Introduction
Fear of gaining weight can be a deterrent for quitting smoking. However, Healthcare Providers should not assume clients are worried about weight gain based on their weight, shape, size, or BMI. Healthcare Providers should follow clients’ cues and only discuss weight changes related to quitting smoking, if clients express concern. In such cases it can be helpful to:
- Acknowledge that concern about weight gain can be worrisome for some people who are quitting smoking.
- Understand and explain some of the physiological drivers for changes in appetite.
- Explore what might be driving that fear (e.g., health concern, body image, cost of clothing replacement, etc).
- Help clients understand that the health benefits from quitting smoking far outweigh the risk of potential weight gain. Weight itself is not actually a good predictor of health.
Weight Gain
There is evidence that many people who quit smoking gain some weight. On average this ranges between 2.6 to 5.3 kg (5 to 12 lb), although this varies from person to person. Any one person may lose weight, gain weight, or stay the same weight.
Appetite Changes
It is common for people to experience appetite changes when quitting smoking. It can be helpful to understand why clients might be noticing these changes.
- Increased taste perception: Smoking can decrease taste perception. Improved ability to taste can increase enjoyment and desire to eat.
- Increased hunger and fullness cues: Smoking can be used to blunt or decrease hunger cues. As smoking is decreased, clients may notice that they feel more hungry than they had previously. Eating when hungry and learning to tune into their body’s hunger and fullness cues can be helpful.
- Lingering impaired glucose tolerance and insulin sensitivity: Smoking has been reported to increase type 2 diabetes risk due to decreased insulin sensitivity. Higher insulin levels found in people who smoke may also increase cravings for carbohydrates and sweet foods. Over time, quitting smoking can improve glucose tolerance and insulin sensitivity. This means these increased cravings are likely temporary and will decrease over time.
- Eating may reduce the desire to smoke: Both nicotine and sweet foods and beverages drive reward/ pleasure systems. As a result, smoking can decrease food cravings and cutting back on, or quitting smoking can increase cravings.
- Managing mental health symptoms: Both food and nicotine can impact symptoms of anxiety and depression. Helping clients notice how they have used nicotine or food to cope, and developing other strategies they can use, may be helpful.
Food and Mood
The relationship between food and mood goes both ways. Food can impact mental and emotional state, and mental and emotional state can impact food decisions. Symptoms of depression may increase or decrease appetite and ability to prepare food.
Fear of weight gain can go hand in hand with restrictive eating or dieting. Research also shows that dieting and restrictive eating can negatively impact mental health. Developing a routine to enjoy regular meals and snacks can be a helpful first step to ensure adequate nutrition and support mental health. You can advise clients to:
- Avoid skipping meals
- Listen to their body. If they are hungry between meals, they could plan to have a snack
- Plan to include food they enjoy the taste of and foods they know make their body feel good
- Consider talking to a registered dietitian. (see Resources)
Refer clients with disordered eating or eating disorder symptoms for additional nutrition and mental health support. If clients report binge eating or feeling out of control with eating it is not recommended to focus on weight.
What to Say
Acknowledge concerns and explore how their concerns might be impacting their decision to quit smoking or cope with life stressors while quitting smoking.
There is no sure way of telling if your clients gain, lose or stay the same weight after quitting smoking.
- Age, genetics, how much and how long people have been smoking, stress, mental health, habits, behaviours, and environment can all affect how quitting smoking might impact weight.
Weight is not a good predictor of overall health and well-being. Quitting smoking is a key contributor to improved health but weight is not.
- Emphasize the benefits of quitting smoking: easier breathing, lower blood pressure, more money, better tasting food, and more enjoyable movement, etc. Relate information to the client’s reasons for quitting.
- Try to focus on health and well-being, rather than the number on the scale or the size of clothes.
If your client has the capacity to focus on food too, recommend trying to improve overall nutrition and enjoyment of food rather than starting a diet, or restricting food to prevent weight gain.
- Encourage taking a mindful and curious approach to eating as a way to manage cravings. Suggest they ask themselves: Am I hungry? What am I feeling? How can I choose foods that make me feel good, and meet my needs?
- Taste preferences and cravings might change after quitting smoking. Encourage clients to be patient with themselves.
Health At Every Size® Approach
Weight is a body characteristic that is primarily genetically determined, and involves many factors outside of our control. Weight and Body Mass Index (BMI) are not the best indicator of health. Focusing on weight/BMI can lead to obscuring other important indicators of health and well-being.
Because there are no evidence-based methods for people to lose weight and keep it off in the long-term, focusing on weight can be harmful to health. Focusing on weight can lead to:
- Attempts at quick weight loss
- Unhealthy weight control practices
- Weight cycling (losing and regaining weight).
There are many things clients can do to improve health without focusing on weight. It’s important to recognize that body weight and shape change due to changing life stage and circumstance. Research shows that self-concept and self-worth impact well-being.
For example: feeling good about yourself and believing your body is worthy of care the way it currently is, is more likely to improve health behaviours, than focusing on changing your body.
As professionals, it’s essential to reflect on the social determinants of health. Not everyone has the same opportunity for health. Inadequate income is a better predictor of poor health outcomes than individual choices.
So while providing advice on health behaviours may be helpful for some clients, it might not be for others as they may not be able to put the advice into action.
Both eating well and moving can have benefits to physical and mental health.
- There are many different ways to eat healthy. It’s the pattern over time that matters.
- Over-restricting, skipping meals or cutting out entire food categories (e.g., fad diets, cleanses) deprives the body of essential nutrients.
- Engaging in eating habits that are sustainable and enjoyable for the long term are much more likely to result in improvements in health. Some tips might include:
- Starting the day with a satisfying breakfast
- Planning or packing nutritious snacks
- Cooking at home more often
- Choosing water over sweetened beverages more often
- Noticing a tendency to eat a lot later in the day. Recognize this is often due to under eating earlier in the day.
- Engaging in physical activities that are enjoyable and help us to feel good may look very different from person to person based on ability and interest.
Resources
Having a Conversation: Weight Gain while Quitting Smoking (available from Huron Perth Public Health)
Refer client to, or encourage seeking out a registered dietitian or mental health professional, if the client is struggling with eating.
- Family Health Team
- Community Health Centre
- Community Mental Health Services
- Hospital/Diabetes Education Centre
- Private Practice (fee for service).
Ontario residents can speak with a dietitian for free through Telehealth Ontario at 1-866-797-0000 or TTY 1-866-797-0007 (press 2 to be directed to a dietitian).
For more information on Health At Every Size (HAES) visit the Association for Size Diversity and Health at www.sizediversityandhealth.org
