Obesity and smoking: comparing cessation treatment seekers with the general smoking population

Associations of Smoking Behaviors and Body Mass Index Among American Participants of a Clinical Tobacco Cessation Program: A Pilot Study

Background

Tobacco usage and obesity remain critical public health issues in the United States. This study examined the relationship between smoking behaviors, specifically-cigarettes per day (CPD) and motivations to smoke-and body mass index (BMI). We hypothesized that motivations related to food or stress, as well as a higher CPD, will be positively associated with BMI.

Methodology

We analyzed the electronic medical records of 204 patients from the Johns Hopkins' Tobacco Treatment and Cancer Screening Clinic (TTCSC) between January and April 2022. Demographic information, smoking behavior, CPD, and motivations to smoke were recorded. Multiple linear regression analysis was performed.

Results

We found no statistical significance between motivations to smoke, CPD, and BMI. However, the age at a patient's first visit to the TTCSC was negatively associated with BMI (B = -0.152, P < 0.001).

Conclusions

Smoking behaviors were not significantly related to BMI in our sample. It is advisable for clinicians working in tobacco cessation clinics to consider the BMI of individuals who present for cessation services, especially for younger individuals who smoke. They may be more likely to have an elevated BMI at presentation.

Prevalence of Obesity Among Electronic Cigarette and Tobacco Users in the United States: Results from the 2018 Wave of the Behavioral Risk Factor Surveillance System

Objective: Tobacco use and obesity are leading causes of preventable death in the U.S. E-cigarette use is on the rise; however, obesity prevalence among e-cigarette users is unknown. The present study characterized obesity prevalence among e-cigarette and tobacco users in a national sample of U.S. adults. Method: Data were obtained from the 2018 Behavioral Risk Factor Surveillance System. Approximately 249,726 participants provided data on e-cigarette and tobacco use, height, weight, and demographics, and were categorized as follows: Ever vaped, ever smoked; Ever vaped, never smoked; Never vaped, ever smoked; Never vaped, never smoked. Results: Obesity prevalence (BMI ≥30 kg/m2) differed significantly across groups: 33.0% (ever vaped, ever smoked); 27.7% (ever vaped, never smoked); 33.1% (never vaped, ever smoked); 32.1% (never vaped, never smoked), p < .001. Groups also differed demographically. Logistic regressions adjusted for demographics revealed subjects in the never vaped, ever smoked group were significantly more likely to have obesity relative to those in the never vaped, never smoked group (p < 0.001) with vaping status having no main effect. Secondary analyses using never smokers as the reference found current smokers were less likely to have obesity and former smokers were more likely to have obesity, p < .001. Discussion: The present study is the first to characterize U.S. obesity prevalence among e-cigarette and tobacco users. Obesity prevalence was lower in the ever vaped, never smoked group; however, this finding appears to be attributable to demographic variables. As e-cigarette use becomes more common, future research should examine the development and maintenance of obesity among users.

Reward and inhibition in obesity and cigarette smoking: Neurobiological overlaps and clinical implications

Cigarette smoking and obesity are the leading causes of premature morbidity and mortality and increase the risk of all-cause mortality four-fold when comorbid. Individuals with these conditions demonstrate neurobiological and behavioral differences regarding how they respond to rewarding stimuli or engage in inhibitory control. This narrative review examines the role of reward and inhibition in cigarette smoking and obesity independently, as well as recent research demonstrating an effect of increased body mass index (BMI) on neurocognitive function in individuals who smoke. It is possible that chronic smoking and overeating of highly palatable food, contributing to obesity, dysregulates reward neurocircuitry, subsequently leading to hypofunction of brain networks associated with inhibitory control. These brain changes do not appear to be specific to food or nicotine and, as a result, can potentiate continued cross-use. Changes to reward and inhibitory function due to increased BMI may also make cessation more difficult for those comorbid for obesity and smoking.

Pilot randomized trial of cognitive-behavioral treatment plus contingency management for quitting smoking and weight gain prevention among smokers with overweight or obesity

BACKGROUND

Post-cessation weight gain is a risk factor for relapse among quitters. The primary study aim was to evaluate, among smokers with overweight or obesity, the feasibility and acceptability of a cognitive-behavioral treatment (CBT) plus contingency management (CM) for quitting smoking and weight control. The secondary aim was to examine preliminary tobacco abstinence and weight change outcomes.

METHODS

In an 8-week pilot randomized clinical trial, 41 participants (M_age = 52.73, SD = 10.91, 56.1% females) with overweight or obesity (M_BMI = 31.86, SD = 4.7) received a CBT for both quitting smoking and weight gain prevention (n = 24) or the same treatment plus CM (n = 17), consisting of providing incentives contingent upon smoking abstinence biochemically verified.

