Smoking Cessation and Changes in Body Mass Index: Findings From the First Randomized Cessation Trial in a Low-Income Country Setting.
BACKGROUND
In high-income countries, quitting cigarette smoking is associated with weight gain, which can reduce motivation to abstain. Whether smoking cessation is associated with weight gain in a low-income country context has never been investigated. We aimed to determine the post-cessation changes in body mass index (BMI) and its predictors among smokers who received a smoking cessation intervention in a low-income country setting.


METHODS
We performed post hoc analyses of data from 269 smokers who participated in a two-group, parallel-arm, double-blind, placebo-controlled randomized trial of combined nicotine replacement therapy (NRT) and behavioral counseling in primary care clinics in Aleppo, Syria. We used generalized estimating equation modeling to identify predictors of changes in BMI at 6 weeks and 6- and 12-month follow-ups after quit date.


RESULTS
The mean pre-cessation BMI of the sample was 27.9kg/m2 (SD = 5.2). Over 12 months of follow-up, BMI of smoking abstainers averaged 1.8 BMI units (approximately 4.8kg) greater than non-abstainers (p = .012). Throughout the study, greater BMI was associated with being female (p = .048), reporting smoking to control weight (p < .001) and having previously failed to quit due to weight gain (p = .036).


CONCLUSIONS
Similar to findings from high-income countries, smoking cessation in Syria is associated with weight gain, particularly among women and those who have weight concerns prior to quitting. This group of smokers may benefit from tailored cessation interventions with integrated body weight management elements that take into consideration the prevailing local and cultural influences on diet and levels of physical activity.


CONCLUSIONS
This study provides the first evidence regarding post-cessation changes in BMI among smokers who attempt to quit in a low-income country setting. Our findings advance knowledge regarding post-cessation weight gain and offers insight for researchers and clinicians to identify smokers at higher risk of post-cessation weight gain. This information will help in delivering interventions that take into account the prevailing cultural influence on diet and physical activity and will ultimately help in designing future tailored cessation programs in Syria and other low-income countries with similar cultural background and level of development.
Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL.
Ziyad
Z
Ben Taleb
Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN.|Syrian Center for Tobacco Studies, Aleppo, Syria.
Kenneth D
KD
Ward
Syrian Center for Tobacco Studies, Aleppo, Syria.|Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
Taghrid
T
Asfar
Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL.
Rana
R
Jaber
Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL.
Raed
R
Bahelah
Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL.|Syrian Center for Tobacco Studies, Aleppo, Syria.
Wasim
W
Maziak
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D013593:Syria; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy*; D015430:Weight Gain; D055815:Young Adult