Smoking and Eating Disorders — Their Strange Relationship

Smoking prevalence and eating disorders are intertwined in the human psyche. Plenty of scientists have noticed this, and done some exploration, but conclusions about the relationship are far from solid. A multi-author meta-analysis with ties to 15 institutions wanted to determine exactly how prevalent smoking is among people with eating disorders (ED), as compared to the general population. Idle curiosity was not the motive. Together, the two lifestyles add up to one big problem, namely, an important public health issue.

The authors started out knowing already that “Cigarette smoking is associated with severe mental illness including schizophrenia and bipolar disorder, and with morbidity and mortality.” But what about eating disorders? They wrote,

There appears to be a longstanding belief that nicotine suppresses appetite, and smoking has been shown to increase resting metabolic rate, which is why smoking is used for weight control. In individuals with ED, the perceived benefits of nicotine for weight-control and temporary stress reduction may outweigh any concerns about the long-term harms of smoking.

But… this holds true only if they have one of two specific problems, and not the third:

People with binge eating disorder and bulimia nervosa are significantly more likely to be life-time smokers than healthy controls, which is not the case for anorexia nervosa.

Isn’t that odd, or at the very least, counterintuitive? Because out in the world, AN patients get up to some pretty desperate tricks just to shrink a few more fat cells. It seems like it would be the most natural thing in the world, for anorexics to turn to smoking. Yet, apparently they do not. Concerning this and other matters, the paper reiterates a useful concept that is not heard often enough: “The relationship… appears to be complex.”

But wait! Another study, very close in time, contradicted that one. According to the Department of Psychiatry at the University of North Carolina…

[…] subjects with eating disorders of any type, including anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder, had increased rates of smoking and higher nicotine dependence compared to controls.

That is what it says, “disorders of any type, including anorexia nervosa.” This is why there are lots of laboratories and lots of trials, so results can be checked again and again. The big takeaway from this study was that tobacco use and eating disorders do not just happen to coincide once in a while, but hang out together on a fairly regular basis.

Unless the patient’s smoking and eating problems are treated comprehensively and simultaneously, failure can be predicted. Serious rehab costs a king’s ransom. It is said that “many” treatment programs offer support to those with co-occurring conditions, but that may be overly optimistic. For most Americans, the more pressing question is whether an insurance plan offers the same support.

The news gets even worse. The “smoke your way to slimness” trope appears to be based on a false belief. This paper says,

The idea that cigarette smoking is helpful in controlling body weight has been part of popular culture for many decades, dating back to 1930s advertisements that suggested women could smoke to help curb cravings for sweets.

Michelle Lippy of offers a handy checklist for the person who is trying hard to quit cigarettes without bringing in overeating as a replacement. The name of the game is mindfulness. Interrogate yourself like a concerned friend or a skillful therapist, and figure out what the real problem is. Try some of the other suggestions on the page. None of them could possibly hurt.

Your responses and feedback are welcome!

Source: “The association between smoking prevalence and eating disorders: a systematic review and meta-analysis,” SGUL.AC.UK, May 2016
Source: “When Cigarette Smoking is Used as an Appetite Suppressant,”, 05/07/17
Source: “How to Avoid Falling into Using Food to Replace Tobacco,”
Photo credit: Photos by Chloe Muro on Visualhunt/CC BY-ND

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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.
You can contact Dr. Pretlow at:


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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