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Weight Gain After Smoking Cessation and Lifestyle Strategies to Reduce it

Jain, Priyankaa; Danaei, Goodarza,b; Manson, JoAnn E.a,c; Robins, James M.a,d; Hernán, Miguel A.a,d,e

doi: 10.1097/EDE.0000000000001106

Background: Weight gain following smoking cessation reduces the incentive to quit, especially among women. Exercise and diet interventions may reduce postcessation weight gain, but their long-term effect has not been estimated in randomized trials.

Methods: We estimated the long-term reduction in postcessation weight gain among women under smoking cessation alone or combined with (1) moderate-to-vigorous exercise (15, 30, 45, 60 minutes/day), and (2) exercise and diet modification (≤2 servings/week of unprocessed red meat; ≥5 servings/day of fruits and vegetables; minimal sugar-sweetened beverages, sweets and desserts, potato chips or fried potatoes, and processed red meat).

Results: Among 10,087 eligible smokers in the Nurses’ Health Study and 9,271 in the Nurses’ Health Study II, the estimated 10-year mean weights under smoking cessation were 75.0 (95% CI = 74.7, 75.5) kg and 79.0 (78.2, 79.6) kg, respectively. Pooling both cohorts, the estimated postcessation mean weight gain was 4.9 (7.3, 2.6) kg lower under a hypothetical strategy of exercising at least 30 minutes/day and diet modification, and 5.9 (8.0, 3.8) kg lower under exercising at least 60 minutes/day and diet modification, compared with smoking cessation without exercising.

Conclusions: In this study, substantial weight gain occurred in women after smoking cessation, but we estimate that exercise and dietary modifications could have averted most of it.

From the aDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA

bDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA

cDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

dDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA

eHarvard-MIT Division of Health Sciences and Technology, Boston, MA.

Submitted December 12, 2018; accepted September 18, 2019.

Research grants received from UM1 CA186107, UM1 CA176726, and R01 HL080644 from the National Institutes of Health.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Availability of data and code for replication: Researchers interested in accessing the Nurses’ Health Study data are required to submit a formal proposal for collaboration. See instructions in The computer code used for these analyses is available from the authors upon request.

Correspondence: Miguel A. Hernán, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115. E-mail:

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