A multiple health behavior change intervention for people with obesity who smoke cigarettes: a randomized clinical trial

About This Grant

Project Summary/Abstract Individuals with obesity who smoke cigarettes are disproportionately at risk for disease, disability, and premature death but may be reluctant to give up smoking due to fear of subsequent weight gain and trouble managing their weight without cigarettes. Applying weight gain prevention as part of a multiple health behavior change program prior to smoking cessation, may help this population lose weight, which itself would be beneficial, and could increase confidence in ability to tackle the challenge of quitting smoking. Previous studies have provided weight loss interventions during or after smoking treatment, and mostly not among individuals with obesity. Weight loss in advance of quitting smoking could provide a buffer against future potential post-cessation weight gain and may improve mood, help increase the salience of future health outcomes, and increase self-efficacy for tackling the challenges associated with quitting smoking among individuals with obesity who smoke. Design: A 2-group randomized controlled clinical trial of 220 adults with obesity who smoke cigarettes (BMI ≥ 30) who will be randomly assigned to either weight gain prevention (an intervention based on self-regulation approaches to produce and maintain weight loss shown to be effective for weight gain prevention) or lifestyle education (control condition) before smoking cessation treatment. Method: Participants will receive 8 weeks of remotely delivered weight gain prevention or lifestyle education followed by 8 weeks of smoking cessation with counseling and combination nicotine replacement therapy. Smoking cessation treatment will include brief maintenance sessions of the weight gain prevention or lifestyle education intervention. Changes in weight and biochemically verified smoking abstinence will be measured during the intervention and through a 12-month follow-up. Aims: Primary hypothesis 1a is that the weight gain prevention group will have significantly less weight gain at the end of smoking treatment and 6, 9, and 12-months post-treatment relative to baseline compared to the lifestyle education group. Primary hypothesis 1b is that the weight gain prevention group will have significantly higher rates of abstinence from smoking at the end of smoking treatment and 6, 9, and 12-months post-treatment compared to the lifestyle education group. Significance: This project focuses on preventing weight gain and improving smoking cessation outcomes in an at-risk group during a critical period using an innovative, evidence-based, self-regulation approach to weight gain prevention. Use of a multiple health behavior change intervention can maximize anticipated health benefits of smoking cessation and reduce the potential for relapse to smoking due to post-cessation weight gain. With an effective program, more individuals with obesity who smoke cigarettes may be willing to attempt smoking cessation which could impact the two leading causes of preventable mortality in the US.