Quitting Smoking: Managing the Associated Weight Gain

• Weight gain after quitting smoking
• Behavioural interventions: Changing your actions
  • Physical activity
  • Changing your diet
• Cognitive interventions: Changing your thinking patterns
• Pharmacotherapy
• Individualised approach

Weight gain after quitting smoking

Weight gain can be an unfortunate side effect of quitting smoking. Many people trying to quit smoking use food as a substitute for nicotine, which increases the total energy intake. Stopping smoking also reduces the metabolic rate, which decreases total energy utilisation. The combination of increased energy intake and decreased energy output will result in weight gain.

On average, an individual gains three to 5.5 kilograms after quitting smoking but some studies have reported figures of double that amount. For 10% of men and 13% of women who quit smoking there is a risk of major weight gain (greater than thirteen kilograms).

Twenty six per cent of males and 50% of females who want to quit smoking express concerns over the risk of weight gain. Although this is understandable, the fear of weight gain is a major barrier to smoking cessation and research suggests that the negative health effects of smoking by far outweigh those associated with the average weight gain after cessation.

Smokers who are concerned about weight gain are less likely to attempt to quit and those who do make an attempt are less likely to be successful. It has been found that individuals who are more concerned about weight gain tend to gain more weight after cessation.

While quitting smoking may cause weight gain, a recent study has identified that smokers tend to have higher body fatness and abnormal fat distribution than non-smokers. This means that once you have quit smoking and can focus on losing weight you may achieve a more ideal body shape and composition than while you were smoking.

Behavioural interventions: Changing your actions

Behavioural interventions or behaviour therapy are the most common management strategy used to prevent and reduce weight gain after smoking cessation. Behavioural interventions, as the name suggests, try to change behaviours that lead to weight gain. The aim of these therapies is to keep the energy intake and energy output balanced. This is done by either restricting food intake, or increasing physical activity, or a mixture of the two. Which intervention is used will depend on the individual; different people respond better to different strategies.

Physical activity

Increasing physical activity will not only reduce the weight gained but has also been shown to reduce the urge to smoke, reduce nicotine withdrawal symptoms and improve mood. As a consequence, exercise alone as an intervention has been shown to be successful.

Yoga is one exercise that can be utilised. Yoga improves weight control and can also be a very effective way of reducing stress (anxiety) and mood changes.

Dietary interventions

Dietary interventions for weight control in people trying to quit smoking have shown mixed results but still remain one of the most popular management strategies. It has been shown that restricting energy consumption increases the urge to smoke and smoking behaviour. So while it may reduce weight gain it is not associated with positive quit outcomes.

There are different ways to reduce energy intake but studies have shown that sticking to a very low kilojoule diet compared to modestly restricting kilojoule intake may be more beneficial. The body responds to low kilojoule diets by using fat for energy (a process called ketosis). This can reduce hunger and in turn reduce nicotine cravings. Some dietary interventions restrict kilojoule intake but will allow ‘treat’ foods that can be used during cravings.

Cognitive interventions: Changing your thinking patterns

Cognitive interventions or cognitive therapy for the management of weight gain aim to help you quit first and then psychologically cope with the weight gain. These interventions are not designed to have an active effect on reducing the weight but rather help you to accept that putting on weight may happen and how to manage it if it does. Remember that the health benefits of quitting smoking far outweigh the risks associated with minor weight gain and weight can be lost once you have successfully managed to quit.

It is very important to remember though that once you accept you are going to put on a modest amount of weight this does not mean you can eat whatever you like without consequence. You should monitor your weight throughout the quit process to make sure it does not exceed the norm and cause negative health outcomes.

You can ask your doctor to help you develop a long term weight management plan. If you get ‘off-track’ during the quit process don’t be disheartened! You can visit your doctor again and they can help you to readjust your plan.

For more information, see Cognitive Behavioural Therapies for Quitting Smoking

Pharmacological interventions

Pharmacological quitting therapies such as bupropion (e.g. Zyban SR), varenicline (Champix) and Nicotine replacement therapy (NRT) can have a positive effect against weight gain. If your concerns about weight gain are the main reason you want to start pharmacotherapy then you will need counselling from your doctor as well. This is because while these agents are quite effective in limiting weight gain this effect only lasts for as long as you use the drug. Once you have stopped the therapy there is a risk of weight gain.

These agents are not appropriate for all people. Your doctor will assess whether medication will be safe and helpful for you.

For more information, see Pharmacotherapy for Quitting Smoking.

Individualised approach

 

Every person will feel and respond differently toward their weight gain during smoking cessation. It is for this reason that your doctor will try and tailor your weight management to suit you as an individual. You will have different exercise targets and dietary goals and you will also think about weight gain differently to the next person. Your therapy, or combination of therapies, will reflect this.

More Information

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For more information on smoking, its health effects and how to quit smoking, as well as some useful tools, videos and animations, see Smoking.

References

1. Spring B, Howe D, Berendsen M. Behavioral intervention to promote smoking cessation and prevent weight gain: a systematic review and meta-analysis. Addiction. 2009;104(9):1472–1486. [Abstract]
2. Levine MD, Perkins KA, Kalarchian MA, et al. Bupropion and cognitive behavioral therapy for weight-concerned women smokers. Arch Intern Med. 2010;170(6):543-550. [Abstract]
3. Travier N, Agudo A, May AM, et al. Smoking and body fatness measurements: A cross-sectional analysis in the EPIC-PANACEA study. Preventive Medicine. 2009;49(5):365-73. [Abstract]
4. Parsons A, Lycett D, Aveyard P. Behavioural interventions to prevent weight gain on smoking cessation: A response. Addiction. 2009;104(12):2118–2120. [Abstract]
5. Bock BC, Morrow KM, Becker BM, et al. Yoga as a complementary treatment for smoking cessation: rationale, study design and participant characteristics of the Quitting-in-Balance study. BMC Complementary Altern Med. 2010;10:14. [Abstract | Full text]