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Do You Have to Gain Weight When You Quit Smoking?

Tuesday, June 19, 2012 - 12:17Renee Despres

About 80 percent of people who stop smoking gain weight after they quit the cigarette habit. In our weight-obsessed society, that simple and incontrovertible fact is enough to make many a smoker – and ex-smoker – light another cigarette. However, you can break out of the cycle of quitting smoking, gaining weight, and starting smoking again, if you know the facts about quitting smoking and weight gain.

How Much Weight Will You Gain When You Quit Smoking?

“While it’s true that people do gain weight after stopping smoking, they don’t gain that much,” says Jonathan Bricker, PhD, a smoking cessation specialist at the Fred Hutchinson Cancer Center and the University of Washington. “Weight gain tends to be relatively modest,” says Bricker. “The average is 8 to 10 pounds for women and a little less for men.”  

There are wide variations in the amount of weight people gain after smoking. About 20 percent of people who quit smoking do not gain any weight at all. Bricker’s 8-to-10 pounds estimate is only an average – many people gain far less. On the other hand, about 10 percent of people gain 25 to 30 pounds or more.

Need Help Quitting Smoking?

Want to quit smoking, but need some help? Consider enrolling in WebQuit, an ongoing study of online smoking cessation programs. People who sign up for the program will be enrolled in one of two free online programs designed to help them quit smoking for good. For more information about WebQuit, see our interview with study director Jonathan Bricker, Ph.D. and visit the study website at www.webquit.org.

Five Common Myths about Smoking and Weight Gain
  • Myth #1: If I quit smoking, I’ll become obese
  • Busted: Most people who quit smoking gain a modest amount of weight – about 8 to 10 pounds for women and a little less for men. A very few people gain 20 pounds or more, and a very few people gain none at all.
  • Myth #2: Dieting is the best way to control my weight when I quit smoking.
  • Busted: People who try to diet and stop smoking at the same time tend to succeed at neither.
  • Myth #3: People gain weight after quitting smoking because metabolism decreases.
  • Fact: Nicotine has only a slight effect on metabolism. Nicotine and other substances in cigarettes suppress appetite. Having a cigarette after a meal makes you feel full longer. Instead of reaching for a snack when they’re hungry, many people reach for a cigarette. After you quit, you’ll feel more hungry. 
  • Myth #4:  The health risks of weight gain are equivalent to smoking.
  • Busted:  Overweight is a major public health problem, and it carries multiple health risks. But to experience the same level of health risks as you do if you smoke one pack a day, you’d have to be 100 pounds overweight.
  • Myth #5:  I can control weight gain by skipping meals.
  • Busted: Skipping meals only leads to a hungrier you– and often to poorer food choices. You may tend to binge or overeat more if you go for a long time between meals.

The more you smoked before you quit, the greater the amount of weight you’re likely to gain. A person who smoked two packs a day could expect to gain more weight than someone who smoked half a pack a day.

Expect to gain as much as five pounds the first week after you quit, due to water retention. Those pounds will disappear quickly as your body readjusts. But other pounds are likely to creep on more slowly and stick around longer.

Why Do Women Gain More Weight than Men?

After 20-plus years of smoking a pack a day, Sue finally quit smoking after a serious asthma attack left her gasping for air. Two years later, she ruefully patted her belly. She had gained about 20 pounds – mostly by substituting sweetened iced tea for cigarettes. Still, she said, it was worth it. She felt so much better overall, despite the extra weight. Now she just wished her husband could quit, too.

Researchers aren’t sure why women who quit smoking tend to gain more weight than do men, but a combination of cultural pressure to be thin and nicotine’s appetite-suppressant effects may come into play. Conversely, women’s concern about weight gain may make it for them to quit smoking. Women may be more likely to start with a negative body image – and body image, in turn, may worsen when women quit smoking, especially if they gain a few pounds (King et al., 2005).

Women are also more likely than men to use smoking for weight control. Studies suggest that up to 40 percent of women rely on the appetite suppressant effects of nicotine to help control their weight, compared to only 12 to 25 percent of men.

For some women, weight-control smoking may mask serious eating problems. Findings published in 1993 by a team of investigators from the University of Michigan suggest that many women weight-control smokers use nicotine to control underlying eating disorders and a form of excessive eating called hyperphagia. For the study, the women were divided into two groups – “weight-control” smokers and “non-weight-control” smokers. The women abstained from cigarettes for 48 hours and tracked their eating behaviors during that time. Women in the weight-control group gained more weight and said they felt hungrier than women in the non-weight-control group. Weight control smokers were also more likely to binge eat during the abstinence period.

