BACKGROUND: Cigarette smoking increases the risk of cardiovascular disease, and is an important preventable cause of death and illness. One major deterrent to smoking cessation is a gain in body weight. Understanding the mechanisms that contribute to this weight gain may maximize the success of long-term smoking cessation. We hypothesized that smoking cessation is associated with an increase in adipose tissue lipoprotein lipase (AT-LPL) activity and=or a decrease in lipolysis, two metabolic factors that determine the balance between fat storage and fat utilization, and thus affect the propensity for weight gain. MATERIALS AND METHODS: Ten premenopausal women (37.1 AE 6.2 y, 31.7 AE 6.4 kg=m 2 body mass index (BMI), mean AE s.d.) participated in a 4 week smoking cessation program. Measurements of body weight, waist and hip circumferences, adipose cell metabolism and resting metabolic rate were obtained at baseline and after 4 weeks of smoking cessation. RESULTS: Of the 10 women who began the intervention, five successfully completed the smoking cessation intervention. After 4 weeks of smoking cessation, there were significant increases in body weight (95.1 AE 13.9 -97.7 AE 14.4 kg, P < 0.05), with no change in waist and hip circumferences or resting energy expenditure. Gluteal AT-LPL activity significantly increased in all women by 2.8-fold (1.65 AE 1.30 -4.72 AE 3.34 nmol=g=min, P < 0.05). Abdominal AT-LPL activity increased in four out of the five women, but did not reach statistical significance (1.14 AE 0.88 -3.50 AE 3.76 nmol=g=min, P ¼ 0.14). The increase in body weight correlated with the increase in gluteal AT-LPL activity (r ¼ 0.89, P < 0.05), as well as the baseline activity of gluteal AT-LPL (r ¼ 0.86, P ¼ 0.06). There were no changes in basal or stimulated lipolysis in the gluteal or abdominal fat depots. CONCLUSIONS: These results suggest that smoking cessation is associated with significant increases in body weight, as well as changes in adipose cell metabolism, in particular increases in AT-LPL activity. This increase in LPL activity may contribute to the increase in body weight associated with smoking cessation.