Electronic cigarettes, or vapes, have become increasingly popular, particularly among adolescents and young adults. Marketed as a safer alternative to traditional cigarettes, vapes function by heating a liquid solution to produce an inhalable aerosol containing nicotine, flavorings, and other chemicals. While initially conceived as a smoking cessation aid, vaping's impact on weight control behaviors, a well-known effect of traditional smoking, remains unclear. This article delves into the existing research to explore the relationship between e-cigarette use and body weight changes, especially in adolescents and young adults, while also considering the potential health implications.
Introduction: Vaping and Weight Management Concerns
The increasing prevalence of e-cigarette use among young people is driven by factors such as taste preferences, perceived harm reduction compared to traditional cigarettes, and, notably, weight management considerations. Adolescents often grapple with weight management and body image issues due to societal pressures and the pervasive influence of social media, which promotes unrealistic standards of beauty and thinness. This pressure can lead some young individuals to turn to vaping as a misguided means of weight control, driven by misconceptions about its appetite-suppressing effects and its potential to substitute for snacking.
Methods: A Systematic Review of Existing Literature
To investigate the potential correlation between e-cigarette usage and weight control concerns, a systematic review was conducted, adhering to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A thorough literature search was performed across seven databases: PubMed, The Cochrane Library, Embase, Science Direct, Web of Science, Scopus, and Google Scholar, spanning from 2010 to October 2023. The search included terms like ‘Vaping,’ ‘e-cigarettes,’ ‘Weight Loss,’ and ‘weight control’ to identify relevant studies. Studies included in the review encompassed prospective, retrospective cohort, and cross-sectional studies reporting on vaping and weight changes in subjects, irrespective of gender, especially in adolescents/young adults (14-25 years of age). The methodological quality of all selected studies was assessed using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklists for Studies.
Prevalence and Motivations: Why Adolescents Vape for Weight Control
The systematic review identified a significant use of e-cigarettes among high school students, driven by taste preferences, weight management, and perceived harm reduction. Regular e-cigarette users who reported being overweight and used calorie restriction for weight reduction were more likely to view vaping as a weight loss or control strategy.
Morean and associates explored the weight control practices of adult e-cigarette users, revealing that individuals who regularly used e-cigarettes, particularly those already overweight and engaged in calorie intake restriction, were more likely to use e-cigarettes as a means to reduce their weight.
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Morean et al. investigated the prevalence of using flavor-infused e-liquids for appetite control or weight reduction in high school teenagers, finding that about 9.3% of teenagers reported using flavor-infused e-liquids specifically for weight loss. Similarly, Sanchez et al. reported that among overweight or obese subjects in Texas, 82.9% expressed an intention to lose weight, with male respondents with obesity who intended to reduce weight found to be significantly more likely to use e-cigarettes than female respondents.
These findings suggest that, particularly among girls facing body image pressures, vaping serves as a weight control method.
Perceptions and Associations: Weight Concerns and E-Cigarette Usage
The relationship between e-cigarette usage and perceived weight status was examined in several studies. Bennett and Pokhrel investigated the association between the weight concerns of young adults and their consumption of cigarettes and e-cigarettes. They found a significant correlation between concerns about being overweight and the frequency of current smoking, lifetime and current smoking status, as well as susceptibility to smoking. Interestingly, the frequency of current e-cigarette usage was positively correlated with heightened weight concerns.
Cho and colleagues identified a robust correlation between e-cigarette usage among female teenagers and their perceived weight status, with adolescent females who perceived themselves as overweight more likely to report having used e-cigarettes compared to those who considered themselves of normal weight. The highest prevalence of e-cigarette use was observed among both overweight males and females.
Lanza et al. conducted a cross-sectional study among undergraduate students to examine the relationship between weight status and e-cigarette usage, finding that respondents who were obese were more inclined to use e-cigarettes rather than alcohol, indicating a relationship between e-cigarette usage and weight status.
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However, Wang et al. did not identify any correlations between using e-cigarettes for weight control purposes, observing instead that teenagers who engaged in poor weight control practices had a higher likelihood of becoming e-cigarette users.
E-Cigarettes as a Weight Loss Tool: Is It Effective?
While some studies suggest nicotine in vaping might suppress appetite and affect weight, the evidence is still limited and doesn’t support vaping as a reliable weight loss method. It's fairly well-known that smoking cigarettes can link to weight loss and that quitting smoking can lead to weight gain. But does this apply to vaping as well? And what about vapes that don’t involve nicotine, such as those with CBD?
A 2021 research review suggested nicotine can help manage weight by helping reduce appetite and food intake, possibly by affecting the release or activity of neuropeptide Y (NPY) and pro-opiomelanocortin (POMC). NPY and POMC are proteins involved in helping you manage hunger and satiety. However, it’s still a little unclear whether vaping with nicotine has the same effect as cigarettes on weight management.
In a 2022 review examining the specific impact of e-cigarette use on body weight, the findings differed across in vitro, human, and animal studies. Some in vitro studies found no significant association between e-cigarettes and body weight changes. Human studies demonstrated mixed results regarding weight management behaviors and e-cigarette usage. Some report that vaping helps with weight management or assists in managing weight gain after quitting smoking. In a 2016 study involving adult e-cigarette users aiming to manage weight, 13.5% used e-cigarettes for this purpose. The findings show that those vaping for weight management tended to vape more, experience overweight, restrict calories, have difficulty managing impulses, and prefer flavors like coffee or vanilla.
