Americans Flocked to Weight-Loss Medications During the Pandemic But Continued to Smoke
Key takeaways:
During the pandemic, Americans filled fewer prescriptions for medications that aid in quitting smoking. But they filled more prescriptions for weight-loss medications.
Increased pandemic-related anxiety, depression, and boredom, coupled with a Chantix recall, may be responsible for the drop in fills for smoking cessation medications.
Gym closures and increased binge eating during the pandemic may explain the uptick in weight-loss medication fills.
The COVID-19 pandemic has undoubtedly caused stress, as well as boredom, in the lives of many Americans. This, in turn, has led to more sedentary lifestyles, higher smoking rates, and quarantine weight gain (coined the “COVID 15”). However, as case numbers subside, interest in healthy behaviors has started to regain momentum — but only for some habits.
The GoodRx Research team wanted to understand how pandemic stress affected Americans’ smoking cessation and weight-loss strategies in 2020 and 2021. We specifically wanted to look at fill trends for two common medications used to aid in quitting smoking and losing weight: Chantix and sympathomimetic medications, respectively.
In doing so, we found an interesting phenomenon: The pandemic has spurred an interest in losing weight — and a disinterest in quitting smoking.
What’s going on here? There is a lot at play, including pandemic stress and fewer visits with healthcare providers. And we are not the first ones to make these observations. Below, we walk through our research.
Fills for smoking cessation medications declined during the pandemic
Smokers often pursue three types of quitting strategies:
Smoking alternatives such as nicotine patches, nicotine inhalers, and electronic cigarettes that can provide nicotine to satisfy a smoker’s cravings without many of the harmful effects of traditional (or “combustible”) cigarettes.
Individualized therapy, hypnosis, and peer groups provide counseling support.
Medications such as Chantix, Zyban, and varenicline help smokers quit by blocking nicotine from reaching receptors in the brain.
In early 2020, prior to the start of the COVID-19 pandemic, Americans’ interest in quitting smoking was higher than the year before, following an overall reduction in smoking across the previous decade. Prescription fills for medications to help quit smoking were up, as were Google searches for smoking cessation strategies.
But these trends quickly declined below the 2019 average for a good portion of 2020 and 2021, with the exception of the new year’s periods, when interest in smoking cessation typically surges as part of new year's resolutions. This was especially true during the 2021 new year’s period.
Reports suggest that cigarette use went up during state lockdowns, partly due to anxiety, boredom, and irregular routines, as well as changes in workplace smoke-free protections coverage and increased opportunities for smoking or vaping. What’s more, cigarette sales increased by 0.4% in 2020, the biggest increase in 20 years. Manufacturers sold 203.7 billion cigarettes, up from 202.9 billion in 2019.
In 2021, Google search interest for alternative and general smoking cessation also increased during the new year’s period, to pre-pandemic levels. However, that interest plummeted in February, presumably because smokers abandoned their resolutions to quit smoking.
Search interest in smoking cessation medications increased later in 2021 as well. But that was likely driven by reports that anti-smoking drugs contained excessive amounts of potential cancer-causing impurities, which led to an official recall of Chantix. The recall may also explain the sharp drop in medication fills in the second half of 2021.
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Our research supports a concerning trend that experts are just beginning to uncover: Drug manufacturing as well as COVID-19 have led to a drop in the number of those interested in quitting smoking. Results from a Massachusetts General survey of current and former smokers found that nearly one-third of respondents increased their smoking during the pandemic. Some researchers are even coining this the “lost year” as progress to curb smoking rates slows.
Researchers have a couple of theories as to why we’re seeing higher smoking rates and lower fills for anti-smoking medications:
Stress: Current and former smokers may have turned to cigarettes to cope with pandemic-fueled stressors, including anxiety and depression. Stress has also made quitting even harder.
Less time with healthcare providers: Providers can be the main resource for smoking cessation tips and prescriptions. So, as doctor visits slowed during the pandemic, so did efforts to quit smoking.
Recall of Chantix: Finally, the Chantix recall of 2021 may have eroded the trust of both providers and smokers in these medications.
Fills for weight-loss medications rose during the pandemic
Interestingly, while fewer Americans tried to quit smoking during the pandemic, more Americans sought out weight-loss interventions.
