From the Guidelines
Managing weight gain after quitting smoking requires a comprehensive approach focusing on diet, exercise, and behavioral strategies, as the health benefits of quitting smoking far outweigh the risks of modest weight gain, with most people gaining between 3-5 kg after quitting, as noted in the 2025 standards of care in diabetes 1.
Key Strategies for Weight Management
- Establish regular physical activity, aiming for at least 150 minutes of moderate exercise weekly, combining cardio and strength training to boost metabolism and preserve muscle mass.
- Adopt a balanced diet rich in fruits, vegetables, lean proteins, and whole grains while limiting processed foods, sugary snacks, and alcohol.
- Practice portion control by using smaller plates and being mindful of hunger cues.
- Stay hydrated with water rather than caloric beverages, which can help control appetite.
- Develop healthy coping mechanisms to replace smoking, such as deep breathing, walking, or engaging in hobbies.
Medications and Therapies
Some medications like bupropion (Zyban) can help with both smoking cessation and weight management, as mentioned in the 2024 standards of care in diabetes 1. Consider nicotine replacement therapy (NRT) which may delay weight gain during the initial quitting phase.
Importance of Quitting Smoking
Weight gain occurs after quitting because nicotine suppresses appetite and increases metabolism; when removed, appetite increases and metabolism slows by about 100-200 calories per day. Recent research has demonstrated that post-cessation weight gain does not diminish the substantial cardiovascular benefit realized from smoking cessation, as highlighted in the 2020 standards of care in diabetes 1.
Recommendations
Advise all individuals not to use cigarettes and other tobacco products or e-cigarettes, and include smoking cessation counseling and other forms of treatment as a routine component of diabetes care, as recommended in the 2023 standards of care in diabetes 1. Address smoking cessation as part of diabetes education programs for those in need, and assess the level of nicotine dependence, which is associated with difficulty in quitting and relapse, as noted in the 2018 standards of care in diabetes 1.
From the Research
Weight Gain Mechanism After Smoking Cessation
- Weight gain after smoking cessation is a common concern, with most smokers gaining weight after quitting, and some developing new onset obesity and type 2 diabetes 2.
- The average weight gain after smoking cessation is around 5 to 6 kg, with the risk of weight gain being highest during the 2 years immediately following smoking cessation 3.
Factors Associated with Weight Gain
- Factors significantly correlated with weight gain after smoking cessation include triglyceride levels, high-density lipoprotein cholesterol, daily cigarette consumption, and the Fagerström Test for Nicotine Dependence (FTND) score 4.
- Smokers with a high FTND score are more likely to gain weight during smoking cessation therapy, suggesting that smokers with high nicotine dependency may require intervention against weight gain 4.
Interventions to Manage Weight Gain
- 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 2.
- Combining sibutramine and varenicline may facilitate smoking abstinence by attenuating weight gain, and warrants further investigation 5.
- Physical exercise, older age, higher baseline body mass index, and lower rates of smoking can also attenuate the degree of weight gained after smoking cessation 3.
Clinical Approaches to Addressing Weight Concerns
- Alternative approaches to addressing weight concerns include more effective weight control, direct reduction in weight concerns by cognitive-behavioral treatment, and smoking cessation only 6.
- Since the typical amount of weight gain is essentially trivial from a health standpoint, particularly when compared with the health benefits of quitting smoking, the most appropriate clinical strategy may be to combat the weight concerns themselves rather than the weight gain 6.