Ckr023 1.5

The European Journal of Public Health Advance Access published April 7, 2011
European Journal of Public Health, 1–5ß The Author(s) 2011. Published by Oxford University Press on behalf of the European Public Health Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License by-nc/2.5) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
doi:10.1093/eurpub/ckr023 The tobacco industry’s past role in weight controlrelated to smoking Semira Gonseth1, Isabelle Jacot-Sadowski1, Pascal A. Diethelm2, Vincent Barras3, Jacques Cornuz1 1 Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Switzerland2 OxyRomandie, Geneva, Switzerland3 Department of History of Medicine, Lausanne University Hospital, Switzerland Correspondence: Semira Gonseth, MD, Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Rue duBugnon 44, 1011 Lausanne, Switzerland, tel: +41(21)314 49 45, fax +41(21)314 72 44, e-mail: [email protected] Received 29 October 2010, accepted 10 February 2011 Background: Smoking is thought to produce an appetite-suppressing effect by many smokers. Thus, the fear of body weightgain often outweighs the perception of health benefits associated with smoking cessation, particularly in adolescents. Weexamined whether the tobacco industry played a role in appetite and body weight control related to smoking and smokingcessation. Methods: We performed a systematic search within the archives of six major US and UK tobacco companies (AmericanTobacco, Philip Morris, RJ Reynolds, Lorillard, Brown & Williamson and British American Tobacco) that were Defendants intobacco litigation settled in 1998. Findings are dated from 1949 to 1999. Results: The documents revealed the strategies plannedand used by the industry to enhance effects of smoking on weight and appetite, mostly by chemical modifications of cigar- ettes contents. Appetite-suppressant molecules, such as tartaric acid and 2-acetylpyridine were added to some cigarettes.
Conclusion: These tobacco companies played an active and not disclaimed role in the anti-appetite effects of smoking, atleast in the past, by adding appetite-suppressant molecules into their cigarettes.
Keywords: appetite, body weight, smoking, tobacco additives, tobacco documents, tobacco industry the link between smoking and appetite or body weight and howsuch a link was used to promote tobacco products.
Tobacco is a major cause of death in developed countries.1,2 The objective of our study was to answer the following Smoking is thought to produce an appetite-suppressing effect questions: did the tobacco industry try to take advantage of the by many smokers, particularly in adolescents.3 Most smokers want relationships between body weight, appetite, smoking and smoking to stop smoking, but the fear of body weight gain might outweigh cessation? Did it go as far as modifying its products to obtain such the perception of potential health benefits associated with smoking cessation, particularly in women.4–7 For instance, female studentsconcerned about their weight are at an increased risk of initiating smoking.8 In general, smokers have a lower body mass index(BMI) than non-smokers.9 Six months after smoking cessation, We conducted a systematic search within the archives of six major the mean body weight gain is estimated 3.5 kg.10 Among tobacco companies (American Tobacco, Philip Morris, RJ sedentary smokers, weight gain might even be higher.11,12 Reynolds, Lorillard, Brown & Williamson and British American Smoking and weight share a complex relationship.13 On one Tobacco) that were defendants in tobacco litigation settled in hand, on average, smokers have a lower BMI than non-smokers 1998.20,22 We retrieved the documents online from the Legacy and sustained quitters have the same BMI than never smokers. On Tobacco Document Library.23 The search identified documents the other hand, heavier smokers defined as either nicotine- by means of a search using keywords such as ‘Body weight gain’, dependent smokers or smokers of more than a pack a day, have ‘Appetite’, ‘Weight control’, ‘Relapse’, etc. Then, using a ‘snowball a higher BMI than lighter smokers.14–17 In longitudinal studies, sampling method’,22 other documents were found. Our results are smoking cessation is associated with weight gain.18,19 Hypotheses presented and grouped by theme; they do not follow a strict about the cause of post-cessation weight gain involve increased chronological order. Documents presented in this article are energy intake by alteration of food preferences, food intake as a substitute for cigarette, as well as decreased energy expenditureby suppression of the stimulating effect of nicotine on metabolicrate.19 Following the 1998 ‘Master Settlement Agreement’ between US Industry’s projects to add substances to cigarettes tobacco industry and 46 States, US tobacco companies made theirinternal documents available on the Internet.20 Previous research into the archives of tobacco companies have helped the health-care Since the 1960s, tobacco companies intended adding appetite sup- community to understand the industry’s strategies.21 To our pressant in cigarettes to attract new smokers concerned about their knowledge, no study has explored the industry’s knowledge of body weight. PM stated in a 1965 internal memorandum: ‘If we were able to develop cigarettes which are much ‘‘safer’’ than the slogan regarding the Trims cigarettes: ‘This new longer length existing ones [. . .] and which also act as appetite depressants, then cigarette actually contains an appetite depressant to keep you we may uncover a new market of smokers. The potential smokers looking and feeling as slim and trim as your cigarette’ (Bates no.
