World No Tobacco Day 2024: Tobacco use is a major risk factor for many chronic diseases like cancer, lung disease, cardiovascular disease, and stroke. Globally and in India it is one of the major causes of death and accounts for nearly 1.35 million deaths every year. India is the second largest consumer and producer of tobacco. A variety of tobacco products are available at very low prices in the country.
Nearly 267 million adults (15 years and above) in India (29% of all adults) are users of tobacco, according to the Global Adult Tobacco Survey India, 2016-17. The most prevalent form of tobacco use in India is smokeless tobacco and commonly used products are khaini, gutkha, betel quid with tobacco and zarda. Smoking forms of tobacco used are bidi, cigarette and hookah.
According to Dr Pritam Kataria, Consultant Medical Oncology Sir H. N. Reliance Foundation Hospital, the idea that cigarette smoking helps control body weight has been part of popular culture for many years. For many smokers, the anticipation of weight gain can hinder the campaign of smoking cessation.
“Most healthcare providers would agree that the decrease in morbidity and mortality associated with smoking cessation far outweighs the health risks associated with post-cessation weight gain. Nevertheless weight gain can reduce some of the health benefits on account of quitting smoking. For example, weight gain after smoking cessation contributes to an increased risk of type 2 diabetes and hypertension and also reduces the improvement in lung function conferred by quitting smoking,” Dr. Kataria told Financial Express.com.
The mechanisms through which smoking decreases body weight are complex and incompletely understood. Most of the effects of cigarette smoking on body weight are mediated by nicotine, although smoking a cigarette may also serve as a behavioral alternative to eating, resulting in decreased food intake.
Nicotine reduces body weight by raising the resting metabolic rate while blunting the expected increase in food intake in response to the increase in metabolic rate. Smoking increases 24-h energy expenditure by ~10 percent and this increase in energy expenditure more prominent during exercise and after eating than while at rest.
According to Dr. Kataria, nicotine has complex effects on these hormones.
The acute response leads to the activation of systems that increase body metabolism and decrease appetite, whereas the chronic changes are consistent with the activation of systems that increase appetite and decrease metabolic rate.
“Nicotine also produces other metabolic effects that directly relate to body weight or composition, including insulin resistance. When smokers quit smoking, the loss of the metabolic boost and appetite suppression conferred by nicotine is often accompanied by increased caloric intake but no increase in physical activity. This positive energy balance leads to weight gain. Behavioral interventions to manage post-cessation weight gain have therefore focused on managing caloric intake, increasing physical activity, or both,” he told Financial Express.com.
Several pharmacotherapies have been evaluated for preventing post-cessation weight gain. These include bupropion, nicotine-replacement medications, fluoxetine, and varenicline. These medications appear to delay, rather than prevent, post-cessation weight gain. That is, once the drug regimens are completed, the weight increases to a level consistent with what would have been reached if no medication had been used.
However, a temporary suppression of weight gain might increase smokers’ motivation to quit, allowing time for the smoker who is concerned about weight gain to focus on quitting smoking first and subsequently address dietary intake and physical activity, he said.
“So the combination of pharmacological therapies and behavioural therapy may help to prevent weight gain during the post-smoking cessation period and prevent factors that jeopardize our efforts for smoking cessation,” he said.