Bonnie Spring is a Professor of Preventive Medicine, Psychology, and Psychiatry and Behavioral Sciences Director of Behavioral Medicine, and Co-Program Leader for Cancer Prevention at Northwestern University. A Past President of the Society of Behavioral Medicine, she is board-certified in clinical health psychology. Dr. Spring’s most recent book is Smoking Cessation with Weight Gain Prevention, and in the original post below, she reflects on her own struggle with giving up cigarettes and maintaining her weight.
“You’ve given me new hope.” So read the e-mail that arrived shortly after Parade Magazine published a story about my research showing that trying to manage weight gain while stopping smoking can help rather than hurt successful quitting. A steady stream of similar messages flowed in, taking my mind back to the days when I first started to study weight gain after quitting smoking. I still flinch at the memories. Faculty colleagues asked when I would switch to studying a real health problem – one with serious medical consequences. The reception was about as chilly at the National Institutes of Health. The words of a usually supportive program officer float back to me, “Oh come on…There’s only an average six to eight pound weight gain after quitting. That’s not a health problem – that’s a cosmetic problem. We’re in the business of studying threats to health – not insults to personal vanity!”
The physicians I spoke with weren’t much more helpful. They said things like, “Look, there’s no question that the much greater health risk comes from the smoking rather than the weight gain. The average person would have to gain about 100 pounds to offset the health benefit of quitting.” Indeed, medical practice guidelines conveyed a similar message. The U.S. Public Health Service Guideline on Tobacco Treatment encouraged physicians to tell patients not to worry about weight gain until they were fully confident and secure as non-smokers. The fear was that trying to manage both things at once – smoking and weight – would be overwhelming and would undermine the success of the quit attempt. Yet even though that guidance seemed right-minded and conservative, I watched it prompt my friends to make a life-threatening decision. Nor did I watch detachedly, because I was one of the many smokers who responded by making the same bad decision. Having to choose between being smoke-free and being slender felt like being crushed between a rock and a hard place. Yes, I cared about my long-term health and wanted very badly to quit. However, maintaining a slender, attractive appearance felt essential to sustain the social reinforcers that were vital to my quality of life. We can call it vain, irrational or disordered till the cows come home, but my priorities were certainly not unusual then or now. I continued to smoke.
Living out the truism that “research is me-search,” I began a series of treatment studies to test different ways to help smokers quit smoking without gaining weight. We already knew that ex-smokers gain weight especially because they eat more, but also because their metabolism slows down a bit. So I conducted a number of clinical trials using weight loss agents that are known to reduce food intake. Some of the drugs worked well in the short term. But as soon as patients stopped taking the medication, they gained weight, catching up to and sometimes surpassing the weight gain of patients who’d taken a placebo. Those studies convinced me that available medications were not a good long-term solution to prevent weight gain. I went back to the drawing board and began to experiment with cognitive behavioral interventions. The experimentation taught me enough to finally lick my own smoking habit without gaining weight. Eventually, the National Institutes of Health funded a clinical trial of 315 women who received smoking cessation treatment alone or the combined smoking and weight management treatment. Quitting smoking first and then beginning to self-regulate diet and exercise suppressed post-cessation weight gain. To our great surprise, given the ominous warnings in tobacco treatment guidelines, adding weight management to smoking cessation treatment didn’t compromise the quit attempt. To the contrary, it somewhat increased the likelihood that abstinence would be achieved. Fascinated by our findings, we culled the world research literature to learn whether others had found similar effects. Of the 779 articles we identified that used non-drug treatments to promote smoking cessation and prevent weight gain, 10 trials met our quality criteria. Meta-analyzing the responses of all 2027 participants included in those trials produced absolutely no evidence that combining smoking and weight control treatment produces any harm. From this expanded global purview, we observed again that combining smoking and weight treatment tends to improve both smoking cessation and weight control.
Indeed these findings do give new hope to the many smokers – now about 50% of women and 25-30% of men around the world – who say that fear of gaining weight discourages them from trying to quit. Providers no longer need to discourage their patients from pursuing two healthy goals – quitting smoking and managing weight. Smokers no longer need to hide their weight-related worries from their physicians. Clinicians have a new, non-drug treatment to help their patients to achieve both smoking cessation and weight management. We now know that striving for these two worthy outcomes isn’t going to do any harm and it’s likely to do some good for both quitting smoking and managing weight.
And now it’s time for me to go for a run, smell some fresh air, and come home to my snack of fruits and veggies.
Share your story with us below! What was the most difficult thing when YOU tried to quit smoking?