Many smokers rate the fear of weight gain as their number-one barrier to quitting. They worry that the weight they gain may be a greater risk than their present smoking habit. This is unrealistic; to reach the same health risk as smoking just one pack of cigarettes per day, the average smoker would have to be roughly 125 pounds overweight.

The fact is that many, but not all, ex-smokers do gain some weight after they quit. One study found that 60 percent of men and 51 percent of women ex-smokers put on extra pounds. But the degree of weight gain is relatively small in most cases. The average long-term weight gain for quitters is about 5 pounds, and in one study, 23 percent of quitters actually lost weight.

Smokers weigh less because smoking depresses the appetite for certain foods, while quitters, whose appetites are not suppressed, gain weight because they take in more calories. Nicotine may also alter the smoker's metabolism so that smokers burn more calories and convert fewer calories into fat. In addition, smoking serves as a meal terminator (rather than taking a second or third helping or dessert, you are likely to stop eating and have a cigarette).

The following strategies can help you prevent weight gain:

Strategy 1: Ignore it

The most common approach is to just go ahead and quit smoking—you may be one of the lucky ones who gains little or no weight. This is better for light smokers and those who would not be greatly upset by gaining a few pounds.

Strategy 2: Exercise

It's difficult to try to quit smoking and try to make other major life changes. Thus you should begin a regular exercise program several months before your planned quitting date. Not only will exercise help keep your weight down, but it can provide you with an alternative activity that will help you make it through cigarette withdrawal.

Strategy 3: Reduce sweets

You needn't go on a full-scale, all-out diet. Instead, restrict the type, not the quantity, of your food. One way to ease a craving for sweets is to use sugar substitutes or eat more fruit. The desire for sweets will fade as your body readjusts its bloodsugar level.

Strategy 4: Alter your routine

Practice these mealtime and between-meal tips: (1) Take smaller portions (encourage this by using small plates); (2) eat slowly and try to be the last one finished; (3) put your fork down between bites; (4) drink a large glass of water with each meal and take frequent sips between bites; (5) serve fruit for dessert or skip dessert altogether, (6) get up from the table as soon as you finish; (7) terminate your meal with a nonsmoking activity (take a walk, brush your teeth, wash the dishes, etc.); (8) stock up on raw vegetables for healthy between-meal snacks; (9) go to bed earlier to avoid the temptation to snack.

Strategy 5: Do something dramatic

One ex-smoker came up with a unique approach: "When I quit smoking I gained 12 pounds. Determined to lose it, I drove to a supermarket two miles from home, marched up to the butcher counter, and had them grind me 12 pounds of hamburger. I left my car in the parking lot and carried it home. By the time I got home I was exhausted. I was carrying that much extra weight around with me every day—no wonder I felt tired all the time! I gave most of the hamburger away to friends and neighbors, then started a running program the next day. I eventually shed those 12 pounds."

By Tom Ferguson, M.D.

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