It's estimated that 21% of Canadians over the age of 15 are smokers – a total of 5.4 million Canadians -- and many of them are women, with some 16,000 deaths a year attributable to smoking. Many women smokers who want to quit are stopped by their concern about weight gain that usually happens when you quit.  Studies have shown us that this sub group are much less likely to quit smoking and if they do try, they are more likely to drop out of treatment and indeed they do gain more weight after smoking cessation than women who are not as concerned about the weight gain.

Interestingly enough, when weight loss and dieting are added to smoking cessation counselling, it does not improve the rates of being successful in the long term, and in fact, might even be counterproductive.

In this study in this week's Archives of Internal Medicine is a study that looked at addressing the concerns about post cessation weight gain rather than trying to prevent the weight gain itself.
 
In this study, women who wanted to quit smoking and were anxious about weight gain entered into different treatment arms. These women were identified in a screening questionnaire and answered yes ( in the range of very much so to extremely concerned) to the following questions:

• How concerned are you about gaining weight after quitting?
• How concerned would you be if quitting smoking caused you to permanently gain 10 to 15 pounds?

In the study, women were randomly assigned to receive standard counselling alone, or combined with a placebo or the smoking cessation medication buproprion. The other randomization was to CONCERNS counselling alone or combined with a placebo or bupropion.

The CONCERNS counselling did not only address smoking cessation but had something called cognitive therapy aimed at reducing the concerns about post cessation weight gain. It challenged what are called maladaptive thoughts such as- I should smoke rather than eat too much OR If I gain any weight I will be unattractive. Lessons also did target restrained eating and encouraged moderate intake of healthy in between-meal snacks.

Overall, 31.8% of women stopped smoking for 3 months, 21.8% after 6 months and 16.3 % after 12 months. However for those women on buproprion and CONCERNS versus those on placebo and CONCERNS the quit rates at  3 months were 40.6% versus 18.4%, at 6 months 34% versus 11.5%, and at 12 months 23.6% versus 8.1%.

In addition, the combination of this special counselling and medication showed the quitters were slower to relapse- 266 days versus 46 days. For those who were on medications alone with standard counselling, the quit time or time to relapse was not improved and it may be that in this sub type of quitters- those with weight concerns- bupropion alone is not successful.

Interestingly enough, among women who sustained abstinence there were no group differences in weight gain. Weight gain was somewhere between 4.98 kg and 5.49 kg at 3 months into the study.
 
Smoking is a hard habit to break but one that has notable benefits if it can be achieved. Adding the concern of weight gain can really stand in the way of being successful. This gives us insight into a new strategy to help female smokers quit.

WATCH: My segment on Canada AM this week: Butting out and weight gain