would be the non-smokers who are more concerned with losing 01587028/7036). Tartaric acid was added to its Trims cigarettes for weight than with contracting respiratory or blood circulatory its appetite-suppressant effect. However, this tobacco product was illnesses. [. . .] To develop new smoking products which will be no longer considered only as a cigarette but as a drug by the FDA low in tobacco tar, low in tobacco gas and rich in appetite- that won a case against the Lorillard Company in 1977. The de- depressing factors’ (Bates no. 2056159412). In a 1971 internal scription of the judgement was the following: ‘the product is memorandum about ‘New Product Ideas’, PM discussed the pos- intended to affect for the ingestion of food and thereby sibility of creating a cigarette that controlled appetite, either by achieving a reduction in the body’s weight’, and ‘based solely stimulating or reducing it. Under ‘Specific Appetite Inducers’ upon that claim held that it was a drug’ (Bates no. 1003045052/ they contemplated the following course of action: ‘Incorporate special herbs or medications in a cigarette form as appetite The RJR Company also launched the development of a weight stimulants or possibly for tension release. Especially for people control cigarette product. In 1982, they searched ideas about ‘a who live alone (elderly) or business men to stimulate appetite’.
cigarette concept that turns build-up into an appetite suppressant’ PM also considered an ‘Alternate product’ containing an (Bates no. 502788460–502788508). In 1988, they devised new ‘appetite suppressant ingredient’ (Bates no. 1000300217/0220).
cigarettes, which suppressed appetite: ‘For diets as well as for One year later, this company envisaged the creation of ‘cigarette when you are hungry but it’s not time [to] break for lunch yet’ products which are marketed as appetite reducers (sweet tasting) (Bates no. 521386038/6045). A RJR scientist, in a memorandum or thirst-inducing companion for beer or other beverages (salty).
about ‘Project FD’ [Future Dimensions], reported ‘the psycho- The former relies its efficacy on the empirical evidence that con- logical and physiological state of human[s] can be strongly ventional cigarets [sic] depress appetite; the sweet taste is not influenced by both aromatic and odourless compounds. Herein intended to change blood sugar levels, but merely to provide a lies a fascinating new business/product opportunity for both the sensory confirmation that appetite is being reduced’ (Bates tobacco and food operation[s] of RJR Nabisco’. The author ex- no.1000110930/0933). In 1988, PM investigated the possibility of plained one of the concepts of Project FD: ‘Hunger control—food creating ‘a slimmer Marlboro’, an ‘updated Marlboro that’s more aromas with ‘‘mouth fullness’’ stimulation’ (Bates no. 521386038/ attractive to female’, in which it would ‘make it an appetite depressant’ (Bates no.506656719–506656749).
The PM documents contained also some drawings—seemingly Specific industry’s projects to add substances with an resulting of a brainstorming—showing how addition of ‘appetstat [sic] grains’ could be put inside the cigarette filter: the ‘sweet’ ones Our research identified several substances with an effect on depress appetite, and the ‘salt’ ones stimulate thirst and appetite appetite, used, or intended to be used, by the industry (table 1).