Researchers said their findings suggested that female weight-control smokers may be relying on nicotine to control unpredictable or excessive eating. For these women, quitting smoking may precipitate underlying eating disorders, binge eating, and excessive weight gain.  These women may be at risk of gaining excessive weight – and quitting may be even harder for them.

Limiting Weight Gain: More than Just Vanity

Preventing or limiting weight gain after quitting smoking is more than a matter of vanity. Like smoking, overweight and obesity increase the risk of many diseases, including diabetes, heart disease, and stroke. Both obesity and smoking increase the risk of atherosclerosis, the buildup of plaque inside blood vessel walls that leads to stiff, inflexible vessels, sometimes described as “hardening of the arteries.”

When you quit smoking, your risk for heart and blood vessel disease starts to decrease almost immediately. But when you add a few pounds, the risks go up. For smokers who already have the beginnings of atherosclerotic plaque building up in their vessels, the picture may be more complex than previously thought.

Even a gain of six pounds might lessen the beneficial effects of quitting smoking on diabetes and atherosclerosis. Research published in 2011 suggests that weight gain might dampen some of the benefits of quitting smoking.  The research team, led by Fuminao Takeshima Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, Japan, tracked indicators of insulin resistance – a precursor to type 2 diabetes – and atherosclerotic changes in 28 men who successfully quit smoking. Some of the men gained weight after quitting, while some did not. The total average weight gain was about 6 pounds.

Takeshima’s team then measured factors in the men’s blood both one week and nine weeks after they quit smoking. Men who gained weight after quitting smoking had more indicators of insulin resistance and atherosclerosis than did men who did not gain weight. Researchers said that their findings strongly suggested that weight gain might counter some of the health benefits of quitting smoking.

Still, modest weight gain cannot approach the health risks of smoking. Smoking increases the risk of not diabetes and heart and blood vessel disease but the risk of lung disease, some cancers, and other health problems.

Did You Know?

Experts estimate that a pack-a-day habit results in the same health risks as a 100-pound weight gain.

Bricker concurs. “Modest weight gain, in terms of health and appearance, is far less important than the impact that each cigarette has on a person’s life,” he says. “You’re much better off gaining 8 to 10 pounds than you are not quitting smoking. Put it in perspective. By quitting smoking, you’re going to prolong your life.”

Why Do You Gain Weight When You Quit Smoking?

Conventional wisdom holds that a decrease in metabolism – how fast you burn energy – after you quit is the main reason for weight gain. “You can find that story all over the internet, but that’s actually a very minor contribution,” says Bricker. “Nicotine has only a minimal effect on speeding up metabolism.” 

Nicotine’s effect on appetite is far more important than its effect on metabolism. Nicotine cues the liver to release glycogen. Glycogen, in turn, increases your blood sugar level – and you feel less hungry, just as you would had you just eaten a meal.

“When you smoke after eating, it tends to suppress your appetite for longer,” say Bricker. “In-between-meal snacking is cut down by smoking. The smoker who reaches for a cigarette between meals is suppressing her appetite.” So if you reach for a cigarette instead of a candy bar during breaks at work, you won’t be eating those extra calories – and you won’t feel as hungry.

Without nicotine to suppress it, appetite rebounds. In addition, food tastes better after you quit smoking. Smoking interferes with the senses of taste and smell. For most people, the sense of taste and smell return to normal shortly after they quit. They may eat more simply because it’s tastier.

In addition, many newly quit smokers report craving sweet or fatty foods. They may instinctively be looking for a replacement for nicotine’s feel-good effects. Both nicotine and sugary, fatty, high-calorie foods cause the brain to release the same feel-good chemical, called dopamine. Alcohol also causes dopamine to be released – and many new quitters report increased alcohol consumption, as well.

Some people eat simply because it’s something to do. Instead of having a cigarette in their hands, they substitute food. “I had to keep my hands busy,” says Terri, who started smoking at 12 years old but quit when she was in her thirties without gaining a pound. “I learned how to crochet.”

Why Dieting Doesn’t Work

Want to guarantee that you’ll gain weight after you quit smoking and reduce the likelihood that you’ll quit successfully?

Diet.

 “It turns out dieting is a really bad idea when you’re trying to quit smoking,” says Becker. “It’s hard to change two behaviors at the same time. You’re setting yourself up to fail.”

