Does combination pharmacological intervention for smoking cessation prevent post-cessation weight gain? A systemic review

Background: Most smokers who quit smoking gain weight. There are some interventions designed to limit weight gain following smoking cessation. Objective: To conduct a systematic review to evaluate if combination pharmacological therapy interventions for smoking cessation are effective in reducing post-cessation weight gain. Methods: The following databases were researched: Medline, PubMed, PsycINFO, CENTRAL and EMBASE. Detailed inclusion and exclusion criteria were specified a priori before conducting abstract and full text screening. Included studies were required to: (1) report data on combination pharmacotherapy including at least one FDA-approved smoking cessation medication; (2) report outcome measure of weight change from baseline to the end of follow up; (3) incorporate a minimum of 2-week follow-up; (4) recruit adult smokers. Studies were excluded if they had (1) behavioral interventions; (2) sample size of <30; (3) switching medications; or (4) they were not written in English. Abstracts and the full texts were reviewed independently by two investigators. Inclusion of studies was decided by a third independent investigator in case of disagreement between the two primary investigators. Results: Out of 1873 studies identified, 1083 studies were included for abstract screening. Finally, 12 studies met the eligibility criteria after full text screening of 242 studies. Seven studies showed that participants in the combined therapy group had less post-cessation weight gain than those in the group of individual drugs or placebo. Four studies did not report differential weight gain measures by treatment groups. Only one study showed that post-treatment weight gain in the combined therapy group was more than the monotherapy group, although the result was not statistically significant. Conclusions: Seven out of twelve studies indicated that combination smoking cessation medications had less post-cessation weight gain than monotherapy or placebo in short term. Long term weight gain was not well documented by most of the studies and future research is warranted. (C) 2012 Elsevier Ltd. All rights reserved.