Why weight is a concern for people presenting for smoking cessation.

Smoking tobacco has been around for over 2000 years but its only in the last few decades of this century that it became linked with a whole host or chronic and debilitating illnesses leading to premature aging and death.

Smoking around the world has significantly reduced in recent times due to policy, increased taxes, health awareness campaigns, and the social undesirability of causing harm to self and others e.g., through passive smoking.

New Zealand for example aims to achieve a <5% smoking prevalence by 2025, requiring significant increases in cessation rates, especially among Maori populations (Ikeda, et al., 2015).

In the Americas, tobacco use prevalence has been decreasing, with the Region on track to reduce prevalence by 30% or more by 2025, particularly among males, although progress varies widely among countries (Marquizo, et al., 2022).

In Australia, according to the AIHW, smoking rates continue to decline, although the concern now on the agenda is that vaping rates have tripled as a result!

Smoking is a habit which often starts for younger people due to peer pressure, modelled from significant influencers such as parents or older siblings, a need to appear older, cooler, and more mature amongst peers, and for many, as an appetite suppressant as a way of managing weight.  

Many of the secondary gains i.e., benefits for continuing to smoke, that trigger someone into smoking, create a reliance well beyond the purpose originally intended. And many become psychologically dependent on nicotine despite not really wanting, or able to afford, to be for financial or health reasons.

Secondary gains are often below a client’s conscious radar. Often, so many years have passed since they started smoking and the original purpose for using cigarettes becomes buried. Many however are very aware of their secondary gains and it's typically the reason they have not been successful at quitting so far.

The reason hypnotherapy provides one of the best ways to quit any kind of habit and/or addiction, however, is that it can raise consciousness to a client’s secondary gains whilst keeping defences low. In our practice the most common secondary gains for those seeking to quit smoking using hypnosis are typically a client’s concerns about putting on weight. This doesn’t necessarily materialise immediately and unravels when we start to unpack their narrative and the historical significance of their smoking behaviour.

For many clients unconscious desires to not overeat or put on weight are not just a start to their smoking career, but a strategy put in place which enables it to continue, and also  result in a high rate of relapse when they try to quit. Once they become aware of weight or eating being a concern, we can then address it more openly to manage smoking as a secondary issue rather than it being their primary one.

If the concerns about putting on weight are left unearthed by a hypnotherapist, the client at best may return to smoking as a well-trodden management strategy which requires less effort than having to cycle round the weight loss world, or worst still stop smoking but revert back to their worst fear of piling on the weight.

With two-thirds to three-quarters of the western world now overweight or obese, it’s become the most pressing lifestyle induced health concern in recent history with a high propensity to trigger significant disease and illness. In Australia alone more than 300 people are newly diagnosed with  diabetes every day and the major triggers for diabetes are overweight, obesity, and physical inactivity!

Researchers such as e.g., Yang Hu, et al., (2018), found significant risks of type 2 diabetes, mortality from cardiovascular disease, and all-cause mortality in patients who had reported smoking cessation and experienced significant weight increase after quitting.

Those who are self-quitters are more likely to experience such effects given secondary gains are not always conscious and obvious to them until it’s too late. Seeing a professional to help them quit who understands secondary gains and the issues that can occur with symptom displacement or replacement provides the added reassurance that they will be putting themselves in the best position possible for a successful outcome.

What was also interesting about Yang’s research was that the risk of type 2 diabetes was higher in people who had recently quit smoking (2 to 6 years prior) compared to those who were still smokers. Their findings concluded that the elevated risk of type 2 diabetes was directly associated with weight gain after quitting.

When we work with clients who have concerns about overeating or putting on weight after quitting, we typically ensure they have essential resources in place prior to quitting to mitigate risks of weight gain. This might include helping them address lifestyle issues e.g., increasing exercise, changing aspects of their diet, seeking positive support, managing stress, having 'go to' strategies for reward and reinforcement away from food and eating, and address any emotional eating concerns brought about through grief, loss, depression, trauma, and so on. Whilst we can’t address every aspect of a clients life, we can give them a fighting chances of being happy with their ability to quit without relapsing back into smoking or other unhealthy habits.