“Health” at any cost: Popular press comparison of the risks of obesity and tobacco use

Background: News coverage of health problems frequently places issues in "competition" with one another for status as most important issue. Popular press coverage of tobacco use and overweight/obesity presents an opportunity to examine how such a “competition” formulates the idea of “health" and how one might attain it.

Methods: Using the LexisNexis and Ebsco databases, we identified 688 newspaper and magazine articles, published between 1980 and 2005, which included references to both smoking/tobacco and obesity/overweight. After excluding those with only minor mentions of either tobacco or overweight/obesity, 185 were selected for qualitative analysis, based on their inclusion of comparative statements about obesity and tobacco use.

Results: The focus of the articles was predominately on overweight/obesity. The articles emphasized obesity as a matter of personal responsibility, avoided through healthy eating and lifestyle choice. Corporate or environmental causes and policy solutions were infrequently discussed. Avoiding tobacco use was rarely emphasized. In these articles, health was equated solely with non-obesity, though specifics about attaining this state were not detailed.

Conclusions: When health issues are placed in competition with one another, the overall image of health presented may suffer. In this case, press coverage suggested that weight control was so important, its attainment might justify any means - including tobacco use for weight loss or avoidance of the usually minor quitter's weight gain. Public health practitioners need to discourage the tendency to place issues in competition, and discuss problems in the context of a larger picture of health.