RESULTS

Recruitment success rate was 80.39% (41/51), completion rate was 90.24% (37/41), and mean number of sessions attended (out of 15 possible) was 13.20 (SD = 3.1). Mean satisfaction rating for the treatment (1-10 likert-type scale with 10 being most satisfactory) was 9.73 (SD =.61). Preliminary efficacy data indicated that the CM group achieved higher abstinence rates compared with the CBT condition (100% vs. 58.33%, p = .007). Abstinent participants increased 1.25 kg (SD = 1.79) their baseline body weight at the end of treatment (p = .001).

CONCLUSIONS

Providing weight gain prevention strategies and CM within a smoking cessation treatment seems feasible and acceptable. Preliminary data indicated that including CM facilitates tobacco abstinence rates, nevertheless no advantage for CM was found for weight control.

Examining the association between work stress, life stress and obesity among working adult population in Canada: findings from a nationally representative data

Background

Obesity is a priority public health concern in Canada and other parts of the world. The study primarily aims at assessing the role of  self-perceived work and life stress on obesity among working adults in Canada.

Methods

The study was conducted based on a total of 104,636 Canadian adults aged 18 and above, extracted from the 2017–2018 Canadian Community Health Survey (CCHS) data. We used a mixed-effect logistic regression model to determine the possible association between two stress variables and obesity, controlling for other variables in the model. The random effect term accounts for the correlation among the observations from the same health region.

Results

A total of 63,815 adult respondents (aged 18 and above) who were working during the 12 months prior to the survey were studied. Of those, 18.7% were obese based on their self-reported BMI > =30.0 kg/m². More than two-thirds of the respondents reported that their stress level is a bit stressful to extremely stressful. The results of multivariable mixed-effect logistic regression showed that the odds of obesity were 1.432 times (95% CI: 1.248–1.644) among those who reported extremely work-related stress, compared to those who had no work-related stress. Perceived life stress was not significantly associated with obesity risk among working adult population, after adjusting other factors.

Conclusion

The study concluded that obesity among Canadian adults is 18.7% of the working adult population being obese. Given the reported high prevalence of stress and its effect on obesity, the findings suggested improving social support systems, individual/group counseling, and health education focusing on work environments to prevent and manage stressors and drivers to make significant program impacts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00865-8.

An exploration of associations between smoking motives and behavior as a function of body mass index

Objective

Cigarette smoking and obesity are the leading causes of premature morbidity and mortality and increase the risk of all-cause mortality four-fold when comorbid. Although research suggests that smoking motives may differ based on body mass index (BMI), it is unclear how these differences translate to smoking behavior.

Method

Three groups of adults who smoke cigarettes (N = 79; obese n = 25, overweight n = 30, and lean n = 24) completed measures of smoking and the Smoking Motivations Questionnaire. Groups did not differ on age, education, cigarettes per day (CPD), pack-years, or nicotine dependence, as measured by the Fagerström Test for Cigarette Dependence (FTCD).

Results

Analyses revealed different associations between reasons for smoking and smoking behavior depending on lean, overweight, or obesity status. Participants (N = 37 female, average age 39.8 years) self-reported smoking was positively associated with Addictive, and Automatic subscale scores among lean participants, with only the Addictive subscale score among those with overweight, and only the Automatic subscale score among those with obesity. Post hoc MANCOVA analysis revealed a significant interaction effect of Group x Automatic Smoking on Pack-years (F(2, 79)=3.34, p = 0.04).

Conclusion

Findings suggest smoking motives are differentially associated with smoking behavior in adults who smoke depending on weight status. The daily smoking rate of participants with obesity may be less related to the addictive quality of smoking, and automaticity may be less associated with smoking history in those with overweight. Additional research on the influence of BMI on cigarette smoking is necessary to fully elucidate how obesity may impact treatment outcomes to optimize smoking cessation treatment among those with excess body weight.

Exploration of the influence of body mass index on intra-network resting-state connectivity in chronic cigarette smokers

BACKGROUND

Obesity and cigarette smoking are two leading preventable causes of death. Previous research suggests that comorbid smoking and obesity likely share neurobehavioral underpinnings; however, the influence of body mass index (BMI) on resting-state functional connectivity (rsFC) in smokers remains unknown. In this study, we explore how BMI affects rsFC and associations between rsFC and smoking-related behavior.

