Characteristics associated with excessive weight gain after smoking cessation in men

Substitutability of nicotine and sucrose in rats: A behavioral economic analysis

Despite considerable evidence suggesting that sweet foods are a substitute for nicotine in humans, no formal behavioral economic analysis of this interrelationship has been conducted in nonhumans. The purpose of the present study was to examine this phenomenon in rats using concurrent schedules of sucrose pellet, chow pellet, and nicotine reinforcer delivery. Rats responded on separate levers that delivered sucrose pellets, chow pellets, or nicotine infusions under concurrent fixed-ratio (FR) 1 schedules for each commodity within a closed economy. Following stable food and nicotine intake, the unit price of either sucrose or nicotine (the primary commodity) was increased while the two alternative commodities remained unchanged. Substitution was quantified using a behavioral economic cross-price model, as well as a novel commodity relation index that normalizes consumption of dissimilar commodities. Asymmetrical partial substitution was observed, wherein sucrose served as a partial substitute for nicotine, but nicotine failed to substitute for sucrose. Moreover, sucrose was a stronger partial substitute for nicotine than chow in most rats. These findings indicate that substitution of food for nicotine depends on the type of food. These findings mirror the selective increase in carbohydrate intake that can occur during smoking cessation and demonstrate a behavioral economic mechanism that may mediate it.

Race differences in predictors of weight gain among a community sample of smokers enrolled in a randomized controlled trial of a multiple behavior change intervention

African Americans have disproportionate rates of post-cessation weight gain compared to non-Hispanic whites, but few studies have examined this weight gain in a multiracial sample of smokers receiving evidence-based treatment in a community setting. We examined race differences in short-term weight gain during an intervention to foster smoking cessation plus weight management.

Data were drawn from the Best Quit Study, a randomized controlled trial conducted via telephone quitlines across the U.S. from 2013 to 2017. The trial tested the effects on cessation and weight gain prevention of adding a weight control intervention either simultaneously with or sequentially after smoking cessation treatment. African Americans (n = 665) and whites (n = 1723) self-reported smoking status and weight during ten intervention calls. Random effects longitudinal modeling was used to examine predictors of weight change over the intervention period (average 16 weeks).

There was a significant race × treatment effect; in the simultaneous group, weight increased for African Americans at a faster rate compared to whites (b = 0.302, SE = 0.129, p < 0.05), independent of smoking status, age, baseline obesity, and education. After stratifying the sample, the effect of treatment group differed by race. Education level attenuated the rate of weight gain for African Americans in the simultaneous group, but not for whites.

African Americans receiving smoking and weight content simultaneously gained weight faster than whites in the same group; however, the weight gain was slower for African Americans with higher educational attainment. Future studies are needed to understand social factors associated with treatment receptivity that may influence weight among African American smokers.

Early weight gain after stopping smoking: a predictor of overall large weight gain? A single-site retrospective cohort study

OBJECTIVES

Most people gain weight on stopping smoking but the extent of weight gain varies greatly. Interventions aimed at all quitters to prevent weight gain on cessation have proven unpopular but targeting people who have gained excess weight immediately after quitting may improve uptake and cost-effectiveness. We examined whether early large postcessation weight gain predicts overall large weight gain.

DESIGN

Retrospective cohort study.

SETTING

Primary care setting-smoking cessation centre in Prague, Czech Republic.

PARTICIPANTS

Out of 3537 patients treated between 2005 and 2013, 1050 were continuous abstainers (verified by carbon monoxide measurement) at 1-year follow-up and formed the cohort of the current report. 48.7% were women (n=511) with the mean age of 46 (±14.4) years.

METHODS

In this retrospective cohort study, all patients underwent usual tobacco dependence treatment using evidence-based methods. Weight was measured prior to smoking cessation and at each visit after quitting.

RESULTS

The mean weight gain in the first month (n=763) was 0.79% (±2.03%), in the second month (n=646) was 1.49% (±2.58%), for the third month (n=566) 2.33% (±3.44%) and 4.1% (±5.31%) after 1-year follow-up (n=1050). The regression coefficient per 1% rise in the first 3 months was +0.13% (95% CI -0.04% to 0.30%). A receiver operating curve analysis showed that patients gaining more than 0.98% of their baseline weight during first 3 months had a sensitivity of 66% and specificity of 44% for gaining 7% or more weight by 12 months. In addition, lower body mass index and an increase in appetite at 3 months after quitting were associated with greater weight gain, while using nicotine replacement therapy was associated with less weight gain at 1-year follow-up.

CONCLUSIONS

People who stop smoking and gain a larger amount of weight early after quitting are not more likely to gain excessively at 1 year.

Anthropometric and body composition changes in smokers vs abstainers following an exercise-aided pharmacotherapy smoking cessation trial for women

INTRODUCTION

Post-cessation weight gain contributes to smoking relapse, especially for women. Furthermore, excess weight in the form of android or visceral fat is associated with metabolic health problems. For this study, a secondary analysis was conducted in 2015 to determine whether quitting status, achieved through a 14 week supervised exercise-aided nicotine replacement therapy (NRT) cessation program [Getting Physical on Cigarette Trial-2009 to 2013; Prapavessis, et al., 2016], affects anthropometric and body composition parameters in female smokers (N = 413, M age = 42.39 years).

METHODS

Anthropometric (weight and BMI) and body composition (% total body fat, % android fat, lean mass and visceral fat) indices were assessed at baseline and end of treatment. Smoking status was confirmed weekly from expired breath carbon monoxide. Adherence to exercise and NRT patch was calculated from the number of exercise sessions attended and patches worn to the number of exercise sessions offered and patches supplied, respectively.

RESULTS

Factorial (smoking status) ANCOVAs controlling for baseline anthropometric and body composition parameters as well as adherence to exercise and NRT revealed significant differences in weight (p = .033; ɳ_p² = 0.017) and BMI (p = .020; ɳ_p² = 0.020) at week 14. This equated to abstainers weighing 1.26 kg more and having a 0.52 higher BMI than smokers. No significant differences were found for any of the body composition parameters at week 14 (ɳ_p² range from 0.001-0.007).

CONCLUSIONS

Abstainers gain modest weight compared to smokers. This weight gain is related to increases in lean mass and not total, android, or visceral fat.

Prevalence of smoking in Sudanese individuals with diabetes and associated complications: Population-based study

INTRODUCTION

Smoking cigarettes and diabetes are major public health problems in Sudan. Smoking is associated with insulin resistance and can be associated with type 2 diabetes. The aim of this study was to investigate the prevalence of smoking in individuals with diabetes and associated complications.

METHODOLOGY

a descriptive analytical cross-sectional study, included 315 of participants with diabetes. The data collection was performed to gather demographic information, prevalence of smoking and presence of complications. In addition to measurement of blood pressure, weight and height measurement for calculation of body mass index and biochemical tests. Statistical association at p.value of 0.05 was measured using T-test for quantitative data and Chi square test for categorical data.

RESULTS

The overall prevalence of smoking was found to be 33.9%. Smoking was statistically significant associated with being male; increase in age; and being married. HbA1c and triglycerides are significantly associated with smoking (P value = 0.01 and 0.05 respectively); therefore, statistical significance was found with ischemic heart disease(IHD) as well (P value = 0.05). Hypertension, duration of diabetes, low density lipoprotein (LDL), cholesterol and body mass index (BMI) were not statistically significant with smoking.

CONCLUSION

Almost third of the population with diabetes are smokers (33.9%). Smoking is statistically associated with IHD, high triglyceride and HbA1c. Therefore, smoking cessation schemes should be advocated by health authorities and the public in Sudan.

Association of current and former smoking with body mass index: A study of smoking discordant twin pairs from 21 twin cohorts

Background

Smokers tend to weigh less than never smokers, while successful quitting leads to an increase in body weight. Because smokers and non-smokers may differ in genetic and environmental family background, we analysed data from twin pairs in which the co-twins differed by their smoking behaviour to evaluate if the association between smoking and body mass index (BMI) remains after controlling for family background.