Smoking causes lower body mass index (BMI) probably because of the anorexic effect of nicotine. The behavioural aspects to smoking (hand to mouth action, opening cigarettes, putting cigarettes in the mouth and time taken by smoking) fill time and provide distraction that may influence food consumption although evidence from low nicotine cigarettes and comparisons between inhalator and patch tend to go against this assumption. Smokers are therefore, in general, lighter than non-smokers. As smoking rates have declined in many countries in recent years, obesity rates have risen. There is strong evidence that many people who successfully stop smoking gain weight. A meta-analysis found mean weight gain was 4.8 kg at one year, although there was a lot of variation between individuals, with 13% of quitters gaining >10 kg. Most weight gain occurred within three months. Fear of weight gain may be a barrier to smoking cessation.
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However, there is no strong evidence supporting the hypothesis that vaping prevents weight gain after smoking cessation. A survey of a convenience sample of adult vapers in the USA who were trying to lose or maintain weight (n = 459) found that respondents who reported vaping for weight loss or control (13.5% of the sample) were more likely to be overweight already, vaped more frequently, had poor impulse control and preferred particular types of e-cigarette flavours (coffee or vanilla flavour).
Non-Nicotine Vaping and Weight Management
Not all vapes contain nicotine. Some include nicotine-free fluid, cannabis, or CBD. Cannabis is well-known for its appetite-increasing properties, yet research on how cannabis vaping specifically affects weight is limited.
Regarding CBD, a 2022 review involving 11 trials investigated the impact of vaping CBD on weight. The majority of these trials reported that CBD led to a reduction in appetite or body weight. However, some studies found no significant changes, while one even described increased appetite.
It’s also possible that weight-management mechanisms associated with vaping may extend beyond nicotine’s effects, encompassing factors like taste perception, physical mouthfeel, and behavioral substitution. These factors could potentially apply to any vape.
Health Risks Associated with Vaping
Vaping is not without its risks. Several health risks are associated with vaping, such as a higher risk of developing cardiovascular disease. The act of vaping may also be habit-forming. In addition, losing weight through appetite suppression may lead to complications, such as vitamin and mineral deficiencies.
Inhaling aerosolized nicotine salt containing liquids from e-cigarettes may elevate the risk of cardiovascular diseases by inducing sympathetic dominance and cardiac arrhythmias. Moreover, the health risks associated with e-cigarette use and the implications of the simultaneous use of traditional cigarettes and vaping (‘dual usage’) remain unclear.
E-cigarettes are marketed to assist with smoking cessation and are frequently described as a ‘safe cigarette’ with fewer toxicants and lower risks of diseases. However, in recent years, e-cigarettes have gained significant popularity amongst younger people, albeit the latest report on acute lung injury and death in the US. While nicotine-containing e-cigarettes have been used to satisfy a nicotine addiction, even among those who never used tobacco cigarettes, nicotine-free e-cigarettes have also been largely used recreationally by ‘cloud chasers.’
The recognition of the harmful effects of e-cigarettes is increasing among adults; however, there is a common misconception that only nicotine is harmful. What is more worrying is that more teenagers have started to vape because they think that e-cigarettes are harmless. In the US, only the sale of tobacco-flavored e-fluids is permitted to reduce the potential harm induced by the flavoring chemicals. However, in Australia, only the sale of nicotine-free e-fluid is legal.
Nicotine-free e-vapour exposure alone can elicit a strong systemic inflammatory response in the serum and abdominal adipose tissue, even more so than HFD-consumption alone. Therefore, adipose tissue, but not the lung, may be the major driver of inflammation in response to nicotine-free e-vapour exposure alone; however, unknown mechanisms may contribute to the suppressed inflammatory effects in the serum and adipose tissue observed with the combination of HFD and nicotine-free e-vapour.
Healthier Alternatives for Weight Loss
Given the potential health risks associated with vaping, people can try the following tips for healthy weight loss:
- Balanced diet and nutrition: Try eating a balanced diet rich in fruits, vegetables, healthy fats, and whole grains. Managing portion sizes and incorporating nutrient-dense foods can help manage weight.
- Regular physical activity: Make an effort to engage in regular exercise or physical activities. This can include cardio workouts, strength training, yoga, or staying active throughout the day.
- Support groups or counseling: Joining support groups focused on weight management or getting counseling can provide guidance and motivation for maintaining a moderate weight.
- Fitness apps: Fitness apps can help you track food and exercise.
- Mindfulness and stress management: Techniques like meditation, yoga, or deep-breathing exercises can help manage stress and emotional eating, contributing to weight management.
- Long-term habits: Healthy, sustainable lifestyle habits can help people lose and maintain weight in the long term rather than short-term solutions.
- Aim for gradual weight loss: Losing 1-2 pounds each week is a safe and sustainable way of losing weight and may make regaining weight less likely.
- Set short-term goals: Break down a weight loss goal into achievable steps per week or month, and celebrate milestones such as feeling fitter.
- Focus on other benefits: Increasing physical activity and healthy eating may have benefits other than weight loss, such as improved mood, increased energy, and new skill development.
- Track progress: People may find it helpful to use an app or device to track their progress.
- Getting enough sleep: Getting enough good quality sleep may help reduce weight gain and support healthier eating habits.
Quitting Vaping and Potential Weight Gain
When people stop vaping, they might experience changes in appetite or eating habits, leading to some weight gain. However, not everyone who quits vaping may gain weight, and the amount gained can differ widely from person to person.
The weight gain that can occur after quitting cigarette smoking isn’t only due to the lack of nicotine. It can also occur because of new habits formed (such as increased snacking) when quitting. It’s important to note that not everyone will gain weight, and any weight gain that occurs can often be managed by focusing on healthier habits after quitting.