. I did not struggle with cravings for 10 years as was suggested above, but others may struggle.
        I also struggle with weight and for the most part, I eat well. I can guarantee that being judged doesn’t help anyone. I do have health issues that don’t help and genetics etc. I don’t think that this should stop me from trying to lose weight but it helps to realize that this may be a problem and keep me from throwing in the towel and quitting!
        No one likes to have their faults thrown in their face and we all have faults. Some are just more visible!

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  7. I completely concur with the sentiment that her size will have nothing to do with her competency.

    That being said, it would be completely naive to believe that our sedentary lifestyle and overindulgence in certain foods have absolutely nothing to do with the obesity epidemic we are living in. I agree that it is a complex chronic disease given that I see and manage it everyday but we are doing ourselves a disservice by allowing a “built-in” excuse for being overweight.

    Most of the overweight individuals I see admit to having a very sedentary lifestyle and certain vices that have led to their situation – and I think it is healthier for them to acknowledge that it is indeed a problem that needs to be addressed.

    I am against “fat-shaming” but at the same time, people do need to take more responsibility for their weight, and not blaming “low-metabolism”.

    Unrelated, but I do find it interesting that the physician in the governing party was not picked to be the health minister. There probably would be less of an uproar if this person was health minister and made the same decision.

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  8. B.S. Obesity may have several inputs out of the person’s control, such as fetal exposure to chems from plastics, but the outputs are the same as with smokers. As an ex-smoker, my experience is that it is the exact opposite of what Jesus said: it IS what you put into your mouth that matters…

    At the grocery store the other day, I saw a woman so obese she was disabled and was riding an electric chair. In her shopping basket was six 2-litre bottles of pop. And a head of lettuce. I said to her: “You know there is over 40-teaspons of sugar in each of those bottles, right?”

    Defensive and angry she barked back: “So what?!”

    Her helper, a short skinny man, looked at me helplessly as if to say: “She won’t listen; please don’t make a scene.” Others in the lineup were readying themselves to defend her right to eat pure sugar if she wanted to. What could I do?

    So instead, I shifted gears and replied: “It’s like drinking diabetes,” which immediately ended the tension.

    The point is NOT that obese folks have trouble with their eating; but that they have trouble with their BUYING. Just like a smoker needs to stop putting cigarettes into their mouths, so too the obese need to stop buying sugary, processed, junk, snack, fatty fake foods.

    Eat REAL food and healthy fats. Drop the sugar and the salt. And please folks, STOP MAKING EXCUSES for these people.

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    • Do you have any obese friends? I’m guessing not from your obvious hatred of them. If you did, you might see some who are obese who don’t drink soda, don’t eat at McDonalds all the time, or do any of the other stereotypes you keep pushing.

      I’m just in awe of your self importance. Why do you need to do anything about what a stranger is buying in a grocery store? It isn’t your business. Worry about yourself. I don’t understand people who feel so strongly about someone else’s appearance that they feel it’s OK to make comments about anything that person is doing.

      And it does come down to appearance. Few people make comments about what is in a person of normal weight’s grocery cart, or that they are eating a hamburger. The obese had the nerve to gain weight, doing the things that many non-obese people do but don’t gain weight doing. There are a lot of variables at play here.

      You keep using your success at quitting smoking as proof that losing weight is easy. Not comparable. Not even remotely.

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      • Sorry Annie; just as your assumptions have accused me of assuming, you’re wrong. I regularly comment on what folks are buying in a grocery store. Everything from letting them know that a competitor has a lower price to laughing that a shopper did not buy enough Junk Food, if their cart is full of Real Food. Sure some folks don’t like it, but, Annie, the truth is it is a public market and speech is still free.

        I also tell my neighbors not to cut their grass so short (we live in a semi-desert area) and that pruning flowering shrubs in the spring before they flower is just wasting the flowers. I mean why grow flowering shrubs if you’re going to cut most of the flowers off?

        The “it isn’t your business” argument is trite and has been used to tell folks not to intervene when they see a child or a women being abused in public; or a dog being locked in a hot car. It’s fake morality. Are we not our brother’s keeper? Do we live in Communities, or as hermits in caves?

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        • You sound like a barrel of fun!

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          • Every time I see someone looking at the Wonder Bread, I always make a joke:
            “Do you know they call it Wonder Bread?”

