Strategies Of Weight Control During Cessation

The focus of weight control strategies during cessation has revolved around diet, exercise, and most recently, pharmacologic agents. Weight control programs through behavioral self-management of dietary intake have been largely ineffective. In two large randomized trials of behavioral weight management during cessation, the standard care (control) groups with no weight control intervention had better cessation outcomes than the groups that received the behavioral intervention. One of the studies, however, reported that the amount of weight gained was lower for individuals receiving the dietary weight control intervention than individuals not receiving it.

In recent years, a number of research studies examining the effect of physical exercise on weight control during cessation have been conducted. The majority of these studies have been conducted with women. The largest randomized study to date found that women who participated in exercise as well as a smoking cessation program were twice as likely to be abstinent from smoking 12 months after the program than those who participated in the smoking cessation program alone. In addition, the exercise group gained considerably less weight than the nonexercise group.

Pharmacologic agents are increasingly used to prevent or delay weight gain during smoking cessation. Nicotine itself has been the focus of much pharmacologic research. The effect of various nicotine replacement delivery systems, such as nicotine polacrilex gum, the transdermal nicotine patch, nicotine nasal spray, and the nicotine inhaler, on weight gain has been assessed. Nicotine polacrilex gum has been widely studied for its weight control effects during cessation. An early review of five existing studies showed that gum users gained less weight than those on a placebo; however, the effects were small. Recent randomized studies of the effects of nicotine gum on weight gain suggest that there are no long-term effects of gum use on weight gain, and with the discontinuation of gum, there are no significant differences in weight gain between gum users and nonusers. Overall, findings are mixed in terms of weight gain during use of the other nicotine replacement products. The studies that have been conducted on the nicotine transdermal patch indicate either no effect or a delayed effect in controlling weight gain during cesssation. Similar findings have been reported for the nicotine nasal inhaler. Overall, it appears that any nicotine replacement effects on weight gain disappear after the nicotine replacement is discontinued.

Other pharmacologic agents have also been examined for their effects on weight gain during cessation. In a study of the effects of fluoxetine hydrochloride (Prozac) on weight gain during smoking, individuals on the drug gained significantly less weight than those on a placebo; however, the fol-lowup was very short (10 weeks). A study of the effects of ¿-fenfluramine, which is thought to suppress appetite by releasing serotonin, on weight gain during cessation suggested that d— fenfluramine did control weight over a placebo. Serious medical complications that accompany d— fenfluramine, at least when used in combination with phertermine, however, have diminished enthusiasm for this drug. A study using phe-nylpropanolamine, an over—the—counter weight control drug, indicated that phenylpropanolamine users gained less weight and had higher quit rates over a placebo group and a no treatment control group. A study of bupropion (Zyban) and weight gain indicated that weight gain was suppressed while on the drug, but the effect disappeared when the drug was discontinued.

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