OBJECTIVES: Most people gain weight on stopping smoking but the extent of weight gain varies greatly. Interventions aimed at all quitters to prevent weight gain on cessation have proven unpopular but targeting people who have gained excess weight immediately after quitting may improve uptake and cost-effectiveness. We examined whether early large postcessation weight gain predicts overall large weight gain. DESIGN: Retrospective cohort study. SETTING: Primary care setting-smoking cessation centre in Prague, Czech Republic. PARTICIPANTS: Out of 3537 patients treated between 2005 and 2013, 1050 were continuous abstainers (verified by carbon monoxide measurement) at 1-year follow-up and formed the cohort of the current report. 48.7% were women (n=511) with the mean age of 46 (±14.4) years. METHODS: In this retrospective cohort study, all patients underwent usual tobacco dependence treatment using evidence-based methods. Weight was measured prior to smoking cessation and at each visit after quitting. RESULTS: The mean weight gain in the first month (n=763) was 0.79% (±2.03%), in the second month (n=646) was 1.49% (±2.58%), for the third month (n=566) 2.33% (±3.44%) and 4.1% (±5.31%) after 1-year follow-up (n=1050). The regression coefficient per 1% rise in the first 3 months was +0.13% (95% CI -0.04% to 0.30%). A receiver operating curve analysis showed that patients gaining more than 0.98% of their baseline weight during first 3 months had a sensitivity of 66% and specificity of 44% for gaining 7% or more weight by 12 months. In addition, lower body mass index and an increase in appetite at 3 months after quitting were associated with greater weight gain, while using nicotine replacement therapy was associated with less weight gain at 1-year follow-up. CONCLUSIONS: People who stop smoking and gain a larger amount of weight early after quitting are not more likely to gain excessively at 1 year.

Centre for Tobacco Dependent 3rd Medical Department 1st Faculty of Medicine Charles University and the General University Hospital Charles University Prague Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University and the General University Hospital Charles University Prague Czech Republic

Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK

See more in PubMed

Perkins KA. Weight gain following smoking cessation. J Consult Clin Psychol 1993;61:768–77. 10.1037/0022-006X.61.5.768 PubMed DOI

Pistelli F, Aquilini F, Carrozzi L. Weight gain after smoking cessation. Monaldi Arch Chest Dis 2009;71:81–7. 10.4081/monaldi.2009.367 PubMed DOI

Aubin HJ, Farley A, Lycett D, et al. . Weight gain in smokers after quitting cigarettes: meta-analysis. BMJ 2012;345:e4439 10.1136/bmj.e4439 PubMed DOI PMC

Kmetova A, Kralikova E, Stepankova L, et al. . Factors associated with weight changes in successful quitters participating in a smoking cessation program. Addict Behav 2014;39:239–45. 10.1016/j.addbeh.2013.10.010 PubMed DOI

Cairella G, Ciaralli F, Longo P, et al. . [Smoking cessation and weight gain]. Ann Ig 2007;19:73–81. PubMed

Klein LC, Corwin EJ, Ceballos RM. Leptin, hunger, and body weight: Influence of gender, tobacco smoking, and smoking abstinence. Addict Behav 2004;29:921–7. 10.1016/j.addbeh.2004.02.023 PubMed DOI

Chatkin R, Chatkin JM. [Smoking and changes in body weight: can physiopathology and genetics explain this association?]. J Bras Pneumol 2007;33:712–9. PubMed

Henningfield JE, London ED, Pogun S. Handbook of experimental pharmacology 192. Nicotine psychopharmacology. Preface. Handb Exp Pharmacol 2009:v–viii. PubMed

Filozof C, Fernández Pinilla MC, Fernández-Cruz A. Smoking cessation and weight gain. Obes Rev 2004;5:95–103. 10.1111/j.1467-789X.2004.00131.x PubMed DOI

Mineur YS, Abizaid A, Rao Y, et al. . Nicotine decreases food intake through activation of POMC neurons. Science 2011;332:1330–2. 10.1126/science.1201889 PubMed DOI PMC

Hughes JR. Effects of abstinence from tobacco: etiology, animal models, epidemiology, and significance: a subjective review. Nicotine Tob Res 2007;9:329–39. 10.1080/14622200701188927 PubMed DOI

Hughes JR, Gust SW, Skoog K, et al. . Symptoms of tobacco withdrawal. A replication and extension. Arch Gen Psychiatry 1991;48:52–9. PubMed

Geha PY, Aschenbrenner K, Felsted J, et al. . Altered hypothalamic response to food in smokers. Am J Clin Nutr 2013;97:15–22. 10.3945/ajcn.112.043307 PubMed DOI PMC