METHODS

Treatment-seeking cigarette smokers (N = 87; 54 % men) completed a BOLD resting-state fMRI scan session. We grouped smokers into BMI groups (N = 23 with obesity, N = 33 with overweight, N = 31 lean) and used independent components analysis (ICA) to identify the resting state networks commonly associated with cigarette smoking: salience network (SN), right and left executive control networks (ECN) and default mode network (DMN). Average rsFC values were extracted (p < 0.001, k = 100) to determine group differences in rsFC and relationship to self-reported smoking and dependence.

RESULTS

Analyses revealed a significant relationship between BMI and connectivity in the SN and a significant quadratic effect of BMI on DMN connectivity. Heavier smoking was related to greater rsFC in the SN among lean and obese groups but reduced rsFC in the overweight group.

CONCLUSIONS

Findings build on research suggesting an influence of BMI on the neurobiology of smokers. In particular, dysfunction of SN-DMN-ECN circuitry in smokers with overweight may lead to a failure to modulate attention and behavior and subsequent difficulty quitting smoking. Future research is needed to elucidate the mechanism underlying the interaction of BMI and smoking and its impact on treatment.

Nicotine and energy balance: A review examining the effect of nicotine on hormonal appetite regulation and energy expenditure

Nicotine has been shown to decrease appetite, food intake (FI) and body weight, but the mechanisms are unclear. The purpose of this review was to examine research on the effects of nicotine on energy balance by exploring physiological mechanisms and hormone regulation related to FI, subjective appetite and energy expenditure (EE). We searched PubMed and MEDLINE, and included articles investigating the effects of nicotine on central appetite regulation, FI, leptin, peptide-YY (PYY), ghrelin, glucagon-like peptide-1 (GLP-1), adiponectin, cholecystokinin (CCK), orexin, and EE. A total of 65 studies were included in the qualitative synthesis and review. Our findings suggest that the decrease in appetite and FI may be attributed to nicotinic alterations of neuropeptide Y (NPY) and pro-opiomelanocortin (POMC) but the effect of nicotine on FI remains unclear. Furthermore, nicotine increases resting EE (REE) and physical activity EE (PAEE) in both smokers and non-smokers; and these increases may be a result of the catecholaminergic effect of nicotine. Decreases in body weight and appetite experienced by nicotine users results from increased EE and changes in the central hypothalamic regulation of appetite. There is not enough evidence to implicate a relationship between peripheral hormones and changes in appetite or FI after nicotine use. Although nicotine increases REE and PAEE, the effect of nicotine on other components of EE warrants further research. We conclude that further research evaluating the effect of nicotine on appetite hormones, FI and EE in humans is warranted.

Sex-Specific Link Between Emotional Vulnerability and Poor Weight Control in Cigarette Smokers

BACKGROUND

Cigarette smoking and poor weight control independently and synergistically increase risk for morbidity and mortality. However, few studies have examined the etiological role of emotion-regulatory dysfunction in the link between smoking and poor weight control, as well as the possible moderating role of sex.

METHOD

Participants (n = 577; M_age = 44.42; SD = 13.80; 52.7% female) were daily smokers who completed a single survey online through Qualtrics. Emotional vulnerability was indexed by a latent construct comprised of the subscales from the Distress Tolerance Scale (DTS) and the Anxiety Sensitivity Index-3 (ASI-3). A regression model was constructed to examine the relation between emotional vulnerability and poor weight control, measured via body mass index (BMI).

RESULTS

Emotional vulnerability was significantly and positively associated with BMI (b = .08, p = .020). The effect was moderated by sex, such that emotional vulnerability was significantly related to BMI in female smokers (b = .15, p = .002), but not in male smokers (b = .01, p = .806).

CONCLUSIONS

Emotional vulnerability appears to be a novel female-specific psychological mechanism related to poor weight control in smokers. Possible limitations are discussed.

Prevalence of smoking in Sudanese individuals with diabetes and associated complications: Population-based study

INTRODUCTION

Smoking cigarettes and diabetes are major public health problems in Sudan. Smoking is associated with insulin resistance and can be associated with type 2 diabetes. The aim of this study was to investigate the prevalence of smoking in individuals with diabetes and associated complications.

METHODOLOGY

a descriptive analytical cross-sectional study, included 315 of participants with diabetes. The data collection was performed to gather demographic information, prevalence of smoking and presence of complications. In addition to measurement of blood pressure, weight and height measurement for calculation of body mass index and biochemical tests. Statistical association at p.value of 0.05 was measured using T-test for quantitative data and Chi square test for categorical data.

RESULTS

The overall prevalence of smoking was found to be 33.9%. Smoking was statistically significant associated with being male; increase in age; and being married. HbA1c and triglycerides are significantly associated with smoking (P value = 0.01 and 0.05 respectively); therefore, statistical significance was found with ischemic heart disease(IHD) as well (P value = 0.05). Hypertension, duration of diabetes, low density lipoprotein (LDL), cholesterol and body mass index (BMI) were not statistically significant with smoking.