Dieting is not necessary – and it may hamper your efforts to quit. Studies on dieting and quitting smoking show that people don’t do very well. For some people, dieting can increase the amount of weight they gain. Others may experience no impact. Even worse, dieting can interfere with quitting.

Becker emphasizes, “It seems like the logical thing to do. People think, People think, ‘If I’m gaining weight, maybe I should go on a diet.’ But it will only make life difficult.”

What Works?

So if appetite increases when you quit smoking, and dieting doesn’t work, what does?

There’s growing evidence that two strategies can help you prevent weight gain when you stop smoking: 1) therapy to help address your concerns about weight gain, and 2) physical activity. When the two are combined, the effects appear to be even stronger.

Cognitive Behavioral Therapy (CBT) Helps Smokers Quit and Minimize Weight Gain

A type of psychological counseling called cognitive behavioral therapy (CBT) seems to help smokers quit and maintain control over weight gain. In CBT, the person works with a therapist to uncover patterns of thinking that are maladaptive, as well as the beliefs that led to that thinking. For instance, a smoker might believe that she will be extremely unattractive and fat if she gains ten pounds, when in reality, she started out seven pounds underweight. A skilled CBT practitioner can help her to understand how untrue those beliefs are and find ways to control those thoughts when they arise.

CBT seems to help people quit smoking when the therapy focuses on helping people address concerns about weight gain (rather than the weight gain itself). Results published in 2001 by a research team led by Kenneth Perkins of the University of Pittsburgh show solid evidence of CBT’s effectiveness.

Perkins’ team randomly assigned 219 women smokers who were concerned about weight gain to three groups. Women in all three groups received group smoking cessation counseling. Each group also received one of three additional treatments: (a) behavioral weight control to prevent weight gain; (b) CBT to directly reduce weight concern, in which dieting was discouraged; and (c) standard counseling for smoking cessation, in which weight gain was not explicitly addressed.

Perkins’ team then assessed the women’s success at quitting at three points in time: directly after treatment, six months later, and one year later. In each case, women in the CBT group were more likely to have quit successfully. At one year, 21 percent of the CBT group remained quit, compared to only 13 percent of the weight control group and 9 percent of the standard treatment group.

Crucially, the women’s success at quitting smoking was not related to how much weight they gained, but to their attitude toward that weight gain. The researchers concluded that “CBT to reduce weight concerns, but not behavioral weight control counseling to prevent weight gain, improves smoking cessation outcome in weight-concerned women” (Perkins, 2001).

Exercise Helps Smokers Quit and Stay Slim Longterm

Perkins demonstrated that CBT addressed at weight concern can help women quit. But what about the weight itself? It’s one thing not to worry about the weight. It’s another not to gain it.

That’s where exercise comes into play. Exercise seems to be the most promising answer to actually reducing weight gain and stopping smoking successfully. One of the most compelling studies of the effect of exercise on post-quit weight gain was published in 1996 by a team from Harvard University in Boston, Massachusetts. Investigators analyzed data from two years of the Nurses' Health Study, an ongoing cohort of 121,700 US women aged 40 to 75. Among 1474 women who stopped smoking, the average weight gain over 2 years was 6.6 pounds (3.0 kg). However, women who exercised moderately gained only 4 pounds (1.8 kg), and women who exercised vigorously gained even less –2.9 pounds (1.3 kg). The researchers concluded that even moderate physical activity after quitting smoking minimizes initial weight gain and prevents it over the long term.

Exercise may help quitters prevent weight gain and stay quit if it’s combined with CBT to address weight concerns. In 1999, a research team from Brown University in Providence, Rhode Island published results showing that weight-concerned women who received CBT and participated in an exercise program were twice as successful at quitting smoking and gained 40 percent less weight than a control group.

For the study, the Brown researchers recruited nearly 300 healthy women smokers and divided them into two groups. Women in one group participated in a 12-week CBT smoking cessation program, while women in a second group attended the same CBT program but also attended three supervised exercise sessions per week.

At the end of the study, nearly 20 percent of the women in the exercise group had successfully quit smoking, compared to 10 percent in the CBT group. The lung capacity of the women who exercised increased and they gained less weight – an average of 6.7 pounds (3.05 kg) by the end of treatment, compared to 11.2 pounds (5.40 kg) for the CBT-only group. A year later, the difference was still the same.

