On July 20, Jane E. Brody, in her New York Times column on Personal Health, gave a painful and moving account of her husband’s intractable addiction to cigarettes despite numerous efforts to quit. Although he finally succeeded at the age of 61, his 50 years of smoking eventually took their toll in the form of a decade of suffering from emphysema and finally death from lung cancer. He repeatedly told his sons, “Learn from my mistake – if you never start, you’ll never have to quit.” Fortunately, they took his advice.
You may think it’s too late for you to benefit from his hard-won wisdom. For some smokers, like Brody’s husband, it’s already too late after just a handful of cigarettes. But if you are a very light smoker or smoke only occasionally – say in a bar on Friday nights – you may be fortunate enough to be minimally addicted. Many such smokers are young and female. Sound like you? If so, the right time to stop smoking would be right now – before greater or more prolonged exposure leads to greater dependence and increases exponentially the difficulty of quitting.
More good news: You are unlikely to gain weight when you quit because your exposure to the weight suppressing effects of nicotine thus far has been minimal. My colleagues and I have repeatedly compared the weight of nonsmoking women college students with that of their smoking counterparts, most of whom are fairly light smokers, and found no difference. If you don’t want to gain weight when you quit, the right time to stop smoking would be right now.
One other thing we’ve learned is that many experimenters and occasional smokers do not identify themselves as smokers. If you’re in that category, or if you know someone who is, don’t kid yourself, and don’t tune out quit-smoking messages because you think they don’t apply to you. Every time you light up a cigarette, you’re playing with fire. Even if you only smoke once a month, the right time to stop smoking would be right now.
Experts argue about the term that most accurately describes that longing for a cigarette, that itch that cries out for scratching, but no confirmed smoker has any problem identifying the experience. Craving, urge, desire – whatever you choose to call it – can emerge in half an hour or even less after smoking in an ongoing smoker and is the reason many attempts to quit founder within 24 hours of abstaining from cigarettes.
For someone trying to quit, the discomfort of the experience itself is compounded by the fear that craving will persist for years, a standard feature of quit-smoking lore. Now, a recent internet survey of former smokers of up to ten years provides some reassurance on this score. Although over half the respondents reported at least a casual desire to smoke “within the past year,” only around 10% experienced “clinically significant” persistent craving. Highly dependent smokers and smokers with mental health issues are more likely to find themselves in this predicament.
Whether you quit ten hours or ten years ago, you need an effective and rapid response to these unwanted intrusions in your nonsmoking life – something that can distract you or provide some of the relief you used to get from smoking a cigarette. A little experimentation may help you find the craving busters that work best for you. Techniques that others have found useful include simulating inhalation by taking a series of deep breaths, oral substitution – something to put in your mouth (e.g., a stick of gum or a low-calorie snack like a sliced carrot or a banana; sweet is good!), or finding something to do with your hands (a few rows of knitting?). Recent ex-smokers generally get good results with nicotine substitution via nicotine gum – and the occasional longtime quitter with serious, intractable cravings may resort to it as well. (The transdermal patch, absorbed slowly through the skin, is helpful in preventing craving on a chronic basis but won’t do the trick for acute episodes of craving.)
Topping my own list of favorites are physical activities that you can complete quickly and repeat as needed. The goal here is not physical fitness but rather just enough activity to compensate for or mimic the effects of smoking – which, like exercise, releases stimulatory substances called catecholamines in your body. The easiest thing you can do is to get up and walk around for a few minutes. Or – keep a pair of small hand weights or a Dyna-Band handy for a five-minute mini-workout. If you’re a yoga person, try a sun salutation or strike a warrior pose. A number of DVDs with short exercise routines are available, including The Firm’s 5-day abs workouts, each lasting just a few minutes, and Billy Blanks’ 8-minute Tae-Bo workout. For more suggestions, check out The Anytime, Anywhere Exercise Book,by Joan Price and Lawrence Kassman, which provides instructions for more than three hundred quick and easy exercises. Bursts of physical activity can also help to counteract depressed mood, a withdrawal effect that may trigger craving.
