Wrong question #1: Which is a more serious threat to your health, smoking or obesity? It’s a question that epidemiologists bat around periodically. A few years back, a group of respected scientists announced that obesity was rapidly overtaking smoking as a cause of disease and death, then found themselves in the embarrassing position of having to retract their claim because of a data analytic error. A more recent study tried to estimate the relative overall burden of smoking and obesity over time and after heavily factoring in quality of life issues, concluded that obesity was even more of a bad actor than smoking. Yet bottom line: smoking remains the number one cause of preventable disease and death in the U.S.
The question, of course, is rendered more provocative by the fact that smoking and weight are in a seesaw relationship with one another. On average, smokers weigh a few pounds less than nonsmokers of the same age and sex, and smokers tend to gain a few pounds after quitting. Although the causes of our current obesity epidemic are multifactorial, the success of public health campaigns to discourage smoking has made at least a small contribution to these statistics.
So to be fair, the question of which is a greater health risk is not necessarily a wrong question for policy wonks who need to decide on the allocation of limited resources. But on the individual level, it has always struck me as being about as productive as “Which is worse, death by fire or death by ice?”
Wrong question #2: How much weight would I have to gain to equal the risk of smoking? This is a question raised by experts in the past with the hope of coming up with a number so high (30 pounds? 50 pounds? more?) that the smoker would be convinced it was preposterous either to worry about it or to offer it as an excuse not to quit. Unfortunately, however well-intended, the question may have backfired by unnecessarily raising the specter of out-of-control weight gain. In actual fact, the answer can’t be calculated for any given person without factoring in how much she weighs, how much she smokes, how old she is, how long she’s smoked, etc. Moreover, whatever the answer, you definitely don’t want to go there – nor do you need to.
Wrong question #3: How can I keep from gaining any weight at all when I quit? This is the Holy Grail of smoking cessation for women. When asked about how many pounds they’d be willing to gain if they quit smoking, nearly half of all women say “zero.” The fear of weight gain keeps many women from even trying to quit, and causes others to relapse as soon as they gain a pound or two.
This is sad because I’m convinced the real, deep-down fear of most women is less that they’ll gain a little weight and more that they’ll gain a lot of weight. Face it, when the needle on the scale starts to creep up – and this can happen quite soon after quitting – you have no idea where all this will end up. Like the wheel of fortune, “where she stops, nobody knows.”
Although there are certainly ways to modify your eating behavior to reduce food intake comfortably, most women probably cannot achieve the goal of zero weight gain without being on a permanent diet or being plagued by nagging twinges of hunger. That’s because nicotine has a number of effects, such as increased metabolism and decreased fluid volume, that go away when nicotine is removed, making your body “want” to revert to the weight you would be had you never smoked.
That’s why any program or book or website that promises to teach you “how to quit smoking without gaining weight” will almost certainly disappoint most of its adherents. For every woman who succeeds in the quest to gain no weight at all, many more will not. Anyone who’s had experience treating smokers knows this, so why do they persist in holding out false hopes? Because it sells books? Because they’re afraid knowing the truth will be too discouraging?
Personally I prefer to tell the truth – not just because my mother told me honesty was the best policy (although indeed she did), not just because I respect your intelligence (although indeed I do), but because if you keep asking the wrong question, the all or nothing question, you’ll never learn what you need to learn to get beyond it.
And now for the right question: How much can I gain without putting my health at risk, forcing me to buy a new wardrobe, and making me feel miserable about my body? This question may at first strike you as defeatist, like giving up on the Holy Grail before you’ve even mounted your steed. But it’s the right question because it actually has a practical, positive answer that is within the grasp of most women – and (drumroll, please) here it is: Depending on your height, a unit of Body Mass Index (which is exactly what the experts use to measure weight-related health risk; basically it’s a measure of weight corrected for differences in height) is 5-7 pounds. The difference between one dress size and the next is around 8 pounds. Are you starting to get the picture here? If you can keep weight gain after quitting in the range of 5-10 pounds, you will not increase your health risk, no matter how overweight you are to begin with, and your clothes will still fit. And with a little positive self-talk, you should also be able to negotiate a truce between your mind and your new weight.
Some women will have more trouble than others in staying within the magic window. Women who “use” nicotine to manage a tendency toward binge-eating or to quell depression-induced munchies may need some additional help in regulating behavior and managing mood. For most women, however, this is a realistic goal, one that is near the peak of the bell curve for weight gain and one that can be nudged along by modest lifestyle changes like exercising a little more and eating a little less – changes most women find they can carry out. So even though weight gain can begin quite soon after quitting, don’t worry that it is on a linear upward trajectory. For most women it will level off shortly, leaving you at a weight you can make your peace with.
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.