Cessation-related Weight Gain Research Articles

Behavioral activation for smoking cessation and the prevention of smoking cessation-related weight gain: A randomized trial

BackgroundPost-cessation weight gain (PCWG) is an obstacle to smoking cessation. This trial evaluated a behavioral intervention targeting alternative rewards to smoking and high calorie snacking to promote smoking cessation while mitigating PCWG. MethodsAdult smokers (n = 288; 119 females, 169 males) received eight weeks of transdermal nicotine and were randomized to eight sessions of behavioral activation for smoking cessation and the mitigation of PCWG (BAS+) or standard smoking cessation counseling (SC). Primary outcomes were 7-day point prevalence abstinence and PCWG 26 weeks after the target quit date. Change in caloric intake from pre-treatment through the 26-week follow-up was a secondary outcome. Data were collected from September 2016 to February 2021, and analyses were completed in July 2022. ResultsBAS+ and SC did not differ in smoking abstinence rates at the 26-week follow-up (OR=0.80, 95%CI 0.50–1.27, p = 0.34; 18% versus 23%). There were no significant differences in PCWG between BAS+ and SC who were 7-day point prevalence abstinent (β = −0.29, 95%CI −2.13 to 1.65, p = 0.77; 2.60 versus 2.20 pounds, respectively) or among those continuously abstinent (5.78 versus 5.34 pounds, respectively). There were no significant differences in caloric intake between BAS+ and SC from baseline to the 26-week follow-up (β = 110.65, 95%CI −96.72 to 318.02, p = 0.30; −19.1 versus −116.9 kcals/day, respectively). ConclusionsThe results do not support the efficacy of BAS+ for smoking cessation and the prevention of PCWG. These findings join a growing body of research highlighting the challenge of minimizing PCWG and promoting smoking abstinence.

Smoking cessation and obesity-related morbidities and mortality in a 20-year follow-up study.

Smoking is the biggest preventable factor causing mortality and morbidity and the health benefits of smoking cessation are commonly known. Smoking cessation-related weight gain is well documented. We evaluated the association between smoking cessation and the incidence of obesity-related morbidities such as hypertension, diabetes and metabolic syndrome as well as mortality. We also evaluated telomere length related to smoking cessation. This study was part of the OPERA (Oulu Project Elucidating Risk of Atherosclerosis) study. The mean follow up time among the 600 study subjects was 20 years. We divided the study subjects into four groups by smoking status ("never", "current", "ex-smokers" and "quit") and analyzed their health status. "Ex-smokers" had quit smoking before baseline and "quit" quit during the follow-up time. Information about total mortality between the years 2013-2020 was also utilized. During the follow-up time systolic blood pressure decreased the most in the "current" and in the "ex-smoker" groups. Office SBP decreased the least in the "quit" group (p = 0.001). BMI increased the most in the "quit" and the least in the "ex-smokers" group (p = 0.001). No significant increases were seen in the incidence of obesity-related-diseases, such as metabolic syndrome, hypertension and diabetes was seen. There was no significant difference in the shortening of telomeres. Odds of short-term mortality was increased in the "current" group (2.43 (CI 95% 1.10; 5.39)), but not in the "quit" (1.43 (CI 95% 0.73-2.80)) or "ex-smoker" (1.02 (CI 95% 0.56-1.86)) groups when compared to "never" group. Even though, the blood pressure levels were unfavorable in the "quit" group, there was no significant increase in the incidence of obesity-related-diseases, and a noticeable benefit in short-term mortality was seen during the 6-year follow-up. The benefits of smoking cessation outweigh the disadvantages in the long-term.

Simultaneous vs. sequential treatment for smoking and weight management in tobacco quitlines: 6 and 12\xa0month outcomes from a randomized trial

