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Avoiding smoking-cessation weight gain

by Barbara A. Brehm, Ed.D.

I'd like to quit smoking," your client confesses, "but I am scared to death of gaining weight. Two years ago I quit for six months and gained 15 pounds. I figured since obesity is so bad for your health, I was probably better off smoking. When I went back to smoking, I also went on a diet and most of the weight came off. Now my husband and kids are bugging me to quit smoking again. So is my doctor. Is there any way to quit smoking without gaining weight?"

Fitness professionals know that smoking is much more hazardous to one's health than an extra 15 pounds, but most of us can also understand that a 15-pound weight gain would be pretty depressing. And it doesn't seem fair -- a person tackles a very difficult challenge, quitting smoking, and instead of a reward, they get punished. Of course you know the punch line -- the best way to avoid smoking-cessation weight gain (and the stress of quitting) is to exercise regularly. Fitness professionals can serve as important resources for clients joining the Great American Smokeout every November, and for those quitting any other month as well.

Smoking: A hard habit to break


If you find yourself counseling a smoker, you'll want to express understanding for the difficulty of quitting and confidence in the client's ability to do so. Quitting smoking is difficult for many reasons. The physiological addictiveness of nicotine equals or exceeds that of the opiates heroin and cocaine. Physical addiction to substances results from the effect of these drugs on brain biochemistry. Withdrawal of the substance, nicotine in the case of smoking, results in biochemical changes that cause intense cravings, anxiety and depression. These feelings vary in intensity from person to person, but almost always make quitting a very unpleasant process. The withdrawal effects are most intense the first few days of quitting but, fortunately, so is the commitment to quit. And many ex-smokers continue to experience some degree of craving for many weeks after they quit.

The habitual activity of smoking compounds the difficulty imposed by the physiological addiction. Smokers may have been used to lighting up 20 or more times a day. Many situations may be associated with smoking behavior -- morning coffee, best friends, talking on the phone, driving, eating a meal. Most of these events are common daily occurrences that cannot be avoided, so reminders to smoke are always present.

Obviously you will not want to dwell on these difficulties with your soon-to-be ex-smokers. But by expressing your sympathy, your own or a close friend's difficulty quitting, you let the client know you understand. Since many fitness professionals are militant anti-smokers, clients are often afraid they will encounter condemnation and abuse when they enter the fitness center. Remember, smokers are not bad people. They're people with a bad habit.

Why do people gain weight?


In the past, people believed that the weight gain accompanying smoking cessation was explained by the conversion of the oral habit of smoking to that of eating. Many people do eat more once they quit smoking. Food tastes better as the senses of smell and taste are no longer dulled by smoking. Munching on snacks sometimes serves as a substitute for puffing on cigarettes. But much of the weight gain has a more disturbing explanation -- smoking raises metabolic rate. When people quit smoking but continue to eat the same number of calories, they gain weight. Thus, the weight gain that can occur with smoking cessation usually does not indicate out-of-control eating, but changes in energy balance.

Recommend exercise


People afraid of weight gain may be motivated to increase energy expenditure through exercise. A regular exercise program can significantly reduce a tendency to gain weight with smoking cessation. Of course, smoking cigarettes takes a lot less energy than exercising. But then again, it is accompanied by undesirable side effects. Smokers new to exercise may also experience shortness of breath with exercise. Hopefully this will reinforce their desire to kick the habit, but difficulty breathing may dictate a low-intensity exercise program at first. Remember, if exercise is painful, compliance will be low. Help your new ex-smokers find a level of exertion that's right for them.

As with any group, any exercise is better than no exercise. Figure out what clients are willing and wanting to do, and build from there. To maximize the metabolic "boost" provided by exercise, encourage regular, almost daily activity of an appropriate (moderately vigorous but not painful) intensity combined with resistance training to build muscle. (Resting metabolic rate increases with an increase in muscle mass.)

Many new ex-smokers begin an exercise program to prevent weight gain but become fitness enthusiasts because exercise makes them feel good. Regular physical activity elevates both metabolism and mood. Exercise can help clients through the difficult period of nicotine withdrawal. Fitness centers also support smoking-cessation efforts by providing a positive focus on health and an environment associated with not smoking.

Promote healthful eating habits


Sometimes clients trying to quit smoking face double jeopardy by simultaneously going on a very restrictive diet. Just when they need a healthful diet the most to buffer the stress of quitting, they make themselves irritable and hungry with self-induced starvation. The metabolic drop associated with nicotine withdrawal can be further compounded by the starvation response to very-low-calorie diets. Diet advice for hopeful ex-smokers is the familiar prescription you give to many of your other clients. Don't "diet," but eat a well-balanced, low-fat, heart-healthy diet with plenty of fruits and vegetables. Spread your calories throughout the day -- eat breakfast, lunch and dinner. Keep an eye on portion sizes. Eat foods you like and enjoy your meals. Ex-smokers with a tendency to "munch" need advice on low-fat snacks and activities to keep their hands busy.

Realistic expectations


Some smokers, especially women, may be unhealthfully but fashionably thin. It's possible their nonsmoking weight may be five pounds heavier but more healthful. What is a realistic weight? Consider body build and genetics. Some clients may have a hard time adjusting their expectations.

Help clients continue to make not smoking a priority


Despite your good advice and your client's best exercise efforts, weight gain may occur. Help clients find stress management value in their exercise programs, and encourage them to continue to make not smoking and their health a priority.

Vol. 12, No. 12, pp.30, 32. Copyright November 1996,
Fitness Management Magazine, Los Angeles, Calif.

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