Thin is in!

By now, most people know that quitting tobacco is one of the best things that you can do for your health.  So when people know that smoking accounts for over 440,000 deaths each year, mostly from cancer and cardiovascular disease, why do only 40% want to quit?  It turns out the fear of gaining weight plays a significant role in many women’s decisions to continue smoking.  It may seem vain, or even foolish, but weight gain after quitting smoking is very real.  Though often underestimated as a 5-7 pound gain, a recent study by the Cochrane Database, a leading organization for the review of medical literature, confirms the average weight gain after smoking cessation is 15 pounds, most of which is fat.  More than just being unsightly, increased body fat can increase the risks for many other diseases.  In fact, a recent study published in the Annals of Internal Medicine found that recent ex-smokers are at increased risk of developing diabetes, primarily due to weight gain.

Why does smoking make you thinner?

Researchers have observed for many years that in general, smokers have a lower body weight than their non-smoking counterparts, and have attributed this fact to the increased energy expenditure (by way of a higher metabolism) and the appetite suppressing effects of nicotine. Fat oxidation, the process by which we mobilize and use fat for energy, actually increases with nicotine use.  Post-cessation weight gain is thought to be due to the withdrawal of nicotine and the subsequent decrease in metabolic rate, altered food choices or increased eating as a substitute for the psychological and behavioral effects of smoking.  In other words, you start to feel hungrier, you choose less healthy foods, seek to eat more often, your metabolism slows down and you store more fat. Weight gain is nearly universal among those attempting to quit, and is frequently between 5-10% of  body weight.  Researchers at the University of Texas, in San Antonio, Texas, have found that nicotine influences several neuropeptides (chemical messengers, including orexin, leptin and insulin) that affect feeding behavior and fat storage.  In their study, nicotine treated rats lost about 20% more body fat compared to the control group.  Due to the dangers of tobacco use (and the enormous profits to be made) Big Pharma is currently searching for potential drugs that can mimic the effects of nicotine for weight loss.

Quitting and Restarting Smoking Worse for Weight Gain

Yo-Yo dieter Oprah Winfrey learned a hard lesson

Most smokers who try to quit make several attempts before eventually quitting, or

more likely, before giving up.  Each attempt may be accompanied by more weight gain. In fact, the cycle of starting and stopping smoking can have the same effect on weight gain as “yo-yo dieting.” Frequent dieters encounter a phenomenon where with each

attempt, the weight loss becomes less and less while the subsequent gain when coming off the diet becomes more and more.  Though not as persistent of an effect, researchers have found that

in rats, just one period of nicotine administration and cessation results in changes comparable to that caused by a period of food restriction and re-feeding.

So What Do You Do?

All authorities agree that the benefits of tobacco cessation far outweigh the risks of the associated weight gain. If you smoke tobacco, you should quit. But let’s be realistic for a moment.  Nearly 90% of smokers who try to quit will not succeed long term.  Nicotine replacement therapy (NRT) and other medicines like Zyban (buproprion) can improve success rates significantly, but still have 70-80% failure rates.  Nearly 100% of smokers who try to quit will gain weight, most of which happens in the first few months.  That leaves a pretty high percentage of people who don’t benefit from quitting but get punished for trying.  Though NRT has been shown to be effective in decreasing post-cessation weight gain (only a pound or two less), doctors need to be aware that weight gain is a serious concern for their patients who are trying to quit and should make every effort to support them.

For the vast majority of smokers who fail to quit, the choice the doctors should be concerned about is not just the risk benefit analysis of quitting vs. smoking. That’s obvious and that’s too easy. It needs to include the risk benefit analysis of how a person continues to use nicotine.  When the majority of health risks and premature deaths caused by smoking are NOT caused by nicotine but rather by the chemicals and carcinogens found in tobacco, safer nicotine delivery devices need to be considered.

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