: Weight increase after quitting smoking In clinical setting, weight gain after quitting smoking is a complain that many patients have. Which evidence do we have and what's the reccomended approach to treat this condition?

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The literature regarding smoking cessation and weight gain is abundant and probably I won’t be able to go through all the points in my post.

Some years ago, a paper published in Obesity Reviews by Fizolof et al (Obes Rev. 2004 May;5(2):95-103) provided a excellent overview on the topic.
As it is not open access, here are some interesting extracts which should bring some clarifications

First, regarding the evidence for weight gain smoking cessation:

Whereas numerous studies have found evidence that smoking cessation is
associated with weight gain, there is controversy regarding the
consistency and magnitude of this weight gain. Although most
will gain less than 4.5 kg, as many as 13% of quitters may gain at
least 11 kg. African Americans, people under the age of 55 and
heavy smokers (those smoking more than 25 cigarettes per day) are at
elevated risk for major weight gain. Besides, low
socio-economic status was also associated to higher weight gain.

However, studies often showed some methodological limitations such as

the use of self-reported height and weight, failure to biochemically
validate smoking status, a tendency to report point prevalence vs.
continuous abstinence and limited follow-up periods.

What are the possible mechanisms associated with weight gain?

The mechanism of weight gain include increased energy intake,
decreased resting metabolic rate, decreased physical activ- ity, and
changes in adipose tissue-lipoprotein lipase (AT-LPL) activity and
lipolysis.

There is no clear evidence based recommendations to avoid weight gain after smoking (probably due to the lack of a clear consensus regarding weight gain and smoking cessation).

Filozof reviewed some studies which investigated either pharmacological or behavioural/diet interventions in smoking cessation:

Nicotine replacement – in particular nicotine gum – appears to be
effective in delaying post-cessation weight gain (1). However, once
nicotine gum use ceases, the quitting smoker gains an amount of weight
that is about the same as if she or he had never used gum (1).

1 mg of nicotine (contained in a chewing gum) has a pronounced
thermogenic effect that could be increased by 100% by adding 100 mg
caffeine (2).

Assali et al. reported no prevention of weight gain by transdermal
nicotine replacement patch (3)

Compared with placebo, mean body weight gain at the end of treatment
was significantly lower in patients receiving short-term bupropion
300 mg d-1 who had been continuously abstinent (4), long-term
bupropion (5) or bupropion plus nicotine patch (5)

Danielsson et al. (5) reported higher rates of success for smoking
cessation by combining the smoking cessation programme with an intervention diet.

Some studies (7,8) reported that exercise might minimize weight gain
after smoking cessation.

Sources (did not manage to format the list better...)

Gross J, Stitzer ML, Maldonado J. Nicotine replacement effects on
postcessation weight gain. J Consult Clin Psychol 1989; 57: 87–92.
Jessen AB, Toubro S, Astrup A. Effect of chewing gum con- taining
nicotine and caffeine on energy expenditure and substrate
utilisation in men. Am J Clin Nutr 2003; 77: 1442–1447.
Assali AR, Beigel Y, Schreibman R, Shafer Z, Faineru M. Weight gain
and insulin resistance during nicotine replacement therapy. Clin
Cardiol 1999; 22: 357–360
Hurt RD, Sachs DP, Glover ED, Offord KP, Johnston JA, Dale LC,
Khayrallah MA, Schroeder DR, Glover PN, Sullivan CR, Croghan IT,
Sullivan PM. A comparison of sustained-release bupropion and placebo
for smoking cessation. N Engl J Med 1997; 337: 1195–1202
Hays JT, Hurt RD, Rigotti NA, Niaura R, Gonzales D, Durcan MJ, Sachs
DP, Wolter TD, Buist AS, Johnston JA, White JD. Sustained-release
bupropion for pharmacological relapse pre- vention after smoking
cessation: a randomised controlled trial. Ann Intern Med 2001; 135:
423–433.
Danielsson T, Rossner S, Westin A. Open randomised trial of very low
energy diet together with nicotine gum for stopping smoking in women
who gained weight in previous attempts to quit. BMJ 1999; 319:
490–494.
Kawachi I, Troisi RJ, Rotnitzky AG, Coakley EH, Colditz GA. Can
physical activity minimise weight gain in women after smoking
cessation? Am J Public Health 1996; 86: 999–1004.
Marcus BH, Albrecht AE, King TK, Parisi AF, Pinto BM, Roberts M,
Niaura RS, Abrams DB. The efficacy of exercise as an aid for
smoking-cessation interventions in women: a randomised controlled
trial. Arch Intern Med 1999; 159: 1229–1236