Weight Counseling Plus Drug May Help Female Smokers

NEW YORK – For female smokers worried about gaining weight if they quit, a combination of specialized counseling and the anti-smoking drug Zyban may boost their chances of quitting — at least for a while, researchers reported Monday.

Many smokers gain weight when they quit — typically 5 to 15 pounds — and research suggests that women who are highly worried about that prospect have a particularly tough time giving up the habit.

For the new study, researchers looked at whether they could improve those odds with a combination of specialized counseling focused on women's weight concerns and the smoking-cessation drug bupropion SR, or Zyban.

They found that over six months of treatment, women who received the combo therapy were more successful at quitting than those who received weight counseling only, and also more successful than those who received standard smoking- cessation counseling plus Zyban.

Over six months, 34 percent of women in the weight counseling/Zyban group consistently abstained, the researchers report in the Archives of Internal Medicine.

That compared with 21 percent of women who received standard counseling and Zyban, 11 percent of those who received weight counseling plus a placebo (inactive pills) and 10 percent of those who had standard counseling plus placebo.

However, the advantage over standard counseling plus medication faded during the six months after treatment ended. At the one-year mark, 24 percent of women in the weight counseling/Zyban group had remained abstinent, as had 19 percent of those in the standard therapy/Zyban group.

Still, the findings suggest that counseling focused on weight worries can give certain women an extra push to quit, the researchers say.

"Women concerned with weight might, for better results, need more- specialized counseling," lead researcher Dr. Michele D. Levine, of the University of Pittsburgh Medical Center, said in an interview.

Right now, however, women are not likely to find a targeted program like the one Levine's team developed — cognitive behavioral therapy aimed at smokers' weight-gain issues.

Levine said she and her colleagues want to identify the "key elements" of the therapy program, and see whether they can be distilled into simpler formats — a couple of sessions worked into standard smoking- cessation counseling, for example, or even a set of "talking points" that doctors can discuss with patients trying to quit smoking. Because the team is still working on these issues, they can't yet put a price tag on the intervention.

The current study included 349 female smokers who expressed strong concerns about quitting-related weight gain. They reported an average of three previous quit attempts.

The researchers randomly assigned the women to one of four groups: weight counseling plus Zyban; weight counseling plus placebo; standard smoking-cessation counseling plus Zyban; or standard counseling plus placebo.

In all groups, counseling involved 12 90-minute sessions given over three months. Drug or placebo treatment lasted six months.

Women in the weight-focused group received standard smoking-cessation counseling plus therapy to help them re-evaluate their body-image and weight-gain worries.

The idea of the weight counseling, according to Levine, is to change quitters' thinking toward weight gain, rather than trying to prevent it through dieting — which research suggests is ineffective, and may even be counterproductive to smokers' quit attempts.

However, while Levine's team found that women in the weight-counseling group were more likely to abstain over six months, there was actually no clear effect on their reported weight concerns.

That finding is surprising, Levine said, and raises the question of why the program plus Zyban worked better in the shorter term.

More studies are needed to answer that question, she and her colleagues say, and to see how weight-focused counseling can be most practically delivered.

The study was funded by the National Institute on Drug Abuse; two co- researchers have served as consultants to Zyban maker GlaxoSmithKline.

SOURCE: Archives of Internal Medicine, March 22, 2010.