Operations

Understanding and Managing the Benefits of Weight Gain After Smoking Cessation

Issue 1 and Volume 40.

After working a particularly trying cardiac arrest, you and your partner step out the ED doors and head for the ambulance to begin cleaning up the cables, IV and medical box debris, and various bodily fluids now decorating the floor of your rig.

“I’ll be there in a second,” you call to your partner, and pause to find a spot for a quick cigarette. You know better. The logical part of your brain tells you that smoking a pack a day may well have contributed to your most recent patient’s cardiac condition. But this is a stressful day in a stressful job, and every time you try to stop smoking, you find your weight slowly creeping up. You try to rationalize and tell yourself high body weight is stressful on your heart, too, and pause for a final drag before joining your partner to begin decontaminating.

Managing Stress

Studies have shown high-stress jobs are associated with increased prevalence and intensity of tobacco use.1 There’s no disputing that EMS can be categorized as high-stress, so it stands to reason that prevalence of smoking among emergency personnel is notably higher than that of the general population: 19.7% of male and 25.5% of female EMS providers currently smoke, in contrast to 18.1% of American adults.2,3

The risks of smoking are common knowledge, particularly among healthcare providers. Tobacco use can contribute to heart disease, cancer, pulmonary disease and a plethora of other disease conditions; according to the Centers for Disease Control and Prevention (CDC), cigarette smoking is the leading cause of preventable death in the United States.4 Judging by cessation attempts, EMS personnel do in fact know better. Of those who currently smoke, 98% report attempting to quit within the past 12 months.2

Added Pounds

So if the knowledge and the intention to kick the habit are there, what’s holding us back? A number of factors likely play a role, including stress, social pressures and physical addiction, but one reason that tops the list for many people is fear of gaining weight. One study reports that 26% of males and 50% of females are discouraged from smoking cessation because they’re afraid of weight gain.3 In addition, many smokers who are successfully attempting to quit are scared off when they notice their weight beginning to creep up, and they resume the habit.4

There are several explanations for weight gain with smoking cessation. The most common is that, without a cigarette to put in their mouth, the ex-smoker instead turns to eating for oral gratification. While that does play a role, the main culprit for added pounds is in fact the physiological change induced by the chemicals found in cigarettes.

Nicotine increases resting metabolic rate—the amount of energy (calories) burned at rest—by 6%.5 This means that, with no change in exercise level or diet, a smoker of average build burns about 200 more calories a day than a nonsmoker. When that smoker quits, they lose that chemical advantage as their metabolism slows down slightly.

Overall, this is a healthy change, both in regards to the aforementioned long-term disease risks and in the short-term stress on the heart. The faster metabolism comes from acutely increased heart rate and blood pressure elevation, so removing that acute cardiac stress is of great benefit to the body.

But the question about what to do about the weight gain remains.The short answer: nothing. On average, when a person stops smoking, they gain about 10.3 pounds over the course of 12 months. Some people gain more, some people may actually lose weight, but 10 pounds is the “normal” expected gain. This may mean adjusting your belt by one loop, or maybe increasing one pant size. It’s not ideal, but it’s also not the end of the world.

Accepting the likelihood of weight gain may require a major perspective shift. Many lay people consider weight loss to be of greater health benefit than smoking cessation.6 Although a sudden and significant weight gain isn’t optimal, a gradual weight gain of about 10 pounds, particularly on a person with an average-to-large frame, is likely to be much less detrimental to health than the continuation of a heavy smoking habit would be. Smoking 20 cigarettes per day puts about the same amount of stress on the heart as 90 pounds of excess body weight.7 So if you can kick smoking and only put on 10 or 15 pounds, from a cardiac health standpoint, you’re coming out ahead.

On average, when a person stops smoking, they gain about 10.3 pounds over the course of 12 months.

 

Long-Term Plan

Having realistic expectations of how your body weight will naturally adjust can help increase your chances of success, but that doesn’t give you a free pass to gorge on fast food and sit on the couch missing your cigarettes. You can try to minimize your weight gain and increase your overall health with a few basic measures of preparation and action.

