Knowledge, attitudes and beliefs about smoking, quitting and weight gain: What obese smokers have to say

Issues: Over nine million adults are obese and smoke, markedly increasing their mortality risk. Unfortunately, weight gain following cessation is common and is associated with an increased incidence of diabetes and hypertension. Obese smokers have lower quit rates and gain more weight after quitting but reasons for the poor outcomes are unknown. This study aims to understand obese smokers' thoughts about quitting and potential challenges. Description: Semi-structured interviews were conducted with 29 obese smokers from state quitlines. An immersion/crystallization approach was used to analyze taped interviews using codes obtained through multiple iterations of coding templates. Lessons learned: Obese smokers' awareness of the associations of quitting, change in diet and change in weight was high. Although weight gain was often experienced in prior quit attempts, there was variability in level of weight concerns and the language used to discuss weight providing information for tailored messaging. Some would not tolerate any gain. Others would accept weight gain and made behavioral changes to minimize the expected gain. Opinions were often voiced in the context of satisfaction with their weight or body image. Other unique themes included the need and desire to quit smoking and challenges in obtaining this goal. Stress and chronic disease were cited as conditions most likely to impact cessation. Recommendations: Obese smokers may benefit from interventions providing support around stress reduction, chronic diseases and weight concerns. This study provides the first data of this kind and contributes to the evidence needed to inform treatment development for this high risk population.