PROQUEST DTG-Interaction Between Smoking and Body Weight: Implications for Public Health Policy

Sun, Ruoyan (2019) PROQUEST DTG-Interaction Between Smoking and Body Weight: Implications for Public Health Policy. Post-Doctoral thesis, University of Michigan.

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Abstract

Cigarette consumption and excess weight are the two leading causes of premature death and disability in the US. Smoking cessation has well-documented health benefits. However, 80% of quitters experience an unintended consequence of quitting: post-cessation weight gain. Currently, the health message provided to smokers is that it is never too late to quit, without addressing the weight concern that many have. I outline three papers in this dissertation to study the interaction of smoking behaviors and body weight. The first paper examines the age-specific changes in BMI and BMI distribution among US adults, adjusting for smoking and socioeconomic status (SES). I examine population representative annual BMI change across two time periods (1997 to 2007 and 2007 to 2017) by age, gender, SES and smoking status using a synthetic cohort approach. I also assess the changes in BMI distribution among age-specific groups. Information on BMI change and BMI distribution change can help us identify age-groups that are more susceptible to excess weight gain. The second study investigates the tradeoff between the health benefits of quitting smoking and the harm due to post-cessation weight gain. I estimate the break-even weight gain, i.e. the weight individuals would need to gain to offset the benefits of smoking cessation. A potentially attainable break-even weight gain exists for certain combinations of quit-age and BMI. The break-even weight gain decreases with quitage. The break-even weight gain for white males with an initial BMI of 30 is 29.9 kg if they quit at 50 but decreases to 4.2 kg if they quit 80. I identify subgroups with higher initial BMI and higher cigarette consumption as high-risk to receive negative net health benefits from quitting. Smoking cessation should be coupled with weight management programs to maximize health gains. Lastly, I explore interventions that could reduce post-cessation weight gain and estimate the potential increase of overall welfare in the population. Employing an agent-based model, I simulate three interventions on a nationally representative sample of US smokers: pharmacotherapy, physical activity intervention and alternative tobacco product (electronic cigarette). These interventions affect both smoking cessation rates and post-cessation weight gain. Model results show that electronic cigarette is the dominant intervention that increases life-years saved and reduces obesity prevalence.

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