            “Cause you Wonder if it has any food value1”

      • Might I interject here? I do have a very obese friend, so much so that she has developed pcos and is in a lot of pain a lot. I care about her and don’t like seeing her in pain, and try to help her stop gaining weight. The problem is, because of the victim mentality that she has been enabled to have from tumblr and “studies” like this, she denies what she eats and gets angry if it is brought up because she can be “fat and healthy”, apparently. I see what she eats. I have never seen her touch fruit or vegetables (I’m doing schooling with her). Her go-to every day snack is a white baguette filled with butter and nutella. She has a chocolate bar with every meal. She drinks soft drink every day. She buys all the sweets available in the cafeteria. But she insists that she’s healthy, because HAES. If stuff like this wasn’t feeding her denial and delusions, maybe she would have motivation to eat better and not be in so much pain all the time. It kills me to see her doing this to herself.

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        • Well Surely, people who make fun of others just because someone is obese, or too thin, too dark or too pale is ridiculous to the core. What I believe is that is that those who are weak and insecure, paranoid, etc. can only make fun of others’ weaknesses or their distress. People have another misconception that smoking does not contribute to weight gain, it does!!, research has proven it.

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    • So what exactly are your qualifications, since you have no problem calling into questioning those of a learned and respect physician and trolling anyone who recognizes the complexity of obesity? I’m glad you have found something that has worked for you personally. I eat pretty much the same as you do, whole foods only, lots of good fats and almost no carbs. But for the last 40 years dieticians and nutritionists have been telling people the opposite. They have been promoting an ultra low-fat, high carb diet and it’s made people sick and fat. The reliance of ready-meals that are packed with salt, poor fats and carbs and high calorie snacks available readily and cheaply combined with sitting behind a desk for 9 hours, then behind the tv for another 4 at home have made it worse.

      BUT by looking at people alone, you cannot tell what their lifestyle is. I have a couple friends who do triathalons – one is a size 10 the other a size 18. I have a couple good friends who exist on cigs pop tarts, KD and to them a healthy meal is a pizza with green peppers, both are less than 110lbs.

      Yes, people need to be encouraged in general to make healthy decisions, but considering the people we are supposed to look to for advice, (Dieticians and Nutritionists) have royally f**ked up by promoting an ultra-low fat, high carb for 40 years, people don’t know who to trust. And add to that every wannabe Dr Oz who puts out a new diet book every other week and the MLM schemes, diet product industry etc. People need help. Shaming overweight people does not fix anything.

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    • Well, if being obese is, as you maintain, the matter of will, than why are you so rude and so full of hate? That’s surely something you can decide not to be, and also much more toxic – for you and others – than obesity.

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  9. “Starvation mode” and “95% of diets fail” are both myths, and anyone repeating them is offering nonsense. While the BMR of a smaller person (even a formerly obese person) is lower than a large person, that’s just thermodynamics, as it takes more energy to fuel a larger ‘engine’ than a smaller one.

    As for the 95% of diets fail- http://www.nytimes.com/1999/05/25/health/95-regain-lost-weight-or-do-they.html

    If you’re going to offer your silly opinions, at least try and get facts correct.

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  10. I think it is hilarious how people post on blogs like this–the blog of a doctor who is at the international forefront of obesity research–because they feel legitimate in questioning his findings.
    Lets make a distinction between people who actually ARE researchers and people who are not.
    Basically all of the negative comments here are: He might be a doctor, but fatties are lazy and I don’t like them.
    Good for you, you think like 95% of the rest of the population. If you scratch the surface of any of these health scare tactics, then you will realize that the science of obesity is really really complicated. Bless you Dr. Sharma for replying to these ridiculous comments and for always sticking with the science and not stereotypes.

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    • look here!: a surviving Modernist in the post-Modern era. Someone who still believes in the purity honesty and expertise of those who claim to be experts.

      We all know that obesity is a complex syndrome, but the final observation is in what we see obese people doing. Are they making smart choices, or choosing what drives their un-health? Is the mind not a part of the body?

      Go to a Costco food court and tell me what do you see. The fat people are all choosing foods that make people fat. Huge servings of French Fries with gravy and deep fried chicken, plus a hotdog and finish with ice cream. A weeks worth of calories in one meal. Like WTH? are you hiking home with backpacks filled with your purchases?

      Go to a grocery store and observe what the obese are putting into their shopping carts. Is it REAL FOODS or processed/snack/junk foods? It does not take an expert to see that disconnecting the link between consumer choice and personal health is falsehood.

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      • Kal Anne, I also see a lot of thin people eating huge servings of french fries with gravy and deep fried chicken, plus a hotdog and finishing with ice cream. A weeks worth of calories in one meal. You don’t see them? Or is it OK with you because eating poorly manifests itself in thin people in a way you can’t see?

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        • LIAR: While there may be the occasional thin person who “eats a weeks worth of calories in one meal” (most likely a vigorous young person), the norm is NOT “a lot of” as you claim.