Carry healthy snacks. When you feel the need to munch, try to choose healthier options most of the time. Pack a bag full of sliced peppers, carrot sticks and other favorite easy-to-grab, handheld fruits and veggies for each shift you work. Keep it handy in the ambulance to avoid the temptation to choose chips or cookies from the EMS break room.

Stock up on the right sweets. Many people who quit smoking find themselves craving sweet tastes. Try to satisfy this craving with fresh or frozen fruit, chewing flavored gum or drinking flavored water without a lot of added sugar. Again, keep these things with you during your shifts so you aren’t tempted to buy high-calorie treats on the go.

Stay active. Exercise releases some of the same feel-good hormones that cigarettes do. It can also boost your metabolism for up to 24 hours after each activity session. Try building in enjoyable exercise on your days off, or before or after your shift if you can fit it into your schedule. If your employer is encouraging you to quit smoking, see if they’re willing to help get you a discounted gym membership or offer some sort of workout facilities for employees to use during downtime and days off.

Control your situations. Identify situations that you know are triggering for you and try to avoid them. If you know that standing outside the ED and chatting with your partner while they smoke will be tempting, then avoid finding yourself in that situation. Relive the call with them while you’re still in the hospital or after you’re back in the truck. Use their smoke break as a chance to use the restroom, eat your healthy snack, or get a head start on your paperwork. When you’re not working, try to avoid situations where you’re drawn to smoking, such as watching sports games at the bar. Choose nonsmoking restaurants or ask to be seated in a nonsmoking section if possible.

Talk to your doctor. Several pharmacological aids have been shown to both ease the cessation process and reduce weight gain while quitting. Talk to your primary care doctor to see if buproprion, fluoxetine, nicotine replacement therapies or e-cigarettes could be useful in your quitting process.

Get personal. Seek out personalized nutrition counseling if you can afford it. Weight gain is reduced in smokers getting personalized nutrition attention.6 A registered dietitian can help you plan meals and snacks to fit your work schedule and cooking abilities as well as helping you figure out what eating pattern is best for your individual medical situation. Check with your insurance company to see if you’re covered for any individual or group sessions and identify a dietitian that is covered in-network.

Stay realistic. Manage your expectations and set reasonable goals. If you can look back a year from now and say that, although you’ve gained 10 pounds you no longer smoke and you can breathe more easily, then that would be a pretty big win. Don’t try to stop smoking, lose weight, start a whole new exercise program, and take up Zen meditation all at the same time—unreasonable expectations set you up for failure. If you set a goal you can reach, you’re more likely to stick with it and reap the benefits.

Conclusion

Once you’ve successfully stopped smoking, then you can worry about trying to take off whatever weight you may have gained in the process. Hopefully at that time you’ll feel healthier and find yourself able to be more active than you could be when you were smoking. Gradually build on that new healthier lifestyle by adding enjoyable exercise to your routine, working in more fruits and vegetables, and building healthy habits, both on the job and on your days off. Remember that every little change adds to the big picture of building a long and healthy life.

References

1. Azagba S, Sharaf MF. The effect of job stress on smoking and alcohol consumption. Health Econ Rev. 2011;1(1):15.
2. Fernandez AR, Studnek JR. Smoking and cessation patterns among nationally registered emergency medical services professionals. Annual meeting of the National Association of EMS Physicians. (2008.) [Lecture.]
3. Centers for Disease Control and Prevention. (Feb. 14, 2014.) Adult cigarette smoking in the United States: Current estimates. Retrieved Sept. 28, 2014, from www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/.
4. Cunningham E. Is weight gain inevitable after smoking cessation? J. Acad. Nutr. Diet. 2013;113(1):180.
5. Perkins KA, Epstein LH, Stiller RL, et al. Acute effects of nicotine on resting metabolic rate in cigarette smokers. Am J Clin Nutr. 1989;50(3):545–550.
6. Sallit J, Ciccazzo M, Dixon Z. A cognitive-behavioral weight control program improves eating and smoking behaviors in weight-concerned female smokers. J Am Diet Assoc. 2009;109(8):1398–1405.
7. Martin T. (July 9, 2014.) Smoking and metabolism. About Health. Retrieved Sept. 18, 2014, from http://quitsmoking.about.com/od/weightgain/a/metabolism.htm.