Dear Michelle Obama,
A New York Times article published on July 8 highlighted our national failure to reach “Healthy People 2010” goal of reducing high school smoking to 16%. The decline in smoking rates among high school students from 34.8% in 1995 to 21.9% in 2003 had led to earlier optimism that this trajectory would continue, but recently progress has stalled, with high school cigarette smoking rates hovering just below the 20% mark (around the same as the smoking rate for adults), along with additional tobacco use in the form of smokeless tobacco products and hookah smoking.
As you are probably aware, this article raised the possibility that your efforts to combat childhood obesity “may be hampering donations to antitobacco campaigns as public health issues shift in emphasis and compete for funds.” Although it may be obvious how smoking and obesity could compete for limited financial resources, especially in the context of an economic downturn, they also compete in less obvious ways. Because tobacco suppresses appetite and body weight, smoking and weight are in a seesaw relationship with one another. Many young people, especially girls, are aware of this relationship and take up smoking in the misguided hope of controlling weight (misguided because these effects emerge over time and are not likely to make much of a difference in the early years of tobacco use, when smoking is often light and intermittent). Moreover, stigmatizing obesity may lead to eating disorders such as bulimia nervosa and binge-eating, which in turn are strongly associated with smoking.
Despite the dangers of obesity, tobacco use remains the number one preventable cause of premature mortality in the U.S. One third of high school smokers, for example, can expect to die prematurely from tobacco-related disease. Thus, smoking to control weight is not a good tradeoff for either children or adults.
I know you are keenly aware of the dangers of smoking as well as the difficulty of quitting, and I am sure it was never your intention to pit these health hazards against one another. I therefore urge you to use your bully pulpit as First Lady to ensure that this does not happen – by telling children explicitly that smoking is the wrong way to control weight and by publicly encouraging support for antitobacco campaigns. The fight against these two public health scourges must go hand in hand, mutually reinforcing rather than competing with each other.
Cynthia S. Pomerleau, Ph.D.
I rely on regular attendance at aerobics classes to help keep my weight under control. But although a recent week of babysitting my grandchildren (the reason, BTW, for no blog post last week) kept me too busy to visit the gym, the needle on the scale held steady. James A. Levine, MD, PhD would undoubtedly call that a textbook example of NEAT (nonexercise activity thermogenesis) in action Hoisting a 4-year-old girl to see over a fence, running to keep up with an 8-year-old boy, and bending over to pick up about a million Legos apparently provided all the exercise I needed – enough to offset not only my absence from the gym but also the extra ice cream I had to eat to keep the children company.
Dr. Levine is a professor of medicine at the Mayo Clinic in Rochester, MN, where he specializes in nutrition and metabolism. He has achieved international prominence as an expert on obesity and has published widely in both scientific journals and the popular press.
He is also the inventor of the Walkstation, a combination treadmill and desk, complete with keyboard and monitor. This contraption, which at first blush may sound just about as practical as a cross between an electric razor and a blender, epitomizes his conviction that our bodies are designed for standing, not sitting, for moving, not staying still. His enthusiasm is so infectious that he has managed to persuade Steelcase to manufacture the things and a number of visionary employers to buy them, to the tune of several thousand dollars apiece.
Now Dr. Levine has written a book describing the detrimental effects of sitting, explaining how we got ourselves into this pickle, and telling us how to reclaim our bodies’ birthright. Over two million years ago, our ancestors got up on their hind legs and evolved the anatomical modifications needed to stay there. We are walking animals. But in the past fifty years, and especially in the past ten to twenty years, a mere eyeblink in terms of human history, we’ve become amazingly adept at developing devices that enable us to carry out our daily lives in a sitting position instead of on our feet as nature intended. Gone are the outhouse, the butter churn, the wind-up alarm clock that our grandparents used. Here instead are the computer, the internet, the cell phone, and a host of machines to do everything from shoveling the snow to feeding the cat to brushing your teeth automatically – and many of these gadgets have remote controls so we don’t even have to get up to operate them. The result is what he terms sitting disease, characterized by obesity, hypertension, diabetes, cancer, depression, and myriad other health problems.