Methods and findings

The international CODATwins database includes information on smoking and BMI measured between 1960 and 2012 from 156,593 twin individuals 18–69 years of age. Individual-based data (230,378 measurements) and data of smoking discordant twin pairs (altogether 30,014 pairwise measurements, 36% from monozygotic [MZ] pairs) were analysed with linear fixed-effects regression models by 10-year periods. In MZ pairs, the smoking co-twin had, on average, 0.57 kg/m² lower BMI in men (95% confidence interval (CI): 0.49, 0.70) and 0.65 kg/m² lower BMI in women (95% CI: 0.52, 0.79) than the never smoking co-twin. Former smokers had 0.70 kg/m² higher BMI among men (95% CI: 0.63, 0.78) and 0.62 kg/m² higher BMI among women (95% CI: 0.51, 0.73) than their currently smoking MZ co-twins. Little difference in BMI was observed when comparing former smoking co-twins with their never smoking MZ co-twins (0.13 kg/m², 95% CI 0.04, 0.23 among men; -0.04 kg/m², 95% CI -0.16, 0.09 among women). The associations were similar within dizygotic pairs and when analysing twins as individuals. The observed series of cross-sectional associations were independent of sex, age, and measurement decade.

Conclusions

Smoking is associated with lower BMI and smoking cessation with higher BMI. However, the net effect of smoking and subsequent cessation on weight development appears to be minimal, i.e. never more than an average of 0.7 kg/m².

Association between smoking cessation and weight gain in treatment-seeking African Americans

INTRODUCTION

Research has shown that African Americans gain more than average weight after smoking cessation. However, African Americans have been underrepresented in post-cessation weight gain research. The current study examined 1) the pattern of weight gain and 2) the association between smoking status and weight gain in a sample of African Americans seeking smoking cessation treatment.

METHODS

Data were drawn from a randomized controlled trial testing the efficacy of a 4-week culturally specific smoking cessation cognitive behavioral therapy (CBT) intervention among African American smokers (N = 342). Weight was measured and self-reported smoking status was biochemically verified at baseline, end of counseling, 3-, 6-, and 12-month follow-ups. Random effects multilevel modeling was used to examine weight gain over twelve months post CBT, and a fully unconditional model tested the pattern of weight gain over time. Smoking status was included as a time-varying factor to examine its effect on weight gain, controlling for potential confounding variables.

RESULTS

Weight significantly increased among those who remained abstinent over 12 months post CBT [average gain of seven lbs. (three kg)]. Controlling for covariates, abstinence was predictive of the rate of weight gain for those with high weight concern.

CONCLUSIONS

Weight gain among African American abstainers was comparable to the average post-cessation weight gain observed among the general population. It is possible that exposure to CBT (culturally specific or standard) may have mitigated excessive weight gain. Future research should assess predictors of weight gain in African American smokers to inform future smoking cessation interventions and help elucidate factors that contribute to tobacco- and obesity-related health disparities.

Smoking Cessation and Changes in Body Mass Index: Findings From the First Randomized Cessation Trial in a Low-Income Country Setting

Background

In high-income countries, quitting cigarette smoking is associated with weight gain, which can reduce motivation to abstain. Whether smoking cessation is associated with weight gain in a low-income country context has never been investigated. We aimed to determine the post-cessation changes in body mass index (BMI) and its predictors among smokers who received a smoking cessation intervention in a low-income country setting.

Methods

We performed post hoc analyses of data from 269 smokers who participated in a two-group, parallel-arm, double-blind, placebo-controlled randomized trial of combined nicotine replacement therapy (NRT) and behavioral counseling in primary care clinics in Aleppo, Syria. We used generalized estimating equation modeling to identify predictors of changes in BMI at 6 weeks and 6- and 12-month follow-ups after quit date.

Results

The mean pre-cessation BMI of the sample was 27.9kg/m2 (SD = 5.2). Over 12 months of follow-up, BMI of smoking abstainers averaged 1.8 BMI units (approximately 4.8kg) greater than non-abstainers (p = .012). Throughout the study, greater BMI was associated with being female (p = .048), reporting smoking to control weight (p < .001) and having previously failed to quit due to weight gain (p = .036).

Conclusion

Similar to findings from high-income countries, smoking cessation in Syria is associated with weight gain, particularly among women and those who have weight concerns prior to quitting. This group of smokers may benefit from tailored cessation interventions with integrated body weight management elements that take into consideration the prevailing local and cultural influences on diet and levels of physical activity.

Implications

This study provides the first evidence regarding post-cessation changes in BMI among smokers who attempt to quit in a low-income country setting. Our findings advance knowledge regarding post-cessation weight gain and offers insight for researchers and clinicians to identify smokers at higher risk of post-cessation weight gain. This information will help in delivering interventions that take into account the prevailing cultural influence on diet and physical activity and will ultimately help in designing future tailored cessation programs in Syria and other low-income countries with similar cultural background and level of development.

Obesity Might Be a Predictor of Weight Reduction after Smoking Cessation

BACKGROUND AND OBJECTIVES

Approximately one in five ex-smokers reduces or maintains weight after smoking cessation but little is known about who succeeds to avoid weight gain. The purpose of this study was to identify predictors of weight reduction after long-term smoking cessation in a general population.

METHODS

Data was obtained from two Danish population-based cohorts (the Inter99 and the Helbred2006 study). Anthropometric measurements were performed by trained research staff. Out of 3.577 daily smokers at baseline 317 participants had quit smoking at the five-year follow-up for at least one year. Multiple logistic regression analysis was performed to determine predictors of weight reduction.

RESULTS

Thirteen percent reduced weight by at least 1 kg and 4% maintained their weight. Quitters with obesity had more than seven times higher odds than normal weight quitters to lose weight (OR 7.13 (95% CI 2.76-19.71)), and they had the largest median weight loss of 4.45 kg. The only other significant predictor of weight reduction was low tobacco consumption at baseline.

CONCLUSIONS

Predictors of weight reduction after smoking cessation were high body mass index and low tobacco consumption at baseline. This study might motivate smokers with obesity to quit smoking and health professionals to give them support.

Lifestyle correlates of overweight in adults: a hierarchical approach (the SPOTLIGHT project)

BACKGROUND

Obesity-related lifestyle behaviors usually co-exist but few studies have examined their simultaneous relation with body weight. This study aimed to identify the hierarchy of lifestyle-related behaviors associated with being overweight in adults, and to examine subgroups so identified.

METHODS

Data were obtained from a cross-sectional survey conducted across 60 urban neighborhoods in 5 European urban regions between February and September 2014. Data on socio-demographics, physical activity, sedentary behaviors, eating habits, smoking, alcohol consumption, and sleep duration were collected by questionnaire. Participants also reported their weight and height. A recursive partitioning tree approach (CART) was applied to identify both main correlates of overweight and lifestyle subgroups.

RESULTS

In 5295 adults, mean (SD) body mass index (BMI) was 25.2 (4.5) kg/m2, and 46.0 % were overweight (BMI ≥25 kg/m2). CART analysis showed that among all lifestyle-related behaviors examined, the first identified correlate was sitting time while watching television, followed by smoking status. Different combinations of lifestyle-related behaviors (prolonged daily television viewing, former smoking, short sleep, lower vegetable consumption, and lower physical activity) were associated with a higher likelihood of being overweight, revealing 10 subgroups. Members of four subgroups with overweight prevalence >50 % were mainly males, older adults, with lower education, and living in greener neighborhoods with low residential density.

CONCLUSION

Sedentary behavior while watching television was identified as the most important correlate of being overweight. Delineating the hierarchy of correlates provides a better understanding of lifestyle-related behavior combinations which may assist in targeting preventative strategies aimed at tackling obesity.