BackgroundSmoking cessation often results in weight gain which discourages many smokers from quitting and can increase health risks. Treatments to reduce cessation-related weight gain have been tested in highly controlled trials of in-person treatment, but have never been tested in a real-world setting, which has inhibited dissemination.MethodsThe Best Quit Study (BQS) is a replication and “real world” translation using telephone delivery of a prior in-person efficacy trial. Design: randomized control trial in a quitline setting. Eligible smokers (n = 2540) were randomized to the standard 5-call quitline intervention or quitline plus simultaneous or sequential weight management. Regression analyses tested effectiveness of treatments on self-reported smoking abstinence and weight change at 6 and 12 months.ResultsStudy enrollees were from 10 commercial employer groups and three state quitlines. Participants were between ages 18–72, 65.8% female, 68.2% white; 23.0% Medicaid-insured, and 76.3% overweight/obese. The follow-up response rate was lower in the simultaneous group than the control group at 6 months (p = 0.01). While a completers analysis of 30-day point prevalence abstinence detected no differences among groups at 6 or 12 months, multiply imputed abstinence showed quit rate differences at 6 months for:simultaneous (40.3%) vs. sequential (48.3%), p = 0.034 and simultaneous vs. control (44.9%), p = 0.043. At 12 months, multiply imputed abstinence, was significantly lower for the simultaneous group (40.7%) vs. control (46.0%), p < 0.05 and vs. sequential (46.3%), p < 0.05. Weight gain at 6 and 12 months was minimal and not different among treatment groups. The sequential group completed fewer total calls (3.75) vs. control (4.16) and vs. simultaneous group (3.83), p = 0.01, and fewer weight calls (0.94) than simultaneous (2.33), p < 0.0001. The number of calls completed predicted 30-day abstinence, p < 0.001, but not weight outcomes.DiscussionThis study offers a model for evaluating population-level public health interventions conducted in partnership with tobacco quitlines.ConclusionsSimultaneous (vs. sequential) delivery of phone/web weight management with cessation treatment in the quitline setting may adversely affect quit rate. Neither a simultaneous nor sequential approach to addressing weight produced any benefit on suppressing weight gain. This study highlights the need and the challenges of testing intensive interventions in real-world settings.Trial registrationClinicalTrials.gov Identifier: NCT01867983. Registered: May 30, 2013.

The influence of smoking cessation-related weight gain on cardiovascular risk in patients treated with drug-eluting stent after acute coronary syndrome

The influence of smoking cessation-related weight gain on cardiovascular risk in patients treated with drug-eluting stent after acute coronary syndrome

Reducing alcohol consumption to minimize weight gain and facilitate smoking cessation among military beneficiaries

IntroductionSmoking cessation-related weight gain can have significant negative health and career consequences for military personnel. Alcohol reduction combined with smoking cessation may decrease weight gain and relapse. MethodA randomized clinical trial of military beneficiaries compared a standard smoking cessation (i.e., brief informational) intervention (N=159), with a brief motivational smoking cessation intervention that emphasized reduced drinking to lessen caloric intake and minimize weight gain (N=158). ResultsParticipants who received the motivational intervention were significantly more likely to quit smoking at the 3-month follow-up (p=0.02), but the differences were not maintained at 6 (p=0.18) or 12months (p=0.16). Neither weight change nor alcohol reduction distinguished the 2 groups. Smoking cessation rates at 12months (motivational group=32.91%, informational group=25.79%) were comparable to previous studies, but successful cessation was not mediated by reduced drinking. ConclusionsAlcohol reduction combined with smoking cessation did not result in decreased weight gain or improved outcomes.

Post-Cessation Weight Concerns Among Women Calling a State Tobacco Quitline

Obese and overweight women who smoke are more likely to be concerned about weight gain following cessation, impacting ability to quit and relapse. To determine differences in weight concerns for underweight, normal weight, overweight, and obese female smokers by race/ethnicity. From March to November 2008, female adult tobacco users calling the Oklahoma Tobacco Helpline were asked questions to determine the prevalence of obesity and concern for cessation-related weight gain. A score of 50 or greater, where 0=not at all concerned and 100=very concerned, on one of two weight concerns questions defined the outcome. BMI was calculated from self-reported height and weight. For the current analyses in 2013, race, ethnicity, age, education, marital status, and tobacco use history were examined as covariates. Multiple logistic regression was used to calculate ORs and 95% CIs. A significant interaction between race and BMI was observed; thus, separate models were created for white (n=3,579); black (n=330); American Indian (n=441); and Hispanic (n=125) women. BMI was independently associated with weight concerns among all racial/ethnic groups, but the strength of the association varied. For black and Hispanic women, there was a particularly strong association between BMI and weight concerns among obese women (OR=9.55, 95% CI=5.05, 18.07, and OR=8.46, 95% CI=2.57, 27.83, respectively), although sample sizes were small. State quitlines should consider tailoring promotional efforts and treatment protocols to include concerns about weight gain, especially for obese African American and Hispanic smokers.

