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:
I’m often asked how I came to write Life After Cigarettes. “Aren’t there already a lot of how-to-stop-smoking books already?” “Does the world really need another how-to-quit book, even one with a special focus on women and weight concerns?”
Indeed there are a lot of how-to-stop-smoking books. Many of them are of dubious value – written either by charlatans or more often by people who found a method that worked for them after all else failed and are sincerely convinced it will also help others, despite the lack of randomized clinical trials that would really establish superiority and control for placebo effects. But there are are several written by recognized authorities and based on approved, well-tested methods. There are also a number of excellent books targeting not the end user but clinicians who want to learn how to help smokers quit. (To do this successfully, you really need to understand the unique pharmacological and behavioral rhythms of smoking and nicotine dependence; knowing how to treat alcohol dependence or other forms of drug dependence isn’t enough.)
Back when I was looking for an agent to help me identify a publisher for Life After Cigarettes, one of them asked me about the genre of the book. I told him it was in some ways sui generis – in a class by itself – and he frowned. (Well, to be exact, he e-frowned.) Publishers don’t know what to do with a book they don’t know what to do with. It’s much easier to market a book when it fits neatly into a well-established pigeon-hole.
Although amazon.com does in fact classify the book under smoking, I have never thought of Life After Cigarettes as either a how-to book in general or a stop-smoking book in particular. It’s not a how-to book because it doesn’t include step-by-step instructions, each one building logically and systematically on the previous milestone. It doesn’t include lots of self-tests to help you identify what type of smoker you are or how dependent you are or any of the other things that might serve as the basis for choosing one quitting strategy over another. And it’s not a stop-smoking book because the central message has more to do with the weight increase and depression that can follow quitting than with quitting itself. Competent and accurate instruction on how to quit smoking is a good thing, but as noted, it’s already been done, and in at least a few instances, done well.
But wait, isn’t there a whole chapter in Life After Cigarettes on how to stop smoking? Yes, and here’s a little secret about that chapter – it was the very last one to be written. The material in that chapter, in a much sketchier form, was originally relegated to an appendix. Why? Because I felt strongly not only that my little book was not about how to quit smoking but also that to frame it as such would exclude an important part of the book’s potential readership – that is, former smokers who were dissatisfied with where they’d landed after quitting and wanted to go back and get it right. But the Powers that Be at Hunter House, my publisher, were very insistent that the words “how to quit” be included in the subtitle. My editors were refreshingly hands-off about the text of the book but much more directive about the title and indeed anything that appeared on the cover. Since my contract stated that in case of disagreement, Hunter House had the final say, and since I was committed to truth-in-advertising, I decided that if the cover was going to promise information on how to quit, I was honor-bound to provide it. Thus Chapter 7, Quitting for Good, was born. I placed it just before the final chapter, in order to emphasize that it was not part of the book’s main thrust but rather included as a courtesy to readers who had not yet found the help they needed on the “mechanics” of quitting. Like the rest of the book, it is not prescriptive; rather, it reviews available options and the scientific rationale for each, leaving the reader to match the method to her own preference.
In retrospect, I think adding this chapter was a good decision. I see it as a lagniappe, as the Cajuns say – something a little extra, a bonus – and I’m grateful to Hunter House for pushing me to include it. But as I say, it wasn’t part of my original plan.
But enough about what Life After Cigarettes is NOT. Although I didn’t believe I had a unique contribution to make to the smoking cessation literature, I saw a crying need for a book that dealt sympathetically but honestly with the topic of smoking and weight, a book that translated scientific findings into a motivational message that women could apply directly to their own needs, a book written from a woman’s point of view. The gap in the available literature was twofold: 1) Most such books are written by health professionals, mostly men, who with all the good intentions in the world just don’t get it. Deep down they don’t understand how someone can take a serious health risk just to avoid gaining weight—even though both men and women take all sorts of risks for reasons that are equally hard to defend if your sole aim is to maximize short- and long-term health. They exceed the posted speed limit to compensate for a late start, they go hurtling down steep hills on skis because it gives them a brief thrill, they drive home after an evening of drinking; the list goes on and on. 2) Virtually all such books claim to tell you how to quit without gaining any weight. Yet most women know, from watching their friends or their sisters or their mothers quit or from their own experience, that this isn’t a realistic expectation or likely outcome. And anyone starting with the attitude of “three pounds and I’m gone” is on a fast track to early relapse.