Smoking cessation and long-term weight gain in the Framingham Heart Study: an application of the parametric g-formula for a continuous outcome

Weight gain after smoking cessation can lessen the health benefits of, and reduce the incentives for, quitting smoking. Randomized clinical trials of smoking cessation have estimated this weight gain only over short periods of follow-up. We provide an estimate of long-term post-cessation weight gain in the Framingham Heart Study, a prospective observational study. We identified 2001 smokers free of diabetes, cancer, and cardiovascular disease in 1952. Using the parametric g-formula we estimated mean weight in 1972 if all smokers had quit at baseline versus if all had continued smoking. Our estimates were adjusted for demographic, socio-economic, and clinical factors at baseline and during follow-up. The estimated mean weight (95 % CI) at 20 years if all smokers had quit smoking was 75.2 kg (73.5, 76.6), compared with 70.2 kg (68.7, 71.8) if they had smoked 20 cigarettes/day and 73.4 kg (71.9, 74.6) if they had smoked 5 cigarettes/day (i.e., an estimated mean weight gain of 5.1 kg (3.1, 6.6) and 1.8 kg (0.8, 2.8), respectively). Smokers who were overweight or obese at baseline had a greater post-cessation weight gain on average. Our estimates suggest that smoking cessation can result in increases in body weight over 20 years. While the benefits of smoking cessation outweigh the risks due to post-cessation weight gain, our results highlight the need for long-term weight management interventions in combination with smoking cessation.

The effect of tobacco cessation on weight gain, obesity, and diabetes risk

OBJECTIVE

Most smokers gain weight after quitting, and some develop new onset obesity and type 2 diabetes. The purpose of this paper is to synthesize the current science investigating the consequences of tobacco cessation on body weight and diabetes, as well as intervention strategies that minimize or prevent weight gain while still allowing for successful tobacco cessation.

METHODS

Systematic reviews and relevant studies that were published since prior reviews were selected.

RESULTS

Smoking cessation can cause excessive weight gain in some individuals and can be associated with clinically significant outcomes such as diabetes or obesity onset. Interventions that combine smoking cessation and weight control can be effective for improving cessation and minimizing weight gain but need to be tested in specific populations.

CONCLUSIONS

Despite the health benefits of quitting tobacco, post-cessation weight gain and new onset obesity and diabetes are a significant concern. Promising interventions may need to be more widely applied to reduce the consequences of both obesity and tobacco use.

Association between Smoking Status and Obesity in a Nationwide Survey of Japanese Adults

OBJECTIVE

A positive association between the number of cigarettes smoked per day and obesity has been reported, whereas how other smoking-related indices, such as pack-years and duration of smoking, are related with obesity has been less investigated. We analyzed the age-adjusted cross-sectional association between smoking and obesity in a general Japanese population.

METHODS

We used data from a nationwide epidemiological study of Japanese adults (N = 23,106). We compared the prevalence of obesity (defined as body mass index ≥ 25kg/m2) among groups classified by smoking behavior, pack-years, number of cigarettes per day, duration of smoking, and duration and time of smoking cessation.

RESULTS

In men, current smokers had a lower odds ratio (OR) for obesity of 0.80 (95% confidence interval (CI): 0.72-0.88) compared to non-smokers, whereas past smokers had a higher OR of 1.23 (95% CI: 1.09-1.37) compared to current smokers. In women, there were no differences in obesity between the three groups classified by smoking behavior. However, in both sexes, the prevalence of obesity tended to increase with pack-years and the number of cigarettes per day, but not with duration of smoking in current and past smokers. Further, in male smokers, the risks for obesity were markedly higher in short-term heavy smokers compared with long-term light smokers, even with the same number of pack-years. Regarding the impact of smoking cessation, female past smokers who quit smoking at an age > 55-years had an elevated OR of 1.60 (95% CI:1.05-2.38) for obesity.

CONCLUSIONS

In a general Japanese population, obesity is progressively associated with pack-years and number of cigarettes per day, but not with the duration of smoking. When investigating the association between obesity and cigarette smoking, the daily smoking burden and the duration of smoking require to be independently considered.

The role of BMI change on smoking abstinence in a sample of HIV-infected smokers

The prevalence of cigarette smoking among persons living with HIV/AIDS (PLWHA) is approximately 40%, significantly higher than that of the general population. Identifying predictors of successful smoking cessation for PLWHA is necessary to alleviate the morbidity and mortality associated with smoking in this population. Weight gain has been associated with smoking relapse in the general population, but has not been studied among PLWHA. Data from 474 PLWHA enrolled in a smoking cessation randomized clinical trial were analyzed to examine the effect of BMI change, from baseline to 3-month follow-up, on smoking outcomes using multiple logistic regression. The odds of 7-day smoking abstinence at 3-month follow-up were 4.22 (95% CI = 1.65, 10.82) times higher for participants classified as BMI decrease and 4.22 (95% CI = 1.62, 11.01) times higher for participants classified as BMI increase as compared to participants with a minimal increase or decrease in BMI. In this sample, both weight gain and loss following smoking cessation were significantly associated with abstinence at 3-month follow-up among HIV-infected smokers. Further research and a better understanding of predictors of abstinence will encourage more tailored interventions, with the potential to reduce morbidity and mortality.

The association between quitting smoking and weight gain: a systematic review and meta-analysis of prospective cohort studies

This systematic review and meta-analysis aimed to quantify weight gain after smoking cessation and the difference in weight gain between quitters and continuing smokers. Five electronic databases were searched before January 2015. Population-based prospective cohort studies were included if they recorded the weight change of adult smokers from baseline (before smoking cessation) to follow-up (at least 3 months after cessation). Thirty-five cohort studies were identified, including 63,403 quitters and 388,432 continuing smokers. The mean weight gain was 4.10 kg (95% confidence interval [CI]: 2.69, 5.51) and body mass index (BMI) gain was 1.14 kg m(-2) (95% CI: 0.50, 1.79) among quitters. Compared with continuing smoking, quitting smoking was significantly associated with absolute weight (adjusted mean difference [MD]: 2.61 kg; 95% CI: 1.61, 3.60) and BMI gain (adjusted MD: 0.63 kg m(-2) ; 95% CI: 0.46, 0.80). Subgroup analyses using geographic region found that the difference in weight gain was considerably greater in studies from North America than from Asia. Follow-up length was identified as a source of heterogeneity, such that studies with longer follow-up showed greater difference in weight gain. Effective strategies are needed to encourage smokers to quit irrespective of potential weight gain and to help quitters avoid excess weight gain.

Ten-year weight gain in smokers who quit, smokers who continued smoking and never smokers in the United States, NHANES 2003-2012

BACKGROUND/OBJECTIVES

Weight gain after quitting smoking is a common concern for smokers and can discourage quit attempts. The purpose of this analysis was to describe the long-term weight gain, smoking cessation attributable (SCA) weight gain and describe their relationship to cigarette consumption and body mass index (BMI) 10 years ago in a contemporary, nationally representative sample of smokers who continued to smoke and those who quit.

SUBJECTS/METHODS

In all, 12,204 adults ⩾36 years old were selected from the 2003-2012 National Health and Nutrition Examination Survey (NHANES). Ten-year weight gain for never, continuing and former smokers (who quit 1-10 years ago) was calculated by body mass index (BMI) 10 years ago and cigarettes per day (CPD). SCA weight gain was calculated by taking the difference between the adjusted mean 10-year weight gain of former smokers and that of continuing smokers.

RESULTS

Mean 10-year weight gain among continuing smokers was 3.5  versus 8.4 kg among former smokers; the SCA weight gain was 4.9 kg. After Bonferroni correction, there was no significant difference in overall weight gain between continuing and former smokers of 1-14 CPD, and SCA weight gain was lowest in this group (2.0 kg, confidence interval (CI): 0.3, 3.7). SCA weight gain was highest for former smokers of ⩾25 CPD (10.3 kg, CI: 7.4, 13.2) and for those who were obese (7.1 kg, CI: 2.9, 11.3) mostly because of lower than average weight gain or weight loss among continuing smokers in these groups.