CONCLUSION

Almost third of the population with diabetes are smokers (33.9%). Smoking is statistically associated with IHD, high triglyceride and HbA1c. Therefore, smoking cessation schemes should be advocated by health authorities and the public in Sudan.

The Impact of Weight and Weight-Related Perceptions on Smoking Status Among Young Adults in a Text-Messaging Cessation Program

Introduction

Weight gain and concerns about weight can influence a smoker's ability to successfully quit, and young adults are a subgroup of smokers who are particularly concerned about the impact of quitting on their body weight. This study explored the associations between body mass index, weight perceptions, and smoking status among young adults.

Methods

The sample consisted of 4027 young adults between the ages of 18 and 29 who participated in a randomized control trial of the National Cancer Institute's SmokefreeTXT program. Multivariable logistic regression models were used to examine the associations between weight related variables and smoking status.

Results

Obese participants had a 0.72 lower odds (95% CI: 0.62, 0.85) of reporting smoking at the end of the program than participants of normal weight, and this difference persisted over time. Weight perceptions were also associated with smoking status. Those who perceived themselves to be slightly underweight/underweight were more likely to report smoking than those who reported being just about the right weight (OR: 1.53, 95% CI: 1.20, 1.95), and those who strongly disagreed that smoking cigarettes helps people keep their weight down were less likely to report smoking at the end of treatment than those who neither agreed nor disagreed with this statement (OR: 0.69, 95% CI: 0.54, 0.87).

Conclusions

Weight related factors assessed at baseline predicted smoking status at the end of treatment and through long term follow-up. Smoking cessation programs that tailor content to addresses the specific needs of weight concerned smokers may enhance effectiveness.

Implications

This study explores the association between weight related factors and smoking status among young adults, a priority population for smoking cessation efforts. This study demonstrates that both actual weight and weight perceptions (eg, perception of body weight, perception of associations between smoking and weight) are associated with smoking outcomes, and thus need to be a considered in the development of smoking cessation programs.

The effect of tobacco cessation on weight gain, obesity, and diabetes risk

OBJECTIVE

Most smokers gain weight after quitting, and some develop new onset obesity and type 2 diabetes. The purpose of this paper is to synthesize the current science investigating the consequences of tobacco cessation on body weight and diabetes, as well as intervention strategies that minimize or prevent weight gain while still allowing for successful tobacco cessation.

METHODS

Systematic reviews and relevant studies that were published since prior reviews were selected.

RESULTS

Smoking cessation can cause excessive weight gain in some individuals and can be associated with clinically significant outcomes such as diabetes or obesity onset. Interventions that combine smoking cessation and weight control can be effective for improving cessation and minimizing weight gain but need to be tested in specific populations.

CONCLUSIONS

Despite the health benefits of quitting tobacco, post-cessation weight gain and new onset obesity and diabetes are a significant concern. Promising interventions may need to be more widely applied to reduce the consequences of both obesity and tobacco use.

Non-communicable disease risk factors and treatment preference of obese patients in Cape Town

BACKGROUND

Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning.

AIM

To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs) or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG]) versus usual care (individual consultations) treatment.

SETTING

A primary healthcare facility in Cape Town, South Africa.

METHODS

One hundred and ninety-three patients were recruited in this cross-sectional study. Ninety six chose FBTG while 97 chose usual care. A questionnaire, the hospital database and patients' folders were used to collect data. Weight, height and waist circumference were measured. STATA 11.0 was used for descriptive statistics and to compare the two groups.

RESULTS

The subjects' mean age was 50.4 years, 78% were women and of low education levels and income, and 41.5% had type 2 diabetes, 83.4% hypertension and 69.5% high cholesterol. Mean (s.d.) HbA1c was 9.1 (2.0)%, systolic BP 145.6 (21.0) mmHg, diastolic BP 84.5 (12.0) mmHg, cholesterol 5.4 (1.2) mmol/L), body mass indicator (BMI) 39.3 (7.3) kg/m2 and waist circumference 117 (12.6) cm). These figures were undesirable although pharmacological treatment for diabetes and hypertension was in place. Only 14% were physically active, while TV viewing was > 2h/day. Mean daily intake of fruit and vegetables (2.2 portions/day) was low while added sugar (5 teaspoons) and sugar-sweetened beverages (1.3 glasses) were high. Usual care patients had a higher smoking prevalence, HbA1c, number of NCD risk factors and refined carbohydrate intake, and a lower fruit and vegetable intake.

CONCLUSION

Treatment seekers were typically middle-aged, low income women with various modifiable and intermediate risk factors for NCDs. Patients choosing usual care could have more NCD risks.

