Bupropion and Cognitive Behavioral Therapy for Weight-Concerned Women Smokers (original) (raw)
Related papers
Addressing women's concerns about weight gain due to smoking cessation
Journal of Substance Abuse Treatment, 1997
Specific concerns about weight gain following smoking cessation inhibit attempts to quit smoking, especially in women. However, adjunct interventions to prevent weight gain after cessation have generally been successful only in attenuating, rather than preventing, weight gain. More aggressive weight control adjuncts may be necessary to prevent cessation-induced weight gain. On the other hand, weight control programs have not been found to improve long-term smoking abstinence and, in fact, may actually impede abstinence, necessitating a search for alternative approaches to addressing weight concerns. Since the ~. pical amount of weight gain is essentially trivial from a health standpoint, particularly when compared with the health benefits of quitting smoking, the most appropriate clinical strategy may be to combat the weight concerns themselves rather than the weight gain. A second alternative approach is to focus all treatment efforts on smoking cessation alone, to avoid placing excessive burdens on participants resulting from attempting simultaneous changes in multiple health behaviors (i.e., smoking and those related to weight). The rationales for these three clinical approaches to addressing concerns about weight gain--more effective weight control, direct reduction in weight concerns by cognitive-behavioral treatment, and smoking cessation only--are presented, followed by descriptions of the adjunct treatments based on these approaches currently being evaluated in a clinical outcome study with women t~. ing to quit smoking. © 1997 Elsevier Science Inc.
BMC Public Health, 2016
Background: Prevalence of multiple health risk behaviors is growing, and obesity and smoking are costly. Weight gain associated with quitting smoking is common and can interfere with quit success. Efficacy of adding weight management to tobacco cessation treatment has been tested with women in group sessions over an extended period of time, but has never been tested in real-world settings with men and women seeking help to quit. This paper describes the Best Quit study which tests the effectiveness of delivering tobacco and weight control interventions via existing quitline infrastructures. Methods: Eligible and consenting smokers (n = 2550) who call a telephone quitline will be randomized to one of three groups; the standard quitline or standard quitline plus a weight management program added either simultaneously or sequentially to the tobacco program. The study aims to test: 1) the effectiveness of the combined intervention on smoking cessation and weight, 2) the cost-effectiveness of the combined intervention on cessation and weight and 3) theoretically pre-specified mediators of treatment effects on cessation: reduced weight concerns, increased outcome expectancies about quitting and improved self-efficacy about quitting without weight gain. Baseline, 6 month and 12 month data will be analyzed using multivariate statistical analyses and groups will be compared on treatment adherence, quit rates and change in weight among abstinent participants. To determine if the association between group assignment and primary outcomes (30-day abstinence and change in weight at 6 months) is moderated by predetermined baseline and process measures, interaction terms will be included in the regression models and their significance assessed. Discussion: This study will generate information to inform whether adding weight management to a tobacco cessation intervention delivered by phone, mail and web for smokers seeking help to quit will help or harm quit rates and whether a simultaneous or sequential approach is better at increasing abstinence and reducing weight gain post quit. If proven effective, the combined intervention could be disseminated across the U.S. through quitlines and could encourage additional smokers who have not sought cessation treatment for fear of gaining weight to make quit attempts. Trial registration: Clinicaltrials.gov NCT01867983.
Value in Health, 2012
► Combination therapy had less post-cessation weight gain than monotherapy in short term. ► Long term weight gain was not well documented by most of the studies. ► Smoking cessation medication plus behavioral intervention is suggested for weight gain. a b s t r a c t a r t i c l e i n f o Background: Most smokers who quit smoking gain weight. There are some interventions designed to limit weight gain following smoking cessation. Objective: To conduct a systematic review to evaluate if combination pharmacological therapy interventions for smoking cessation are effective in reducing post-cessation weight gain. Methods: The following databases were researched: Medline, PubMed, PsycINFO, CENTRAL and EMBASE. Detailed inclusion and exclusion criteria were specified a priori before conducting abstract and full text screening. Included studies were required to: (1) report data on combination pharmacotherapy including at least one FDA-approved smoking cessation medication; (2) report outcome measure of weight change from baseline to the end of follow up; (3) incorporate a minimum of 2-week follow-up; (4) recruit adult smokers. Studies were excluded if they had (1) behavioral interventions; (2) sample size of b 30; (3) switching medications; or (4) they were not written in English. Abstracts and the full texts were reviewed independently by two investigators. Inclusion of studies was decided by a third independent investigator in case of disagreement between the two primary investigators. Results: Out of 1873 studies identified, 1083 studies were included for abstract screening. Finally, 12 studies met the eligibility criteria after full text screening of 242 studies. Seven studies showed that participants in the combined therapy group had less post-cessation weight gain than those in the group of individual drugs or placebo. Four studies did not report differential weight gain measures by treatment groups. Only one study showed that post-treatment weight gain in the combined therapy group was more than the monotherapy group, although the result was not statistically significant. Conclusions: Seven out of twelve studies indicated that combination smoking cessation medications had less post-cessation weight gain than monotherapy or placebo in short term. Long term weight gain was not well documented by most of the studies and future research is warranted.
