A randomized controlled trial to reduce post-cessation weight gain

Abstract

Background/Objectives Weight gain is a barrier to smoking cessation. Previous interventions targeting weight gain while quitting smoking have largely been unsuccessful. The current study aimed to assess the efficacy of weight stability and weight loss interventions compared to a low-intensity, self-guided bibliotherapy weight management group. Subjects/Methods A randomized controlled trial with 12-month follow-up from 2018 to 2022 was conducted with participants ( N = 305) who reported smoking at least five cigarettes per day for the last year and interest in quitting initially recruited from the Memphis, TN, USA area. Recruitment was expanded nationally with the onset of the COVID-19 pandemic. Subsequently, 276 completed 12-month follow-up. Interventions/Methods The Bibliotherapy group was provided a weight management book. Both the Stability and Loss groups met via telephone for eight weeks to learn strategies for maintaining/losing weight, respectively. All three groups then received the same six-week smoking cessation intervention, with six months of varenicline provided. Results Individuals in the Loss group lost more weight (−2.01 kg, SE = 1.58) than individuals in the Bibliotherapy group (+1.08 kg, SE = 1.49, p = 0.0004), while the Stability group (−0.30 kg, SE = 1.56) was not significantly different from the Bibliotherapy group ( p = 0.17). Those in the Stability group did not gain a significant amount of weight. Participants in the Loss group did not gain back all weight lost after smoking cessation and ended the study approximately 2.01 kg lower than baseline. The Bibliotherapy group did not gain the amount of weight expected after cessation. There were no significant differences between groups related to self-reported smoking cessation at each time point except at eight-month follow-up ( p = 0.005). Conclusions and relevance Results indicated the Stability and the Loss interventions were effective for preventing post-smoking cessation weight gain, with the Loss group having the benefit of sustained weight loss. These interventions may be helpful to implement to combat weight gain and potentially facilitate smoking cessation. Trial Registration The trial is registered on clinicaltrials.gov (NCT03156660).

Importance of self‐weighing to avoid post‐cessation weight gain: A secondary analysis of the fit and quit randomized trial

“…Additionally, individuals who enrolled in this trial may have been inherently more motivated to lose or maintain their weight than the general population of individuals quitting smoking. Lastly, only 40%–50% of participants in this study successfully quit smoking; thus, these findings represent a mix of individuals who quit smoking and those who continued to smoke, 26 which could have impacted the findings.…”

“…All methods of the Fit & Quit trial have been described previously, 25 and main outcomes have been reported elsewhere. 26 The goal of the parent study was to investigate the efficacy of a Inclusion criteria focused on recruiting adult cigarette smokers desiring smoking cessation who had a BMI of greater than or equal to 22 kg/m 2 and who were able to participate in study activities (e.g., had email and phone access, could exercise for 10 min). The Loss intervention encouraged all participants to lose at least 5% of their baseline weight to offset expected cessation-related weight gain; thus, the BMI cut-off of 22 kg/m 2 was selected so that even participants with normal weight were able to lose 5% of their baseline The weight management interventions for this study have been described previously.…”

“…Self‐weighing data gathered via e‐scales from participants in the “Fit & Quit” randomized controlled trial was used for this secondary analysis study. All methods of the Fit & Quit trial have been described previously, 25 and main outcomes have been reported elsewhere 26 . The goal of the parent study was to investigate the efficacy of a weight loss and a weight stability intervention in reducing post‐smoking cessation weight gain.…”

“…All methods of the Fit & Quit trial have been described previously, 25 and main outcomes have been reported elsewhere. 26 The goal of the parent study was to investigate the efficacy of a weight loss and a weight stability intervention in reducing post‐smoking cessation weight gain. Participants in the parent study were allocated by the study statistician using a custom SAS randomization algorithm with a sequence blocked by baseline weight category (normal weight, overweight, obesity) and gender to one of three conditions: Stability (focused on small changes leading to weight gain prevention), Loss (focused on weight loss) or Bibliotherapy (minimal, self‐guided intervention using the EatingWell Diet book).…”

Effects of Electronic Nicotine Delivery Systems Substitution on Body Weight Status: Protocol for a Systematic Review and Meta-Analysis

“…The phenomenon of weight gain following smoking cessation is a well-documented concern in scientific research [ 1 ]. Typically, individuals who quit smoking experience an average weight increase ranging from 4.67 to 4.8 kg after 1 year, with more than 10% experiencing a rise exceeding 10 kg [ 2 , 3 ].…”