Interventions for preventing weight gain after smoking cessation

Department of Primary Care & General Practice, University of Birmingham, Birmingham, West Midlands, UK, B15 2TT.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2009; 1(1):CD006219. DOI: 10.1002/14651858.CD006219.pub2
Source: PubMed


Most people who give up smoking put on weight. This is of concern to many smokers and often puts people off trying to quit or leads to people going back to smoking after managing to quit. A variety of drug and behavioural treatments have been tested to see if they increase the chances of quitting whilst also limiting weight gain. Among the drug treatments, naltrexone showed the most promise, but there was no evidence of its effects on weight once drug treatment stopped or in the long term. Behavioural treatments were more successful when tailored to the individual, with very low calorie diets and cognitive behavioural therapy showing the most promise in limiting weight gain. Both treatments increased success in long-term quitting, but the long-term effect on weight was only found with cognitive behavioural therapy. There was not enough evidence to judge whether very low calorie diets helped people maintain their weight reduction long-term. Interventions to help smokers to quit may also have an effect on weight gain after quitting. Bupropion, fluoxetine and nicotine replacement therapy were all found to limit weight gain during treatment. However the effects on limiting weight gain were smaller once treatment had stopped, and there was not enough evidence to be sure that these effects persisted in the long term. Varenicline may also reduce weight gain during treatment, but there was not enough evidence to confirm this or to measure its long-term effect on weight. There was some evidence to suggest that exercise reduced long-term weight gain after quitting, but more studies are needed to confirm this effect.

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    • "In a 10 year study, the mean weight gain attributable to cessation was 5.0 kg in women and 4.4 kg in men [3]. Multiple studies have shown that 33-75% of ex-smokers reported weight gain within the first year of cessation [8]. "
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    ABSTRACT: Individuals who smoke generally have a lower body mass index (BMI) than nonsmokers. The relative roles of energy expenditure and energy intake in maintaining the lower BMI, however, remain controversial. We tested the hypothesis that current smokers have higher total energy expenditure than never smokers in 308 adults aged 40-69 years old of which 47 were current smokers. Energy expenditure was measured by doubly labeled water during a two week period in which the subjects lived at home and performed their normal activities. Smoking status was determined by questionnaire. There were no significant differences in mean BMI (mean ± SD) between smokers and never smokers for either males (27.8+5.1 kg/m2 vs. 27.5+4.0 kg/m2) or females (26.5+5.3 kg/m2 vs. 28.1+6.6 kg/m2), although the difference in females was of similar magnitude to previous reports. Similarly, total energy expenditure of male smokers (3069+764 kcal/d) was not significantly different from that of never smokers (2854+468 kcal/d), and that of female smokers (2266+387 kcal/d) was not different from that of never smokers (2330+415 kcal/d). These findings did not change after adjustment for age, fat-free mass and self-reported physical activity. Using doubly labeled water, we found no evidence of increased energy expenditure among smokers, however, it should be noted that BMI differences in this cohort also did not differ by smoking status.
    Nutrition & Metabolism 11/2010; 7(1):81. DOI:10.1186/1743-7075-7-81 · 3.26 Impact Factor
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    • "In short, all processes of physiological restoration can be used as examples of short-term positive outcomes of abstinence (Bize et al., 2005). Conversely, examples of negative short-term outcomes of newly gained abstinence include negative affect (Kenford et al., 2002), weight gain (Parsons et al., 2009), and all of the common withdrawal symptoms (craving, irritability, anxiety, restlessness, insomnia, and concentration difficulties) (Piasecki, 2006). "
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    ABSTRACT: The digital therapy intervention for smoking cessation, ‘Happy Ending’, has been shown to be efficacious in two previous randomised controlled trials. The aim of the current article is to disentangle the rationale of the intervention and describe its development. For this purpose, Intervention Mapping is used as a descriptive tool. The intervention is fully automated and delivered by means of the Internet and mobile phones. It is based on self-regulation theory, social cognitive theory, cognitive-behaviour therapy, motivational interviewing and relapse prevention. The ordering of the content is based on a reasoned chronology, modelled according to psychological processes that people experience at certain time points in a process of therapy-supported self-regulation. The design of the intervention is innovative in that it combines four media channels (SMS, IVR, e-mail, and web), and in the combination of just-in-time therapy and a tunnelling strategy based on the natural chronology of quitting. The two forms of just-in-time therapy are a craving helpline (mainly targeting negative affect), and the provision of relapse therapy based on a daily assessment of the target behaviour. The present article meets the recent calls for more thorough descriptions of interventions, and may inform systematic reviews and the development of interventions.
    The Journal of Smoking Cessation 06/2010; 5(1):29–56. DOI:10.1375/jsc.5.1.29
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    ABSTRACT: Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness. To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data. Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention. Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used. Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes.There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I(2) > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I(2) = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse.Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.
    Cochrane database of systematic reviews (Online) 07/2009; 3(3):CD001055. DOI:10.1002/14651858.CD001055.pub3 · 6.03 Impact Factor
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