The researchers concluded that vigorous exercise, when combined with a cognitive-behavioral smoking cessation program, helps women quit smoking, improves their capacity for exercise, and delays weight gain following smoking cessation.

When and how should you phase in an exercise program? “After you’ve been smoke free for a couple of months, phase in exercise,” advises Bricker. “Your exercise program should be phased in gradually to avoid changing two major things at once.” He suggests starting with brisk walking and gradually increasing the distance you walk. Other alternatives include light exercise at the gym, aerobics, or yoga.

Need to Know

Before starting any exercise program, get a thorough physical from your doctor. A physical exam is especially important if you’re 45 or older.

If you were already exercising before quitting smoking, bring up the intensity gradually and modestly, Bricker advises. “Go up to three times a week, 20 to 45 minutes a session useful as a strategy to help stave off weight gain. Exercise can also help to control appetite.”

How to Prevent Weight Gain When You Quit Smoking

Can you quit smoking without gaining weight?  Probably not, at least in the short run. But you can take some concrete steps toward minimizing that weight gain.

Preventing or minimizing weight gain and successfully quitting smoking require a combination of attitude, acceptance, consistency, and awareness. “Be open to the reality that you probably will gain some weight,” says Becker. “Realize your appearance is going to be affected in a relatively minor way by weight gain. You’re going to feel so much better. You’re going to be healthier and have more energy. Your skin’s going to look better. You’re going to smell better and enjoy your life more, even if you gain the average amount of weight.

“Imagine what your life is going to be like after you quit smoking. It’s going to change in some pretty wonderful ways.”

If you starting from that premise, you can take some concrete steps to prevent or limit weight gain – and quit successfully. Here are some practical tips and tricks for quitting smoking without putting on (too many) extra pounds:

Quit with Awareness and Planning

  • Accept that you’re probably going to gain some weight, and don’t beat yourself up about it. Your life will be better – and likely longer – if you quit and stay quit.
  • Address any concerns you have about weight. Seek help from a qualified mental health professional, such as a psychologist, psychiatrist, or social worker who is trained in cognitive behavioral therapy and smoking and other addictions.
  • Set one goal at a time. Make stopping smoking your primary goal. Weight control can follow. By setting one goal at a time, you crease your chance achieving both goals.
  • Identify situations that will bring on an urge to smoke – or to eat – and plan how you will deal with them. For instance, if you always have a donut and cigarette with your morning coffee, try a healthier alternative. A chewy, toasted bagel with low-fat cream cheese and a bowl of melon will leave you far more satisfied. And without the donut “cue,” you might lessen the craving for a cigarette, too.
  • Get enough sleep. If you’re tired and cranky, you’re more likely to experience cravings for both cigarettes and food – especially high-calories foods.
  • Create a support network. “We know that having a spouse or close friends who smoke is a challenge to staying quit,” says Becker. “We advise people to form relationships with nonsmokers who model healthy behaviors like exercise. They can provide support during the process of quitting or help you to stay quit. Having people who care about you who are nonsmokers there to keep you from slipping are really key, important factors in quitting.”