What I really wanted was to create a space in which women smokers and ex-smokers would feel safe in confronting their profoundest fears about gaining weight. I believe that when they learn the scientific facts about the effects of smoking on appearance and about weight gain after quitting, they will understand that a few pounds are an excellent trade-off not just in terms of health but also in terms of appearance. The operative word here is “few.” I am convinced that the real, deep-down, bedrock fear of most women is not of gaining a few pounds but of weight spinning out of control – a fear compounded by the fact that quitters often gain a couple of pounds or more in the first week after their last cigarette. Women need to know that this the weight gain curve quickly tapers off. They need to know that managing weight gain so that it stays in the 5-10 pound zone, within a unit of BMI and within a dress size, is a realistic goal. They need the tools for doing so. That’s Life After Cigarettes’ niche, and I know of no other book that fills it.
The link between smoking and depression is well-documented. Smoking can relieve depression, and depressed mood can emerge as a withdrawal symptom after quitting, particularly in people with a tendency towards depression to begin with. Severe depression is relatively uncommon and may require medical intervention; for the more mundane blues and blahs that may plague quitters, here’s something you can try on your own – something that doesn’t take any special equipment or medication and requires no planning or preparation.
Although we generally think of a smile as something that results from rather than causes good feelings, it has actually been shown in the Laboratory that moving your facial muscles to form a smile produces self-reported mood elevation. (This experiment is not so easy as it sounds, since your results will be hard to interpret if you generate amusement by your instructions rather than by the smile itself; but scientists have succeeded in conducting a convincing demonstration of the phenomenon.) Smiling has the additional benefits of making you look younger and more attractive. It may even boost your immune system!
Improving your mood by acting the way you want to feel is not restricted to smiling; apparently the rest of your body can also be recruited for this purpose. I recently saw a fascinating presentation by Dr. Tal Shafir, a postdoctoral fellow in my Department, who along with her colleagues has conducted a study in which participants were taught to carry out short sequences of happy, sad, and neutral whole body movements. These researchers found, as predicted, that the happy movements increased positive feelings and decreased negative feelings. The happy movements also produced different patterns of brain activation from the sad and neutral movements. Looking at Dr. Shafir’s happy-movement photos, one of which resembled a cheerleader’s leap, I wryly asked if she could recommend something a little easier on the knees, and she responded that the critical element was probably “opening the chest.”
So next time you’re feeling glum and thinking about smoking, try squaring your shoulders and pasting on a happy face. You have nothing to lose but the blues.
I recently blogged about the Rule of Thirds – the myth that only a third of smokers gain weight after quitting (with a third remaining the same and a third actually losing weight). This would be nice if it were true but it simply is not. The large majority of quitters gain weight. Only a handful actually lose weight, and as I have suggested elsewhere, some of those who do may be suffering from loss of appetite associated with depression.
Another dubious claim floating around out there is that weight gain after quitting smoking is temporary, and that after an initial increase in weight, quitters will return to their pre-cessation weight with no special effort. This optimistic view – basically just a twist on misleading promises that anyone can quit without gaining weight – is propagated in a government pamphlet entitled Forever Free. Even then, the pamphlet waffles, asserting that “most [quitters] lose weight over time with no special action” but repeatedly suggesting otherwise in the text.
So far as I can tell, the idea that weight gained after quitting magically melts away originated with an MIT economist named Jonathan Gruber, who flatly stated, “There’s no evidence in the medical literature that quitting smoking will affect your weight over a long period of time.” In fact, there is considerable evidence in both cross-sectional studies, including one from my own laboratory, and longitudinal studies showing that exsmokers weigh about the same as people who never smoked, even several years after quitting, and that both of these groups weigh more than current smokers. These findings are consistent with the common-sensical inference that quitters on average revert to the weight they would have been had they never smoked.
What IS true is that the period of gaining weight is temporary. When you stop smoking, your weight generally goes up by a few pounds, mostly within the first six months. Although Americans typically put on weight as they age, little of the weight you gain beyond your six-month anniversary is likely to be attributable to the fact that you stopped smoking.
This is also not to say that you cannot avoid weight gain or even lose weight after quitting by aggressively modifying your dietary and exercise patterns. Alternatively, you can accept a few extra pounds as your badge of success, knowing that those pounds are likely to land in all the right places as your body, no longer exposed to the anti-estrogenic effects of smoking, assumes a more “feminine” shape. And you can manage that weight gain so that you remain in the 5-10 pound category that will minimize the impact on your Body Mass Index and your wardrobe – a very achievable goal.
