Nutritional Pearls: Does Smoking Really Help with Weight Control?

Maggie is a 24-year-old woman who smokes. She tells you that she would like to quit smoking, but she is concerned about the weight she will gain after doing so.

How do you advise your patient?

What is the correct answer?
(Answer and discussion on next page)

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Answer: Quitting smoking is not directly related to gaining weight.

It's another piece of conventional wisdom that quitting smoking results in weight gain. Just why that might be isn't quite clear, but as we saw with "salty foods make you thirsty,” sometimes the conventional wisdom hasn't been investigated.
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The Research

A team of scientists in Oregon designed a prospective study to look at weight status among female college students: specifically comparing smokers to non-smokers. They note in their article that the largest age group of smokers in the United States is those between the 18 and 24 years old, and that college-age women often cite "weight control" as their reason for continuing (or starting) smoking. On the other hand, those who are thinking about quitting smoking often cite weight gain as one of their main concern for stopping tobacco use. 

The team recruited almost 400 women with body image concerns from a local university to participate in a body acceptance program.¹ Of those participants, 29 were smokers. The women were randomly assigned to either a once-weekly group-based eating disorder prevention program that met for 4 weeks, or provided with an educational brochure on eating disorders. At the start of the study, and at 1 month, 6 months, 1 year, and 2 years, the participants responded to questionnaires that included questions about smoking - whether they did, and if so, how much. Their height and weight were also measured at each interval.

About half (48%) of those who reported smoking said that they smoked on a daily or near-daily basis, but the majority of those (55%) said that they smoked only 1-2 cigarettes per day. Only 21% of the smokers reported smoking 9 cigarettes or more on those days they smoked.

The Results

Interestingly, those women who reported smoking had higher body mass indexes (BMI) at the start of the study, with a BMI average of 25 compared to non-smokers' average of 23.5. Over the course of the 2 years of the study, those who began as smokers and continued smoking throughout gained an average of 1.4 kilograms, and those who quit smoking during the study gained an average of 4.8 kilograms. Those who never smoked, however, gained an average of only 0.9 kilograms.

While this is a small study, it appears to disprove the idea that smoking helps with weight control. Keep in mind that those who smoked weighed more at the start of the study and all of the participants had body image problems. Those who use such ineffective measures to manage their weight as smoking, diet supplements, appetite suppressants, or laxatives tend to gain more weight over time than those who take a healthier approach

What’s The “Take Home”?

Tell your patients who are thinking about quitting smoking that they can learn to manage their weight in a healthful way without resorting to unhealthy habits or ineffective quack medicines. They can start by learning more about what a healthy diet really is by reading The Dr. Gourmet Healthy Eating Coaching Series - a series of brief essays on everything from "What is a healthy portion size?" to "How to read food labels."

Reference:

1. Eric Stice, C. Nathan Marti, Paul Rohde, Heather Shaw. Young woman smokers gain significantly more weight over 2-year follow-up than non-smokers. Appetite. 2015;85:155-159.