Age plays an important role in the relationship between smoking status and obesity risk: a large scale cross-sectional study of Chinese adults

OBJECTIVE

To study the role of age plays in the relationship between smoking status and obesity in both Chinese men and women.

METHODS

From Chinese Physical and Psychological Database, participants were divided into non-smokers, current smokers, and former smokers. Body mass index (BMI), waist circumference (WC), fat percentage, fat mass, and fat free mass were measured. The mean, standard deviation and frequency of these indicators were calculated for each age bracket. One-way ANOVA and post-hoc test analyses were used to detect the difference among these three groups.

RESULTS

In men, from 19 to 24 years old, BMI, WC and fat free mass of current smokers were higher than that of non-smokers (P<0.01). However, fat mass and fat percentage of current smokers were lower than that of non-smokers but higher than that of former smokers (P<0.01). From 25 to 34 years old, BMI and fat mass of former smokers were higher than non-smokers and current smokers (P<0.01). In addition, WC and fat free mass of non-smokers were lower than that of current smokers and former smokers (P<0.01). From 45 to older, BMI, WC, fat mass, fat free mass and fat percentage of former smokers were higher than that of current smokers (P<0.01). From 55 to older, BMI, WC, fat mass, fat free mass and fat percentage of current smokers were lower than that of non-smokers (P<0.01). In women, smoking status might not be significantly related to obesity (P>0.05).

CONCLUSION

For young men, smoking might have an effect on increasing fat free mass, BMI and WC, and decreasing fat mass and fat percentage. For middle and older men, smoking might have an effect on decreasing fat free mass, fat mass, BMI, WC, and fat percentage. Obesity risk should be paid more attention in smoking cessation programs for those former smokers.

Smokers' physical activity and weight gain one year after a successful versus unsuccessful quit attempt

OBJECTIVE

To examine whether smokers' physical activity is related to weight change following a quit attempt.

METHOD

Data were analyzed for participants (n=683) of a randomized controlled trial comparing the efficacy of different smoking cessation pharmacotherapies (Wisconsin, 2005-2008). Activity (assessed via pedometry) and body weight were measured in the days surrounding the quit day and again one year later, at which time 7-day point-prevalence abstinence from smoking was assessed. We examined the effects of quitting, physical activity, and their interaction, on a one-year weight change with relevant covariate adjustment.

RESULTS

Participants were predominantly female (57%), 46 ± 11 years of age (mean ± SD), and took 7544 ± 3606 steps/day at baseline. Of those who quit, 87% gained weight. A main effect was found for quitting (p<0.001), but not physical activity (p=0.06). When pattern of activity was examined across the 1-year study period, quitters who decreased their physical activity had significantly greater weight gain than quitters who increased their physical activity (p<0.01) or maintained a high level of activity (p=0.02).

CONCLUSION

Physical activity is associated with an attenuation of the weight gain that often occurs after quitting smoking.

Examining substance use and affective processes as multivariate risk factors associated with overweight body mass among treatment-seeking smokers

Cigarette smoking and obesity are two major public health problems. However, factors related to the underlying risk for being overweight are not well established. Certain demographic, smoking, and psychological factors have been linked to overweight/obese body mass. The current study examined a multivariate risk model, stratified by gender, in order to better explicate the nature of overweight body mass among daily smokers. In a sample of treatment-seeking smokers (n = 395), among males and females, (1) older age, (2) stronger expectancies about the weight/appetite control effects of smoking, (3) greater smoking-based inflexibility/avoidance due to smoking-related sensations, and (4) less problematic alcohol use, were associated with being overweight. Additionally, among males, having a tobacco-related medical problem and higher tolerance for physical discomfort aided in the discriminant function model for classifying smokers as overweight. Together, numerous cognitive-affective vulnerabilities and smoking processes may be targetable and potentially inform weight-related prevention programs among smokers.

The relationship between obesity and prescription of smoking cessation medications

The objective of this study was to examine the differences in prescription of smoking cessation medications among smokers with different body mass index (BMI) classifications. A retrospective cross-sectional study was conducted using National Ambulatory Medical Care Survey data (2006-2010). Self-reported current smokers aged 18 years and older were included in the study. The outcome of interest was receiving a prescription for a Food and Drug Administration-approved smoking cessation medication. Multivariate logistic regression was performed to assess the association between the outcome variable and the main independent variable (BMI classification), controlling for other covariates. The results showed that overweight, obese, and severely obese smokers were less likely to be prescribed a smoking cessation medication as compared to normal weight smokers. Although 5.11% of normal weight smokers were prescribed a smoking cessation medication, only 3.70% of overweight smokers, 3.41% of obese smokers, and 2.50% of severely obese smokers were prescribed a smoking cessation medication. In addition, older smokers, whites, smokers visiting primary care providers, smokers receiving tobacco counseling, and nondiabetic smokers were more likely to be prescribed a smoking cessation medication. Lower prescription of smoking cessation medications among overweight, obese, and severely obese smokers might be driven by patients' health concerns and behavioral factors or providers' treatment preferences or biases. The disparity in smoking cessation medication prescription among smokers with different BMI classifications raises quality of care and health care concerns for overweight, obese, and severely obese smokers.