Americans attempt to lose weight through exercise, diet, and medication. We found that at the start of 2020, the fill rate for weight-loss medication was comparable to the 2019 average. But it increased at the onset of the pandemic. In fact, the fill rate increased throughout 2020 and had nearly doubled by the summer of 2021.
That was in contrast to the generally seasonal prescription fill rate for weight-loss medication. Interest in weight-loss medications is high in January as part of the new year’s resolution period. It then declines in the spring, increases in the summer, and drops in the fall as the holiday season approaches.
Google search trends for weight-loss exercise and diet during the pandemic were also unusual. At the start of 2020, Americans were searching for exercise and diet at higher levels than 2019.
Although it’s common for weight-loss searches to increase during the new year's period, searches for exercise increased after the U.S. declared a public health emergency in late January and peaked in April as major fitness clubs closed nationwide. They remained higher than the 2019 average throughout 2020 and 2021.
Searches for weight-loss diets dropped for much of 2020 and 2021, while searches for weight loss medications were seasonal, increasing during the new year’s and summer periods.
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COVID-19 weight gain is a likely factor in these trends. A Harvard Health study reported that nearly 40% of their participants gained weight, validating the “COVID-15” phenomenon (quarantine weight gain). At the onset of the pandemic, gym closures nationwide drove Americans to search for exercise regimens they could perform at home. And although interest in exercise remained high throughout the first 2 years of the pandemic, it's possible that some Americans didn’t have the space, time, and resources needed to exercise outside of a gym, leading to weight gain.
The decline in search interest for weight-loss diets may be a result of pandemic anxiety and may also explain part of the weight-gain phenomenon. In fact, a study by the American Society for Nutrition revealed that Americans were in fact consuming less vegetables and whole grains during the pandemic.
Another study by the University of Minnesota Medical School found an 8% increase in eating disorders in their participants, with 14% reporting binge eating during the pandemic. Finally, the International Food Information Council reported in its 2020 Food and Health Survey that only 43% of its respondents followed some type of diet during the first year of the pandemic.
Taken together, the lack of gyms or adequate resources to exercise at home, coupled with reduced interest in diets, may explain COVID-19 weight gain and why more Americans have filled more weight-loss medications during the pandemic. In fact, Novo Nordisk reported strong sales of its new weight-loss drug during the pandemic. We also know obesity increases the risk of severe illness from COVID-19, so it's possible that providers were more likely to prescribe weight-loss medication in an effort to mitigate this risk.
Summing it up
Resolving to lead a healthy life is even more difficult in periods of stress. During the pandemic, Americans filled fewer prescriptions for medications to quit smoking. But they filled more prescriptions for weight-loss medications. Pandemic-related anxiety, depression, and boredom, coupled with a Chantix recall, may be responsible for the drop in infills for smoking cessation medications. Gym closures and increased binge eating during the pandemic may explain the uptick in weight-loss medication fills.
The question now is: What’s in store for weight-loss management and anti-smoking strategies post-pandemic? As the pandemic anxiety subsides, will weight-loss medications become more common and smoking cessation efforts remain low? Or, are these just pandemic-related trends?
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Co-contributors: Sasha Guttentag, PhD, Swetha Pola, MIDS, Amanda Nguyen, PhD, Tori Marsh, MPH
Methodology
For this analysis, GoodRx Research compared prescription fills for weight loss and smoking cessation to Google user search queries at the national level. Data for this study was collected between January 1, 2019, and December 31, 2021.
Weight loss drug inclusion criteria
Weight loss drugs used in this analysis were restricted to sympathomimetic medications, which are a class of prescribed drugs used to suppress appetite and treat obesity. Drugs used to treat neurological issues or diabetes were excluded so we could focus on weight loss-specific medications. The final list of weight loss drugs used in this analysis includes phentermine, diethylpropion, phendimetrazine (bontril pdm), phendimetrazine er, lomaira, adipex-p, and benzphetamine.
Smoking cessation drug inclusion criteria
In this study, we included the following medications for smoking cessation: Chantix (varenicline tartrate), Nicorette/Nicotrol/NicoDerm CQ (including nicotine patch, lozenge, gum, and/or titration packs), and Zyban (bupropion, buproban). The data analyzed in this story encompasses both over-the-counter (OTC) and prescription drugs filled by a pharmacist; it may not capture OTC drugs not purchased at the pharmacy counter.