But why not tell a little white lie if it might encourage people to quit by making them more hopeful? Is it really any worse than responding “Fine” when people casually ask how you are, even if you had a fight with your husband, the dog threw up on the rug, and you feel a cold coming on?
Anyone following this blog has heard my mantra that realistic expectations are the best path to life as a contented nonsmoker who is not plagued by craving for cigarettes or dissatisfaction with her body. I would rather see smokers directly addressing the task of managing weight gain after quitting than facing disappointment, a sense of personal failure, and relapse because they hoped that if they ignored it, it would just go away.
Take a naturally-occurring mildly addictive substance (there are many), then refine and redesign it so it’s more addictive – maybe much more addictive. There are lots of ways to do this. You can combine it with other substances that enhance its addictive properties, you can modify the vehicle so that it’s easier to ingest or can be ingested via a route that reaches the brain more rapidly (faster “rise time”), you can increase its availability so that users can dose themselves readily, and you can standardize the concentration of the substance so that users can dose themselves reliably. You can advertize and display it prominently on shelves so that it is salient in the environment. You can make it available to young people so that dependence can be established in the susceptible developing brain.
Tobacco’s like that. The tobacco that native Americans put in their peace pipes was probably somewhat addictive, but the tobacco in cigarettes is exponentially more so. Why? It’s combined with flavorants that make it more palatable. It’s flue-cured and modified in other ways to make it easier to inhale, so that nicotine, the main psychoactive ingredient in tobacco, reaches the brain in just a few seconds. The nicotine content is manipulated to produce a consistent, fairly strong product. The invention of the Bonsack cigarette-rolling machine in the 19thcentury allowed the tobacco industry to start making its product much more widely available and affordable.
Cocaine is like that, too. Cocaine as absorbed from chewing or drinking tea brewed from coca leaves acts as a mild stimulant but is only questionably addictive. Purify that cocaine and cook it up as crack, and you have a substance that produces highly euphoric and psychoactive effects, a product that poses serious threats to the individual user and to society.
And a lot of the food we eat is like that.
Yes, food manufacturers have taken a page from the tobacco industry’s playbook and devoted considerable research to developing combinations of salt, sugar, and fat that maximize palatability. “Once a preference is acquired, most people do not change it, but simply obey it,” wrote a top Frito-Lay scientist in a 1979 internal memorandum. For a more extended account of these practices, read David Kessler’s excellent description in his book entitled The End of Overeating, which I reviewed in an earlier post. These products have never been seen in nature, nor do you have to forage for them; accessibility is as easy as tearing open a bag or replying “yes” to the question, “Supersize those fries?”
Recent calls to reduce the salt content of processed foods have produced an outcry from the manufacturers of salt and of products made with salt. They claim it’s needed as a preservative and for a variety of other culinary reasons. They acknowledge that low-salt foods require more expensive (read better quality!) ingredients to taste good. They fear that consumers will abandon them if they tamper with tried and true formulas.
All these things are true. But in emphasizing the forces to which they must passively submit, the food manufacturers soft-pedal their own active efforts to create products that many people will be unable to resist. And here, the food manufactures have taken another page from Big Tobacco’s playbook. It’s called blame the victim. Point to their customers’ strong appetites for their products. Stress the need for personal responsibility and restraint to curb consumption.
Although some people are clearly more susceptible to addiction than others, remember that for most of human history we lived in an environment where food was scarce and required work to obtain, an environment in which most of the products on supermarket shelves didn’t even exist. (If you doubt this, read the list of ingredients on virtually any package you pick up. What would your grandmother make of a recipe that called for lactose, soy lecithin, partially hydrogenated soybean oil, and artificial flavor – all listed among the ingredients in Snickers, the most popular candy bar of all time?) Remember, food tastes good for a reason. We are meant to eat, and to eat heartily. But what happens when we are confronted with food engineered to interact with our brain chemistry in such a way as to be irresistible to a large portion of the population?
Now let’s talk about the “obesity epidemic.” Why are we suddenly living in a culture where, like the children in Lake Wobegon, “all the people are above average?” No one answer can fully explain this phenomenon. Although it’s sometimes said that our genes haven’t changed, in fact they have, at least collectively, in the ethnic composition of our population. The decline in smoking, with quitters tending to gain weight, has probably made a modest contribution. People are living longer, leading to an older population, and weight gain with age is typical if not normal.