Contemporary Clinical Trials Communications, 2017
Background: Two-thirds of treatment-seeking smokers are obese or overweight. Most smokers are concerned about gaining weight after quitting. The average smoker experiences modest post-quit weight gain which discourages many smokers from quitting. Although evidence suggests that combined interventions to help smokers quit smoking and prevent weight gain can be helpful, studies have not been replicated in real world settings. Methods: This paper describes recruitment and participant characteristics of the Best Quit Study, a 3-arm randomized controlled trial testing tobacco cessation treatment alone or combined with simultaneous or sequential weight management. Study participants were recruited via tobacco quitlines from August 5, 2013 to December 15, 2014. Results: Statistical analysis on baseline data was conducted in 2015/2016. Among 5082 potentially eligible callers to a tobacco quitline, 2540 were randomized (50% of eligible). Compared with individuals eligible but not randomized, those randomized were significantly more likely to be female (65.7% vs 54.5%, p < 0.01), overweight or obese (76.3% vs 62.5%, p < 0.01), more confident in quitting (p < 0.01), more addicted (first cigarette within 5 min: 50.0% vs 44.4%, p < 0.01), and have a chronic disease (28.6% vs. 24.4%, p < 0.01). Randomized groups were not statistically significantly different on demographics, tobacco or weight variables. Two-thirds of participants were female and white with a mean age of 43. Conclusions: Adding weight management interventions to tobacco cessation quitlines was feasible and acceptable to smokers. If successful for cessation and weight outcomes, a combined intervention may provide a treatment approach for addressing weight gain with smoking cessation through tobacco quitlines. Trial registration: Clinicaltrials.gov NCT01867983.
2000
This study investigated the relationship between weight gain concern and outcomes of a large- scale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers.
Drug and Alcohol Dependence, 2010
Background: Fear of weight gain is a significant obstacle to smoking cessation, preventing some smokers from attempting to quit. Several previous studies of naltrexone yielded promising results for minimization of post-quit weight gain. Given these encouraging findings, we endeavored to test whether minimization of weight gain might translate to better quit outcomes for a population that is particularly concerned about gaining weight upon quitting. Methods: Smokers (N = 172) in this investigation were prospectively randomized to receive either 25 mg naltrexone or placebo for 27 weeks (1 week pre-, 26 weeks post-quit) for minimization of post-quit weight gain and smoking cessation. All participants received open label therapy with the nicotine patch for the first 8 weeks post-quit and behavioral counseling over the 27-week treatment. The 2 pre-specified primary outcomes were change in weight for continuously abstinent participants and biologically verified end-of-treatment 7-day point-prevalence abstinence at 26 weeks after the quit date. Results: The difference in weight at 26 weeks post-quit between the naltrexone and placebo groups (naltrexone: 6.8 lbs ± 8.94 vs placebo: 9.7 lbs ± 9.19, p = 0.45) was not statistically different. Seven-day point-prevalence smoking abstinence rates at 26 weeks post-quit was not significantly different between the 2 groups (naltrexone: 22% vs placebo: 27%, p = 0.43). Conclusions: For smokers high in weight concern, the relatively small reduction in weight gain with low-dose naltrexone is not worth the potential for somewhat lower rates of smoking abstinence.
Addictive Behaviors, 2013
► Combination therapy had less post-cessation weight gain than monotherapy in short term. ► Long term weight gain was not well documented by most of the studies. ► Smoking cessation medication plus behavioral intervention is suggested for weight gain. a b s t r a c t a r t i c l e i n f o Background: Most smokers who quit smoking gain weight. There are some interventions designed to limit weight gain following smoking cessation. Objective: To conduct a systematic review to evaluate if combination pharmacological therapy interventions for smoking cessation are effective in reducing post-cessation weight gain. Methods: The following databases were researched: Medline, PubMed, PsycINFO, CENTRAL and EMBASE. Detailed inclusion and exclusion criteria were specified a priori before conducting abstract and full text screening. Included studies were required to: (1) report data on combination pharmacotherapy including at least one FDA-approved smoking cessation medication; (2) report outcome measure of weight change from baseline to the end of follow up; (3) incorporate a minimum of 2-week follow-up; (4) recruit adult smokers. Studies were excluded if they had (1) behavioral interventions; (2) sample size of b 30; (3) switching medications; or (4) they were not written in English. Abstracts and the full texts were reviewed independently by two investigators. Inclusion of studies was decided by a third independent investigator in case of disagreement between the two primary investigators. Results: Out of 1873 studies identified, 1083 studies were included for abstract screening. Finally, 12 studies met the eligibility criteria after full text screening of 242 studies. Seven studies showed that participants in the combined therapy group had less post-cessation weight gain than those in the group of individual drugs or placebo. Four studies did not report differential weight gain measures by treatment groups. Only one study showed that post-treatment weight gain in the combined therapy group was more than the monotherapy group, although the result was not statistically significant. Conclusions: Seven out of twelve studies indicated that combination smoking cessation medications had less post-cessation weight gain than monotherapy or placebo in short term. Long term weight gain was not well documented by most of the studies and future research is warranted.
Addictive Behaviors, 2014
To identify possible predictors of post-cessation weight gain in smoking abstainers. Patients and methods: A sample of 607 successful abstainers seen at the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2005 and 2010, was included in this analysis. This sample was followed up for 1 year and included 47.9% women (N = 291) with the mean age of 48 years (18-85). Findings: Post-cessation weight gain occurred in 88.6% of the 607 abstainers. The mean weight gain after one year post-quit was 5.1 kg (95% confidence interval 4.7-5.5 kg). Baseline characteristics associated with increased weight gain included a higher baseline smoking rate (p b 0.001), more severe cigarette dependence (p = 0.003), less physical activity (p=0.008), and a report of increased appetite on the baseline assessment of withdrawal symptoms (p b 0.001). Conclusions: Smokers who are more dependent and have minimal physical activity are at increased risk for postcessation weight gain. For these smokers, incorporating interventions targeting the weight issue into tobacco dependence treatment is recommended. Further research should be done to identify reasons for this important quitting complication.