An empirical investigation of the impact of smoking on body weight using an endogenous treatment effects model approach: the role of food consumption patterns

Abstract

BackgroundThis study explored the influence of cigarette smoking and food consumption patterns on BMI after adjusting for various socio-demographic characteristics. Since weight-based stereotypes may have an impact on smoking behaviour and both obesity and smoking have been associated with detrimental health effects, an interdependency between them is quite possible.MethodsCross-sectional data were collected via a formal standardized questionnaire administered in personal interviews and two additional self-completion questionnaires from a random sample of 3471 German adults. The empirical framework considered potential endogeneity between smoking and body weight by employing an endogenous treatment effects model with an ordered outcome. The estimations derived from the endogenous treatment effects approach were also compared to the univariate ordered probit model results.ResultsOur findings showed that ignoring potential endogeneity may affect both the statistical significance of the smoking estimate and the direction of the influence of smoking on BMI. Smoking was positively associated with BMI in both male (β = 1.236, p < 0.01) and female (β = 0.634, p < 0.10) participants. Smokers presented a 23.1% higher risk of obesity and a 24.3% lower likelihood of being within a healthy weight range. Male smokers also appeared to have a considerably augmented probability of being obese compared to their female counterparts (23.6% vs 15.1%). The relationship between smoking and BMI may be attributed to dietary practices, since smoking was correlated with poor dietary habits characterized by the frequent intake of more energy-dense foods (meat products and white-toasted bread) and less frequent consumption of healthy food items, such as whole-grain bread, vegetables and fruits. Concerning the impact of eating habits on body weight, frequent consumption of meat products and confectionery was found to have a direct association with BMI in both genders. Furthermore, white-toasted bread consumption was negatively linked with body weight in males (β = − 0.337, p < 0.01).ConclusionsOur findings raised questions about the general belief that smoking is an effective weight control tool. Health interventions should be oriented toward a simultaneous decrease in smoking and obesity, since both behaviours seem to be interdependent. Nutrition programmes should also be designed according to the characteristics of different target groups in order to promote a healthy lifestyle.

Risk of Tobacco Smoking and Consumption of Energy Drinks on Obesity and Central Obesity Among Male University Students

“…In this study, most students smoked daily (67.9%). In agreement with other studies, an inverse relationship between smoking and body weight has been documented [14][15][16][17][18][19]51,52]. This study concluded that cigarette smoking is linked to being underweight.…”

“…Obesity risk factors include, but are not limited to, poor diet and sedentary lifestyle [12,13]. A common thought among people is that cigarette and waterpipe smoking can be used for weight control [14][15][16][17][18][19]. Moreover, consuming excessive amounts of caffeine-containing fluids can serve as a weight control method by masking hunger, aiding in purging behavior, or increasing energy levels [20,21].…”

The Role of Snack Choices, Body Weight Stereotypes and Smoking Behavior in Assessing Risk Factors for Adolescent Overweight and Obesity

“…More specifically, in the endogenous treatment effects model with an ordered outcome the dependent variable was specified through BMI classification and measured on an ordinal scale ranging from 1 to J ( j = 1,…, J ). Thus, the BMI equation (outcome) can be expressed as [ 75 , 76 , 77 ]. where μ j ’s refer to threshold parameters and is the latent outcome variable for the i th adolescent defined as where is the error term, is a vector of the explanatory variables including participant’s gender, age, household size, maternal and paternal educational attainment, snacking behavior, and weight stereotypes (endorsement of thinness, and anti-fat attitudes), and describes respondent’s smoking behavior.…”

The long‐term health effects of initiating smoking in adolescence: Evidence from a national longitudinal survey

“…Endogeneity can result from omitted variables, reverse causality or simultaneity, and measurement error. Omitted variable bias may stem from unobserved characteristics that are correlated with the smoking status and future health outcomes, such as when dissatisfaction with body weight leads adolescents to take up smoking or other unhealthy practices to control their weight (Vartanian & Porter, 2016, Raptou & Papastefanou, 2018). While the long time lag between smoking in adolescence and the health outcomes used in this paper alleviates some concerns about reverse causality, other endogeneity concerns remain.…”