BY: Addie Humphrey

DATE: 6 January 2017

As e-cigarette use has skyrocketed, the popularity of “vaping” has become visible in day-to-day life. For some, vaping is an alternative to traditional cigarette use, but most people use both traditional and electronic cigarettes¹. Since the popularity of vaping is relatively new, we don’t know much about e-cigarette use among people with eating disorders.

In a recent research study, Morean and L’Insalata assessed differences among adult e-cigarette users based on eating disorders history². Participants with a current eating disorder diagnosis were almost four times more likely to vape daily than participants without an eating disorder history. Those with eating disorders were also more likely to use liquid nicotine in their e-cigarettes (91.6% vs. 85.7%) and used a higher nicotine concentration on average (9.50 mg vs. 7.86 mg). These findings fit with previous research findings that people with eating disorders may be at greater risk of smoking cigarettes and of developing nicotine dependence³. This suggests that among individuals with eating disorders, the prevalence of e-cigarette use may mirror that of traditional cigarette use.

People with eating disorders often report smoking to lose weight and may use nicotine to suppress appetite and cravings⁴. As expected, individuals with eating disorders in the Morean and L’Insalata study reported controlling weight as a motivation for vaping at a much higher rate the non-eating disorder group (32.0% vs. 10.4%). People with eating disorders were also more likely to report other motives for vaping, including the sweet flavors available for e-cigarettes, ability to hide from others, and undetectable use indoors².

This was the first study to show a link between vaping and eating disorders. It’s important that clinicians who work with patients with eating disorders assess for e-cigarette use. Ability to hide vaping from others and undetectable use indoors were more commonly reported as motivators for vaping by people with eating disorders. This indicates that without clinicians asking directly, patients may not disclose their use of e-cigarettes. Friends and family members of people with eating disorders should be aware that vaping may be driven by desire for weight control and appetite suppression. Individuals may use vaping in a similar way to other compensatory behaviors, such as taking diet pills, purging, or exercising excessively.

1. McMillen, R. C., Gottlieb, M. A., Shaefer, R. M. W., Winickoff, J. P., & Klein, J. D. (2014). Trends in electronic cigarette use among US adults: Use is increasing in both smokers and nonsmokers. Nicotine & Tobacco Research, 17(10), 1195–1202.
2. Morean, M. E., & L’Insalata, A. (2017). Electronic cigarette use among individuals with a self‐reported eating disorder diagnosis. International Journal of Eating Disorders, [e-pub before print].
3. Anzengruber, D., Klump, K. L., Thornton, L., Brandt, H., Crawford, S., Fichter, M. M., … Mitchell, J. (2006). Smoking in eating disorders. Eating Behaviors, 7(4), 291–299.
4. White, M. A. (2012). Smoking for weight control and its associations with eating disorder symptomatology. Comprehensive Psychiatry, 53(4), 403-407.