Interventions to prevent weight gain after smoking cessation

Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M, AveyardP. Interventions to prevent weight gain after smoking cessation. Cochrane Database of Systematic Reviews 2021, No. 10. Art. No.: CD006219. doi: 10.1002 /14651858.CD006219.pub4. Accessed November 2, 2021.

Commentary

This study has the following two objectives

(1) To target interventions for weight change and weight gain after smoking cessation.

(2) To systematically review the effects of interventions designed to support smoking cessation that plausibly affect weight gain after smoking cessation.

Part 1

Thirty-seven completed studies included intermittent very-low-calorie diets (VLCDs) that included full-meal replacements with intensive nutritionist support provided free of charge, significantly reduced weight gain at the end of treatment compared with education on how to avoid weight gain, but there was no evidence of benefit at 12 months There is no evidence of benefit at 12 months. The VLCD also increased the likelihood of abstinence at 12 months, but a second study found that no one completed the VLCD intervention or achieved abstinence.

Interventions aimed at increasing acceptance of weight gain reported mixed effects at the end of treatment and at 6 and 12 months, with confidence intervals including both increases and decreases in weight gain compared to no advice or health education. Due to high heterogeneity, we did not combine the data.

According to several pharmacological interventions tested to limit post-cancellation weight gain (PCWG), they reduced weight gain at the end of treatment. (Dexfenfluramine, phenylpropanolamine, and naltrexone)

The effects of ephedrine and caffeine combinations, lorcaserin, and chromium were too imprecise to give useful estimates of treatment effects.

Part 2

83 completed studies are included, 27 of which are new to this update.

Weight was lost at 12 months, although there was less confidence that the exercise intervention would result in minimal or no weight loss compared to the standard of care at the end of treatment. Both bupropion and fluoxetine limited weight gain at the end of treatment, but there was no evidence of benefit at 12 months for bupropion. Also, the fluoxetine study did not provide data at 12 months.

In summary, there are no interventions with moderate certainty of clinically useful effects on long-term weight gain. And there is also no evidence with high certainty that interventions designed to limit weight gain reduce the likelihood of achieving smoking cessation.