Issues in the Prevention of Weight Gain after Smoking Cessation

Abstract

Abstract Although commonly accepted, there is essentially no direct support for the assumption that preventing weight gain after smoking cessation will improve the likelihood of remaining abstinent from smoking. First, developing interventions to prevent this weight gain has proven to be extremely difficult. To date, no adjunct behavioral treatment has been shown to be successful in attenuating cessation-induced weight gain in healthy ex-smokers. Reasons for this failure may stem from inadequate intensity of interventions, poor compliance due to the complexity of interventions aimed at both eliminating smoking and controlling weight, or to biological pressures for weight to increase after removal of the weight suppressing effects of smoking (i.e. altered energy regulation). Pharmacological interventions, despite being successful during brief periods of active use, have not been studied beyond several months' duration of treatment. Second and more importantly, prospective studies have not reported that weight gain after cessation directly predicts relapse, and results of a recent intervention indicate that adjunct weight control treatment may be associated with greater smoking relapse. Although contrary to common belief these findings are very consistent with a large body of basic animal research showing that food or weight restriction increases drug intake. In light of these observations, a more prudent and fruitful approach for basic and clinical research may be to re-examine the fundamental relationships among smoking, eating, body weight, and perhaps weight-related attitudes, rather than developing intensive strategies for combating weight gain after smoking cessation. If further study continues to find no positive relationship between this weight gain and risk of subsequent smoking relapse, it may be necessary to consider developing treatments designed to help ex-smokers accept, rather than fight, weight gain after cessation.