Body Dissatisfaction in Women Smokers
In spite of public health campaigns highlighting the risks of smoking, many men and women experience difficulties with smoking cessation. In the UK, the highest incidence for women is amongst 25-34 year olds, where 19.8% of women are regular smokers (Cancer Research UK, 2015). Nicotine is usually identified as the key substance responsible for addition to cigarette smoking. However, psychological factors also play a vital part in smoking initiation and maintenance. Smoking in women may be linked to perceptions of body image and weight concern where fear of gaining weight may discourage smoking cessation.
Women smokers tend to have a smaller waist circumference and lower body mass index than those who have never smoked (Kaufman, Augustson and Patrick., 2012). As smoking reduces the palatability of food through reductions in taste and smell, nicotine has a tendency to supress appetite and leads to a distraction from eating (Mineur et al., 2011). On quitting smoking, appetite and metabolic rate revert to pre-smoking levels and food becomes more palatable again. Consequently, most people gain weight as smoking is no longer a distraction from food.
Both qualitative and quantitative research has demonstrated that women smokers report initiating smoking to reduce appetite and aid with weight loss (Grogan et al., 2009), as well as to assist with maintaining current weight (Potter et al.,2004). Unsafe weight loss practices such as fasting and diet pills are utilised more by women smokers than non-smoking women (Stice & Shaw., 2003). Women who are concerned with weight gain adopt smoking as a mechanism to reduce appetite and support weight loss. As concern with gaining weight is an important factor for women smokers, it poses difficulties for those who have body image concerns and want to stop smoking.
Appearance concerns and body dissatisfaction have been reliably linked to smoking. Cross sectional studies measuring body satisfaction in both women smokers and non-smokers found that women smokers were less satisfied with their bodies that non-smoking women (Grogan et al., 2010: Grogan., 2012). A thinner ideal body was also found to be endorsed by women smokers than non-smokers (Pomerleau & Saules., 2007). Body dissatisfaction and perception of body size were identified as important predictors of smoking outcomes at the end of a 3 month randomised smoking cessation trial. A greater discrepancy was found between actual size and ideal size in women smokers than non-smokers and the most difficulties experienced in quitting smoking were found in those who over estimated their body size (King et al., 2005). This implies that women who perceive themselves as overweight may use smoking to reduce their appetite and control eating habits in order to reduce weight, which suggests that body dissatisfaction precedes smoking.
Interventions designed to address weight concerns may aid women with smoking cessation. A US smoking cessation program targeted women with weight gain concerns and provided information on the amount of weight most women gain when quitting smoking, and the benefits of weight gain to health, as oppose to the negative effects of continuing smoking. Women were discouraged to diet and advised on healthy eating, as well as advised on strategies to promote a positive body image. This intervention lead to higher smoking abstinence rates than a condition where non weight related issues were discussed (Perkins et al., 2001). This suggests interventions designed to reduce weight concerns can aid smoking cessation in women who are concerned with weight gain after quitting smoking.
Women smokers experience lower levels of body satisfaction and have higher levels of concern with weight gain than non-smoking women. Research suggests that interventions tackling women smokers concerns with weight gain are more effective in promoting smoking cessation. Addressing body image concerns in smoking cessation interventions aids smoking cessation and promotes higher levels of body satisfaction in women smokers.
As smoking is linked to weight concerns for women, interventions focusing on reducing these concerns may be effective in promoting body satisfaction and enabling women smokers to quit. However, it is also important that these interventions are delivered by trained health care professionals who are sensitive to women smokers concerns and promote smoking cessation without increasing appearance dissatisfaction in those who already have concerns with body image and weight gain.
By Naheed Hanif
Naheed Hanif is a PhD researcher at Manchester Metropolitan University. Her primary research area is behavioural interventions in health psychology. She also has a background in providing equitable health care for BME communities.
Cancer Research UK (2015). Tobacco Statistics. Retrieved 5th March 2015 from
Grogan, S., Fry, G., Gough, B., & Connor, M. (2009). Smoking to stay thin or giving up to save face. Young men and women talk about appearance concerns and smoking. British Journal of Health Psychology, 14, 175-186
Grogan, S., Hartley, L., Fry, G., Connor, M., Gough, B. (2010). Appearance concerns and smoking in young men and women: going beyond weight control. Drugs: Education, Prevention and Policy, 17, 261-269
Grogan, (2012). Smoking and body image. In T. Cash (ed). Encyclopaedia of Body Image and Human Appearance (pp. 745-750). London: Elsevier
Kaufman, A., Augustson, E.M., & Patrick, H. (2012). Unravelling the Relationship between Smoking and Weight: The Role of Sedentary Behaviour. Journal of Obesity, 2012,735465
King, T.K., Matacin, M., White, K.S., & Marcus, B.H. (2005). A prospective examination of body image and smoking in women. Body Image: An International Journal of Research, 2, 19-28
Mineur, Y.S., Abizaid, A., Rao, Y., Salas, R., DiLeone, R.J., Gundisch, D., Diano, S., De Biasi, M., Horvath, T.L., Gao, X. B. & Picciotto, M. R. (2011). Nicotine decreases food intake through activation of POMC neurons. Science, 332, 1330-2
Perkins, K.A., Marcus, M.D., Levine, M.D. et al. (2001). Cognitive behavioural therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women. Journal of Consulting and Clinical Psychology, 69, 604-613.
Pomerleau, C.S., & Saules, K. (2007). Body image, body satisfaction, and eating patterns in normal-weight and overweight/obese women current smokers and never-smokers. Addictive Behaviours, 32, 2329-2334
Potter, B., Pederson, L.L., Chan, S.S.H., Aubut, J.L & Koval, J.J. (2004). Does a relationship exist between body weight, concerns about weight, and smoking amongst adolescents? An integration of the literature with the emphasis on gender. Nicotine and Tobacco Research, 6, 397-425
Stice, E. & Shaw, H. (2003). Prospective relations of body image, eating and affective disturbances to smoking onset in adolescent girls: how Virginia Slims. Journal of Consulting and Clinical Psychology, 71, 129-135.