The study, conducted by University of Michigan Health System researchers, is published in the October issue of Addictive Behaviours. Cindy Pomerleau, Ph.D., director of the U-M Nicotine Research Laboratory, said that cigarettes are well known to suppress appetite and weight. "So it's hardly surprising that women who have trouble managing their weight or are dissatisfied with their bodies are drawn to smoking," she said.
The research team also found that overweight women smokers who were overweight as children were far more likely to have started smoking in their early teens than women whose weight problems started later in life. They also had worse withdrawal symptoms when they tried to quit. Once they make a serious attempt to quit, evidence suggests that most weight-concerned smokers can be just as successful in kicking the habit as others.
"The problem here is getting women who are concerned about their weight to be willing to try to make a quit attempt and then helping them gain a sense of control over their weight," Pomerleau said. She noted women who are highly concerned about weight tend to be concerned about other aspects of their appearance as well. She said that what they need to understand is that smoking has an impact on many aspects of appearance and attractiveness. Among other things, it causes wrinkled skin, thinning hair, cracked fingernails, yellowed teeth and terrible breath.
Pomerleau also said that some beliefs about smoking and weight are true. For instance, nicotine suppresses the appetite and increases resting metabolic rate. Smokers on average weigh less than people who have never smoked, and that smokers who quit tend to gain weight. Adding to these perceptions are tobacco advertisements that portray female smokers as slim and successful. She said that even so, the effect of quitting on weight is often less dramatic than many women fear. A rough rule of thumb is that one in four women who quit smoking will gain less than five pounds, and another two out of four will gain five to 15 pounds. Only one in four women who quit will gain 15 pounds or more.
However, Pomerleau's own research has suggested that many women smokers start out with an unrealistic image of how they would like their bodies to look. This may make their dread of gaining weight even worse. Her study is based on a survey of 587 women between the ages of 18 and 55, including 420 smokers and 167 women who had never smoked. An equal proportion of both groups were overweight or obese, with a body mass index of 25 or more.
As part of the study, the smokers and non-smokers were asked to look at silhouette pictures of 10 different body types, ranging from thinnest to fattest, and to choose which one their current body type was closest to, and which one they wanted to look most like. They were also asked questions about their self-image and their eating habits, about how concerned they were about gaining weight if they quit smoking, and about how sure they were that they could stay off cigarettes even if they gained weight.
It was found that smokers chose an ideal body shape that was slimmer than the non-smokers chose, and further from how they perceived themselves as looking. They also had more problems with limiting their eating. Smokers who were overweight were especially doubtful about their ability to stay off tobacco if they started to gain weight. Pomerleau said, the study suggests that if women smokers are to succeed in quitting, they may need extra help in achieving a more realistic body image and paying attention to unhealthy eating patterns, particularly if they are already overweight.
During the study, it was also found that the earlier in life a weight problem starts, the more likely a woman is to start smoking. In a study of 89 overweight women smokers, those who remembered being overweight before they reached junior high school reported that they had started experimenting with smoking at around age 13 as compared to women whose weight problems didn't start until junior high or after, who hadn't tried smoking till they reached age 15.
The women who were overweight as children also reported more nicotine-withdrawal symptoms when they tried to quit smoking, especially symptoms like anger, irritability and trouble concentrating. The studies point to the importance of finding new strategies to help women quit smoking without losing control of their weight. Although severe dieting during a smoking cessation attempt has not been shown to be helpful in either quitting smoking or controlling weight, it may be unrealistic to expect women with strong weight concerns to put these concerns on hold for several weeks or months while they try to quit tobacco.
"What we would like to work for is a kind of compromise strategy, where the focus is on the smoking cessation, but women can also take some passive and active measures to control their weight," Pomerleau said. Passive measures include things like nicotine patches and gum, and medicines like bupropion, which can help in controlling weight gain while keeping nicotine withdrawal symptoms at bay.
Another option for women is to launch their stop-smoking effort early in their menstrual cycle, so that the bloating that can happen soon after they snuff out their last cigarette won't be compounded by the bloating that comes along right before their period begins. Pomerleau said that although strenuous dieting is not recommended, women can start immediately to rebalance the energy-in/energy-out equation by not substituting eating for smoking, and by increasing their physical activity.
Even brief bouts of exercise, such as stretching or walking, can be effective in distracting a woman when the urge to smoke strikes, she says, and they burn a few calories too.