(Bates no. 1000110840/0922). In 1981, PM stated in an internal As mentioned above, ‘tartaric acid’ has been the anti-appetite report: ‘It was noted that one beneficial attribute ascribed to molecule added to the Lorillard Trims cigarettes (Bates no.
smoking is appetite suppressance [sic]. A thorough study of this 1003045052/5092). Before that case, in 1961, a PM document effect and publication of the results may have a beneficial impact entitled ‘Additives to smoking tobacco’ listed numerous patents on the image of smoking. If particular compounds responsible of of substances that were added to cigarettes, and gave the reasons this effect could be found, it might be possible to enhance the effect for their use. The patent ‘Ferguson 2 773 785’ was then used as ‘an in a cigarette aimed at people desiring help with weight control.
appetite reducer which dries and puckers the mouth, etc.
Care must be taken not to make specific claims or to invoke a comprising additive of tartaric acid’ (Bates no. 2028665546/ ‘‘drug additive’’ image. This is simply a natural effect of the 5552). The patent description of this additive found in the PM product and/or its use’ (Bates no.1003395096/5101). The archives explained in details the putative mechanism of action company was aware that advertising the appetite suppression char- of this ‘new and improved therapeutic appetite satient compos- acteristic of cigarettes as a benefit would entail the risk of potential ition designed to curb the appetite without supplying calories Food and Drug Administration (FDA) interference (Bates no.
to the body and particularly to a therapeutic appetite satient com- 01587028/7036; Bates no. 500417387; Bates no. 1003395088/5092; position in combustible from which can be smoked and upon smoking causes loss of appetite’ (Bates no. 2026479779–780). We During the 1970s, Lorillard also explored the ‘technical feasibility of did not find any other arguments suggesting a link between Edgar [. . .] use of active agents beyond nicotine which might provide an A. Ferguson and the tobacco industry. Tartaric acid has also additional dimension of physiological effect—facilitate/depress been claimed as an ingredient on the ‘UK Tobacco Additives’ sleepiness, enhance/reduce appetite feeling [. . .]’ (Bates no.
list (of unknown date) held in BAT documents (Bates no.
81564000/4004). In 1976, its scientists suggested a new brand that would ‘give smokers an additional benefit that is different, 2-Acetylpyridine is a molecule patented for its appetite- but compatible with traditional cigarette benefits. (An example suppressant effect.24 It has been used as a cigarette ingredient, as here might be the addition of an appetite depressant to the by PM, B&W, BAT and RJR (its chemical codename is 1122-62-9) cigarette to help dieting)’ (Bates no. 80635192/5195). Lorillard (Bates: 605006573; Bates no. 2078541185; Bates no. 508403623; scientists raised the following questions: ‘How to enhance Bates no. 508403623/3699; Bates no. 2078541185/1198; Bates no.
whatever effect elements like nicotine already has for benefits like 321973087–321973167). In a confidential 1995 memorandum, PM weight control’, ‘How to help with weight control’, ‘How to researchers expressed their interest in the appetite-suppressant address weight control without adding pharmacological agency’ effect of 2-acetylpyridine and reported some independent and ‘How to convince consumer[s] [a] cigarette is [a] weight scientific research about its effect. This molecule ‘smells like corn control agent’ (Bates no. 83910635/0661). They concluded in chips’, and might have anti-smoking properties25 (Bates no.
1979 that: ‘Revolutionary Next Era possibilities suggested by our Agencies [included]: [. . .] Use of the cigarette to deliver another Tobacco industry investigated additional substances for their benefit like an appetite depressant’ (Bates no. 03547249/7251; anti-appetite effects, but they were not found in cigarette ingredi- Bates no. 01399043/9049). This company thought of turning the ents lists: ‘Ephedrine and amphetamine’, two well-known sympathico-mimetic appetite suppressants, were considered as advantage. Already, in 1974, Lorillard devised the following cigarette ingredients in the 1960s. In 1968, a RJR scientist wrote: Tobacco industry’s role in weight control related to smoking Table 1 Substances investigated and/or added for body weight control by tobacco industry and their putative mechanism(s) of action Appetite-suppressant effect via drying of the mouth: tartaric acid volatilizes and is reformed in the mouth. Tartaric acid acts on the membranes in the mouth and produces a dryness that has anappetite-reducing effect.