          Like I said, go to Costco (where most shoppers are middle age/older) and observe. Count them, the ones eating monster-calorie servings and get back to us. Tell me: how many were “overweight” and how many were not?

          My Costco used to serve a monster serving size of Fries; enough for a whole family. I repeatedly recommended that they cut that in half, and they did. But the serving is still huge, enough for 2 people if that was their entire meal. Obese people are obese because they order that with poutine toppings AND Pizza or a Hot Dog AND a large drink with 15-20 teaspoons of sugar.

          I challenge you to go to Costco and observe. OPEN YOUR EYES!

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    • He’s not “a doctor who is at the international forefront of obesity research,” he’s a barbaric surgeon. Certainly that in itself doesn’t absolve him of blame – but you would think that a doctor writing about a medical topic and presenting an opinion that is overwhelmingly unpopular in the medical community would provide some shred of evidence for his extraordinary claims, which he did not. Dr. sharma does not stick with the science: the science tells us that smoking and overeating both lead to a myriad of health problems. Instead, he tries to cloud the issue with semantics, suggesting that overeating and obesity are not essentially the same thing, which is an absurd denial of basic physics. I know everybody’s out to make a dollar, but Sharma is just shameles in his outright violation of the Hippocratic Oath.

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    • Anonymous, these comments are pure entertainment. Who cares if the good doctor went to med school and actually has research at his back? These people know the truth! It’s just so simple! Stop giving fat people excuses!

      How discouraging this must be for the actual experts who are working toward understanding this complex issue.

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  11. Thank you doctor for a wonderful article. It seems that the point most commentators are missing in your article is that there are so many variables as to why someone has an issue with their health. I had a brother who worked out every day and only allowed the healthiest of foods pass his lips, did not smoke or drink, yet passed away from a massive heart attack at the age of 54. He wanted to live a long healthy life. Based on some of the commentators arguments one could also argue that his healthy lifestyle was the direct cause of his death. The arguments are absurd. By the way heart disease runs rampant in the maternal side of my family and cancer on the paternal side. Because of this we are all extremely vigilant about what we put in our bodies and make every effort to maintain a very healthy lifestyle. Some of us also have extreme challenges with our weight. Menopause is my problem, in spite of watching what I eat and exercizing everyday all of my life, trying to keep extra weight off has become a massive challenge for me. Where once it was a piece of cake not so much anymore. It can be quite demoralizing.

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  12. The 5% success rate you give is based almost entirely on prospective diet studies that recruit participants. There is heavy self selection bias in all of these. People who have successfully lost weight don’t sign up. People who are making their first attempt aren’t going to do so through clinical trials. The subjects of prospective diet studies are almost always serial diet failures. It’s amazing that the success rate is even that high.

    It’s not surprising that your morbidly obese patients self-report only eating carrot sticks and kale. That’s consistent with diet survey finding, which show that the obese report low intake, but actually eat substantially more. The obese regularly report caloric intakes that are incompatible with living, but when measured in a metabolic ward or by doubly labeled water, it turns out that they’re systematically under-reporting their intake by as much as 50%. This is well known. Multiple studies have confirmed this. I’m surprised that a leading obesity researcher isn’t aware of this.

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  13. I am 50 years old, considered obese, the only health issue I have is skin cancer, which has absolutely no relation to my size. Other then that, I have always had a clean bill of health and do not take any kind of medication. Put that in your pipe and smoke it ignorant people.

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  14. Thank you, Dr. Sharma, for your well-written blog post. I simply cannot believe the attitudes of some of the folks who have responded to this post. I agree that this should be submitted to the Edmonton Journal for a wider audience to read. Clearly we have a lot of work to do to educate people about the science of obesity and to eliminate the attitudes that people struggling with weight issues do so because of their own inability to eat right and exercise. If someone approached me and felt the need to comment on items in my shopping cart, regardless of what I was choosing to purchase, I would be enraged. Let’s focus less on judgement and labelling and more on helping all people with ongoing health conditions get the support they need to live as fully as possible.

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  15. Right on Dr. Sharma! Please keep sending out this kind of information to the uneducated masses. There is so much misinformation about obesity out there. And judging by a lot of the comments here, weight bias is still alive and well. Thanks for your comments.

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  16. Not once in here, did I see the word metabolism. Sometimes things just need to be changed up a bit to restart the burning effect, this change of metabolic rate, along with healthy food group choices, protein, greens and good carbs, to provide the burning instead of the storage, will go a long way to improving this type of condition.