Gritz ER, Ippoliti A, Jarvik ME, et al. . The effect of nicotine on the delay of gastric emptying. Aliment Pharmacol Ther 1988;2:173–8. 10.1111/j.1365-2036.1988.tb00685.x PubMed DOI

Miller G, Palmer KR, Smith B, et al. . Smoking delays gastric emptying of solids. Gut 1989;30:50–3. 10.1136/gut.30.1.50 PubMed DOI PMC

Kadota K, Takeshima F, Inoue K, et al. . Effects of smoking cessation on gastric emptying in smokers. J Clin Gastroenterol 2010;44:e71–e75. 10.1097/MCG.0b013e3181be9a0f PubMed DOI

Biedermann L, Zeitz J, Mwinyi J, et al. . Smoking cessation induces profound changes in the composition of the intestinal microbiota in humans. PLoS One 2013;8:e59260 10.1371/journal.pone.0059260 PubMed DOI PMC

Aveyard P, Lycett D, Farley A. Managing smoking cessation‑related weight gain. Pol Arch Med Wewn 2012;122:494–8. PubMed

Swan GE, Carmelli D. Characteristics associated with excessive weight gain after smoking cessation in men. Am J Public Health 1995;85:73–7. 10.2105/AJPH.85.1.73 PubMed DOI PMC

Borrelli B, Mermelstein R. The role of weight concern and self-efficacy in smoking cessation and weight gain among smokers in a clinic-based cessation program. Addict Behav 1998;23:609–22. 10.1016/S0306-4603(98)00014-8 PubMed DOI

Jeffery RW, Hennrikus DJ, Lando HA, et al. . Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation. Health Psychol 2000;19:242–6. 10.1037/0278-6133.19.3.242 PubMed DOI

Lycett D, Munafò M, Johnstone E, et al. . Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers. Addiction 2011;106:188–96. 10.1111/j.1360-0443.2010.03136.x PubMed DOI

Fiore MC, Jaen CR, Baker TB, et al. . Treating tobacco use and dependence: 2008 update, clinical practice guideline. executive summary. 2008. http://www.rcjournal.com/contents/09.08/09.08.1217.pdf (Accessed 26 November 2017). PubMed

Králíková E, Češka R, Pánková A, et al. . [Tobacco dependence treatment guidelines]. Vnitr Lek 2015;61:1S4–15. PubMed

Heatherton TF, Kozlowski LT, Frecker RC, et al. . The fagerström test for nicotine dependence: a revision of the fagerström tolerance questionnaire. Br J Addict 1991;86:1119–27. 10.1111/j.1360-0443.1991.tb01879.x PubMed DOI

Fagerström K. Determinants of tobacco use and renaming the FTND to the Fagerstrom Test for Cigarette Dependence. Nicotine Tob Res 2012;14:75–8. 10.1093/ntr/ntr137 PubMed DOI

Hughes JR, Hatsukami D. Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry 1986;43:289–94. 10.1001/archpsyc.1986.01800030107013 PubMed DOI

West R, Hajek P, Stead L, et al. . Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction 2005;100:299–303. 10.1111/j.1360-0443.2004.00995.x PubMed DOI

World Health Organization. Health Topics. Obesity. 2016. http://www.who.int/topics/obesity/en/ (Accessed 17 Apr 2017).

Beck AT, Steer RA, Ball R, et al. . Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996;67:588–97. 10.1207/s15327752jpa6703_13 PubMed DOI

Can G, Oztuna F, Topbaş M. Complaints related to smoking cessation. Tuberk Toraks 2007;55:364–9. PubMed

John U, Meyer C, Rumpf HJ, et al. . Predictors of increased body mass index following cessation of smoking. Am J Addict 2006;15:192–7. 10.1080/10550490500528738 PubMed DOI

Bacha S, Skandagi W, Khemiri M, et al. . Assessment of eating behavior after smoking cessation. Tunis Med 2016;94:406–11. PubMed

Farley AC, Hajek P, Lycett D, et al. . Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev 2012;1:CD006219 10.1002/14651858.CD006219.pub3 PubMed DOI

Hajek P, Jackson P, Belcher M. Long-term use of nicotine chewing gum. Occurrence, determinants, and effect on weight gain. JAMA 1988;260:1593–6. PubMed

Lycett D, Hajek P, Aveyard P. Trial Protocol: randomised controlled trial of the effects of very low calorie diet, modest dietary restriction, and sequential behavioural programme on hunger, urges to smoke, abstinence and weight gain in overweight smokers stopping smoking. Trials 2010;11:94 10.1186/1745-6215-11-94 PubMed DOI PMC

Lycett D, Aveyard P, Farmer A, et al. . Slimming World in Stop Smoking Services (SWISSS): study protocol for a randomized controlled trial. Trials 2013;14:182 10.1186/1745-6215-14-182 PubMed DOI PMC