Appetite-suppressant effect via neutralization of the olfactory stimulus.
Appetite-suppressant effect via dopaminergic stimulation.
Appetite-suppressant effect via modifications of the taste of food.
Appetite modifications via diminution of upper airways irritation.
Anorectic effect not eventually described.
Potential appetite-suppressant effect not eventually described.
Decrease of brain activity resulting in a decrease in salty food intake in rats.
‘SM67A, an ephedrine congener, was tested for anorexic activity in suppressant: ‘An experiment was conducted to determine rats. In comparison with standard anorexics, SM67A was found to whether mariolide has any appetite-suppressing properties or have some anorexic activity’ (Bates no. 502799201). In 1972, RJR not. [. . .] This experiment shows that the mariolide does have sent a list of ingredients containing SM67A to a company called an ability to decrease food intake but that it occurs at very high Uniroyal Chemical for chemical analysis (Bates no. 508370235/ doses. The mariolide would not be expected, in the light of these 0237). In 1969, American Tobacco was also interested in experiments, to have value as an anorexic agent’ (Bates no.
ephedrine through ‘Project PAC-S-P-69’, where PALL MALL cigarettes were evaluated with the following additives: ‘caffeine ‘Propylene glycol’ was listed in Lorillard’s documents in 1981, 10%, theophylline 10%, theobromine 10% and ephedrine 5%’ and one of its major pharmacological effects was ‘appetite (Bates: 950077074). A PM scientist, reporting on his participation depressant’ (Bates no. 88698405/8407).
at the Tenth Annual Meeting of the Society of Toxicology, made ‘Reserpine’, an anti-hypertensive and a tranquilizer, was the following recommendations: ‘As a result of the meeting I mentioned in the famous ‘Project HIPPO II’ conducted by the would suggest the following studies: (i) the combined effects of Battelle Institute in Geneva for BAT—which investigated the nicotine and ethanol on metabolism of each one; (ii) the combined addictive role of nicotine for the first time—as having some effects of nicotine and barbiturates; (c) the combined effects of effects on appetite. It was observed that reserpine ‘decreased very nicotine and caffeine; (d) the combined effects of nicotine and slightly the appetite in our ‘‘appetite test’’ on rats [. . .]’ (Bates no.
amphetamines’ (Bates no. 1003702971/2974). In 1967, RJR performed the synthesis of molecules where the phenyl group ofdrugs such as amphetamine was replaced by a pyridyl group. This new compound was thought to ‘conceivably lead to an appetitedepressant (anorexient) without undesirable nervous stimulation’ Our search inside the tobacco documents uncovers the tobacco (Bates no. 500613441). Nevertheless, the potential increase in the industry’s attitude towards weight control related to smoking.
