Q & A: A Smoker Who Also Binge Eats

Q: I’m currently treating an obese client with binge eating disorder (BED) who also smokes a pack of cigarettes per day. Although I’ve repeatedly counseled this patient about the significant health risks she faces, she is very reluctant to even think about stopping smoking because she fears that she’ll gain more weight. I know that people who stop smoking are at risk of gaining weight, but is that also true for people who are already obese or for those who have binge eating problems? (F.S., Sacramento, CA)

A: Your client’s concerns regarding weight gain may be well founded. Obese individuals who stop smoking are at risk of gaining even more weight. And, recent research suggests that obese individuals who binge eat and who stop smoking may be at even greater risk of weight gain than are obese individuals who do not binge eat. In a recent study by White et al., based on self-report, in the year following smoking cessation 53.6% of 56 non-binge-eating obese individuals reported weight gains (averaging 5 kg). In comparison 76.6% of 47 obese individuals with BED reported gaining weight, and in this group reported weight gains averaged 11.2 kg. Not surprising, those with more frequent binge-eating episodes were at greater risk of weight gain and tended to gain more weight. As the authors point out, these findings are consistent with the hypotheses that some individuals may begin smoking in an effort to control weight and also that after someone stops smoking, binge eating may replace smoking as a form of coping (IJED 2010; 43:572).

Even with this risk, your client’s overall long-term health is likely to be best served by stopping smoking and then, in turn, dealing with the tendency to overeat and any resulting weight gain. A variety of techniques are available to assist in smoking cessation. Pharmacologically, available evidence currently favors programs using various forms of nicotine (e.g., nicotine gum plus patches), and other options are also available.

— JY