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Meta-Analysis
. 2012 Jul 10:345:e4439.
doi: 10.1136/bmj.e4439.

Weight gain in smokers after quitting cigarettes: meta-analysis

Henri-Jean Aubin  1 , Amanda Farley, Deborah Lycett, Pierre Lahmek, Paul Aveyard
Affiliations
Meta-Analysis

Weight gain in smokers after quitting cigarettes: meta-analysis

Henri-Jean Aubin et al. BMJ. .

Abstract

Objective: To describe weight gain and its variation in smokers who achieve prolonged abstinence for up to 12 months and who quit without treatment or use drugs to assist cessation.

Design: Meta-analysis.

Data sources: We searched the Central Register of Controlled Trials (CENTRAL) and trials listed in Cochrane reviews of smoking cessation interventions (nicotine replacement therapy, nicotinic partial agonists, antidepressants, and exercise) for randomised trials of first line treatments (nicotine replacement therapy, bupropion, and varenicline) and exercise that reported weight change. We also searched CENTRAL for trials of interventions for weight gain after cessation.

Review methods: Trials were included if they recorded weight change from baseline to follow-up in abstinent smokers. We used a random effects inverse variance model to calculate the mean and 95% confidence intervals and the mean of the standard deviation for weight change from baseline to one, two, three, six, and 12 months after quitting. We explored subgroup differences using random effects meta-regression.

Results: 62 studies were included. In untreated quitters, mean weight gain was 1.12 kg (95% confidence interval 0.76 to 1.47), 2.26 kg (1.98 to 2.54), 2.85 kg (2.42 to 3.28), 4.23 kg (3.69 to 4.77), and 4.67 kg (3.96 to 5.38) at one, two, three, six, and 12 months after quitting, respectively. Using the means and weighted standard deviations, we calculated that at 12 months after cessation, 16%, 37%, 34%, and 13% of untreated quitters lost weight, and gained less than 5 kg, gained 5-10 kg, and gained more than 10 kg, respectively. Estimates of weight gain were similar for people using different pharmacotherapies to support cessation. Estimates were also similar between people especially concerned about weight gain and those not concerned.

Conclusion: Smoking cessation is associated with a mean increase of 4-5 kg in body weight after 12 months of abstinence, and most weight gain occurs within three months of quitting. Variation in weight change is large, with about 16% of quitters losing weight and 13% gaining more than 10 kg.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the UK Centre of Tobacco Control Studies, British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, Department of Health, and National Institute for Health Research; H-JA has received sponsorship to attend scientific meetings, speaker honorariums, and consultancy fees from Pfizer, McNeil, GlaxoSmithKline, Pierre-Fabre Sante, Sanofi-Aventis, and Merck-Lipha; PA has done consultancy and research on behalf of the McNeil, Pfizer, and Celtic Biotechnology; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Study selection for inclusion in meta-analysis
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Fig 2 Meta-analyses of mean (95% CI) change in weight (kg) from baseline to one, two, and three month follow-up in abstinent untreated smokers. For the Shiffman studies, smokers were stratified and received two different treatments on the basis of nicotine dependence level (separated in “a” and “b” groups). For the Fiore studies, “a” and “b” refer to two separate studies reported in the same article
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Fig 3 Meta-analyses of mean (95% CI) change in weight (kg) from baseline to six and 12 month follow-up in abstinent untreated smokers. For the Shiffman studies, smokers were stratified and received two different treatments on the basis of nicotine dependence level (separated in “a” and “b” groups)
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Fig 4 Meta-analyses of mean (95% CI) change in weight (kg) from baseline to one, two, and three month follow-up in abstinent smokers treated with nicotine replacement therapy (any dose, any regimen). For the Shiffman studies, smokers were stratified and received two different treatments on the basis of nicotine dependence level (separated in “a” and “b” groups). For the Fiore studies, “a” and “b” refer to two separate studies reported in the same article
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Fig 5 Meta-analyses of mean (95% CI) change n weight (kg) from baseline to six and 12 month follow-up in abstinent smokers treated with nicotine replacement therapy (any dose, any regimen). For the Shiffman studies, smokers were stratified and received two different treatments on the basis of nicotine dependence level (separated in “a” and “b” groups)
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Fig 6 Meta-analyses of mean (95% CI) change in weight (kg) from baseline to two, three, six, and 12 month follow-up in abstinent smokers treated with bupropion (300 mg/day)
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Fig 7 Meta-analyses of mean (95% CI) change in weight (kg) from baseline to two, three, and 12 month follow-up in abstinent smokers treated with varenicline (2 mg/day)
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Fig 8 Percentage of untreated quitting population who would be expected to lose weight, gain <5 kg, gain 5-10 kg, or gain >10 kg over 12 months
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Fig 9 Percentage of quitting population treated with nicotine replacement therapy who would be expected to lose weight, gain <5 kg, gain 5-10 kg, or gain >10 kg over 12 months
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Fig 10 Percentage of quitting population treated with bupropion who would be expected to lose weight, gain <5 kg, gain 5-10 kg, or gain >10 kg over 12 months
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Fig 11 Percentage of quitting population treated with varenicline who would be expected to lose weight, gain <5 kg, gain 5-10 kg, or gain >10 kg over 12 months
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Comment in

References

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