Prescribing Advice for GPs

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Smoking cessation and weight gain

The Cochrane Library has published a review of interventions that aim to prevent weight gain following smoking cessation.

According to the review, most people who stop smoking gain weight, on average about 7kg in the long term. The review examined data for pharmacological and behavioural interventions.

Pharmacological interventions including treatment with fluoxetine produced significant weight loss at the end of treatment but these effects were not found to persist at 6 or 12 months.

Of the behavioural interventions assessed only very low calorie diets and cognitive behavioural therapy (CBT) were associated with improved abstinence and reduced weight gain at end of treatment and at long-term follow up. Exercise interventions had no effect during treatment but if continued these were found to have an effect at 12 months.

Overall the authors conclude that, "the data are not sufficient to make strong clinical recommendations for effective programmes". The plain language summary indicates that drug therapies are not a long term solution. Behavioural interventions that are individualised are most successful but lack long term evidence.

Action: The risk of weight gain may pose a barrier to smoking cessation and continued abstinence for many people. Clinicians should be aware of these barriers and provide tailored lifestyle advice if this would encourage smoking cessation.

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5 Comments to “Smoking cessation and weight gain”

  1. The danger of weight gain:

    The Potential Results Of Obesity

    Obesity has been defined as when excess body fat accumulates in one to where their physical overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as others determine obesity to be of a more serious concern. While obesity is not a disease, it is a serious health risk for one who has this risk.
    As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity.
    Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern. In the United States, greater than one third of all citizens are obese, and this number continues to progress.
    Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. The consequences of these stats on our children are very concerning, considering the health issues they may or likely experience as they get older.
    Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight.
    Women of low socioeconomic status are likely to be twice as obese compared with those who are not at this status. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline because primarily of this obesity problem.
    Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed.
    Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening.
    One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine.
    Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has co-morbidities aside from obesity. This surgery should be considered for the severely obese when other treatment options have failed. The standard of care illustrating as to whether this surgery is reasonable and necessary should be clarified.
    There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Generally, these surgeries are procedures related to gastric restrictive operations or mal-absorptive operations.
    Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.
    It is believed that the results of this surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese. Yet about two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur. However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies at times.
    Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient. Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.
    Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.
    If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: http://www.asmbs.org,

    Dan Abshear

    Comment by Dan — February 28, 2009 #
    Reply

  2. I know the only way to not gain weight while quitting smoking- don't replace smoking by eating.

    Comment by NoSmoker — February 24, 2009 #
    Reply

  3. Simple maths really eat less excercise more =weight loss. Walking is one of the best excercises anyone can do - its free and needs no expensive equipment. Just need to walk briskly for 30 minutes at least on five days per week

    Comment by Jane — February 17, 2009 #
    Reply

  4. I would not usually post to a blog however I am interested in your post so I felt compelled to do so. Going in a slightly different direction from the topic slightly, what is your opinion concerning walking? It is generally being advertised as the best exercise to burn fat.

    Comment by SriMathe — February 14, 2009 #
    Reply

    1. SriMathe,

      Any exercise is good. Walking is just fine as a form of activity provided that you are walking with some purpose and rather than having a sedate stroll.

      Comment by Matthew Robinson — February 16, 2009 #
      Reply

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