Predictors of smoking cessation medication use among nonobese and obese smokers

The objective of this study was to identify and compare the predictors of smoking cessation medication use among obese and nonobese adult smokers. A retrospective cross-sectional study was conducted using the Medical Expenditure Panel Survey (MEPS) data (2008-2009). The study participants included smokers aged 18 years and older who self-reported their smoking status as smoker. The outcome variable was utilization of any Food and Drug Administration approved smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy). Multivariable logistic regression analyses were conducted. A total of 82.20 million (weighted sample size for two years) adult smokers were included; of which nearly 30% were obese-smokers. The use of smoking cessation medication was 2.66% and 5.17% among nonobese and obese smokers, respectively. Multivariable logistic regression results showed that race/ethnicity, health insurance coverage, prescription insurance coverage, usual source of health care, urban residence, region, Charlson comorbidity index, and instrumental activities of daily living (IADL), were significant predictors of using smoking cessation medications. The overall smoking cessation medication use rate was low implying limited compliance to guideline. Predictors identified in this study should be taken into consideration in health promotion programs that are designed to optimize the utilization of these smoking cessation medications.

Once bitten, twice shy: concern about gaining weight after smoking cessation and its association with seeking treatment

BACKGROUND

Concern about weight gain after quitting smoking is often cited as a barrier to smokers making a quit attempt or seeking treatment.

AIM

To identify whether smokers who are non-treatment seekers (NTS) are more concerned about weight gain and have lower confidence to maintain weight after quitting smoking as compared with treatment-seeking smokers (TS).

METHODS

Participants were smokers recruited from Penn State Hershey Medical Center and family practice outpatient clinics. A total of 102 NTS and 186 TS, who participated in a smoking cessation trial, completed a survey regarding tobacco use, weight concern and diet. Stepwise logistic regression was used to identify variables associated with treatment seeking, overall and stratified by those who gained and did not gain weight on a previous quit attempt.

RESULTS

Fifty three per cent of the overall sample (47.1% NTS vs. 56.5% TS, p = 0.127) had gained weight on a prior quit attempt. Among smokers who had gained weight, higher weight gain concern (WGC) and lower confidence in ability to maintain weight were significantly associated with being a NTS after adjusting for other factors.

CONCLUSION

Among smokers who gained weight on a previous quit attempt, NTS had greater concern about gaining weight and less confidence in their ability to maintain their weight after quitting than treatment seekers. Clinicians can identify smokers for whom WGC may be a barrier to seeking treatment by asking if they gained weight on a previous quit attempt. These smokers should be assured that this issue will be addressed in treatment.

Mechanisms linking socioeconomic disadvantage and BMI in smokers

OBJECTIVES

To evaluate a conceptual model of the psychosocial pathways linking socioeconomic status and body mass index (BMI) among smokers.

METHODS

A latent variable modeling approach was used to evaluate the interrelationships among socioeconomic status, perceived neighborhood disadvantage, social support, negative affect, and BMI among smokers recruited from the Houston metropolitan area (N = 424).

RESULTS

A total of 42.4% of participants were obese, with the highest prevalence of obesity among Latinos followed by African Americans. Across all racial/ethnic groups, perceived neighborhood disadvantage, social support, and negative affect functioned as pathways linking socioeconomic status and BMI.

CONCLUSIONS

Findings indicate the need for interventions that target obesity among socioeconomically disadvantaged smokers and provide potential intervention targets for the prevention and treatment of obesity.

Smoking-related weight concerns and obesity: differences among normal weight, overweight, and obese smokers using a telephone tobacco quitline

INTRODUCTION

Substantial evidence suggests that concerns about postcessation weight gain interfere with cessation efforts. However, it is unclear to what extent weight pretreatment affects smoking-related weight concerns. Given that the prevalence of overweight and obesity among callers to tobacco quitlines mirrors that of the population at large, and that women and obese smokers may be more concerned about weight gain, we sought to compare weight gain concerns among normal weight, overweight, and obese callers to a quitline.

