The Impact of Smoking Reduction on Food Demand in People with Excess Weight.

Smoking cessation is commonly associated with increased food intake and weight gain, representing a substantial barrier to quitting, particularly for individuals with overweight or obesity. This study aimed to uncover the behavioral economic mechanisms underpinning this phenomenon by analyzing changes in food demand during smoking cessation treatment among people with overweight or obesity. We also explored whether baseline tobacco use and eating behaviors predicted these changes. In an eight-week clinical trial, 120 adults with tobacco use disorder and overweight or obesity received treatment to promote smoking cessation and prevent weight gain. Tobacco exposure was assessed via urine cotinine, and food demand was measured using the Food Purchase Task (FPT) at baseline, 48 hours before the scheduled quit day (week 5), and post-treatment (week 8). Mixed-effects repeated measures models were used to analyze changes in FPT indices: demand intensity, Omax, Pmax, breakpoint, and elasticity. Participants who reduced or ceased smoking exhibited increases in food demand. Decreases in cotinine levels were significantly associated with higher Omax (p = .02), Pmax (p = .023), and breakpoint (p = .026), indicating increased reinforcing value of food during cessation treatment. Smoking reduction is linked to heightened food reinforcement, which may contribute to post-cessation weight gain. These findings highlight a potential mechanism underlying cessation-related weight gain and support the need for targeted interventions addressing the heightened reinforcing value of food during smoking cessation in individuals with excess weight.