Use and Effectiveness of Quitlines for Smokers With Diabetes: Cessation and Weight Outcomes, Washington State Tobacco Quit Line, 2008

IntroductionHaving diabetes and smoking increases the risk of morbidity and mortality. However, cessation-related weight gain, a common side effect during quitting, can further complicate diabetes. Evidence-based telephone quitlines can support quitting but have not been studied adequately in populations with chronic diseases such as diabetes. The purpose of this study was to evaluate the use and effectiveness of a tobacco quitline among tobacco users with diabetes. Cessation-related weight concerns and weight gain were also assessed.MethodsWe administered a telephone-based follow-up survey to tobacco users with and without diabetes 7 months after their enrollment in a quitline. We collected and analyzed data on demographics, tobacco use, dieting, weight concern, quitting success (7- and 30-day point prevalence), and weight gain. We computed summary statistics for descriptive data, χ2 and t tests for bivariate comparisons, and multivariable analyses to determine correlates of cessation.ResultsTobacco users with diabetes used the quitline in a greater proportion than they were represented in the general population. Quit rates for those with and without diabetes did not differ significantly (24.3% vs 22.5%). No significant differences existed between groups for weight gain at follow-up, regardless of quit status. However, participants with diabetes reported more weight gain in previous quit attempts (34.2% vs 22.4% gained >20 lbs, P = .03). Weight concern was a significant correlate of continued smoking, regardless of diabetes status.ConclusionsResults suggest that quitlines are effective for participants with diabetes, but tailored interventions that address weight concerns during cessation are needed.

Slimming World in Stop Smoking Services (SWISSS): study protocol for a randomized controlled trial

BackgroundQuitting smokers gain weight. This deters some from trying to stop smoking and may explain the increased incidence of type 2 diabetes after cessation. Dieting when stopping smoking may be counterproductive. Hunger increases cravings for smoking and tackling two behaviours together may undermine quitting success. A meta-analysis of randomized controlled trials (RCTs) showed individualized dietary support may prevent weight gain, although there is insufficient evidence whether it undermines smoking cessation. Commercial weight management providers (CWMPs), such as Slimming World, provide individualized dietary support for National Health Service (NHS) patients; however, there is no evidence that they can prevent cessation-related weight gain.Our objective is to determine whether attending Slimming World from quit date, through referral from NHS Stop Smoking Services, is more effective than usual care at preventing cessation-related weight gain.MethodsThis RCT will examine the effectiveness of usual cessation support plus referral to Slimming World compared to usual cessation support alone. Healthy weight, overweight and obese adult smokers attending Stop Smoking Services will be included. The primary outcome is weight change in quitters 12 weeks post-randomization. Multivariable linear regression analysis will compare weight change between trial arms and adjust for known predictors of cessation-related weight gain.We will recruit 320 participants, with 160 participants in each arm. An alpha error rate of 5% and 90% power will detect a 2 kg (SD = 2.5) difference in weight gain at 12 weeks, assuming 20% remain abstinent by then.DiscussionThis trial will establish whether referral to the 12-week Slimming World programme plus usual care is an effective intervention to prevent cessation-related weight gain. If so, we will seek to establish whether weight control comes at the expense of a successful quit attempt in a further non-inferiority trial.Positive results from both these trials would provide a potential solution to cessation-related weight gain, which could be rolled out across England within Stop Smoking Services to better meet the needs of 0.75 million smokers stopping with NHS support every year.Trial registrationCurrent Controlled Trials ISRCTN65705512

Addressing Weight Gain in Smoking Cessation Treatment: A Randomized Controlled Trial

To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns. Randomized controlled trial, blinded 6-month follow-up. The Oklahoma Tobacco Helpline (OKHL). All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP). Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain. Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain. Descriptive statistics and logistic regression. Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. -3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3). The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.

Effects of naltrexone on smoking cessation outcomes and weight gain in nicotine-dependent men and women.

This study examined whether the opioid receptor antagonist naltrexone is efficacious in smoking cessation and whether sex moderates the response. We assessed smoking quit rates and weight gain in a double-blind randomized trial comparing oral naltrexone (n = 162) with placebo (n = 154) in nicotine-dependent participants who wanted to quit smoking. The medication was gradually titrated up to 50 mg during the week before the quit date and then maintained at this dose for 12 weeks. For the first 4 weeks after the quit date, all participants received a nicotine patch to mitigate tobacco withdrawal and attended weekly individual cognitive-behavioral smoking cessation counseling sessions. After this time, participants continued with naltrexone or placebo through 12 weeks. Follow-up assessments were conducted at 26 and 52 weeks. During treatment, naltrexone (vs placebo) increased quit rates, attenuated smoking urge, and reduced weight gain. At follow-up, after medication discontinuation, the effect of naltrexone on improving quit rates was no longer evident. Men and women experienced different benefits from naltrexone; men showed greater reductions in smoking, whereas women showed greater reductions in weight gain. In sum, naltrexone showed acute efficacy in treating nicotine dependence, but after the medication was discontinued, the effect on quit rate was not maintained. Further study of naltrexone in smoking cessation treatment and reduction of cessation-related weight gain, as well as preclinical investigation of mechanisms underlying sex differences, is warranted.

