Why Quitting Means Gaining

By Janice M. Horowitz

Quitting cigarettes is generally something to celebrate, but for many ex- smokers there is a weighty price to pay on the scale. Last week a study by the Centers for Disease Control confirmed what many former smokers have learned from experience: people who swear off smoking can expect to gain weight -- an average of 3.8 kg (8 lbs.) for women, 2.8 kg (6 lbs.) for men. More disturbing is the finding that 1 in 8 women who quit -- and 1 in 10 male quitters -- add a hefty 13 kg (29 lbs.) or more, while continuing smokers tend to gain much less. The CDC's report, published last week in the New England Journal of Medicine, noted that certain groups are particularly likely to lose the battle of the bulge, among them blacks, people under 55 and those who smoked more than 15 cigarettes a day.

The CDC's study is not the first to link quitting with gaining, but it represents the most comprehensive work to date. Epidemiologist David Williamson and his research team reviewed data on 1,885 smokers and 768 nonsmokers who were studied over a period of 13 years. The report provides the clearest demonstration that women gain more than men, notes Neil Grunberg, medical psychologist at Bethesda's Uniformed Services University, who wrote an accompanying editorial. "It's very impressive."

Why do people plump up after giving up cigarettes? There are several emotional and behavioral factors, including simply the habit of putting something into one's mouth. But experts increasingly believe physiological factors play the largest role. Nicotine, found in tobacco, speeds up physiological functions, especially the rate at which the body metabolizes food. "Though people will tell you they smoke to relax, in reality, they're all charged up," says psychologist Daniel Kirschenbaum of Chicago's Northwestern Memorial Hospital. A smoker's heart rate, for instance, averages 84 beats a minute, compared with 72 beats for a nonsmoker. When smoking stops, metabolism slows down, food is burned more slowly and the pounds can start piling on. Research by psychologist Richard Keesey at the University of Wisconsin suggests the added pounds represent a return to a more normal weight. Smoking, he says, "artificially lowers the body weight."

Recent quitters frequently feel an almost uncontrollable urge to gorge on sugary, high-carbohydrate foods. This too is probably due to the powerful influence of nicotine. In smokers, the drug lowers the level of insulin in the bloodstream, which in turn decreases the craving for sweet-tasting food. Grunberg has shown in laboratory animals that removing nicotine causes insulin levels to rise, prompting greater consumption of sweets. This sweet-tooth effect is far more pronounced in female animals than in males, which may explain the difference found between the two sexes in the CDC study. But researchers are baffled by the increased vulnerability of blacks to weight gain. Says Williamson: "More work needs to be done."

Health officials are concerned that the desire to stay slim may be contributing to the high rate of smoking among teenage girls, who tend to take up the habit at a younger age than boys. Just this month the American Journal of Public Health reported that more than twice as many adolescent girls as boys said they were worried about gaining weight if they quit smoking. In years past, cigarette companies capitalized on such fears. Lucky Strike ads in the 1920s encouraged women to "Reach for the Lucky Strike Instead of a Sweet." Unfortunately, doctors note, even modest weight gains can loom large for women: a gain of 8 lbs., for instance, can translate into a different dress size; for men it may only mean letting the belt out a notch or two.

Specialists offer a host of recommendations for warding off the weight. "Just making people aware that nicotine withdrawal may lead to an increase in their appetite is often enough to prevent them from putting on the pounds," says Chicago internist Robert Gluckman, an obesity specialist. Chewing nicotine gum to cut down the physical withdrawal from the addiction is also often advised, as is engaging in some form of aerobic exercise to help push up the metabolic rate. To satisfy the craving for sweets, Grunberg suggests, quitters should sprinkle everything, from meat to poultry to fruit, with a sugar substitute.

National smoking-cessation programs also provide clever techniques to help people adjust to life without a cigarette dangling from their mouth. Smokenders, based in Connecticut, explains that a person puffs about 10 times for every cigarette smoked, or 200 times a day for every pack. With this in mind, the group teaches people to brush and floss after each meal in order to "give mouths plenty of that attention they're missing," says seminar director Charlotte Tausz. She also suggests "ways of engaging in noncaloric pucker responses" like sipping water through a straw or sucking on ginger root and cinnamon sticks.

Will the CDC study discourage smokers from snuffing the habit? If so, this would be a terrible mistake, says Kirschenbaum, who adds that the health risk of smoking a pack and a half to two packs a day "is equal to carrying 60 to 80 extra pounds in body weight." Smoking, which leads to 400,000 U.S. deaths a year, "is about the most dangerous thing a person can do," affirms Tausz. "I'd rather see someone be a few pounds heavier and a nonsmoker, than smoke and be skinny." No doctor would disagree, but try telling that to a teenage girl.

CHART: NOT AVAILABLE

CREDIT: TIME Chart by Dixon Rohr

CAPTION: PUFFING UP

% who gained weight

With reporting by Lynn Emmerman/Chicago and Joseph J. Kane/Atlanta