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Interventions for preventing weight gain after smoking cessation


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									    interventions for preventing weight gain after smoking cessationi
Amanda C Parsons1, Mujahed Shraim2, Jennie Inglis3, Paul Aveyard4, Peter Hajek5

 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.

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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