Smoking and Weight Loss
By Bob Sherman
Although both men and women are equally concerned about smoking cessation, around 50% of females and 25% of males are concerned about weight gain. Concern about weight gain causes some people to avoid smoking cessation attempts and causes relapse to smoking in those trying to quit.
Concern about weight is also a factor drawing people to smoking. Women are more likely to use smoking to help control their weight.
Epidemiological studies on over a quarter million subjects show a strong inverse relationship between smoking and body weight. Smokers weigh significantly less than non-smokers for the same age and sex. Both humans and laboratory animals show significant weight reduction and appetite suppression when nicotine is administered. And, not surprisingly, both humans and laboratory animals show weight gains when nicotine is withheld.
While we do not know for sure the mechanism of nicotine's appetite suppression, there are a number of theories. Nicotine regulates neuron communications in the lateral hypothalamus. Enhanced serotinergic transmission in the hypothalmus may trigger a false feeling of fullness. Nicotine may also, directly or indirectly, influence signals from various organs reporting on the adequacy of food supply and energy requirements.
In one smoking cessation study involving primarily male veterans, 27% indicated concerns over gaining weight. For those expressing weight concerns, they indicated they would relapse to smoking if their weight gain was in the 10 to 12 pound range.
Younger veterans were more likely to express weight gain concerns. Those with general weight control concerns were much more likely to succeed at quitting while those with cessation related weight control concerns were less likely to succeed at quitting.
Females with weight concern are more likely to be Caucasian, have a lower body mass index (BMI), and have lower levels of nicotine dependence (based on the Fagerstrom Test for Nicotine Dependence).
Some researchers have found that body image dissatisfaction plays a role in weight concern. So, improving body image dissatisfaction may help improve quit rates for those with weight concerns.
A study of weight gain among successful quitters showed that 15% lost 5 pounds or more, 33% remained within 5 pounds of their initial weight, 39% gained between 5 and 25 pounds, and 13% gained more than 25 pounds.
Those "super gainers" who gained 25 pounds or more were younger, of lower socioeconomic status, started smoking at a younger age, smoked more cigarettes per day, exercised less, drank more coffee, and (interestingly) ate fewer pastries than other quitters. In addition, the "super gainers" (when compared to those with stable weight) tended to be single (receiving less social support), twice as likely to diet to control their weight, and consume twice as much alcohol.
A study of various weight control treatments (Sharon M Hall et al.) during smoking cessation showed that subjects participating in somewhat complex weight control had lower quit rates than those participating in generalized weight control programs. This complex weight control plan included daily monitoring of weight and calories, an exercise plan, implementing behavioral principles. It appears that complex weight control programs can detract concentration from smoking cessation efforts. Not only that, but the various weight control treatments showed no significant differences in weight control effectiveness.
Another study of 417 women (Phyllis L Pirire. et al.) was conducted in which all participated in the American Lung Association's Freedom from Smoking clinic program. Other interventions given to some participants included nicotine gum and a behavioral weight control program. The weight control program included recommendations to decrease caloric intake, increase exercise activity, record calorie intake using calorie counters, and help to maintain a positive attitude about weight.
The women were randomly assigned to one of four groups:
- Freedom from Smoking
- Freedom from Smoking and nicotine gum
- Freedom from Smoking and behavioral weight loss program
- Freedom from Smoking, nicotine gum, and behavioral weight loss program
Surprisingly, the treatments (nicotine gum and behavioral weight control) did not have a significant effect of the weight gained by successful quitters.
But, the group that used Freedom from Smoking and nicotine gum had significantly more successful quitters then the group combining both treatments (Freedom from Smoking, nicotine gum, and behavioral weight loss program). This indicates that combining smoking cessation programs with weight control programs might produce an "overload" effect that detracts from attention to smoking cessation.
It seems that while adding complex weight control programs has little effect on weight gain, such programs do reduce quit rates. But, weight gain can be reduced by regulating the amount of nicotine you receive from nicotine replacement therapy.
During the use of transdermal nicotine replacement (the patch), weight gain appears to depend on the ratio of nicotine you receive (measured by cotinine levels in the blood) with the patch compared to the amount of nicotine you received by smoking.
If the patch provides less nicotine than you are used to, your hunger cravings are increased and you'll gain weight. If the patch provide as much or more nicotine than you get from smoking, you hunger cravings are significantly reduced and you'll gain significantly less weight.
After stopping use of the patch, weight gain was found to be independent of patch strength, gender, or initial weight. For those successful at quitting for one year, weight gain was approximately 16 pounds for women and 11 pounds for men.
In conclusion, it is likely that you will gain weight while quitting. You can reduce your weight gain by ensuring that your nicotine replacement therapy (NRT) initially replaces the nicotine your body expects from smoking.
References
- Young-Hwan Jo, David A Talmage & Loma W Role, Nicotine Receptor-Mediated Effects on Appetite and Food Intake, Journal of Neurobiology, 53(4), 618-632.
- Theodore V Cooper, Margaret Dundon, Benson M Hoffman & Colby J Stover, General and smoking cessation related weight concerns in veterans, Addictive Behaviors, v 31 (2006), 722-725.
- Matthew M Clark, Richard D Hurt, Ivan T Croghan, Christi A Patten, Paul Novotny, Jeff A Sloan, Shaker R Dakhil, Gary A Croghan, Edward J Wos, Kendrith M Rowland, Albert Bernath, Roscoe F Morton, Sachdex P Thomas, Loren K Tschetter, Steward Garneau, Phillip J Stella, Larry P Ebbert, Donald B Wender & Charles L Loprinzi, The prevalence of weight concerns in a smoking abstinence clinical trial, Addictive Behaviors, v 31 (2006), 1144-1152.
- Lowell C Dale, Darrell R Schroeder, Troy D Wolter, Ivana T Croghan, Richarc D Hurt & Kenneth P Offord, Weight Change After Snmoking Cessation Using variable Doese of Transdermal Nicotine Replacement, Journal of General Internal Medicine, v 13 (1998), 9-15.
- Sharon M Hall, Chrystal D Tunstall, Katharine L Vila & Joanne Duffy, Weight Gain Prevention and Smoking Cessation: Cautionary Findings, American Journal of Public Health, 82(6), 799-803.
- Gary E Swan & Dorit Carmelli, Characteristics Associated with Excessive Weight Gain after Smoking Cessation in Men, American Journal of Public Health, 85(1), 73-77.
- Phyllis L Pirire, Colleen M McBride, Wendy Hellerstedt, Robert W Jeffery, Dorothy Hatsukami, Sharon Allen & Harry Lando, Smoking Cessation in Women Concerned about Weight, American Journal of Public Health, 82(9), 1238-1243.
If you want to loose weight, you probably already know you must take in fewer calories than your body burns during the day. Here is a simple yet effective explanation:
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