The mortality risk of smoking and obesity combined.
ABSTRACT Both smoking and obesity have been linked to increased mortality, but evaluating the joint effect has been limited. This nationwide, prospective mortality study of U.S. radiologic technologists was designed to evaluate the combined mortality risks of obesity and smoking.
Mortality risk was investigated in 64,120 women and 18,760 men who completed a baseline questionnaire (1983 to 1989). Body mass index (BMI) (weight adjusted for height, or kilograms divided by meters squared) was calculated from self-reported weight and height at baseline, with five categories: less than 18.5 (underweight), 18.5 to 24.9 (normal), 25.0 to 29.9 (overweight), 30.0 to 34.9 (moderately obese), and 35.0 and higher (very obese). Participants were followed from the questionnaire until the date of death or through 2002, whichever occurred first. The combined association among BMI and smoking and all-cause, cancer, and circulatory disease mortality by gender and attained age (less than 65 years, 65 years and older) was examined using Cox proportional hazards regression analyses (conducted in 2005). Person-years at risk averaged 16 years (women aged less than 65), 6 years (women aged 65 and older), 15 years (men aged less than 65), and 7 years (men aged 65 and older), totaling 1.35 million person-years.
In all gender/age groups, both obesity and smoking, particularly current smoking, contributed substantially to all-cause mortality, with 3.5- to 5-fold risks for very obese, current smokers compared to normal weight, never smokers. Current smoking was the predominant risk factor for cancer mortality. Combining obesity with current smoking increased circulatory disease mortality by 6- to 11-fold for people aged less than 65 years, compared to normal weight, never smokers. Obese former smokers (less than 65 years) had notably lower risks.
Obese smokers (aged less than 65 years) had strikingly high mortality risks, particularly from circulatory disease mortality.
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ABSTRACT: Weight gain that commonly accompanies smoking cessation can undermine a person's attempt to quit and increase the risk for metabolic disorders. Research indicates that obese smokers have more weight concerns and gain more weight after quitting than non-obese smokers, yet little is known about possible reasons for these outcomes. We sought to gain an understanding of obese smokers' experiences of quitting and their attitudes and beliefs about the association between smoking and weight gain. In-depth semi-structured interviews were conducted with obese smokers who called a state tobacco quitline. Interviewers elicited discussion of obese smokers' thoughts about smoking, the effects of quitting on change in weight, challenges they faced with quitting, and how quitlines might better serve their needs. Participants (n = 29) discussed their fear of gaining weight after quitting, their beliefs about smoking and their weight and significant experiences related to quitting. Participants' awareness of weight gain associated with quitting was based on prior experience or observation of others who quit. Most viewed cessation as their primary goal and discussed other challenges as being more important than their weight, such as managing stress or coping with a chronic health condition. Although weight gain was viewed as less important than quitting, many talked about changes they had made to mitigate the anticipated weight gain. Weight gain is a concern for obese smokers interested in quitting. Understanding the relative importance of body weight and other challenges related to smoking cessation can help tailor interventions for the specific group of smokers who are obese and interested in smoking cessation.BMC Public Health 11/2014; 14(1):1229. DOI:10.1186/1471-2458-14-1229 · 2.32 Impact Factor
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ABSTRACT: Introduction Rates of obesity are higher among more dependent smokers and 37-65% of smokers seeking cessation treatment are overweight or obese. Overweight or obese smokers may possess metabolic and neurobiological features that contribute to difficulty achieving cessation using front-line nicotine replacement products. Attention to factors that facilitate effective cessation treatment in this vulnerable population is needed to significantly reduce mortality risk among overweight and obese smokers. Method This secondary analysis of two large trials of transdermal nicotine replacement in general medical practices evaluated the hypothesis that higher body mass index (BMI) would moderate the efficacy of the nicotine patch. We examined the potential for gender to further moderate the relationship between BMI and treatment efficacy. Results In the placebo controlled trial (N=1,621), 21 mg patch was no more effective than placebo for assisting biochemically verified point prevalence abstinence up to one-year after quitting for women with higher BMI, but appeared to be effective for men at normal or high BMI (gender x BMI beta = -0.22, p = 0.004). We did not find differential long-term cessation outcomes among male or female smokers in the 15mg patch trial (n=705). However, we observed significantly higher rates of early lapse among women with higher BMI treated with nicotine patch across both trials. Conclusion These results suggest that increased BMI may affect the efficacy of nicotine patch on reducing risk of early lapse in women. Additional research is needed to explore mechanisms of risk for decreased efficacy of this commonly used cessation aid. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: email@example.com.Nicotine & Tobacco Research 12/2014; DOI:10.1093/ntr/ntu256 · 2.81 Impact Factor
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ABSTRACT: Obesity is a major health concern for developed countries. One pharmacotherapy option available in the United States is the selective serotonin 2c agonist, lorcaserin. This review will discuss the efficacy and safety profile of lorcaserin. In addition, it will discuss the novel findings of potential applications for this medication, such as smoking cessation and fibromyalgia. Introduction Obesity is classified in adults as having a body mass index (BMI) of 30 kg/m 2 or greater. Available data from 2012, estimates 17% and 35% of youths ages 2‒ 19 (BMI ≥ 95 th percentile) and adults ages 20 or older, respectively, were classified as obese in the United States . Obesity is a metabolic disorder that results in inflammatory alterations and can lead to comorbidities such as cancer, stroke, non-insulin dependent diabetes mellitus, osteoarthritis, and heart disease . It has been estimated that the per capita annual medical costs for obese individuals are $1,429 greater than for non-obese individuals . Successful long-term treatment for obesity, therefore, would ease the national and individual health care burden. Current treatment options include reducing caloric intake and increasing physical activity, which are often times not effective or hard to maintain. In addition to diet and exercise, other treatment approaches include pharmacotherapy and in more severely obese individuals, bariatric surgery. In the last few years, the landscape of pharmacotherapy options for the long-term treatment of obesity has changed dramatically. In 2012, the US Food and Drug Administration approved two central acting medications, lor-caserin hydrochloride (Belviq) and a combinational drug of phentermine/topiramate (Qsymia). In addition to these medications and the peripherally acting orlistat (Xenical, Alli), two other drugs, naltrexone/bupropion and liraglutide, are likely to receive approval for the long-term treatment of obesity [4, 5].