Abstract
BackgroundWeight gain accompanies smoking cessation, but dieting during quitting is controversial as hunger may increase urges to smoke. This is a feasibility trial for the investigation of a very low calorie diet (VLCD), individual modest energy restriction, and usual advice on hunger, ketosis, urges to smoke, abstinence and weight gain in overweight smokers trying to quit.MethodsThis is a 3 armed, unblinded, randomized controlled trial in overweight (BMI > 25 kg/m2), daily smokers (CO > 10 ppm); with at least 30 participants in each group. Each group receives identical behavioural support and NRT patches (25 mg(8 weeks),15 mg(2 weeks),10 mg(2 weeks)). The VLCD group receive a 429-559 kcal/day liquid formula beginning 1 week before quitting and continuing for 4 weeks afterwards. The modest energy restricted group (termed individual dietary and activity planning(IDAP)) engage in goal-setting and receive an energy prescription based on individual basal metabolic rate(BMR) aiming for daily reduction of 600 kcal. The control group receive usual dietary advice that accompanies smoking cessation i.e. avoiding feeling hungry but eating healthy snacks. After this, the VLCD participants receive IDAP to provide support for changing eating habits in the longer term; the IDAP group continues receiving this support. The control group receive IDAP 8 weeks after quitting. This allows us to compare IDAP following a successful quit attempt with dieting concurrently during quitting. It also aims to prevent attrition in the unblinded, control group by meeting their need for weight management. Follow-up occurs at 6 and 12 months.Outcome measures include participant acceptability, measured qualitatively by semi-structured interviewing and quantitatively by recruitment and attrition rates. Feasibility of running the trial within primary care is measured by interview and questionnaire of the treatment providers. Adherence to the VLCD is verified by the presence of urinary ketones measured weekly. Daily urges to smoke, hunger and withdrawal are measured using the Mood and Physical Symptoms Scale-Combined (MPSS-C) and a Hunger Craving Score (HCS). 24 hour, 7 day point prevalence and 4-week prolonged abstinence (Russell Standard) is confirmed by CO < 10 ppm. Weight, waist and hip circumference and percentage body fat are measured at each visit.Trial RegistrationCurrent controlled trials ISRCTN83865809
Highlights
Weight gain accompanies smoking cessation, but dieting during quitting is controversial as hunger may increase urges to smoke
Smoking cessation-related weight gain partly explains the finding that the incidence of type II diabetes is increased by 50-100% in the years after cessation [4,5] and there is a 30% increased risk of hypertension [6] compared to continuing smoking
The reviewers reported that general dietary education to reduce energy intake through eating a low fat, healthy diet did not prevent weight gain compared to standard smoking cessation behavioural support
Summary
Weight gain is a well known consequence of smoking cessation [1,2]. It may deter smokers from attempting to quit [3] and offsets some advantages of giving up smoking. Evidence suggests that hunger increases urges to smoke (smokers smoke more when hungry)[9,10] and people who gain most weight are more likely to succeed in quitting smoking[11] These observations led to attempts to reduce cigarette cravings by using glucose tablets, which was shown to be effective[12]. Our aim is to use the results of this trial to inform a study large enough and of long enough duration to assess long term effects on dietary change, weight, cardiovascular risk, lung health and smoking abstinence For this reason we have designed DeMiST to be a small scale model of such a trial. DeMiST extends beyond the initial quitting phase into a second treatment stage where both the VLCD and the control group receive individually tailored dietary advice The reason for this in the VLCD group is to provide them with conventional support to establish long term healthy habits. There is evidence to suggest that the latter may be more successful than the former, this hasn’t been tested with an adequately powered trial, [17] we plan to do so in our future trial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