CONCLUSIONS

In a current, nationally representative sample, baseline BMI and CPD were important factors that contributed to the magnitude of long-term weight gain following smoking cessation. Light to moderate smokers (<15 CPD) experienced little SCA weight gain, whereas heavy smokers (⩾25 CPD) and those who were obese before quitting experienced the most.

Predictors of marked weight gain in a population of health care and industrial workers following smoking cessation

Background

Concerns about postcessational weight gain might hamper rather than encourage smokers to quit smoking.

Methods

We conducted a comprehensive multi-institutional smoking cessation program for health care and industrial workers (n = 654) employed at University Hospital Basel (Switzerland) and two local health industry companies (Novartis International AG, F. Hoffmann-La Roche AG). The program contained counselling with an option of pharmacological support. Changes in body weight were observed during 24 months of follow-up. Factors associated with longitudinal weight gain (>5 % of baseline weight) were identified by cox-regression analysis.

Results

In 51 % of permanent quitters no significant changes of mean body weight were observed after 12 (0.52 kg, SD ±2.87 kg) and 24 months (0.40 kg, SD ± 2.99 kg). Marked weight gain following smoking cessation was characterized by a wide margin of changes. In more than a half of former smokers (58 %) weight increases were moderate (<5 kg), whereas excessive increases (>10 kg) were seen in only 10 % of quitters. Lower baseline BMI (HR 0.60, 95 % CI 0.40- 0.80, p = 0.03), daily consumption of less than ten cigarettes (HR 0.53, 95 % CI 0.27- 0.63, p = 0.04) and ischemic cardiopathy (HR 0.21, 95 % CI 0.07-0.62; p < 0.01) were associated with a lower risk for weight gain. Employees with lower educational levels (HR 2.60, 95 % CI 1.60-5.50, p < 0.01), diabetes mellitus (HR 3.05, 95 % CI 2.20-8.06, p = 0.02) and those smoking to reduce boredom in life (HR 1.68, 95 % CI 1.21-2.33, p < 0.01) were at highest risk.

Conclusion

Marked postcessational weight gain occurs less often than expected, but remains difficult to be predicted. Our findings might be helpful to alleviate weight concerns in the average smoker willing to quit.

Weight gain and smoking: perceptions and experiences of obese quitline participants

Background

Weight gain that commonly accompanies smoking cessation can undermine a person’s attempt to quit and increase the risk for metabolic disorders. Research indicates that obese smokers have more weight concerns and gain more weight after quitting than non-obese smokers, yet little is known about possible reasons for these outcomes. We sought to gain an understanding of obese smokers’ experiences of quitting and their attitudes and beliefs about the association between smoking and weight gain.

Methods

In-depth semi-structured interviews were conducted with obese smokers who called a state tobacco quitline. Interviewers elicited discussion of obese smokers’ thoughts about smoking, the effects of quitting on change in weight, challenges they faced with quitting, and how quitlines might better serve their needs.

Results

Participants (n = 29) discussed their fear of gaining weight after quitting, their beliefs about smoking and their weight and significant experiences related to quitting. Participants’ awareness of weight gain associated with quitting was based on prior experience or observation of others who quit. Most viewed cessation as their primary goal and discussed other challenges as being more important than their weight, such as managing stress or coping with a chronic health condition. Although weight gain was viewed as less important than quitting, many talked about changes they had made to mitigate the anticipated weight gain.

Conclusions

Weight gain is a concern for obese smokers interested in quitting. Understanding the relative importance of body weight and other challenges related to smoking cessation can help tailor interventions for the specific group of smokers who are obese and interested in smoking cessation.

The joint influence of gender and amount of smoking on weight gain one year after smoking cessation

Weight gain is often associated with smoking cessation and may discourage smokers from quitting. This study estimated the weight gained one year after smoking cessation and examined the risk factors associated with weight gain in order to identify socio-demographic groups at higher risk of increased weight after quitting. We analyzed data from 750 adults in two randomized controlled studies that included smokers motivated to quit and found a gradient in weight gain according to the actual duration of abstinence during follow-up. Subjects who were abstinent for at least 40 weeks gained 4.6 kg (SD = 3.8) on average, compared to 1.2 kg (SD = 2.6) for those who were abstinent less than 20 weeks during the 1-year follow-up. Considering the duration of abstinence as an exposure variable, we found an age effect and a significant interaction between sex and the amount of smoking before quitting: younger subjects gained more weight than older subjects; among light smokers, men gained more weight on average than women one year after quitting, while the opposite was observed among heavy smokers. Young women smoking heavily at baseline had the highest risk of weight gain after quitting.

Factors associated with weight changes in successful quitters participating in a smoking cessation program

OBJECTIVE

To identify possible predictors of post-cessation weight gain in smoking abstainers.

PATIENTS AND METHODS

A sample of 607 successful abstainers seen at the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2005 and 2010, was included in this analysis. This sample was followed up for 1year and included 47.9% women (N=291) with the mean age of 48years (18-85).

FINDINGS

Post-cessation weight gain occurred in 88.6% of the 607 abstainers. The mean weight gain after one year post-quit was 5.1kg (95% confidence interval 4.7-5.5kg). Baseline characteristics associated with increased weight gain included a higher baseline smoking rate (p<0.001), more severe cigarette dependence (p=0.003), less physical activity (p=0.008), and a report of increased appetite on the baseline assessment of withdrawal symptoms (p<0.001).

CONCLUSIONS

Smokers who are more dependent and have minimal physical activity are at increased risk for post-cessation weight gain. For these smokers, incorporating interventions targeting the weight issue into tobacco dependence treatment is recommended. Further research should be done to identify reasons for this important quitting complication.

Effect of smoking cessation on gestational and postpartum weight gain and neonatal birth weight

OBJECTIVE

To examine the association among smoking cessation, gestational and postpartum weight gain, and neonatal birth weight.

METHODS

We analyzed prospectively collected data from 1,774 women with term singleton pregnancies. Smoking status during pregnancy was categorized as nonsmokers, smokers, and quitters; and smoking status 1 year postpartum as nonsmokers, smokers, relapsed quitters, and sustained quitters. The association between smoking status and gestational weight gain, weight gain 1 year postpartum, and neonatal birth weight was tested by linear regression analysis, and the association between smoking status and neonatal birth weight less than the 10th percentile for gestational age and sex was tested by multivariable logistic regression analysis.

RESULTS

Gestational weight gain at 16 weeks of gestation was comparable for nonsmokers, smokers, and quitters. The adjusted mean gestational weight gain at 37 weeks of gestation was 2.0 kg (95% confidence interval [CI] 1.5-2.6) higher in quitters compared with nonsmokers. The rate of neonatal birth weight less than the 10th percentile was 21.7% among smokers, 8.0% among quitters, and 7.4% among nonsmokers. The adjusted odds ratio (OR) for birth weight less than 10th percentile was 3.6 (95% CI 2.5-5.2) in neonates born to smokers; the risk was similar for quitters (OR 1.0, 95% CI 0.6-1.6). One year after delivery, sustained quitters had a 2.4-kg (95% CI 1.6-3.1) higher adjusted postpartum weight gain than nonsmokers.

CONCLUSION

Smoking cessation is associated with gestational as well as postpartum weight gain. However, smoking cessation is associated with a substantially lower rate of neonatal birth weight less than the 10th percentile.

LEVEL OF EVIDENCE

II.

The effects of extended intravenous nicotine administration on body weight and meal patterns in male Sprague-Dawley rats

RATIONALE

Increased appetite and weight gain after cessation is a deterrent for quitting smoking. Attempts to understand the mechanism for these effects using animals have been hampered by the difficulty or inconsistency of modeling the effects seen in humans.

