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interventions for preventing weight gain after smoking cessationi Amanda C Parsons1, Mujahed Shraim2, Jennie Inglis3, Paul Aveyard4, Peter Hajek5 1 Department of Primary Care & General Practice, University of Birmingham, Birmingham, UK. 2Public Health and Epidemiology, Birmingham and Midland Eye Centre, Birmingham, UK. 3Dept of Public Health, University of Birmingham, Birmingham, UK. 4Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. 5Wolfson Institute of Preventive Medicine, Queen Mary’s School of Medicine and Dentistry, London, UK Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006219. DOI: 10.1002/14651858.CD006219.pub2. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. abstract Background Main results Most people who stop smoking gain weight, on average We found evidence that pharmacological interventions about 7kg in the long term. There are some interventions aimed at reducing post-cessation weight gain resulted in a that have been specifically designed to tackle smoking ces- significant reduction in weight gain at the end of treatment sation whilst also limiting weight gain. Many smoking (dexfenfluramine (-2.50kg [-2.98kg to -2.02kg], fluoxetine cessation pharmacotherapies and other interventions may (-0.80kg [-1.27kg to -0.33kg], phenylpropanolamine (PPA) also limit weight gain. (-0.50kg [-0.80kg to -0.20kg], naltrexone (-0.76kg [-1.51kg to -0.01kg])). No evidence of maintenance of the treatment Objectives effect was found at six or 12 months. This review is divided into two parts. Among the behavioural interventions, only weight con- (1) Interventions designed specifically to aid smoking trol advice was associated with no reduction in weight gain cessation and limit post-cessation weight gain and with a possible reduction in abstinence. Individual- (2) Interventions designed to aid smoking cessation that ized programmes were associated with reduced weight gain may also plausibly have an effect on weight at end of treatment and at 12 months (-2.58kg [-5.11kg to -0.05kg]), and with no effect on abstinence (RR 0.74 [0.39 Search strategy to 1.43]). Very low calorie diets (-1.30kg (-3.49kg to 0.89kg] Part 1: We searched the Cochrane Tobacco Addiction at 12 months) and cognitive behavioural therapy (CBT) Group’s Specialized Register which includes trials indexed (-5.20kg (-9.28kg to -1.12kg] at 12 months) were both asso- in MEDLINE, EMBASE, SciSearch and PsycINFO, and other ciated with improved abstinence and reduced weight gain reviews and conference abstracts. at end of treatment and at long-term follow up. Part 2: We searched the included studies of Cochrane Both bupropion (300mg/day) and fluoxetine (30mg and smoking cessation reviews of nicotine replacement ther- 60mg/day combined) were found to limit post-cessation apy, antidepressants, nicotine receptor partial agonists, weight gain at the end of treatment (-0.76kg [-1.17kg to cannabinoid type 1 receptor antagonists (rimonabant), -0.35kg] I2=48%) and -1.30kg [-1.91kg to -0.69kg]) respect- and exercise interventions, published in Issue 4, 2008 of ively. There was no evidence that the weight reducing effect The Cochrane Library. of bupropion was dose-dependent. The effect of bupropion at one year
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