Thursday, 17 January 2013

Smoking your way to a fat figure- The obesity risks of cigarettes

The cigarette puff has been glamourized over the years, and associated with slinky women and macho men. However, apart from the health negatives of smoking, one of the not so glamorous sides of smoking is obesity. Studies have shown that among smokers, it is women who are more susceptible to fat accumulation around the middle.

Smoking and obesity are the leading causes of mortality and morbidity worldwide (Chiolero) and perhaps it is no surprise that the two go hand in hand. Not only does smoking associated obesity have cosmetic negatives, but more importantly there are serious health implications. Chiolero observes that according to the Framingham study, the life expectancy of obese smokers was 13 years less than that of normal-weight nonsmokers. Clair writes of recent studies which suggest that smoking is associated with metabolic disorders such as diabetes and obesity. Obesity is known to be a risk factor for cardiovascular disease among others. Persons with both conditions (smoking and obesity) are at high risk for cardiovascular disease and cancer, and have a substantially reduced life expectancy.

Chiolero observes that considering that obesity is epidemic and that smoking prevalence is high and increasing in many parts of the world, especially in developing countries, it is clear that the co-occurrence of the 2 conditions will increase, with devastating effects on the health of the world’s populations.

Does smoking cause weight gain?

The Nurses’ Health Study had a reliable comparison of various categories of smokers and nonsmokers. An 8-y follow-up of 55 000 women showed that nonsmokers had a lower weight gain than did smoking initiators or continuous smokers. Heavy smokers gained more weight than did light smokers in that cohort. In the Cancer Prevention Study I, whereas smokers had lower body weight than did never or former smokers, heavy smokers were more likely to be overweight than were other smokers. In a general adult population sample in Germany, male heavy smokers were more likely to be obese than were male light smokers. Chiolero et al recently showed in a large survey of a general adult population in Switzerland that the odds of being obese increased progressively with smoking.

Does the cigarette make women fat?

Barrett-Connor observed a dose-response relation of increasing waist-hip ratio with increasing number of cigarettes smoked. The associations, seen in both sexes, were stronger in women. Carole Clair observed similarly that among smokers, cigarettes smoked per day were positively associated with central fat accumulation, particularly in women. Clair writes that current smokers tend to have a larger waist circumference and a higher waist-to-hip ratio than non-smokers, suggesting that smoking may favor the accumulation of abdominal fat.
The findings, she claims, were in accordance with studies reporting a stronger association between smoking and abdominal fat accumulation in women. The sex difference Clair says, could be explained by a stronger antiestrogenic effect of nicotine in women than in men.

Why would smoking lead to obesity?

One explanation put forward by Chiolero is that heavy smokers are more likely to adopt behaviors favoring weight gain (eg, low physical activity, unhealthy diet, and high alcohol intake) than are light smokers or nonsmokers. Smokers eat less fruit and vegetables, adopt unhealthy patterns of nutrient intake, drink more alcohol, and engage in less physical activity than do nonsmokers . A strong clustering of risk behaviors (ie, low physical activity, low intakes of fruit and vegetables, and high alcohol intake) that correlated with the level of cigarette consumption have been identified by them. Also, especially in persons of lower socioeconomic status, tobacco consumption is clustered with other risk behaviors known to favor weight gain (eg, poor diet and low physical activity).

Reference ( available via the free domain):

1.   Consequences of smoking for body weight, body fat distribution, and insulin resistance, Arnaud Chiolero, David Faeh, Fred Paccaud, and Jacques Cornuz, Am J Clin Nutr 2008;87:801–9.

2.    Cigarette smoking and increased central adiposity, Barrett-Connor E, Khaw KT, Ann Intern Med. 1989 Nov 15;111(10):783-7

3.    Dose-dependent positive association between cigarette smoking, abdominal obesity and body fat: cross-sectional data from a population-based survey, Carole Clair, Arnaud Chiolero, David Faeh, Jacques Cornuz, Pedro Marques-Vidal, Fred Paccaud, Vincent Mooser, GĂ©rard Waeber, Peter Vollenweider, BMC Public Health 2011, 11:23


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