OBJECTIVE

To examine the effects of extended daily access to intravenous nicotine, via programmed infusions, on body weight and meal patterns in rats.

METHODS

Intravenous (IV) nicotine infusions (0.06 mg/kg/inf) were administered noncontingently, every 30 min throughout the dark cycle and the last 3 h of the light cycle, to emulate self-administration. The effect of these infusions on food intake, meal patterns, and weight change were examined relative to a control group during treatment and in a post-nicotine phase.

RESULTS

Nicotine-treated rats gained half the weight that vehicle treated animals gained and ate approximately 20 % less food overall than vehicle-treated rats. Whereas a compensatory increase in meal frequency occurred during the dark period to account for smaller meals, no compensation was observed throughout the light period. In a post-nicotine phase, the nicotine group maintained a lower weight for 1 week and then gained weight back to control levels. The rate of weight gain post-cessation was faster in animals that had received nicotine compared to controls.

CONCLUSION

Compared to previous studies examining the effects of minipump or intraperitoneal injections of nicotine on food intake, the present study was able to detect previously unknown circadian differences in meal patterns which will be important in the development of smoking cessation and weight gain prevention drugs.

The effects of noncontingent and self-administered cytisine on body weight and meal patterns in male Sprague-Dawley rats

RATIONALE

Increased appetite and weight gain after cessation are deterrents for quitting smoking. Pharmacotherapies that can reduce this weight gain in ex-smokers would be invaluable, and yet are not well studied in this context.

OBJECTIVE

To examine the effects of extended daily exposure to intravenous cytisine, an alpha4beta2 nAChR partial agonist used for smoking cessation in some European countries, on body weight and patterns of food intake in rats.

METHODS

In the first experiment, programmed infusions of cytisine were administered over 15 h per day. Food intake, meal patterns, and weight change were examined relative to a vehicle-infused group during treatment, and in a post-cytisine phase. The second experiment examined the effects of cytisine on food intake, meal patterns, and weight change when substituted for nicotine in a self-administration protocol. Rats self-administered nicotine and cytisine during alternating four day periods, and changes in body weight, drug infusions, and meal patterns were compared between drugs and during an extinction phase.

RESULTS

In the first experiment, cytisine-treated rats ate less and gained less weight than those that received the vehicle. This occurred primarily by a reduced frequency of meals. In the 12 day post-cytisine phase, animals maintained a lower body weight relative to controls throughout. In the second experiment, total pellet intake increased during cytisine substitution relative to nicotine and animals self-administered cytisine significantly less than nicotine. However, cytisine substitution maintained decreases in food intake and weight gain compared to baseline via decreases in total pellet intake and meal size.

CONCLUSION

Cytisine administration results in decreased weight gain and changes in meal patterns dependent upon mode and pattern of administration and a previous history of nicotine administration.

Weight concerns among Finnish ever-smokers: a population-based study

INTRODUCTION

Concern over weight gain after smoking cessation has been hypothesized to discourage quit attempts and consequently reduce smoking cessation rates. The aim of this study was to examine the association between smoking status and weight concerns among a population-based sample of Finnish ever-smokers.

METHODS

Data were collected in conjunction with the National FINRISK 2007 Study from a population-based sample of 25- to 74-yearold Finns. These analyses were based on a subsample of 1,614 ever-smokers. Participants were divided into 4 groups (daily smokers, occasional smokers, recent quitters, and former smokers) based on the self-reported smoking status. Weight concerns were analyzed as a sum score including 6 items (range 0-24). Regression analyses were used to examine the association between smoking status and weight concerns, while adjusting for multiple confounders.

RESULTS

Smoking status was significantly associated with weight concerns, current daily smokers reporting the highest levels of weight concerns. After adjusting for potential confounders (age, gender, body mass index, socioeconomic status, and health behavior), the weight concerns of daily smokers remained significantly higher in comparison with all other groups. Although women were more concerned about their weight than men, no gender-specific associations were found between weight concerns and smoking status.

CONCLUSIONS

Current daily smokers are more concerned about their weight than recent quitters, as well as former and occasional smokers. Weight concerns should be taken into account in tobacco dependence treatment.

Altered hypothalamic response to food in smokers

BACKGROUND

Smoking cessation is often followed by weight gain. Eating behaviors and weight change have been linked to the brain response to food, but it is unknown whether smoking influences this response.

OBJECTIVE

We determined the influence of smoking status (smokers compared with nonsmokers) on the brain response to food in regions associated with weight changes in nonsmokers.

DESIGN

In study 1, we used functional MRI (fMRI) to identify regions of the brain associated with weight change in nonsmokers. BMI and the brain response to a milk shake, which is a palatable and energy-dense food, were measured in a group of 27 nonsmokers (5 men). Sixteen subjects (3 men) returned 1 y later for BMI reassessment. The change in BMI was regressed against the brain response to isolate regions associated with weight change. In study 2, to determine whether smokers showed altered responses in regions associated with weight change, we assessed the brain response to a milk shake in 11 smokers. The brain response to a milk shake compared with a tasteless control solution was assessed in 11 smokers (5 men) in comparison with a group of age-, sex- and body weight-matched nonsmokers selected from the pool of nonsmokers who participated in study 1.

RESULTS

The response in the midbrain, hypothalamus, thalamus, and ventral striatum was positively associated with weight change at the 1-y follow-up in 16 nonsmokers. Compared with nonsmokers, smokers had a greater response to milk shakes in the hypothalamus.

CONCLUSION

Smokers display an altered brain response to food in the hypothalamus, which is an area associated with long-term weight change in nonsmokers.

Predictors of weight change in sedentary smokers receiving a standard smoking cessation intervention

INTRODUCTION

Quitting smoking is associated with weight gain, which may threaten motivation to engage or sustain a quit attempt. The pattern of weight gained by smokers treated according to smoking cessation guidelines has been poorly described. We aimed to determine the weight gained after smoking cessation and its predictors, by smokers receiving individual counseling and nicotine replacement therapies for smoking cessation.

METHODS

We performed an ancillary analysis of a randomized controlled trial assessing moderate physical activity as an aid for smoking cessation in addition to standard treatment in sedentary adult smokers. We used mixed longitudinal models to describe the evolution of weight over time, thus allowing us to take every participant into account. We also fitted a model to assess the effect of smoking status and reported use of nicotine replacement therapy at each time point. We adjusted for intervention group, sex, age, nicotine dependence, and education.

RESULTS

In the whole cohort, weight increased in the first 3 months, and stabilized afterwards. Mean 1-year weight gain was 3.3kg for women and 3.9kg for men (p = .002). Higher nicotine dependence and male sex were associated with more weight gained during abstinence. Age over median was associated with continuing weight gain during relapse. There was a nonsignificant trend toward slower weight gain with use of nicotine replacement therapies.

CONCLUSION

Sedentary smokers receiving a standard smoking cessation intervention experience a moderate weight gain, limited to the first 3 months. Older age, male sex, and higher nicotine dependence are predictors of weight gain.

The reinforcement-enhancing effects of nicotine: implications for the relationship between smoking, eating and weight

Concerns about body weight represent an important barrier to public health efforts aimed at reducing smoking. Epidemiological studies have found that current smokers weigh less than non-smokers, smoking cessation results in weight gain, and weight restriction is commonly cited as a reason for smoking. The mechanisms underlying the relationship between smoking and weight are complex and may involve a number of factors including changes in caloric intake, physical activity, metabolic rate, and lipogenesis. Amongst these possible mechanisms, nicotine-induced enhancement of food reinforcement may be particularly important. In this paper, we first review data from our laboratory that highlight two distinct ways in which nicotine impacts reinforced behavior: 1) by acting as a primary reinforcer; and 2) by directly (non-associatively) enhancing the reinforcing effects of other stimuli. We then elaborate on the reinforcement-enhancing effects of nicotine as they pertain to behaviors and stimuli related to food. Data from both laboratory animals and humans support the assertion that nicotine enhances the reinforcing efficacy of food and suggest that the influence of these effects on eating may be most important after nicotine cessation when nicotine's effects on satiety subside. Finally, we discuss the theoretical and clinical implications of this perspective for understanding and addressing the apparent tradeoff between smoking and weight gain. Better understanding of the mechanisms underlying the reinforcement-enhancing effects of nicotine broadly, and the effects on food reinforcement per se, may aid in the development of new treatments with better long term outcomes.