To get back on track, Levine advocates actively reincorporating motion into your daily life. Park as far as you can from your office, get up and talk with your coworkers instead of e-mailing, walk on a treadmill while watching TV, go to a museum instead of watching TV, schedule walking meetings, etc., etc. (He even urges his readers to walk while reading this book – raising the question of whether an audiobook might have been a safer and more appropriate format!) He also addresses the issue of energy intake, urging the reader to think of food as “potential energy” and to link what you eat to your NEAT. In practice, this adds up to around 1400 calories/day plus “free” fruits and vegetables, distributed across 7 “fuel cells” (2/meal and one snack) of around 200 calories each. He tries to be minimally prescriptive but emphasizes strategies such as eating breakfast, avoiding “fast food,” and not eating in the car. All good.
Levine’s combination of erudition and evangelical fervor is seductive. By the time I’d finished his paean to the NEAT life, “filled with vibrant little movements infused into your day,” I was starting to feel optimistic that I could lose weight by pirouetting around the kitchen while whisking up a frittata and eager to proceed to the second half of the book, The Plan. What a surprise, then, to discover that the very first day, the first step in a program unfolding over eight weeks and designed to establish a pattern that can be maintained for a lifetime, mandates three 20-minute walks. That would amount to walking 3 miles, at the average human walking speed of 3 miles per hour. By Day 7 of the last week, your daily total includes three 45-minute walks (2 hours and 15 minutes – nearly 7 miles) plus 44 Core Chargers and 16 Sunrise Stretches. (These exercises are described in detail on p. 151; briefly, a Core Charger is a standing elbow-to-opposite-knee calisthenic exercise and a Sunrise Stretch is a toe-touching exercise.) To be fair, the “walks” can include activities you’d be doing anyhow – vacuuming, gardening, and yes, even formal exercise. (And here, the line between NEAT and intentional exercise becomes blurred almost to the vanishing point.) Still, despite Levine’s efforts to downplay the investment of time and energy required to meet the demands of the program, to many this will sound like a daunting amount of nonexercise.
For this reason, I’m doubtful that large numbers of Levine’s readers will embrace his plan sufficiently to achieve and maintain substantial weight loss. More likely it will resemble any other diet or fitness program – adopted by many with initial enthusiasm, providing lasting benefit to a few but followed for the rest by partial or complete relapse. That said, I think this is a valuable book nonetheless, one that can raise consciousness about the hazards of excessive sitting, the benefits of activity, the concept of food as fuel for that activity, and the ease of making at least modest lifestyle changes. Even those who fall short of full compliance are likely to derive some good from this book.
One reservation, hinted at above: In his eagerness to persuade the reader that NEAT is something new and different, Levine unnecessarily disparages intentional exercise and overstates its difference from NEAT. If you want proof, he argues, that exercise is a dirty word (though one he uses repeatedly himself), just consider the term “workout.” Get it? Work. Well, I’ve been enrolling in fitness classes for nearly 20 years and my experience is as follows: The parking lot at the gym is always crowded; lines form for a turn on the elliptical; the aerobics room is filled (and I do mean filled) with familiar faces who have gone through a long series of peak life events – graduations, marriages, babies, illnesses, loss of loved ones – with each other and with the instructor. So even after the many who don’t stick with it are gone, there are plenty left who come back day after day and year after year. Before becoming an aerobics devotee, I was an avid runner for nearly twenty years, and I had plenty of company on the trail, too. I mention this not to contradict Levine’s point about the need for more physical activity in our daily lives but simply to observe that it would be a shame if anyone who enjoys and benefits from regular exercise quit “exercising” because of this book. Levine’s prescriptions should be an add-on, not a replacement, for what you’re already doing. (And by the way, whatever happened to the idea that you need a certain amount of aerobic activity, causing a sustained elevation of heart rate, for cardiac health? Given that understanding the benefits of physical activity is both his life’s work and his passion, Levine must have an answer to this question, but if it’s in this book, it got by me.)
Although this program wasn’t developed with smokers in mind, it is potentially useful for anyone trying to quit:
Cynthia S. Pomerleau, Ph.D., is currently research professor emerita in the University of Michigan Department of Psychiatry. From 1985 to 2009 she served as director of the Nicotine Research Laboratory, where much of her research focused on the impact of smoking on women. She is the author of more than a hundred articles and book chapters on smoking and a contributor to the 2001 Surgeon General’s Report on Women and Smoking.