News Review From Harvard Medical School -- Ex-Smokers Healthier Despite Weight Gain
Gaining weight after quitting smoking won't reduce the benefits of quitting for your heart, a new study finds. People often gain a few pounds after they quit smoking. Some cite that as a fear that keeps them from quitting. The new study included more than 3,200 adults. They were part of a long-running heart-health study. More than half of those who smoked quit during the 27 years of the study. In all, 631 people had a heart attack, stroke, clogged leg arteries or heart failure, or died of related causes. These problems occurred only half as often in former smokers as in smokers. And that benefit was not reduced among people who gained weight after they quit. Typically, people gained about 5 to 10 pounds. These figures apply to people without diabetes. The trend was similar among people with diabetes. However, the differences were small enough in diabetics that they could have happened by chance. The Journal of the American Medical Association published the study. HealthDay News wrote about it March 12.
By Reena L. Pande, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Weight gain after quitting smoking is often cited as a reason not to quit. Many people wonder if the dangers of weight gain offset the benefits of quitting smoking. Both smoking and being overweight increase the risk of developing heart disease.
So are you better off quitting smoking even if there is a chance of gaining weight? Or are you better off continuing to smoke to avoid putting on the weight? These are reasonable questions. Until now, doctors did not have good answers to them.
A study out this week makes the answer clear: You are still better off quitting smoking. Researchers used information from the long-running Framingham Offspring Study. They looked at the risk of heart disease, stroke, peripheral artery disease and congestive heart failure in a six-year period for people who:
- Had never smoked
- Had quit smoking recently
- Had quit at least four years earlier
Researchers also looked at changes in weight in each of these groups. They found that those who had recently quit smoking had the greatest weight gain. The average was about 2.7 kilograms, or 6 pounds, for people without diabetes. Those with diabetes gained an average of 3.6 kilograms, or 8 pounds.
There was no question that the risk of heart and blood vessel disease was lowest for those who had never smoked. Risk was nearly three times as high for those who did smoke. Recent quitters (less than four years) and long-term quitters (more than four years) had a similar risk of heart disease. But overall that risk was reduced by about half compared with active smokers.
The benefits of quitting were just as strong for those who gained weight as for those who didn't.
These findings were very clear in people who did not have diabetes. The trends were the same in diabetics. However, more research will be needed to confirm this effect in people with diabetes.
What Changes Can I Make Now?
There is no denying that quitting smoking is hard. First, you must want to quit. For patients who do, here are some strategies I recommend:
- Think about why you smoke. Is it because of stress, or boredom, or habit? Figuring out why you smoke may help you come up with strategies for how you can quit.
- Think about why you want to quit. Is it for you, your kids, to set a good example, to get healthy? Write these down and keep them with you as reminders.
- Pick a quit date, put it on your calendar, and tell all your friends and family.
- Anticipate the challenges you might face. I tell patients to practice saying "No, thank you, I don't smoke anymore." Then they'll be prepared if anyone offers them a cigarette.
- Get help from your doctor. There are many tools to quit smoking that your doctor can recommend. They include:
- Nicotine replacement, such as including patches, gum, inhalers, sprays or lozenges
- Medicines, such as buproprion (Zyban or Wellbutrin) and varenicline (Chantix), can reduce the urge to smoke.
Remember, some strategies that work for some people don't work for others. Keep trying. Find the tools that work best for you to quit.
How can you manage the weight gain that often comes with quitting smoking? Before you quit, think about ways you might try to keep your weight in check. Maybe you can start a new exercise program before you quit, or work on sticking to a healthy, well-balanced diet. Starting these strategies in advance may help prevent the weight gain altogether.
What Can I Expect Looking to the Future?
Balancing the "pros" of quitting smoking with the "cons" of associated weight gain can be hard. In our society, so focused on weight, the fear of weight gain has kept many people from quitting smoking. This new research reassures us that you are still better off quitting smoking and that those who quit cut their risk of heart disease in half. Gaining weight did not reduce those benefits.
The most challenging part is preparing to quit and just doing it. I hope that in the future we will have more tools to help people quit smoking. Until then, we'll just keep reminding you about the benefits of quitting every time we see you in the office.