risk of cardiac arrhythmias when combining caffeine, ephedrine, The industry made plans and strategies on how to enhance the etc, with nicotine was known by the industry. For example, this effects of smoking on appetite and body weight through adding medical information about nicotine and heart disease toxicity that substances acting as anti-appetite agents. Additionally, we found mentions the role of ephedrine (Bates no. 517585341/5810) was that the industry has added some substances acting as appetite ‘‘N2O (‘laughing gas’)’’ was investigated by Lorillard, as an PM put during the 1960s a substance containing tartaric acid appetite suppressant (Bates no. 80635192/5195). In April 1976, into its cigarette in order to reduce smokers’ appetite. Tartaric acid during a discussion on new brand possibilities, Lorillard research- was considered as an appetite suppressant and removed from the ers mentioned: ‘Additional positive benefits—1. A cigarette that market in 1977 by a decision of a US court. This substance was also helps weight reduction by increasing some component already in added to BAT cigarettes, although we did not find at which date, the smoke, e.g. NO2 [sic]. This cigarette either depresses appetite or and if it is still the case. The Ferguson’s patent description was the makes all foods taste flat; acting as an anti-MSG [monosodium- only information we can find on the anti-appetite putative role of glutamate]. This cigarette is endorsed by weight watchers’ (Bates tartaric acid in the medical and chemical literature. The substance no. 80635192/5195). In June of the same year, during the ‘Lorillard 2-acetylpyridine is also claimed as an appetite-reducing molecule Problem Laboratory’, ‘ideas’ were discussed, notably the ‘use of and is one of the tobacco additives, disclosed on many past lists of laughing gas (already in tobacco) as appetite depressant’ (Bates cigarette ingredients. No independent studies about the role on appetite of other substances mentioned in our study were found ‘Menthol’ was mentioned in a 1952 letter from B&W to an expert, entitled ‘Effect of mentholated cigarettes on appetite’, Our findings must help smokers and the health-care community asking whether the menthol added to mentholated cigarettes could to understand at least partially why cigarette smoking is producing ‘take the edge off the smoker’s appetite any more than a similar the effect of reducing appetite, and could explain in part why cigarette without menthol’. The expert answered that menthol had smokers weigh in general less than non-smokers. Although little an inconclusive effect on smoker’s appetite (Bates: 650203535). In is known in the medical literature about the anti-appetite effect of 1971, Liggett & Myers, looking at ‘New Opportunities in the the above cited substances, we can make the hypothesis that the Menthol Cigarette Market’, observed: ‘weight control’ has substan- weight gain following smoking cessation could be a ‘rebound tial appeal [. . .]. Filters-with-and-without menthol are credited with effect’ of discontinuation of the daily consumption of an anti- suppressing appetite. Salem, as the cross-over ‘‘bridge’’ between appetite substance through cigarette smoking, as it is known for filters-and-menthols, in combination with Salem’s feminity, fulfils the use of other anti-appetite substances.26 weight control expectations’ (Bates no. LG0110469–LG0110548).
The tobacco industry, as we saw it with the Lorillard Trims ‘Mariolide’ was studied by the tobacco industry and described as cigarettes case, has had no advantage to claim the use of their a ‘brain stimulant compound’ (Bates no. 504175618/5619). In anti-appetite additive. In a PM memorandum dated from 1969, 1966, RJR scientists investigated mariolide as an appetite M. H. Wakeham, a scientific director, simply explained why they did not need to declare which additives are put into cigarettes: ‘Inthe response to Roger’s [Fagan] question concerning FDA require- ments on the introduction of a substance into cigarettes, I told himthat the FDA had no requirements until a health claim is made.
World Health Organization. WHO Report on the global tobacco epidemic. 2008 - Then there must be studies on safety, efficacy, mechanism of action, metabolism, etc. If a substance is simply added to a Peto R, Lopez AD, Boreham J, et al. Mortality from tobacco in developed product and no claims are made there is no need for FDA countries: indirect estimation from national vital statistics. Lancet The major limitation of our study is the scattered nature and Austin SB, Gortmaker SL. Dieting and smoking initiation in early adolescent girls relatively small volume of tobacco industry documents related to and boys: a prospective study. Am J Public Health 2001;91:446–50.
our topic. Clearly, the restrictions inherent to the filing and Williamson DF, Madans J, Anda RF, et al. Smoking cessation and severity of indexing system of the industry’s archives are problematic when weight gain in a national cohort. N Engl J Med 1991;324:739–45.
conducting a systematic review of documents; the indexing system Meyers AW, Klesges RC, Winders SE, et al. Are weight concerns predictive of of archives is not always consistent and full-text research tools smoking cessation? A prospective analysis. J Consult Clin Psychol 1997;65:448–52.
might not recognize words due to the poor quality of scanned Twardella D, Loew M, Rothenbacher D, et al. The impact of body weight on documents. However, this alone is not sufficient to explain the smoking cessation in German adults. Prev Med 2006;42:109–13.