Associations of smoking cessation with visceral fat area and prevalence of metabolic syndrome in men: the Hitachi health study

Weight gain after smoking cessation may deteriorate metabolic risk profiles, including that for metabolic syndrome. How risk profiles change according to the duration of smoking cessation and whether the visceral fat area (VFA) or the subcutaneous fat area (SFA) contributes to these changes remains uncertain. The subjects comprised 5,697 Japanese men who underwent an abdominal computed-tomography examination during a health check-up. Using never smokers as a reference group, the odds ratios of having metabolic syndrome and its components, defined using the National Cholesterol Education Program Adult Treatment Panel IIIcriteria, were calculated for each smoking category with adjustments for age, alcohol drinking, and physical activity (model 1) using a logistic regression analysis. Additional adjustments were also made for either VFA (model 2) or SFA (model 3). Current smokers had the lowest VFA (120.4 cm²) whereas ex-smokers (124.0-132.0 cm²) had a higher VFA than nonsmokers (123.1 cm²). Among the ex-smokers, VFA tended to decrease with increasing years of smoking cessation. In model 1, the odds ratios of having metabolic syndrome for current smokers and ex-smokers with smoking cessation for ≤ 4, 5-9, 10-14, and ≥ 15 years were 1.02, 1.33, 1.36, 1.40, and 1.09, respectively. The elevated odds ratios among ex-smokers (≤ 14 years) were reduced by 35-55.6% after further adjustment for VFA but not for SFA. Smoking cessation is associated with a deterioration of the metabolic risk profile, which can be ascribed, at least in part, to an increase in VFA not SFA.

Effects of acute abstinence and nicotine administration on taste perception in cigarette smokers

We investigated the effects of short-term abstinence from smoking and acute nicotine administration on taste perception in smokers. We assessed sensitivity for salt and sucrose solutions and the self-reported intensity and pleasantness of these tastes, using a previously validated model of taste perception. This was in order to investigate mechanisms by which cigarette smoking and smoking cessation may modulate dietary behaviour. Male and female daily smokers attended a single testing session. Participants were randomised to either abstain for smoking for 12 h or smoke as usual on the morning of testing. At the testing session, participants completed subjective ratings of mood and ratings of intensity and pleasantness of salt and sucrose solutions, followed by measurement of the threshold at which these solutions could be detected on the tongue. Participants were then randomised to smoking either a nicotine-containing or denicotinised cigarette, after which they completed the same measures as previously. Our data suggest that following cigarette smoking, lower taste thresholds are obtained after smoking a denicotinised cigarette compared with a nicotinised cigarette, but among females only. This effect was not observed among males and did not differ as a function of abstinence condition. In addition, among non-abstinent smokers, females demonstrated higher taste thresholds (i.e. reduced sensitivity) for salt than males, but this sex difference was not observed among abstinent smokers.

Effect of smoking on body weight: longitudinal analysis of the SUN cohort

INTRODUCTION AND OBJECTIVES

Our aim was to investigate prospectively the association between two major cardiovascular risk factors: smoking and weight gain.

METHODS

We prospectively evaluated 7565 individuals taking part in a dynamic cohort study over a median follow-up period of 50 months. Self-reported weight and physical activity levels had been validated previously. The adjusted mean difference in weight gain relative to never-smokers (the reference group) was estimated for different levels of tobacco exposure.

RESULTS

After adjusting for age, baseline body mass index, sedentary lifestyle, changes in physical activity level, total energy intake, fiber intake, food consumption between meals, and sugary soft drink, fast food and alcohol consumption, it was found that individuals who stopped smoking during follow-up had a greater relative weight gain: men 1.63 kg (95% confidence interval [CI], 1.07-2.19 kg), and women 1.51 kg (95% CI, 1.11-1.91 kg). In addition, active smokers had a greater weight gain than never-smokers: men 0.49 kg (95% CI, 0.11-0.87 kg), and women 0.36 kg (95% CI, 0.07-0.65 kg).

CONCLUSIONS

Individuals who stopped smoking during follow-up and active smokers both experienced significantly greater weight gains than never-smokers. This association between cardiovascular risk factors should be taken into account when developing prevention programs.

The natural history of quitting smoking: findings from the International Tobacco Control (ITC) Four Country Survey

AIMS

To describe the long-term natural history of a range of potential determinants of relapse from quitting smoking.

DESIGN, SETTING AND PARTICIPANTS

A survey of 2502 ex-smokers of varying lengths of time quit recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom, United States) across five annual waves of surveying.

MEASUREMENTS

Quitters were interviewed by telephone at varying durations of abstinence, ranging from 1 to 1472 days (about 4 years) post-quitting. Smoking-related beliefs and experiences (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) were included in the survey.

FINDINGS

Most theorized determinants of relapse changed over time in a manner theoretically associated with reduced risk of relapse, except most notably the belief that smoking controls weight, which strengthened. Change in these determinants changed at different rates: from a rapidly asymptoting log function to a less rapidly asymptoting square-root function.

CONCLUSIONS

Variation in patterns of change across time suggests that the relative importance of each factor to maintaining abstinence may similarly vary.

Effects of smoking cessation and weight gain on cardiovascular disease risk factors in Asian male population

OBJECTIVE

Smoking cessation leads to both beneficial and harmful changes in cardiovascular disease (CVD) risk factors. The basis of the harmful changes, however, is unknown. Our objective was to determine whether they are associated with the weight gain that accompanies smoking cessation.

METHODS

Study subjects were male cigarette smokers aged at least 30 years who visited the Health Promotion Center of Seoul National University Hospital between 1995 and 2007 repeatedly with a 1- to 3-year interval between first and second visit. Self-reporting questionnaires gathered clinical and socio-economic characteristics on the initial visit, and CVD risk factors (blood pressure, fasting blood glucose, and serum lipid profile) were measured on both the visits.

RESULTS

We compared the CVD risk factors between smoking quitters and smoking continuers. The quitters were more likely than the continuers to have harmful health changes such as increase in body weight (P<0.01), in systolic blood pressure, and in serum levels of total cholesterol, LDL-cholesterol, and non-HDL cholesterol (P<0.05). When stratified by body weight change, quitters who had gained more than the median (1.3 kg) were more likely than those who had not to have increase in blood pressure (P<0.01) and in serum levels of total cholesterol, triglycerides, non-HDL cholesterol, and fasting glucose (P<0.05).

CONCLUSIONS

Harmful changes in CVD risk factors associated with smoking cessation were mainly secondary to weight gain. To reduce the risk of cardiovascular disease in quitters, therefore, more attention should be focused on preventing weight gain.

Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation

OBJECTIVES

This paper discusses the benefits that a 'realist' approach can bring to an outcome study using the example of a nutritional intervention offered as an adjunct to the existing smoking cessation programmes to limit post-cessation weight gain.

SUBJECTS AND SETTING

Participants of a smoking cessation programme in areas of deprivation in the north, south and west of Glasgow.

RESULTS

A realist approach enabled the development of a framework able to investigate both implementation and outcomes of the intervention. Drawing on theoretical and experiential knowledge, context-mechanism-outcome hypotheses were developed for further testing at later stages of evaluation. This will focus the further stages of evaluation on testing these specific hypotheses using outcome data collected at the end of the intervention.

CONCLUSION

Adopting such an evaluation approach enables integration of process and outcome data that will refine our understanding of contexts and mechanisms, which are associated with these behavioural changes. It can aid further policy decisions by identifying the type of participant and circumstances that are associated with positive outcomes and those subgroups of participants that can be targeted more effectively using other approaches.