Weight loss and smoking cessation medication fill rates
The fill rate is based on a statistically significant sample of fills at U.S. pharmacies. The monthly fill rate for all drugs between 2020 and 2021 was indexed to the average fill rate for 2019.
Google Ads keyword planning tool for Infoveillance research
The Google Ads discover new keyword tool was used to obtain the average monthly search term volumes made by users between January 1, 2019, and December 31, 2021. This tool takes a list of phrases or keywords and returns the monthly search volume for the inputted terms for each month in the study. This tool also returns other related phrases and keywords. The geographic unit for this analysis was set at the national level.
Google weight loss keyword search strategy
The keyword search seeding query included “weight loss medication,” “phentermine,” “exercise,” “gyms near me,” and “diet.” These terms encompass major weight loss and weight management categories (exercise, diet, medication).
From the initial five-term query, the Google keyword planning tool returned 7,417 Google user search terms that together totalled more than 49 million average monthly searches. Only the top 500 ranked terms with total average monthly search volume greater than 15,000 were considered, and from this initial basket of search terms, 463 were included in the final analysis. Terms were categorized as either exercise, diet, medication, or non-specific weight loss terms. Non-specific terms are terms that are non-specific (“vegans”), or are related to a disease or condition (“ibs diet”) but have a weight component. This category was used as an internal control, and the data is not shown.
Surgical weight loss terms were excluded from this analysis as the aim of this study was to focus on pre-surgical interventions. Although not included in the analysis, these terms did appear 10 times, with the average monthly search volume ranging between 30 and 5,400.
Google smoking cessation keyword search strategy
The keyword search seeding query included “how to quit smoking,” “smoking medication,” “Chantix,” “Zyban,” “Varenicline,” “nicotine patches,” “smoking hypnosis,” “smoking cessation,” and “stop smoking cold turkey.” These terms encompass a majority of smoking cessation categories (medication, alternative, and non-specific). Alternative smoking cessation strategies are Google search terms that include nicotine replacement therapies such as nicotine patches or inhalers, as well as non-medical interventions such as hypnosis.
The Google keyword planning tool returned 3,854 terms, which together accounted for 487,000 average monthly searches. Only terms with a total average search volume greater than 300 were considered. The final basket of terms used in this analysis was 168. Each term was categorized as either medication, alternative, or non-specific. Non-specific refers to Google search terms that do not explicitly include a medication, or a specific smoking cessation strategy (hypnosis, patches), such as "help quit smoking."
Google search volume index
The monthly average search volume by category was indexed to the 2019 average search volume for that category.
GoodRx Care visit data
GoodRx Care data was analyzed for all “quitting smoking” visits from January 1, 2020, through December 31, 2021. The bar chart represents 2020 and 2021 compiled monthly visits for smoking cessation.
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References
American Society for Nutrition. (2021). New research shows trend toward unhealthy eating during pandemic.
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Centers for Disease Control and Prevention. (2020). Current cigarette smoking among adults in the United States.
Centers for Disease Control and Prevention. (2022). Obesity, race/ethnicity, and COVID-19.
Columbia University. (2021). COVID-19 lockdown linked to uptick in tobacco use.
Food and Drug Administration. (2021). Pfizer issues a voluntary nationwide recall for twelve lots of CHANTIX® (Varenicline) tablets due to N-nitroso Varenicline content.
Gonzalez, M., et al. (2021). Smokers are more likely to smoke more after the COVID-19 California lockdown order. International Journal of Environmental Research and Public Health.
Harvard Health Publishing. (2021). Did we really gain weight during the pandemic?
International Food Information Council. (2020). 2020 Food & Health Survey.
Jaklevic, M. C. (2021). COVID-19 and the ‘lost year’ for smokers trying to quit. Journal of the American Medical Association.
Massachusetts General Hospital. (2021). Study reveals changes in cigarette smoking during the COVID-19 pandemic.
NPR. (2021). Cigarette sales went up last year for the first time in 20 years.
Reuters. (2021). Novo Nordisk's new weight-loss drug getting a boost from pandemic -CEO.
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