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SMOKING CESSATION AND WEIGHT PROBLEMS

SMOKING CESSATION AND WEIGHT PROBLEMS. Dr. Zeynep A. Solak Ege University School of Medicine Department of Chest Diseases, İzmir. The goals of this presentation. Weight gain after smoking cessation, a reason for relapse Mechanism of weight gain Is it possible to avoid body weight gain?.

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SMOKING CESSATION AND WEIGHT PROBLEMS

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  1. SMOKING CESSATION AND WEIGHT PROBLEMS Dr. Zeynep A. Solak Ege University School of Medicine Department of Chest Diseases, İzmir

  2. The goals of this presentation • Weight gain after smoking cessation, a reason for relapse • Mechanism of weight gain • Is it possible to avoid body weight gain?

  3. Weight gain after smoking cessation • About 80% of people gain weight after stop smoking • It starts just after cessation and continues through abstinence • This problem is a primary reason for not trying to quit and for relapsing after cessation

  4. Meanchangeafter smoking cessation 7 6 5 4 Weight Changes (kg) 3 2 1 0 7 8 9 10 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 92 96 100 104 Visit Week (N Engl J Med 1997, 337)

  5. The average 5-year weight gain of sustained quitters was • 8.7 kg for women • 7.6 kg for men (Am J Epidemiol 1998; 148)

  6. For smokers who gain 10 kg or more, the risks associated with weight gain may negate some of the health benefits achieved in quitting: • Blood pressure • Serum lipids • Blood glucose • Uric acid levels • Reduction in lung volumes • Respiratory symptoms

  7. Risk Factors: • Age (Younger smokers) • Gender (Women) • Obesity • Number of cigarettes/day • Genetic factors (Dopamine receptor polymorphism) ?

  8. Mechanism of weight gain Nicotine  Metabolic rate both at rest and during activity  Lipolysis Altered feeding patterns  Appetite Reduced body weight

  9. Effects of nicotine on adipose tissue and peptides ? Adipose tissue lipoprotein lipase Leptin Neuropeptide Y Orexins Effects of nicotine on monoamines: Noradrenaline () Dopamine () Serotonin ()

  10. Effects of nicotine on insulin and adiponectin Impair glucose tolerance Insulin resistance Dyslipidaemia Post-prandial lipid intolerance Decreased adiponectin Effects of nicotine on İnflammation (?) İnhibition of the effects of inflammatory mediators on adipocyte metabolism

  11. Smoking cessation  Caloric intake  Resting metabolic rate  Lipoprotein lipase activity Weight gain

  12. Is it possible to avoid body weight gain? • Behavioural Therapy • Pharmacologic Therapy

  13. I) Behavioural therapy • Cognitive-behavioural therapy to reduce concern • Behavioural weight control programme (J Consult Clin Psychol 2001; 69) (Obesity Reviews 2004; 5) (Smoking Cessation Clinical Practice Guideline, AHCPR, 2000)

  14. Cognitive-behavioural therapy to reduce concern You are most likely to be successful if you first try to quit smoking and then later take steps to reduce your weight The great majority of smokers gain weight Smokers will gain weight, even if they do not eat more. There are medication that will help you Think about eating plenty of fruit and vegetables, getting enoug sleep, not eating a lot of fats Although you may gain some weight, compare the importance of this with the added years of healty living you will gain, your better appearance and good feelings about quitting The amount of weight you will likely gain will be a minor risk compared with smoking Evidence C

  15. Behavioural weight control programme Change eating patterns • Smaller portions, eaten slowly • When finished, get up from the table and brush own’s teeth • Stay away from alcohol • Change physical activity • Regular exercise • If possible do not start at the same time • Change lifestyle patterns • Community walking-groups • Exercise programmes at work

  16. II) Pharmacologic therapy Recommendation (Evidence B) Bupropion SR Nicotine replacement therapy, ın particular nicotine gum (Smoking Cessation Clinical Practice Guideline, AHCPR, 2000)

  17. Nicotine replacement therapy (NRT) -Nicotine gum - delaying postcessation weight gain (J Consult Clin Psycol 1989) -Nicotine patches - prevention of weight gain (?) (Clin Cardiol 1999; 22) (Horm Metab Res 2004; 36)

  18. Behavioural weight control programme - diet Nicotine gum -Behavioural advice + After 16 weeks (BMJ 1999; 319)

  19. Nicotine gum -Behavioural advice Behavioural weight control programme - diet + After 1 years

  20. Bupropion SR

  21. Botella-Carretero et al. Open-randomised study BUP 300 or nicotine patches - 7 week treatment Weight gain is not dependent on obesity or drug taken (Horm Metab Res 2004; 36)

  22. New drug - Rimonabant -Endocannabinoid system • Plays role in regulation of food intake and energy expenditure • Plays role in tobacco dependence • Rimonabant • First selective CB1 blocker • Helps to normalize the disrupted EC system

  23. Obesity drugs • Fluoxetine • Sibutramine • Orlistat ?

  24. Summary • Smoking cessation frequently leads to weight gain • The cause is a change in body's metabolic rate and in eating habits • Behavioural advises and pharmacotherapy (NRT, bupropion SR) can limit weight gain • Drugs are effective in reducing weight gain, but weight starts to increase when drug administration stops • Smokers not take strong measures (e.g., strict dieting) to counteract weight gain during a guit attempt

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