BMI, weight stability and mortality among adults without clinical co-morbidities: a 22-year mortality follow-up in the Finnish twin cohort

AIM AND METHOD

Cause-specific mortality was studied in relation to body mass index (BMI) and weight stability (defined as less than 1 BMI unit change during a 6-year period) in 15,424 initially healthy twin subjects from the Finnish Twin Cohort, first examined in 1975, re-examined in 1981, and then followed over 22 years (1982-2003). Additionally, death discordant twin pairs were studied to assess whether body weight differences are associated with mortality independent of childhood factors and genetic background. Deaths and cause of death were ascertained from national registries. Associations with mortality were estimated by Cox proportional hazards model for all individuals and conditional logistic regression analysis for pairwise analyses.

RESULTS

Mortality increased with increasing BMI for all causes and coronary heart disease (CHD) in men, and there were no associations for all natural causes, cerebrovascular disease, and violent deaths. After adjustment for multiple co-variates and changes in co-variates between 1975 and 1981, BMI was associated with CHD mortality in all men (hazard ratio (HR) = 1.22, 95% CI 1.06-1.41) and in men with stable weight between 1975 and 1981 (HR = 1.26, 95% CI 1.03-1.55). Overall risk of death and cause-specific mortality was not associated with BMI in women.

CONCLUSION

Among clinically healthy subjects at low risk of death, BMI appears to be associated with CHD risk in men.

[Smoking and changes in body weight: can physiopathology and genetics explain this association?]

Tobacco use is the leading preventable cause of death in most countries, including Brazil. Smoking cessation is an important strategy for reducing the morbidity and mortality associated with tobacco-related diseases. An inverse relationship between nicotine use and body weight has been reported, in which body weight tends to be lower among smokers than among nonsmokers. Smoking abstinence results in an increase in body weight for both males and females. On average, sustained quitters gain from 5 to 6 kg, although approximately 10% gain more than 10 kg. Pharmacological treatment for smoking cessation attenuates weight gain. The importance of smoking cessation as a contributing cause of the current obesity epidemic has been little studied. In the USA, the rate of obesity attributable to smoking cessation has been estimated at approximately 6.0 and 3.2% for males and females, respectively. Although the mechanisms are unclear, there is evidence that dopamine and serotonin are appetite suppressants. The administration of nicotine, regardless of the delivery system, acutely raises the levels of these neurotransmitters in the brain, reducing the need for energy intake and consequently suppressing appetite. In addition, nicotine has a direct effect on adipose tissue metabolism, influencing the rate of weight gain following smoking cessation. Leptin, ghrelin and neuropeptide Y are substances that might constitute factors involved in the inverse relationship between nicotine and body mass index, although their roles as determinants or consequences of this relationship have yet to be determined.

Smoking-induced metabolic disorders: a review

Smoking is the leading avoidable cause of cardiovascular mortality worldwide. The aim of this report is to briefly review the existing evidence regarding smoking and cardiovascular risk, and to analyze in greater detail the links between tobacco use and metabolic disorders. The evidence so far shows that smoking dose-dependently increases the risk of impaired glucose tolerance, the incidence of type 2 diabetes mellitus and abdominal-type obesity. Although smokers have a lower body mass index than do nonsmokers, recent data show that they have higher waist-to-hip ratios and waist circumferences, established risk factors for cardiovascular disorders-in particular, for coronary heart disease. We propose that smoking may lead not only directly, but also indirectly via these metabolic risk factors, to cardiovascular disorders. As both weight and waist circumference may increase on stopping smoking, further studies are needed to assess whether the post-smoking weight increase and potential changes in waist-to-hip ratio (or waist circumference) have consequences that may reduce the benefits of smoking cessation.

Consequences of smoking for body weight, body fat distribution, and insulin resistance

Our aim was to critically evaluate the relations among smoking, body weight, body fat distribution, and insulin resistance as reported in the literature. In the short term, nicotine increases energy expenditure and could reduce appetite, which may explain why smokers tend to have lower body weight than do nonsmokers and why smoking cessation is frequently followed by weight gain. In contrast, heavy smokers tend to have greater body weight than do light smokers or nonsmokers, which likely reflects a clustering of risky behaviors (eg, low degree of physical activity, poor diet, and smoking) that is conducive to weight gain. Other factors, such as weight cycling, could also be involved. In addition, smoking increases insulin resistance and is associated with central fat accumulation. As a result, smoking increases the risk of metabolic syndrome and diabetes, and these factors increase risk of cardiovascular disease. In the context of the worldwide obesity epidemic and a high prevalence of smoking, the greater risk of (central) obesity and insulin resistance among smokers is a matter of major concern.

Weight concerns and smoking in a general population: the Inter99 study

OBJECTIVE

No previous studies have explored weight concerns in relation to smoking habits, or investigated how weight concerns affect smoking cessation in a general population.

METHOD

Inter99 is a population-based lifestyle interventional study, conducted in 1999-2001 in Copenhagen, Denmark, comprising 30-60 year old men and women. All daily smokers (N=2408) were offered help to quit. The baseline investigation (N=6784) was used for analysing associations of smoking status with weight concerns (cross-sectional design). To analyse how weight concerns affected smoking cessation we included the 1387 daily smokers attending 1-year follow-up; 221 of these were verified quitters (longitudinal design).

RESULTS

Daily smoking men and women had a significantly lower body mass index than never smokers (men: 3%, women 5%) but reported to be significantly less concerned of their weight (men: OR=0.64, 95%CI=0.4-0.9), women: 0.78(0.6-1.0)). Ex-smoking normal weight women were significantly more likely to be frequently concerned of their weight than never smoking normal weight women (OR=2.06, 95CI%=1.6-2.7). Fifty-two percent of the women and 32% of the men with a previous quit attempt reported that weight gain was a reason for relapse. Neither weight concerns nor eating patterns were predictive of point abstinence at 1-year follow-up.

CONCLUSION

Smokers are believed to be very concerned of their weight but in this population-based study, daily smokers more frequently ate what they wanted, had a lower BMI and were significantly less concerned of their weight than never smokers. Weight concerns and eating patterns did not predict abstinence at 1-year follow-up. It seems that weight gain and weight concerns are independent factors.

Association of the mu-opioid receptor gene with smoking cessation

We investigated the association of the OPRM1 genotype with long-term smoking cessation and change in body mass index (BMI) following a smoking cessation attempt among smokers who attempted to quit using the nicotine replacement therapy (NRT) patch or placebo in a randomized controlled trial, and were followed-up over an 8-year period following their initial cessation attempt. We also investigated possible sex differences in these relationships, given evidence for sex differences in smoking cessation and central opioid mechanisms, as well as some evidence for sex differences in response to NRT. Our results indicate that OPRM1 genotype may moderate the effect of transdermal nicotine patch compared to placebo during active treatment, with a benefit of active NRT treatment evident in the OPRM1 AA genotype group only and those carrying one or more copies of the G allele demonstrating no benefit of active NRT versus placebo patch. Our results also indicate a sex difference in change in BMI at 8-year follow-up following a smoking cessation attempt, with ex-smokers demonstrating an increase in BMI, and this increase being greater in female subjects than in male subjects. We did not observe any association of OPRM1 genotype with change in BMI, although there was a trend for genotype to influence the observed sex difference in change in BMI over time. Future studies should attempt to replicate these findings, and investigate the relationship between both short- and long-term weight gain and smoking cessation and investigate possible mechanisms that may underlie these processes. Future studies should also investigate the role of OPRM1 genotype and smoking cessation on other appetitive and reward behaviours such as alcohol consumption.

Weight Gain and Anxiety Levels in Recent Ex-Smokers

OBJECTIVE

To evaluate weight gain and its relation to anxiety in a group of smokers after 3 months of cessation treatment.