Smoking, Smoking Cessation, and Risk for Type 2 Diabetes Mellitus

Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown. To test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly owing to cessation-related weight gain. Prospective cohort study. The ARIC (Atherosclerosis Risk in Communities) Study. 10,892 middle-aged adults who initially did not have diabetes in 1987 to 1989. Smoking was assessed by interview at baseline and at subsequent follow-up. Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004. During 9 years of follow-up, 1254 adults developed type 2 diabetes. Compared with adults who never smoked, the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67). In the first 3 years of follow-up, 380 adults quit smoking. After adjustment for age, race, sex, education, adiposity, physical activity, lipid levels, blood pressure, and ARIC Study center, compared with adults who never smoked, the hazard ratios of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (CI, 0.99 to 1.50), 1.73 (CI, 1.19 to 2.53), and 1.31 (CI, 1.04 to 1.65), respectively. Further adjustment for weight change and leukocyte count attenuated these risks substantially. In an analysis of long-term risk after quitting, the highest risk occurred in the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then gradually decreased to 0 at 12 years. Residual confounding is possible even with meticulous adjustment for established diabetes risk factors. Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.

Prevalence of Weight Concerns and Obesity Among Smokers Calling a Quitline

BACKGROUND: Cessation-related weight gain and weight concerns are common among smokers and have a negative impact on quitting. Obese smokers tend to gain more than the average amount of weight and also have lower quit rates. This article describes the prevalence of obesity and weight concerns among smokers calling a state quitline in the United States. RESULTS: Among 3972 smokers using a state quitline, 33.3% were obese, 30.2% overweight, 33.3% normal weight and 3.2% underweight; a total of 60.6% were concerned about cessation-related weight gain. Compared with non-obese callers, obese callers were more likely to be female, Hispanic, non-White and heavier smokers. CONCLUSIONS: This is the first study to report data on body weight and weight concerns of smokers calling a national quitline. Given the lower quit rates among obese and weight-concerned smokers, and the burden of smoking and obesity, there is an opportunity to develop new treatment approaches for this at-risk population.

Efficacy of naltrexone in smoking cessation: A preliminary study and an examination of sex differences

This double-blinded, placebo-controlled trial evaluated the efficacy of naltrexone as an adjunct to standard smoking cessation treatment. Participants (N = 110) were adult male and female nicotine-dependent smokers who expressed interest in quitting smoking. All subjects received six sessions of behavioral counseling (1 hr/session for 6 weeks), and 1 month of the nicotine patch (21 mg for the first 2 weeks, 14 mg the third week, 7 mg the fourth week). Subjects were randomly assigned to the naltrexone or placebo group. The naltrexone group started at 25 mg daily for 3 days prior to the quit date, and increased to 50 mg/day on the quit date and following 8 weeks. At the end of medication treatment, the naltrexone group had better quit rates versus the placebo group (48% quit on naltrexone vs. 41% on placebo), but this difference was not statistically significant. However, men and women differed on several measures: in the placebo group, women had significantly lower quit rates than men (39% vs. 67%, p<.05), but in the naltrexone group, women had quit rates comparable with those of men (58% vs. 62%, p = ns). Further examination revealed that naltrexone significantly reduced men's and women's cessation-related weight gain and selectively reduced women's urge to smoke to relieve negative affect and withdrawal. The results suggest continued examination of naltrexone as an adjunct in smoking cessation, particularly in female smokers, who have historically shown worse outcomes with traditional treatment methods.

Body image and tobacco cessation: Relationships with weight concerns and intention to resume tobacco use

Concern about weight gain after tobacco cessation is a potential barrier to quitting tobacco. Few studies, however, have examined the role of body image in cessation-related weight concerns and anticipated relapse. This study investigated relationships between current body image dissatisfaction, anticipated body image dissatisfaction (discrepancy between anticipated post-cessation body shape and desired body shape), cessation-related weight concerns, and intention to resume tobacco with weight gain. Body image dissatisfaction was significantly related to cessation-related weight concerns. Participants who reported current dissatisfaction with their body image were 2.6 times more likely to intend to resume tobacco use with cessation-related weight gain than those with no body image dissatisfaction. Individuals with anticipated body image dissatisfaction were 3.4 times more likely to intend to resume tobacco compared to individuals with no anticipated body image dissatisfaction. Women and normal weight individuals with anticipated body image dissatisfaction appear to be at particularly high risk for intending to relapse. Results suggest that tobacco cessation interventions may need to target concerns about body image as well as weight gain.

