Smoking Cessation, Weight Gain and Vapes

    The benefits of smoking cessation are numerous and indisputable. But one of the few negatives can be undesired weight gain after you quit. Adding to the seriousness of this, the fear of gaining weight may prevent people from quitting cigarettes—and is often cited as a reason for resumption of smoking among people who did quit.

    Nicotine vapes are effective smoking cessation tools. But could they also help with the weight issue?

    “I always taught that smoking cessation support should include advice on how to avoid post-cessation weight gain, especially for people who have been advised to lose or avoid gaining extra weight for health reasons,” Dr. Marewa Glover, a behavioral scientist and tobacco harm reduction advocate in New Zealand, told Filter.

    Glover explained that nicotine’s various effects include stimulating metabolism and suppressing appetite. “After stopping smoking, satisfying sweets, food and drink might be used by people seeking a substitute,” she said. “If they are no longer getting nicotine or they lower their nicotine intake, their metabolism could slow down. In addition, their appetite could increase.”

    When vapes can provide equivalent nicotine to cigaretteswithout the harmful smoke—as well as replacing other aspects of the ritual and satisfaction of smoking, it’s logical to consider their impact in this area. A number of scientists have done just that.

    “Our findings in switching trials with e-cigarettes contrast with trials of licensed anti-smoking medications, in which substantial weight gain is typically reported.”

    In brief, our work has shown lack of substantial post-cessation weight increase in those who quit [smoking] by switching to regular e-cigarette use,” Dr. Riccardo Polosa, one of the authors of a study on this question, and professor of internal medicine at the University of Catania, Italy, told Filter.

    “Our findings in switching trials with e-cigarettes contrast with the evidence from smoking cessation trials of licensed anti-smoking medications, in which substantial weight gain is typically reported,” he added.

    Vapes’ capacity to prevent post-cessation weight gain, motivating people who quit cigarettes to stay quit (among other reasons), makes them “great examples of a relapse prevention tool,” Polosa said.

    An earlier paper, coauthored by Dr. Glover, pointed to other factors—besides nicotine—that might potentially add to vapes’ impact on post-smoking cessation weight gain.

    For one, people might overeat, perhaps snacking compulsively, because of the missing ritual of hand-to-mouth movement that came with smoking—an action that vapes directly replace (providing what Polosa said might be a “coping mechanism” to avoid compulsive eating).

    Vape flavors could additionally influence appetite, the authors suggested.

    Glover elaborated to Filter how “potential satiation effects of the smell and flavor of flavored vaping liquids, and actions involved in vaping (drawing vapor into the mouth, or inhaling and exhaling, or blowing out/creating cloud) could have an independent effect,” besides the hand-to-mouth action and the nicotine.

    “I still think vaping flavored nicotine-containing liquids could have potential for slowing post-cessation weight gain,” Glover said. “But since our 2016 paper, gradually reducing the level of nicotine in vaping became a widely advised practice to encourage people to work towards stopping vaping. Surveys of a general population of adults who switch to vaping are therefore not likely to find the weight gain prevention benefits our paper discussed.”

    The paper called for more research in these areas. But its ideas make sense to Chris Robinson, a tobacco harm reduction advocate in Australia who quit smoking with the help of vapes in 2013. He now helps others to do the same, and believes vaping can have an application in preventing unwanted weight gain. “Vape flavors are the key to success,” he told Filter.

    “Any risks associated with vaping are minute compared to the risks of both smoking and obesity.”

    Robinson shared an anecdote of helping a friend who was experiencing an “addiction” to coffee-flavored milk, which was detrimental to his health goals.

    “He asked me to help him get a vaporizer with coffee milk flavor,” Robinson said. “Once we got him set with zero-nicotine juice and a vaporizer, his intake of sweetened milk dropped to zero.”

    Nicotine wasn’t even involved here, though the friend was not using vapes to quit cigarettes. “Any risks associated with vaping are minute compared to the risks of both smoking and obesity,” Robinson said.

    Dr. Polosa emphasized this too. “In particular for individuals who are overweight or obese,” he said, “additional weight gain is a cause for concern because it is associated with an increased risk of cardiovascular events and all-cause mortality.”

    Smoking and obesity are the two leading causes of death in the United States—while in the UK, obesity costs the National Health Service £6.5 billion a year and is the “second biggest preventable cause of cancer” after smoking. Risks of type 2 diabetes and coronary heart disease, among other illnesses, are also increased. So prevention of unwanted weight gain is a pressing concern in itself—well beyond its risk of discouraging smoking cessation.

    Polosa believes the public health problem of obesity is growing so much worldwide that in 10 years’ time, people “will have to worry less about smoking, because most of the people will be dying because of obesity and diabetes.” In that scenario, he said, “the question arises [of] whether the health risk related to post-smoking cessation weight gain can exceed the protective benefits of quitting smoking.”

    Accumulating epidemiological evidence suggests that “the true health benefit of smoking cessation in the context of significant post-cessation weight gain is unclear,” he added.

    The possibility that vape flavors could mitigate two major public health issues at once will only harden harm reductionists’ stance.

    Other researchers have noted that “co-occurrence of obesity and smoking increases the mortality risk above and beyond either risk factor alone.”

    Numerous studies have shown the importance of vape flavors to people who wish to quit smoking. Many choose sweet flavors, rather than tobacco flavor, because they don’t want to be constantly reminded of cigarettes.

    For this reason, harm reductionists have condemned vape flavor bans and widespread moves to impose more of them.

    The possibility that vape flavors could mitigate two major public health issues at once will only harden that stance.

    Individual flavor preferences vary, but for some, “a craving for dessert after dinner can be satisfied by vaping a dessert flavor,” Robinson said. It works by direct substitution. You vape the flavor you have a craving for. It seems to work really well for some people, as it did with my friend and his flavored milk.”



    Photograph by gratuit via FreeImagesLive/Creative Commons 3.0

    Both the Center of Excellence for the Acceleration of Harm Reduction, founded by Dr. Polosa, and the Centre of Research Excellence: Indigenous Sovereignty & Smoking, founded by Dr. Glover, have received grants from the Foundation for a Smoke-Free World. The Influence Foundation, which operates Filter, has also received grants from FSFW. Filter‘s Editorial Independence Policy applies.

    • Kiran is a tobacco harm reduction fellow for Filter. She is a writer and journalist who has written for publications including the Guardian, the Telegraph, I Paper and the Times, among many others. Her book, I Can Hear the Cuckoo, was published by Gaia in 2023. She lives in Wales.

      Kiran’s fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to Filter.

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