METHODS

A sample of 34.6% (n = 206) normal weight, 30.6% (n = 182) overweight, and 34.8% (n = 207) obese quitline callers completed assessments of tobacco use history and smoking-specific weight concerns. Weight categories were compared and gender differences evaluated.

RESULTS

Obese smokers endorsed significantly more concerns about postcessation weight gain [F(2, 592) = 20.35, p < .0001], had less confidence in their ability to maintain their weight without smoking [F(2, 592) = 7.67, p = .0005], and were willing to tolerate less weight gain after quitting than normal weight or overweight smokers [F(2,574) = 30.59, p < .0001). There also were gender differences in weight concerns by weight status. Significantly more women callers were obese (38.2% vs. 28.4%, p = .011), and women consistently endorsed more concern about postcessation weight gain than did men [F(1,588) = 24.04, p < .0001).

CONCLUSIONS

Overweight and obese smokers, particularly women, express substantial concern about gaining weight after quitting. It is possible that smokers who begin quitline treatment with a BMI in the obese range may benefit from adjunctive interventions designed to address smoking-related weight concerns.

Smoking intensity and lipoprotein abnormalities in active smokers

BACKGROUND

Smoking is associated with decreased high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides.

OBJECTIVE

To evaluate the effects of five markers of smoking intensity on lipoprotein concentrations and particle sizes in a large, modern cohort of current smokers.

METHODS

Fasting nuclear magnetic resonance spectroscopy lipoprotein profiles were obtained in a large cohort of current smokers enrolled in a smoking cessation trial. Multivariate linear regression models were constructed to determine predictors of lipoprotein fractions. Models included age, sex, race, waist circumference, level of physical activity and alcohol consumption. Smoking intensity parameters included: current cigarettes smoked/day, pack-years, the Fagerström Test of Nicotine Dependence (FTND) score, and carbon monoxide (CO) levels.

RESULTS

The 1,504 subjects (58% women, 84% white) had a mean (standard deviation) age of 45 (11.0) years. They smoked 21.4 (8.9) cigarettes/day (29.4 [20.4] pack-years). HDL-C (42.0 [13.5] mg/dL) and total HDL particles (30.3 [5.9] μmol/L) were low. Cigarettes smoked/day independently predicted higher total cholesterol (p=0.009), low-density lipoprotein cholesterol (p=0.023), and triglycerides (p=0.002). CO levels predicted lower HDL-C (p=0.027) and total HDL particles (p=0.009). However, the incremental R(2) for each marker of smoking intensity on each lipoprotein was small. Relationships between the FTND score and lipoproteins were weak and inconsistent. Participants in the lowest quintiles of current smoking, pack-years, and CO had more favorable lipoproteins (all p<0.04).

CONCLUSIONS

Among current smokers, increased smoking burden is associated with small increases in total cholesterol, LDL-C, and triglycerides. Increased recent smoke exposure is associated with small decreases in HDL-C and HDL particles.

[The role of risk propensity in smokers and overweight people]

INTRODUCTION

The aim of this study is to investigate the nature of the link associating the risk propensity of smoking and overweight. For example, a person who is a smoker and obese does not have to be more prone to risk than another person who is obese and a non-smoker.

MATERIAL AND METHODS

The data was taken from the German Questionnaire on Personality and Daily (Cross section for the period 2005). This questionnaire was selected because it collects individual data on the sociodemographic characteristic, behaviours, risk attitudes, lottery games, and health status. Our main contribution is to analyse the role of risk propensity taking into account smoking and overweight.

RESULTS

Risk propensity encourages smoking, and to smoke and be overweight are positively associated. When the role of the unobserved characteristics are greater, the lower is the correlation between smoking and overweight. Although the risk propensity is an important determining factor of individual behaviour (smoking and overweight), its inclusion does not decrease the influence of personal circumstances and conditions. The need to define other measurements to be able to analyse the risk propensity of risk specific to risk behaviour is also highlighted.

DISCUSSION

To reduce the number of smokers would require interventions in life styles. Given that overweight is an important determining factor in the decision to smoke, to encourage healthy behaviours, such as physical exercise or balanced diets, could improve the health status of the population on reducing obesity rates, and consequently the number of smokers.

Ambulatory activity associations with cardiovascular and metabolic risk factors in smokers

BACKGROUND

We examined the association between ambulatory activity and biological markers of health in smokers.

METHODS

Baseline data from 985 subjects enrolled in a pharmacologic smoking cessation trial were examined. Body size, blood pressure, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), total and small LDL particles, LDL size, high density lipoprotein cholesterol, triglycerides (TG), C-reactive protein (CRP), creatinine, fasting glucose, and hemoglobin A1c were assessed in relation to pedometer-assessed ambulatory activity, as was the odds of metabolic syndrome and CRP > 3 mg/L. Effect modification by gender was examined.