relative scarcity of the documents we retrieved. It can be Klesges RC, Brown K, Pascale RW, et al. Factors associated with participation, hypothesized that large amounts of material have disappeared, attrition, and outcome in a smoking cessation program at the workplace. Health either by exclusion from the database or destruction by the industry. Indeed, some documents that we retrieved can only be French SA, Perry CL, Leon GR, Fulkerson JA. Weight concerns, dieting behavior, understood in the context of activities or projects, which must and smoking initiation among adolescents: a prospective study. Am J Public have generated further documents of which no trace was found, in spite of our varied attempts. Another shortcoming is the lack of Flegal KM, Troiano RP, Pamuk ER, et al. The influence of smoking cessation on current documents, the most recent document on which our work the prevalence of overweight in the United States.[see comment]. N Engl J Med is based dates back to the late 1990s—this is a general problem that affects all research topics: since it knows its internal documents 10 Williamson DF, Madans J, Anda RF, et al. Smoking cessation and severity of may turn up publicly (i.e. since 1998), the industry can be expected weight gain in a national cohort.[see comment]. N Engl J Med 1991;324:739–45.
to be much more wary about leaving a written trace of activitiesthat may be compromising. In spite of these shortcomings, we are 11 Bize R, Willi C, Chiolero A, et al. Participation in a population-based physical confident that we used the research method recognized by the activity programme as an aid for smoking cessation: a randomised trial. Tob scientific community as the most suitable for obtaining a good understanding of the general attitudes, knowledge and activities of 12 Chiolero A, Jacot-Sadowski I, Faeh D, et al. Association of cigarettes smoked daily the tobacco industry regarding the issue of weight control.22,27–29 with obesity in a general adult population. Obesity 2007;15:1311–8.
In conclusion, we found clear evidence that every one of the six 13 Chiolero A, Faeh D, Paccaud F, Cornuz J. Consequences of smoking for body US and UK tobacco companies elaborated the idea to put appetite weight, body fat distribution, and insulin resistance. Am J Clin Nutr depressants molecule inside cigarettes to enhance this effect. They all investigated various substances for such a use. At least two of 14 John U, Hanke M, Rumpf HJ, Thyrian JR. Smoking status, cigarettes per day, and them, PM and BAT has actually modified its products to affect their relationship to overweight and obesity among former and current smokers appetite and body weight. We already knew the industry modified in a national adult general population sample. Int J Obes 2005;29:1289–94.
its products to enhance addiction and dependence.30 In addition, 15 Pisinger C, Jorgensen T. Weight concerns and smoking in a general population: specific analyses of cigarette contents could be performed, looking the Inter99 study. Prev Med 2007;44:283–9.
especially for substances that could modify food intake or body 16 Chiolero A, Faeh D, Paccaud F, Cornuz J. Consequences of smoking for body weight, such as ephedrine. Research into the tobacco industries’ weight, body fat distribution, and insulin resistance. Am J Clin Nutr archives should be pursued to improve understanding of companies’ strategies, although we should take into account that 17 Bamia C, Trichopoulou A, Lenas D, Trichopoulos D. Tobacco smoking in relation it is highly possible that the past and present more sensitive to body fat mass and distribution in a general population sample. Int J Obes Relat documents are being removed from these databases by the indus- try.31,32 The scientific community is most probably powerless 18 Klesges RC, Meyers AW, Klesges LM, La Vasque ME. Smoking, body weight, and towards this issue. As recommended by the World Health their effects on smoking behavior: a comprehensive review of the literature.
Organization’s Framework Convention on Tobacco Control, strict regulation of cigarette and tobacco additives is needed as part of the 19 Filozof C, Fernandez Pinilla MC, Fernandez-Cruz A. Smoking cessation and fight against tobacco dependence and smoking induced diseases.33 weight gain. Obes Rev 2004;5:95–103.
20 Schroeder SA. Tobacco control in the wake of the 1998 master settlement agreement. N Engl J Med 2004;350:293–301.
21 Hurt RD, Ebbert JO, Muggli ME, et al. Open doorway to truth: legacy of the We thank Pr. Martin McKee for reviewing the manuscript.
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Conflicts of interest: None declared.
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