Our meta analysis has shown that abstinent smokers gain a mean weight of 4 5 kg after 12 months of abstinence. However, we have found substantial variation in weight gain, indicating that this mean value does not reflect many people who give up smoking. We estimated that at 12 months, 16 21% of participants lost weight and 13 14% gained more than 10 kg.

Although weight gain after smoking cessation is widely recognised, this meta analysis provides clinicians and patients with a more robust and detailed description of the first 12 months of weight change after cessation. The finding of a mean weight gain of 4.7 kg in untreated quitters at one year after smoking cessation is substantially higher than the 2.9 kg often quoted in smoking cessation advice leaflets, which stemmed from a previous review.1 Moreover, this mean weight gain is greater than the 2.3 kg gain that female smokers report being willing to tolerate, on average, before embarking on a quit attempt.48

This review reports on variation in weight gain, which is rarely described or discussed in the literature, and has clinical implications. Some people are either destined or able to prevent weight gain without intervention, whereas others seem likely to gain enough weight that puts them at increased risk of diabetes, among other complications.49 In practice, doctors could detect people gaining excessive weight and intervene early to prevent this.

We were unable to show a significant difference between weight change estimates in point prevalence abstainers and prolonged or continuous abstainers, and therefore, we combined all estimates at each time point regardless of abstinence definition. This may be because the data were derived from clinical trials, in which participants were all given the same target quit date, and therefore many point prevalence abstainers were also prolonged abstainers.50 However, the point estimate did indicate a smaller weight change in point prevalence abstainers and it is possible that this difference was the case in our analysis, although it was not sufficiently powered to detect statistical significance.

Most trials aimed at preventing weight gain typically enrolled weight concerned women, but did not provide clear evidence that this group were at risk of greater weight gain. This result might seem surprising, since people concerned about weight may have experienced excessive weight gain in previous quit attempts, and excessive gain is associated with greater weight gain in a current quit attempt.51 However, the association between weight concerns and weight gain after cessation is unclear.18 52 53 Furthermore, nearly all such trials recruited exclusively women, whereas trials appealing to the general population were all mixed sex. Consequently, the data were inevitably confounded and also not precise enough to exclude a difference between weight concerned populations and populations not specifically concerned about weight gain.

Our estimates provided the difference between starting weight and weight up to one year later. The mean weight of a population is likely to increase over one year independently of a smoking cessation attempt.54 The Lung Health Study showed that continuing smokers gain on average of 0.3 kg/year for men and 0.5 kg/year for women.55 Another study7 estimated a gain of about 0.3 kg/year for both sexes, meaning that roughly 4.3 kg of the mean weight gain at 12 months in our analysis was due to cessation (table 3).

These data relate only to weight gain in people who achieve and maintain abstinence, but provide no evidence on what happens to weight in smokers who are abstinent and then relapse or in continuing smokers who never achieve abstinence. For smokers who gain weight on cessation, available data suggest that they lose weight again if they relapse to smoking,56 although few studies have reported data for weight gain in those who relapse. An incremental weight gain would be important because many people repeatedly attempt to quit. Furthermore, because few trials followed participants beyond one year, we cannot report here on weight gain beyond this time point. Evidence is conflicting as to whether weight continues to increase beyond the first year after cessation.55 57 58 59

We limited our review to randomised controlled trials for smoking cessation, pharmacotherapy use, exercise, and interventions aiming to prevent weight gain. The validity of data for weight gain after cessation depends on accurate timing of the start of abstinence, the validity of recording of abstinence, and frequent follow up. Most of the trials we reviewed show these features but few observational studies do. We also limited our review to trials in the Cochrane reviews of first line treatment, which led to the exclusion of a few other trials, chiefly the Lung Health Study.55 However, estimates of the effect of cessation on weight gain at one year from the Lung Health Study were similar to our estimates, and there was no reason to presume that using data from only randomised controlled trials created a bias.

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