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    • Metabolism. Hmm. I had my metabolism measured twice – the second time, because it is so high the dietician did not believe the first measurement. The second test had the same result. Yet, despite my high metabolism, I am still what you would call obese. My metabolism is high for my size, but most people who are bigger burn more energy, not less.

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      • Of course your metabolism is high! It takes a lot of energy to carry around all that excess body weight! Of course, whether you believe it or not, your daily caloric intake matches your base metabolic rate.

        If it didn’t, your body would need to use some of that stored excess energy in order to just live.

        People can argue all they want, but it really is THAT SIMPLE.

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  17. This is very interesting and I thank you for this perspective and expertise on the topic. I am also interested, though, in more information about the comparison to smoking. With addiction also being a disease, involving body responses, which can be managed – would this not make the comparison somewhat relevant?

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  18. You choose to eat terrible foods and not exercize just like you choose to smoke. Sorry but I’m not buying it.

    It is enraging to listen to an obese woman tell you that as an adult tax paying Canadian you can no longer enjoy cherry flavored cigars because they are unhealthy while she sits at the podium 100 lbs overweight. Obesity burdens the healthcare system just as much if not MORE then smoking, because smokers pay exorbitant taxes on their products while obese people get an awful mean from McDonalds for 5 dollars

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  19. Smoking is an addiction. Addiction is a disease. The body will do everything it can to keep you smoking. Your analysis of smoking is as simplistic as most peoples analysis of obesity.

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  20. …my goodness …. The stereotyping and judgement some of these comments exhibit is quite astounding …. Let’s judge people in line at the grocery store??! Really?? That simplistic thinking astounds me. As for the health minister ….. Where is this perfect model of health?? Perhaps we should have a Cinderella-like search across the province for that perfect epitomy of health?! Step forth into the light ……….how ridiculous! Sarah Hoffmans ability as a health minister has nothing to do with her weight.

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  21. Wow, what a lot of anger! For those who think that being fat is a choice: it is surprisingly, difficult to maintain weight loss. Taking lots of weight off is often easy enough, but it almost always comes back. We evolved (and have lived most of our existence) in an environment where weight loss had no advantage at all. Our bodies and brains are designed to maintain or gain weight, because conserving energy was essential for survival during most of our evolution. Never before have we been surrounded by so many opportunities to eat super-high energy foods. It is only surprising that we are not all really fat. You may not want to hear Dr. Sharma’s words, they are based on considerable research, and like many scientific discoveries, the reality of weight loss is surprising and counter-intuitive. By the way, Dr. Sharma is a lot more than a surgeon. He’s one of Canada’s most knowledgeable obesity researchers, and from what I can tell, he doesn’t perform any surgeries.

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  22. You say you’re a doctor? I find that difficult to believe. Because I’ve been a nurse for 22 years and I have yet to meet a single patient who “spend hours in the gym, and still weigh in at 350 lbs or more.” You should know, as a medical professional, that you cannot out train a bad diet. If they’re going to the gym and not losing weight, it’s because they are eating too much. No human being is exempt from the laws of thermodynamics. That’s some serious fat logic you’ve got going on there, doc. And if you’re not helping them to lose the weight, then you’re ineffective at your job.

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  23. Good lord, you spew this garbage and still have your medical degree? I guess you must be the smart one, and EVERY OTHER DOCTOR IN THE WORLD WHO SAYS THE EXACT OPPOSITE must be wrong!

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    • Actually, Biff, Dr. Sharma is right. Remember that for hundreds of years, experts told us that the world was flat. And certainly, it DOES look flat. That doesn’t mean that it is, though. We now know that it’s round, despite what our eyes continue to tell us.

      By the same token, the “calories in-calories out” approach and the accompanying assumption that being fat is a simple choice that you can reverse by just eating “normally” seems to be common sense, just like saying that the world is flat because that is what our eyes tell us. However, the reality of the matter is that overweight is a complicated biological state that cannot be solved by simply putting down your fork. That is Dr. Sharma’s message and one day, it will be recognized as the truth.

      In the meantime, the kind of hate that you and most of the others have spewed in the comments section do nothing to advance either the science or the search for solutions.

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      • Within the parameters of your argument, of course Dr. Sharma is right.
        –“seems to be common sense that being fat is a simple choice that you can reverse by just eating “normally””
        –“overweight is a complicated biological state that cannot be solved by simply putting down your fork.”

        “Putting down the fork” and eating “normally” are the lies that you and the good doctor are opposing as if they were the SOLE SOLUTIONS. But I and others here have made it very clear that we understand that is not the solution. The REAL solution does not enter yours, nor the good doctor’s language.

