Bonnie Spring is a Professor of Preventive Medicine, Psychology, and Psychiatry and Behavioral Sciences Director of Behavioral Medicine, and Co-Program Leader for Cancer Prevention at Northwestern University. A Past President of the Society of Behavioral Medicine, she is board-certified in clinical health psychology. Dr. Spring’s most recent book is Smoking Cessation with Weight Gain Prevention, and in the original post below, she reflects on her own struggle with giving up cigarettes and maintaining her weight.
“You’ve given me new hope.” So read the e-mail that arrived shortly after Parade Magazine published a story about my research showing that trying to manage weight gain while stopping smoking can help rather than hurt successful quitting. A steady stream of similar messages flowed in, taking my mind back to the days when I first started to study weight gain after quitting smoking. I still flinch at the memories. Faculty colleagues asked when I would switch to studying a real health problem – one with serious medical consequences. The reception was about as chilly at the National Institutes of Health. The words of a usually supportive program officer float back to me, “Oh come on…There’s only an average six to eight pound weight gain after quitting. That’s not a health problem – that’s a cosmetic problem. We’re in the business of studying threats to health – not insults to personal vanity!”
The physicians I spoke with weren’t much more helpful. They said things like, “Look, there’s no question that the much greater health risk comes from the smoking rather than the weight gain. The average person would have to gain about 100 pounds to offset the health benefit of quitting.” Indeed, medical practice guidelines conveyed a similar message. The U.S. Public Health Service Guideline on Tobacco Treatment encouraged physicians to tell patients not to worry about weight gain until they were fully confident and secure as non-smokers. The fear was that trying to manage both things at once – smoking and weight – would be overwhelming and would undermine the success of the quit attempt. Yet even though that guidance seemed right-minded and conservative, I watched it prompt my friends to make a life-threatening decision. Nor did I watch detachedly, because I was one of the many smokers who responded by making the same bad decision. Having to choose between being smoke-free and being slender felt like being crushed between a rock and a hard place. Yes, I cared about my long-term health and wanted very badly to quit. However, maintaining a slender, attractive appearance felt essential to sustain the social reinforcers that were vital to my quality of life. We can call it vain, irrational or disordered till the cows come home, but my priorities were certainly not unusual then or now. I continued to smoke.
Living out the truism that “research is me-search,” I began a series of treatment studies to test different ways to help smokers quit smoking without gaining weight. We already knew that ex-smokers gain weight especially because they eat more, but al