All these factors undoubtedly play a role. But I can’t help wondering if changes in the food we buy in grocery stores or eat in restaurants aren’t the most important factor. I don’t know the answer to this question, but perhaps it’s time to start a national conversation about the addictiveness of food similar to the one that finally led to the recognition that tobacco use was not simply a “pleasant adult custom” that could be taken up and put down at will.
One difference between food and tobacco: We don’t need the latter to live but we do need the former. So quitting eating is not an option. We can, however, avoid highly processed products designed to create intense craving without ever fully satisfying it.
Inns providing food along with a place to curl up for the night have undoubtedly existed for as long as people have been traveling in large enough numbers to justify the effort. Establishments where people go for better or fancier food than they eat at home, however, or even just for gastronomic variety, are a more recent phenomenon. Some historians trace the rise of the modern restaurant to the French Revolution, when cooks from households of the nobility suddenly found themselves out of a job. The now-normative two-career family has undoubtedly given restaurants a further boost by adding the elements of time and convenience to the equation.
Whether it’s a family outing, date night for the parents, part of a courtship ritual, a chance to get together with friends, or just a quick bite on the go, three quarters of Americans now eat out at least once a week. Thus, restaurants are part of our regular nutritional landscape, not just an occasional splurge.
For quitters trying to control postcessation weight gain in the context of an increase in appetite, restaurants present a special challenge. Although you don’t have to eat in a restaurant to encounter large portion sizes, it definitely helps. According to one study, the average size of a hamburger is nearly 25% larger than in was 1977, and soft drinks 50% larger. Studies have repeatedly shown that people eat more when confronted with larger portions. And to make matters worse, your meal may be even more calorie-dense than it looks: For example, a portion of Spaghetti & Meatballs at Macaroni Grill contains a whopping 2,270 calories, 56 grams of saturated fat, and 5,330 mg of sodium.
Eating more than you want, need, or intend to eat is not value for money. Here are a few little tricks that can help you keep your favorite restaurant from supersizing you:
And finally, support legislation mandating nutrition information on the menu. Knowing what you’re facing can help you make wise choices and leave the restaurant feeling as good about your meal as when you entered.
A group of researchers at Brigham Young University recently reported on a study in which they exposed groups of men and women to pictures of obese same-sex individuals wearing swimsuits, and then instructed to imagine someone saying “your body looks like hers/his.” Participants were selected for being slim and having no history of eating disorders. Imaging techniques were used to gauge activity in the medial prefrontal cortex, a brain location involved in self-reflection. In the women, the medial prefrontal cortex “lit up,” presumably indicating anxious comparisons with their own bodies. No comparable activity was observed in the men.
Cute little study, catchy enough to attract the attention of Newsweek. But what struck me most forcefully was less the findings of the study itself than a remark by one of the authors, who was quoted in Newsweek as saying that recruitment was a challenge because it was “hard to find women who were really thin but had no history of an eating disorder.”
As I observe in Chapter 3 of Life After Cigarettes: “The sad truth is that, except for exceptionally tall and large-boned women, the calorie quota required to maintain a healthy [and officially “normal”] weight is rather low and discouragingly easy to meet.” (Men – with their faster metabolism and larger body size – have a lot more latitude.)
There are numerous formulas for calculating how many calories are needed to maintain or reduce body weight, depending on sex, height, weight, age, amount of exercise, and sometimes additional variables, but for women the results typically fall in the range of 1,600 to 1,400 or even 1,200 calories per day. (Most experts would not recommend long-term restriction to less than 1,200 calories whatever the formulas may say.) Hardly a starvation diet, but it doesn’t leave a lot of wiggle room for snack attacks and dietary indulgences.
This can be tough for any woman, but especially the quitting smoker, who finds her appetite increasing at the same time as her caloric needs are decreasing. Fortunately, even small changes can make a big difference over time. Avoiding the twin hazards of perpetual hunger and perpetual body dissatisfaction shouldn’t call for heroics, but it will probably require tweaking along several dimensions – a little less food, a little more exercise, a little attitude adjustment (by which I mean recalibrating your idea of how much you should weigh by, say, 5-10 pounds, an amount that is within the grasp of most), and perhaps a few fashion tricks to keep you looking your most svelte. (These strategies are discussed in greater detail in Chapters 3-5 of Life After Cigarettes, as well as elsewhere in this blog.) And for good measure, throw in enough “media literacy” to recognize that we’re all being sold a feminine ideal rarely seen in nature.
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.