        The REAL SOLUTION to fat people everywhere is to make PERMANENT LIFESTYLE CHANGES.
        –Eat REAL FOOD, drop the processed. Realize that processed/snack/junk foods are DESIGNED to stim the appetite
        –drop the sugar, salt habit: stims the appetite
        –realize that fats are not the enemy, but BAD FATS are.
        –Balance carbs with protein: become aware of HOW YOU FEEL. Eating carbs stimulates appetite? Go for protein to calm the monster.

        The point is NOT to suppress the eating, but to shift the eating from foods that drive unhealth to foods that sustain. Like a smoker has to make permanent lifestyle changes, so to do the obese.

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        • Kai Anne: Thank you for your many unfounded assumptions about the way all fat people eat. I am glad that you know the whole truth and nothing but the truth.

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  24. take the energy you are putting towards bashing each other and go change the world in ways it needs to be changed. Fight child abuse. Clean garbage off some wilderness area. Smile at someone, regardless of their size and take the time to get to know them.

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  25. For those who challenge this article by talking about their experience in the grocery store:

    Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program.

    Dr. Sharma is founder and Scientific Director of the Canadian Obesity Network, a network of over 10,000 obesity researchers, health professionals and other stakeholders.

    He is also the Past-President of the Canadian Association of Bariatric Physicians and Surgeons.
    – See more at: http://www.drsharma.ca/about#sthash.bvFryqhg.dpuf

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  26. The level of ignorance in so many of these comments is disheartening – I thought the level of education and knowledge in our society was much higher than that. It is reminiscent of those who vicously criticize people WITH OFFICIAL DISABILITY PASSES (which are only assigned after rigorous medical evaluation) who park in handicap stalls because they don’t “look” or “act” disabled.

    To those fools who presume that obesity is solely the result of people who are lazy arses lacking in willpower: Dr. Sharma specializes in obesity research, so he has a MUCH better understanding of some of the different things underlying obesity than do you. One of MANY different medical conditions that result in obesity (in other words, it is a SYMPTOM of the disorder) is Hashimoto’s disease. No, I’m not going to tell you what it is – look it up and learn something new, and hopefully it will impress upon you just how far from the truth are your smug, bigoted prejudices. I don’t hold out high hopes for that, but hey! miracles do sometimes happen.

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    • L.M. Ridley posted: “To those fools who presume that obesity is solely the result of people who are lazy arses lacking in willpower”

      That is a straw man. Please do take the time to address the stronger arguments rather than invent a strawman to attack. Thanks

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  27. I think both are addiction and we should try to avoid it.

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  28. Your article is so well written. Thank you!!!! One of the saddest commentaries on our society is the total disrespect for people. I was spanked as a child and I suffer the life long disability of ‘respect.’ I respect this Honorable member. She does not deserve the verbal abuse and debasing comments that people who have no respect dished out on her. Shame on our society that we have such little value and appreciation for others who try to make a difference.

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  29. It never stops amazing me how people can throw tantrums when they see evidence of things that differ from their long-established beliefs. You’re not the only obesity doctor/researcher I’ve seen lambasted and dragged over hot coals for having the audacity to state that obesity isn’t simple, that weight gain isn’t automatically from “bad lifestyle choices” (or how much control there is over those “choices”), that weight loss isn’t always the simple formula of “calories in = calories out,” and that weight control is a difficult problem due to the complexities of the human body.

    The logic jumps of these people is a depressing state of our society, where students are no longer taught the basics of logical thinking and fallacies. The comments that call your credentials into question are no surprise to me; if you don’t have the knowledge to properly argue the point, attack the pointer! When I refer to articles like this or the growing number of research studies that back the idea that obesity isn’t always its own death sentence, and that, most horrifically, that the real reason behind obesity-related deaths may be a lack of decent health care due to poor attitude from doctors, I’m compared to Anti-Vaxxers, with the claim that I’m “clinging to one or two studies that are *obviously* false,” no matter how many studies I can cite.

    One of my favorite routines is over one study which talks about the ways that some of the obesity-linked genes, that have so far been identified, contribute to weight gain and control. The people convinced I’m stupid will quote the first line of the study, which says something like, “Obesity is a growing concern in our world.” And to them, that’s the whole study, and it proves I’m wrong. Why bother reading the whole study when you can cherry pick the first line?

    Illegitimi non carborundum, Doctor. Many of us are still listening.

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    • Well said, Moose!

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  30. I love everything you have written — with one exception. Smoking is an addiction. People who try to stop face at least as much hardship as people who try to lose weight. To suggest otherwise does a disservices not only to many smokers who would dearly love to stop, but also to anyone with an addiction challenge. This posted by a non-smoker.

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