In Brief

Women smokers who are concerned about gaining weight when they quit are most likely to quit successfully if smoking-cessation counseling addresses those concerns, according to a study in the August issue of APA's Journal of Consulting and Clinical Psychology (Vol. 69, No. 4).

Compared with men, women are more than twice as likely to expect to gain weight after quitting--and studies show that smokers who are concerned about weight gain are less motivated to quit smoking, report more severe withdrawal and are less likely to succeed at quitting.

"The assumption, over the past 10 to 15 years, has been that what you need to do is to prevent that weight gain, and then the concern will go away," says University of Pittsburgh clinical psychologist Kenneth A. Perkins, PhD, the lead author of the new study.

But it's not that simple, Perkins argues. Research augmenting traditional smoking-cessation counseling with weight-control interventions, he says, has been disappointing. Trying to diet while quitting smoking, the studies suggest, only makes quitting more difficult.

In their study of 219 women smokers concerned about gaining weight when they quit smoking, Perkins and University of Pittsburgh psychologists Marsha D. Marcus, PhD, Michele D. Levine, PhD, Saul Shiffman, PhD, and colleagues compared the effectiveness of a standard smoking-cessation counseling with two supplementary approaches.

In all study conditions, women received counseling for seven weeks. Women who were assigned to a weight-control condition received standard smoking-cessation counseling plus behavioral therapy to help them avoid gaining weight. In another condition, women received both standard counseling and cognitive behavioral therapy (CBT). The therapy was designed to address weight concerns, limit "all-or-none" thinking and encourage women to accept the possibility of modest weight gain.

The researchers found that women in the CBT condition were more successful at quitting smoking than women who received standard smoking-cessation counseling, whereas women in the weight-control condition were not. Even one year after the counseling ended, 21 percent of women in the CBT condition remained abstinent, compared with only 13 percent in the weight-control condition and 9 percent in the standard counseling condition. Surprisingly, one year after treatment, women in the CBT condition also gained less weight than did women in the standard counseling condition. There was no difference in weight gain a year after treatment for the weight-control and standard counseling groups.

In follow-up research, the team is examining the combined effects of CBT to address weight concerns and use of the smoking-cessation drug bupropion, known by the trade name Zyban.