Smoking and Eating Disorders — It’s Complicated

A few years ago, a study set out to observe the relationship between smoking cessation treatment and binge eating. Previous research had discovered that…

[…] both smoking and binge eating modulate negative affect, so it is possible that in the absence of smoking, some individuals begin binge eating in an attempt to regulate negative emotions.

To put it another way, people overeat and/or smoke to move their emotional states away from stress and toward comfort. And why not? Even an amoeba knows to recoil from pain, and for all we know, it might yearn to go to the amoeba equivalent of a beach and enjoy the amoeba equivalent of a Mai Tai.

The study indicated that among people in a quit-smoking program, binge eaters were less likely than normal eaters to abandon nicotine. A non-binge-eater was an impressive three times as likely to successfully quit smoking. So far, sounds like common sense — but the picture becomes complicated.

The research team suspects that some people smoke to tamp down their binge-eating desires, and for them it works. Also, there is evidence that smoking cessation can turn a person into a binge eater, even if they formerly were not. These individuals will gain weight as a consequence. No surprise there. The paper also says,

[…] binge eating is likely to result in weight gain and weight gain may predict relapse for smoking…

This sounds exactly like a vicious cycle, and those are the kind that nobody wants. Getting back to the study itself, there were a couple of problems. First, it depended exclusively on self-reporting, which is always a weak spot. Second, the respondents were left to improvise their own definitions of “binge eating.” But here is the kicker:

[A]ll study participants were taking bupropion, a drug with appetite-reducing and antidepressant effects, which suggests that the rate of binge eating and weight gain observed in this sample may have been influenced somewhat by the medication.

Influenced somewhat? That is an understatement. Unless the specific point was to find out what bupropion does, it seems like the fact that all the subjects were on it should be an automatic disqualifier. But the study did bring up interesting points, and offered one recommendation with which a quarrel would be hard to pick:

Future smoking cessation studies should evaluate and track eating problems throughout the treatment.

In a study five years later, a team examined…

[…] eating disorder psychopathology and depressive symptoms by smoking status (never, former, or current smoker) in persons with binge eating disorder (BED) and bulimia nervosa.

Among the BED patients, the current smokers had more depressive symptoms than the former or never smokers. For the bulimia patients, it didn’t seem to make any difference, and there were “no differences in eating disorder psychopathology by smoking status in either the BED or BN groups.” The report also said,

There is evidence that a subset of individuals use smoking as an appetite and weight control method, and fear of weight gain is a frequently cited barrier to smoking cessation in both non-eating disorder and eating disorder samples.

Your responses and feedback are welcome!

Source: “Effect of Binge Eating on Treatment Outcomes for Smoking Cessation,”, 10/01/10
Source: “Smoking Status and Psychosocial Factors in Binge Eating Disorder and Bulimia Nervosa,”, 12/19/15
Photo credit: Faint Sanity on Visualhunt/CC BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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