Make Conscious Food Choices

  • Don’t diet. Focus on eating healthier foods, as opposed to limiting calories or following a rigid diet plan. High-fiber foods will make you feel fuller for longer periods. Make whole grains, fruits, and vegetables the foundation of your diet. Get protein from lean meats, poultry, fish, legumes, and low-fat dairy products. Limit high-fat foods like nuts, oils, and butter.
  • Snack well. When people quit smoking, they tend to snack more frequently. Keep a handful of clean, ready-to-eat fruits and veggies in the fridge. Pack baby carrots, fruits, air-popped popcorn, low-fat yogurt, and other healthful choices in your lunchbox. Add a small amount of fat to your snacks to make you feel full – just don’t overdo it.
  • Follow your palate. Food may taste better than it did when you were a smoker. Smoking damages your sense of taste and smell, but when you quit, those senses return largely to normal. Food may seem more flavorful. Try adding less salt and sugar – and enjoy the taste of the food itself.
  • Limit caffeine. Nicotine withdrawal can make you jittery and nervous. Caffeine can make you… jittery and nervous. Combined, the two can make you miserable.
  • Keep your mouth busy. Sugar-free hard candies, gum, or fruit can help keep your mouth busy and satisfy sweet cravings.
  • Keep your hands busy. Take up a craft like knitting, crochet, or woodworking. They’re all calorie-free.
  • Think before you drink. While you want to increase your fluid intake, beware of hidden calories. Water is almost always the number one choice for quenching your thirst. Tea, coffee, sparkling water, and other low- or zero-calorie beverages can add a little variety. Avoid fruit juices, sodas, and drinks containing high fructose corn syrup, including regular sodas and widely marketed “health” drinks. Sweetened iced tea or other drinks containing high fructose corn syrup can add sugar and unwanted calories to your waistline in a heartbeat. For instance, Arizona Lemon Iced Tea contains 11 calories per ounce. Drink a 20-ounce per bottle, and you’ve just downed a whopping 222 calories. Those calories can add up fast without making you feel full or satisfied.
  • Limit alcohol. Many people report craving alcohol after they quit smoking. Drink a 12-ounce frozen margarita, and you’ve just consumed the equivalent of a meal – 540 calories – in sugar. A strong, dark beer can run upwards of 300 calories, while a standard can of Budweiser will add 145 calories to your waistline. And you’re really going to drink only one?
  • Indulge. Many people experience cravings for sweet and fatty foods after they stop smoking. Indulge those cravings, but limit them. Allow yourself a sweet only after you’ve eaten a healthy meal (remember when Mom used to say you could only have dessert after you finished your meal? She was right). Try lower-calorie substitutes – for example, frozen yogurt for ice cream. Above all, try not to make yourself feel deprived.

 

Exercise

  • Commit time to exercise. Set aside 20 to 45 minutes each day for a walk, run, bicycle, swim, or other form of aerobic exercise. Do strengthening exercises – for example, weight lifting or Pilates – at least twice a week.
  • Make physical activity part of your life. Incorporate exercise into your everyday routine, instead of making it something you only do when you set aside the time to do it. You don’t have to go to the gym to exercise. Take the stairs instead of the elevator. Bicycle to pick up the kids after school, and bicycle home with them. Walk the dog every night.
  • Turn exercise into a social event. Join a walking, running, cycling, or swimming club. You’ll be doing yourself a triple favor. You’ll build friendships, you’ll hang around with people who don’t smoke, and you’ll probably exercise more frequently, longer, and harder. Besides, you’ll have more fun.
  • Set goals. If you’re the goal-driven type, set exercise goals for yourself. Establish a date by which you will run or walk a 5K, climb a mountain, complete a bicycle tour, or compete in a local tournament. Your goal can be as lofty as you want it to be. Then set little goals along the way.

 

References

Bricker, Jonathan. Interview June 15, 2011.

Inoue, K., Takeshima, F., Kadota K., Yoda, A., Tatsuta Y., Nagaura Y., et al. (2011). Early Effects of Smoking Cessation and Weight Gain on Plasma Adiponectin Levels and Insulin Resistance. Intern Med 50: 707-712, 2011 DOI: 10.2169/internalmedicine.50.4600

Kawachi, I., Troisi, R.J., Rotnitzky, A.G., Coakley, E.H., & Colditz, G.A. (1996). Can physical activity minimize weight gain in women after smoking cessation? American Journal of Public Health, 86:7. Pp 999-1004.

King T.K., Matacin M., White K.S., Marcus B.H. A prospective examination of body image and smoking cessation in women. Body Image. 2005 Mar;2(1):19-28.

Marcus, B.H., Albrecht, A.E., King, T.K., Parisi, A.F., Pinto, B.M., Roberts, M., Niaura, R.S., & Abrams, D.B. (1999). The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med. 159(11):1229-34.

Parsons AC, Shraim M, Inglis J, Aveyard P, Hajek P. (2009). Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev. (1):CD006219. Review.

Perkins KA, Levine MD, Marcus MD, Shiffman S. (1997) Addressing women's concerns about weight gain due to smoking cessation. J Subst Abuse Treat. 14(2):173-82. Review.

Perkins, K.A., Marcus, M.D., Levine, M.D., D'Amico, D, Miller, A., Broge, M, et al. (2001). Cognitive–behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women.  Journal of Consulting and Clinical Psychology,  69(4), pp. 604-613. doi: 10.1037/0022-006X.69.4.604

Pomerleau, C.S., Ehrlich, E., Tate, J.C., Marks, J. L., Flessland, K.A., & Pomerleau, O.F. (1993). The female weight-control smoker: A profile.  Journal of Substance Abuse 5(4), pp. 391-400. Available at http://hdl.handle.net/2027.42/31081