Insufficient evidence on effectiveness of interventions for preventing weight gain after smoking cessation

Clinical question: 
How effective are interventions for preventing weight gain after smoking cessation?
Bottom line: 
Behavioural interventions of general advice only are not effective and may reduce abstinence. Individualised interventions, very low calorie diets, and cognitive behavioural therapy (CBT) may be effective and not reduce abstinence. Exercise interventions are not associated with reduced weight gain at end of treatment, but may be associated with worthwhile reductions in weight gain in the long term. Bupropion, fluoxetine, nicotine replacement therapy, and probably varenicline all reduced weight gain while being used. Although this effect was not maintained 1 year after quitting smoking, for bupropion, fluoxetine and nicotine replacement, the evidence is insufficient to exclude a modest long term effect. The data are not sufficient to make strong clinical recommendations for effective programmes.
Caveat: 
The long term effect of all combined smoking cessation and weight control interventions on weight gain is small at best, at less than 1kg, (compared with a typical weight gain of about 5kg for continuous abstinence over 1 year), and is of borderline clinical relevance. The only possible exceptions are individualised weight control interventions, CBT and very low calorie diets.
Context: 
Smoking cessation is usually accompanied by weight gain and people who quit smoking can expect to gain an average of 4kg to 6kg over 1 year of continuous abstinence. There are some interventions that have been specifically designed to assist smoking cessation while also limiting weight gain. Many smoking cessation pharmacotherapies and other interventions may also limit weight gain.
Review CD#: 
CD006219
PEARLS No: 
152
Date: 
April, 2009
Authored by: 
Brian R McAvoy