RESULTS

Only waist circumference was lower with greater steps/day in the men and women combined (P(trend) < 0.001). No other significant relationships were noted in men, while women with ≥ 7500 steps/day had lower weight, BMI, CRP, TG, total, and small LDL particles compared with those with < 7500 steps/day. These women also had 62% and 43% lower odds of metabolic syndrome and elevated CRP, respectively, compared with the less active women. Adjustment for BMI attenuated all the associations seen in women.

CONCLUSIONS

Greater ambulatory activity is associated with lower levels of metabolic and cardiovascular risk factors in female smokers which may, in part, be mediated by a reduction in BMI.

Smoking among morbidly obese patients

BACKGROUND

Smokers usually have a lower Body Mass Index (BMI) when compared to non-smokers. Such a relationship, however, has not been fully studied in obese and morbidly obese patients. The objective of this study was to evaluate the relationship between smoking and BMI among obese and morbidly obese subjects.

METHODS

In a case-control study design, 1022 individuals of both genders, 18-65 years of age, were recruited and grouped according to their smoking status (smokers, ex-smokers, and non-smokers) and nutritional state according to BMI (normal weight, overweight, obese, and morbidly obese).

RESULTS

No significant differences were detected in the four BMI groups with respect to smoking status. However, there was a trend towards a higher frequency of smokers among the overweight, obese, and morbidly obese subjects compared to normal weight individuals (p = 0.078). In a logistic regression, after adjusting for potential confounders, morbidly obese subjects had an adjusted OR of 2.25 (95% CI, 1.52-3.34; p < 0.001) to be a smoker when compared to normal weight individuals.

DISCUSSION

In this sample, while the frequency of smokers diminished in normal weight subjects as the BMI increased, such a trend was reversed in overweight, obese, and morbidly obese patients. In the latter group, the prevalence of smokers was significantly higher compared to the other groups. A patient with morbid obesity had a 2-fold increased risk of becoming a smoker. We speculate that these finding could be a consequence of various overlapping risk behaviors because these patients also are generally less physically active and prefer a less healthy diet, in addition to having a greater alcohol intake in relation to their counterparts. The external validity of these findings must be confirmed.

Offer of a weight management program to overweight and obese weight-concerned smokers improves tobacco dependence treatment outcomes

Weight concern is a common and significant barrier to abstinence for many smokers. This quasi-experimental pilot study used multivariate logistic regression to examine the effects of offering a weight management treatment program on tobacco dependence treatment outcomes. Age, gender, ethnicity, educational level, nicotine dependence level, body mass index, and concern about weight gain were entered as factors/covariates to account for differences between groups. Offering a weight management program increased attendance at the first scheduled contact (88.1% vs. 71.6%; OR = 2.93; p = .029) and increased 6-month abstinence (21.4% vs. 10.1%; OR = 2.42; p = .052). With factors and covariates included in the multivariate models to account for group differences, those offered weight management were five times more likely to attend their first session (OR = 5.10; 95% CI 1.53-16.98; p = .008) and three times more likely to be abstinent 6 months after tobacco treatment (OR = 2.98; 95% CI = 1.09-8.17; p = .033). Proactively informing weight-concerned, overweight/obese smokers about the availability of a weight management program as an incentive for completing treatment for tobacco dependence may improve tobacco treatment outcomes. 

Effect of smoking status on total energy expenditure

Individuals who smoke generally have a lower body mass index (BMI) than nonsmokers. The relative roles of energy expenditure and energy intake in maintaining the lower BMI, however, remain controversial. We tested the hypothesis that current smokers have higher total energy expenditure than never smokers in 308 adults aged 40-69 years old of which 47 were current smokers. Energy expenditure was measured by doubly labeled water during a two week period in which the subjects lived at home and performed their normal activities. Smoking status was determined by questionnaire. There were no significant differences in mean BMI (mean ± SD) between smokers and never smokers for either males (27.8+5.1 kg/m2 vs. 27.5+4.0 kg/m2) or females (26.5+5.3 kg/m2 vs. 28.1+6.6 kg/m2), although the difference in females was of similar magnitude to previous reports. Similarly, total energy expenditure of male smokers (3069+764 kcal/d) was not significantly different from that of never smokers (2854+468 kcal/d), and that of female smokers (2266+387 kcal/d) was not different from that of never smokers (2330+415 kcal/d). These findings did not change after adjustment for age, fat-free mass and self-reported physical activity. Using doubly labeled water, we found no evidence of increased energy expenditure among smokers, however, it should be noted that BMI differences in this cohort also did not differ by smoking status.