Table 2.4Studies assessing use of smoking to control body weight (clinical samples)

StudyDesign/populationMeasurePercentage endorsingFindings
Welch and Fairburn 1998102 women with bulimia nervosa Mean 23.7 years of age (SD = 4.9) 102 women with mood or anxiety disorders matched by age and socioeconomic status (SES) 204 age- and SES-matched nonpsychiatric controls United KingdomNREver smoked to avoid eating or to control weight (current and former smokers only):
Bulimia = 73%
Psychiatric controls = 19%
Healthy controls = 13%

Ever resumed smoking because of concerns about weight or shape (smokers who had achieved >6 months of abstinence only):
Bulimia = 28%
Psychiatric controls = 4%
Healthy controls = 2%
  • Patients with bulimia more likely (57%) than psychiatric controls (29%) or healthy controls (24%) to be current smokers
  • Bulimic patients more likely than members of either control group to report they started smoking to control weight and that they ever resumed smoking because of concerns about their weight or shape
Crisp et al. 1999879 females with current or former history of eating disorders
Age NR (range 17–40 years)
Participants answered questions assessing their reasons for smoking, including “instead of eating,” “makes me less hungry,” “when I feel like bingeing,” and “to control my weight”

Anticipated consequences of giving up smoking were also assessed, one of which was “put on weight”
Weight-related reasons for smoking:*
Instead of eating = 70%
Makes me less hungry = 52%
When I feel like bingeing = 50%
To control my weight = 48%

Anticipated consequences of quitting smoking:*
Put on weight = 40%

*Responded “yes, definitely”
  • All weight-control-related reasons for smoking were significantly associated with scores on the Interoceptive Awareness scale from the Eating Disorders Inventory (EDI)
  • Smokers scored higher than nonsmokers on the Bulimia subscale of the EDI but not on scales measuring drive for thinness or body dissatisfaction
Krug et al. 2008Case-control study
Mean 25.8 years of age (SD = 8.7)
Eating disorders (n = 879)
Healthy controls (n = 785)
5 European countries
Participants indicated whether they smoked cigarettes or took legal or illegal drugs and/or medicine to influence appetite or weightSmoke cigarettes to control weight:
Total among patients with eating disorders = 26.8%
Anorexia (restrictive type) = 11.0%
Anorexia (bulimic and/or purging subtype) = 36.9%
Bulimia = 39.4%
Eating disorder not otherwise specified (NOS) = 21.1%
Healthy controls = 9.1%

Total among patients with eating disorders = 34.1%
Anorexia (restrictive type) = 17.5%
Anorexia (bulimic and/or purging subtype) = 43.6%
Bulimia = 45.3%
Eating disorder NOS = 31.5%
Healthy controls = 9.2%
  • Patients with eating disorders 3.7 times as likely as healthy controls to currently smoke to control appetite or weight and 5.1 times as likely to have a lifetime history of weight-control smoking
  • Lifetime (47.5% vs. 35.1%) and current (34.8% vs. 24.2%) rates of cigarette smoking significantly higher among patients with eating disorders than in healthy controls

Note: NR = not reported; SD = standard deviation.

From: 2, The Health Consequences of Tobacco Use Among Young People

Cover of Preventing Tobacco Use Among Youth and Young Adults
Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health.

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