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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    • "Whilst progress has been made in identifying factors important to eliciting health behaviour change, in some areas, there remains contradictory or limited results or studies of low methodological quality, resulting in varied evidence (DiCenso et al., 2002; Munro et al., 2007; Parsons et al., 2009; Riemsma et al., 2002; Sowden and Stead, 2003; Stade et al., 2009). Advances in the field of health behaviour change are evolving. "
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    ABSTRACT: Purpose ‐ There is growing evidence that health behaviour change interventions are associated with mental health and wellbeing improvements. This paper aims to examine the effect of healthy lifestyle interventions on mental wellbeing. Design/methodology/approach ‐ Six databases (Medline, Evidence Based Medicine Cochrane Registered Controlled Trials, Evidence Based Medicine Full Text Reviews, British Nursing Index, Embase, PsycINFO) were searched from database commencement up to April 2013. A broad focus on lifestyle interventions and mental health and wellbeing outcomes was chosen. Papers were systematically extracted by title then abstract according to predefined inclusion and exclusion criteria. Inclusion criteria: any individual population (non-couple/family); any health behaviour change interventions; mental health and wellbeing outcomes; and a one-two level of evidence. Interventions aimed at workers were excluded, as were articles assessing cognitive functioning rather than mental health or wellbeing, or those using medications in interventions. Findings ‐ Two authors reviewed 95 full papers. In total, 29 papers met inclusion criteria, representing a range of interventions spanning physical activity, diet, alcohol intake, drug use and smoking. A range of measures were used. The majority (n=25) of studies demonstrated improvements on at least one indicator of mental health and wellbeing. Limitations include the broad range of outcome measures used, varied follow-up times and the lack of detail in reporting interventions. Originality/value ‐ Health behaviour change interventions targeting physical outcomes appear to have benefits to mental health and wellbeing spanning healthy populations and those with physical or mental health problems. Evidence is strongest for interventions targeting exercise and diet, particularly in combination and the actual lifestyle changes made and adherence appear to be important. However, it is not clear from this review which specific components are necessary or essential for improvements in mental health and wellbeing.
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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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    • "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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