PATIENTS AND METHODS

The target population for this prospective, analytical, longitudinal study was smokers being treated in a specialist smoking cessation clinic who were still abstinent at the conclusion of a 3-month treatment program. The following variables were analyzed: age, sex, nicotine dependence (Fagerström test), daily cigarette consumption, number of pack-years, pharmacological treatment (nicotine replacement/bupropion), use of nicotine gum (yes/no), weight gain, body mass index, and degree of state and trait anxiety. Successful cessation was defined as self-reported abstinence confirmed by measurement of expired carbon monoxide (CO) level (< or = 10 ppm). Anxiety was evaluated using the State-Trait Anxiety Inventory. The state anxiety and weight variables were measured on 5 occasions: before smoking cessation, and at the end of week 1, month 1, month 2, and month 3 after cessation. Results for the quantitative variables were expressed as means (SD), and results for the qualitative variables were expressed as percentages and absolute frequencies.

RESULTS

The study population consisted of 122 individuals, 76 of whom were men (62%) and 46 of whom were women (38%). The mean age was 43.9 (9.9) years, and mean nicotine dependence according to the Fagerström scale was 6.2 (2.2) points. Average weight gain was 2.6 kg (3.6%), with no significant difference between the sexes. Weight gain in 25% of this population was greater than 4.2 kg, and maximum weight gain was 9.2 kg. Levels of state anxiety fell progressively as weight increased, although there was no evident relationship between the 2 variables.

CONCLUSIONS

Weight gain is moderate as smokers quit. Anxiety levels, which are greater in the first few weeks after cessation, do not explain weight variation, which is more related to the metabolic effects of nicotine rather than to psychological variables.

No evidence for a major role of polymorphisms during bupropion treatment

This study evaluated the ability of polymorphisms in five candidate genes to predict weight gain among patients taking bupropion or placebo in a smoking cessation trial. Five hundred fifty-three smokers were enrolled into a randomized double-blind, placebo-controlled trial and followed for 12 months. Five candidate genes [DRD2 Taq1 (rs1800497), DRD2-141 (rs1799732), C957T (rs6277), COMT (rs4818), and SLC6A3] were genotyped. Weights at baseline, at end of treatment, and after 6 and 12 months of follow-up were self-reported. Smoking abstinence at each endpoint was self-reported and confirmed biochemically. A self-reported average weight gain after 12 months of 1.1 +/- 6.0 kg (mean +/- standard deviation) in the bupropion group and 1.8 +/- 4.8 kg in the placebo group was noted. For subjects with biochemically confirmed abstinence from smoking, the HL genotype (alleles coding Val at codon 108 are denoted as H, and those coding Met are denoted as L) at the COMT locus and A1A1 genotype at the DRD2 Taq1 locus were associated with less weight gain at the end of treatment. The TC genotype at the C957T locus was associated with increased weight gain at 6 months of follow-up. However, no polymorphisms or their interactions with bupropion consistently and significantly predicted baseline BMI or weight change during treatment for all study subjects. Overall, our results do not support a major role for these five candidate genes in weight gain after smoking cessation.

Smoking, Weight Loss Intention and Obesity-Promoting Behaviors in College Students

OBJECTIVE

To examine whether college smoking was associated with trying to lose weight and other weight-related behaviors.

METHODS

We surveyed 300 students at the University of Kansas about smoking (ever, current, and amount), weight loss intention (y/n), weight-related attitudes, and eating and exercise behavior. Weight, height, and body fat were measured.

RESULTS

About half the students (49%) self-identified as having ever smoked while 53 (17.6%) self-identified as current smokers. After controlling for sex, age, and ethnicity, ever smoking was not related to weight loss intention but was associated with greater pressure to maintain a healthy weight (p = 0.05), and having engaged in mild exercise on more days in the previous year (p = 0.05). Compared to nonsmokers, current smokers ate more at restaurants serving high calorie foods (p < 0.05) and ate more frequently in front of the TV (p < 0.01). Amount smoked was related to diminished use of exercise facilities (p = 0.03) and more frequent eating at restaurants serving high calorie foods (p < 0.05) and in front of the TV (p = 0.01).

CONCLUSIONS

Current smoking among college students was related to weight loss intention. Despite wanting to lose weight, current smoking was concomitant with obesity-promoting behaviors such as eating higher calorie foods and eating in front of the TV. College-based interventions to prevent smoking initiation or promote smoking cessation should include a focus on healthy eating, exercise and healthful ways to lose or maintain weight.

Smoking cessation, weight gain, and DRD4 -521 genotype

We investigated change in body mass index following long-term smoking cessation in a representative cohort of treatment-seeking heavy smokers in the United Kingdom, to determine the extent of long-term weight gain in successful quitters versus continuing smokers. We further investigated whether DRD4 genotype moderated any weight gain in either group. Smoking cessation was associated with an increase in BMI, and persisted up to 8 years after smoking cessation. Ex-smokers at 8-year follow-up weighed over 2.5 kg/m(3) more on average than they did at baseline, while participants who were smokers at both baseline and 8-year follow-up did not demonstrate any change in BMI. We did not observe an interaction between smoking status and DRD4 genotype. However, independently of the weight gain among those who stopped smoking during the course of the study, DRD4 genotype was significantly associated with BMI, with possession of the -521 C-allele associated with increased BMI. The magnitude of increase in BMI following smoking cessation, and the persistence of this change at 8-year follow-up, suggests that health benefits associated with smoking cessation may to some extent be negated by the detrimental effects on health of associated weight gain. Smoking cessation programmes should therefore consider incorporating follow-up support to promote weight loss among those who successfully stop smoking.

Promising pharmacotherapy on the horizon for nicotine dependence

Nicotine dependence pharmacotherapy is important to psychiatrists, as epidemiological studies indicate that a majority of individuals with schizophrenia or affective disorders are daily smokers. The epidemiology of nicotine dependence and the efficacy of nicotine dependence pharmacotherapies are reviewed briefly. Then, novel pharmacotherapies for which FDA approval is expected next year are described.

Smoking status, cigarettes per day, and their relationship to overweight and obesity among former and current smokers in a national adult general population sample

BACKGROUND

Weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The goal was to analyze overweight and obesity depending on smoking status and number of cigarettes per day (cpd) among former and current smokers.

METHODS

The sample included 7124 residents of Germany aged 18-79 y from a national health examination survey (participation rate: 61.4%). Body weight and height were objectively measured; smoking status and cpd were assessed by a questionnaire administered in a health examination center.

RESULTS

The number of cpd was positively related to being overweight and more so to obesity among former smoking men, but not women. The results were adjusted for age, school education, exercise and alcohol consumption. Men who formerly had smoked more than 30 cpd had an adjusted odds ratio (OR) of 5.0 for obesity compared to men who had never smoked.

CONCLUSION

With an increasing number of cpd more psychological and physiological processes of compensation of nicotine supply after smoking cessation may be expected. Male smokers should be provided with information on how to prevent weight gain after smoking cessation. To foster smoking cessation, female smokers should be informed that women who stop smoking manage to have no increase in the rates of overweight or obesity when considered at the general population level.

No considerable long-term weight gain after smoking cessation: evidence from a prospective study

The aim of the study was to analyse predictors of the body mass index (BMI) after smoking cessation. The sample included 4075 residents aged 18-64 years in a northern German area (participation rate 70.2%), drawn randomly from the resident registration files, among them 1545 current and 903 former daily smokers. The current smokers were followed up 36 months after baseline. Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) including questions about body weight and height at baseline and postal questionnaires at follow-up were employed. The data reveal that the number of cigarettes smoked at time of peak consumption in life contributed substantially, and years of abstinence from daily smoking contributed marginally to the BMI in a general linear model. It is concluded that the contribution of smoking cessation to the BMI increase was practically negligible. Efforts to prevent weight gain after smoking cessation should focus especially on heavy smoking.