Review of bupropion for smoking cessation.

The advent of bupropion hydrochloride sustained release (Zyban) has heralded a major change in the options available for smoking cessation pharmacotherapy. Bupropion is a selective re-uptake inhibitor of dopamine and noradrenalin which prevents or reduces cravings and other features of nicotine withdrawal. Bupropion is a useful oral and non-nicotine form of pharmacotherapy for smoking cessation. For this review a total of 221 papers were reviewed plus poster presentations. This review examines in detail original clinical trials on efficacy, categorised according to whether they were acute treatment trials in healthy smokers; studies in specific populations such as people with depression, chronic obstructive pulmonary disease (COPD) or cardiovascular disease; or relapse prevention studies. Overall, these studies in varying populations comprising over four thousand subjects, showed bupropion consistently produces a positive effect on smoking cessation outcomes. The evidence highlights the major public health role that bupropion has in smoking cessation. The methodological issues of published clinical trials reporting one year outcomes were examined in detail including: completeness of follow-up; loss to follow-up; intention to treat analysis; blindness of assessment; and validation of smoking status. The review discusses contraindications, adverse effects, dose and overdose, addictive potential, and the role of bupropion in reducing cessation-related weight gain. Bupropion combined with or compared to other pharmacotherapies (nicotine patch; nortriptyline) is considered. Impressive evidence exists for the use of bupropion in smoking cessation among difficult patients who are hard-core smokers such as those with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and depression. Bupropion reduces withdrawal symptoms as well as weight gain and is effective for smoking cessation for people with and without a history of depression or alcoholism. Serious side effects of bupropion use are rare. The major safety issue with bupropion is risk of seizures (estimated at approximately 0.1%) and it should not be prescribed to patients with a current seizure disorder or any history of seizures. In clinical trials of bupropion for smoking cessation no seizures were reported. Allergic reactions occur at a rate of approximately 3% and minor adverse effects are common including dry mouth and insomnia.

Long-term effects of nicotine gum on weight gain after smoking cessation

Smoking cessation usually results in weight gain. Nicotine gum therapy has been found to reduce weight gain in the first months after cessation, but its long-term effects are not fully known. The present study randomly assigned 608 smokers to receive placebo, 2 or 4 mg nicotine gum. In a follow-up analysis to the short-term weight change results reported in a previous paper [Doherty, Militello, Kinnunen, & Garvey (1996), Journal of Consulting and Clinical Psychology 64:799-807], we examined the effects of the nicotine gum on weight change for 1 year after cessation among the 92 1-year abstainers. We found that weight change showed some variation with gum dose (active vs. placebo), but that weight change appeared to depend more strongly on the percentage of pre-cessation cotinine levels replaced by the nicotine gum. Participants who replaced higher proportions of their pre-cessation cotinine during the gum therapy period gained less weight during the first year post-cessation than those who replaced less cotinine, with those who replaced greater than 90% of their cotinine gaining only 1.7 kg by 1 year post-cessation. These findings suggest that future research is warranted to determine whether sufficiently high levels of nicotine replacement can help to permanently reduce cessation-related weight gain.

Weight concerns and smoking: A literature review

Cigarette smoking has established effects on body weight. The effects of weight concerns on smoking initiation, maintenance, cessation, and relapse, however, are less clear. This review shows that weight concerns are related to smoking behavior in complex ways that differ depending on the smoking outcome (initiation, cessation, relapse), gender, and age. Dieting behaviors and general weight concerns appear to be positively related both cross-sectionally and prospectively to smoking in White adolescent females. In adults, weight concerns specific to smoking cessation appear to be higher in current smokers and may have a negative influence on cessation and relapse. General weight concerns, however, do not differ by smoking status, nor do they appear to hinder cessation or promote relapse. Dieting behavior is most prevalent in former smokers, least prevalent in current smokers, and intermediate in never smokers, suggesting that ex-smokers may be dieting to control cessation-related weight gain. Smoking cessation interventions that promote dieting to control weight have not been successful in preventing cessation-related weight gain, nor have they increased smoking cessation rates. Population-based prospective studies are needed to determine the broader significance of weight concerns in relationship to smoking cessation in adults. Efforts to address weight concerns in smoking intervention programs may need to target a small subset of individuals for whom weight control smoking is a significant barrier to cessation.