Reducing Weight-gain Worries Helps Women Stop Smoking

Many women express one major concern when they decide to stop smoking— gaining weight. Researchers at the University of Pittsburgh School of Medicine found that an intervention directly addressing this concern led to greater success in helping women quit smoking than did interventions with a weight-control element. Women who received counseling to reduce their weight-gain worries put on less weight than those who dieted while quitting smoking.

Women are at greater risk than men for smoking-related illnesses such as heart disease and lung cancer, but have less success in breaking the habit. “Quitting smoking tends to be harder for women than for men, and part of this disparity is attributable to women’s greater fear of gaining a lot of weight if they quit,” suggests Alan Leshner, Ph.D., former director of the National Institute on Drug Abuse (NIDA), which funded the study. “It would be an important clinical advance if we found a way to successfully address those concerns, making it easier for more women to stop smoking.”

The research team, headed by Kenneth A. Perkins, Ph.D., and Marsha Marcus, Ph.D., recruited 219 women for the 7-week program. Over the course of 10 sessions, one group received standard smoking cessation counseling. A second combined the cessation program with diet advice to prevent weight gain. A third group received cessation counseling plus cognitive behavioral therapy (CBT) aimed at decreasing the women’s concerns about gaining weight. None of the groups received medication.

The CBT group was encouraged to accept a small weight gain. Group members avoided dieting and challenged their negative thoughts about their body image. Healthy foods were promoted, and the women learned about nutrition and portion control. They also learned that the risks of smoking far outweigh the risks associated with weight gain.

One year after treatment, 21 percent of the CBT group remained smoke-free. The group that received dieting advice had a 13 percent cessation rate, and those on standard treatment, 9 percent. Although members of the weight control group had the smallest weight gain initially, their average gain at 1 year was 11.9 pounds, compared to 5.5 pounds for the CBT group. Those who received standard cessation therapy gained the most weight—an average of 16.9 pounds.

The researchers concluded that CBT improved smoking cessation beyond either standard cessation counseling or weight control counseling. “The critical factor influencing smoking relapse in women concerned about gaining weight may be the women’s over-concern about weight gain, rather than the experience of weight gain itself,” observes Dr. Perkins in light of his research. The study suggests that health care professionals who offer medication and weight-control advice to help women stop smoking might try nutritional counseling and building positive self-image instead.

This study was supported by NIDA and published in the August 2001 issue of the Journal of Consulting and Clinical Psychology. s