Weight control through behavioral techniques at the smoking cessation clinic

Introduction and Aim: Weight gain can occur after smoking cessation and can result in the interruption of smoking cessation treatment. To prevent weight gain, which is an important public health problem, providing support to people who quit smoking would be beneficial. Interventions with behaviour modification therapy are more effective and long lasting in individuals. The primary aim of the study was to determine whether cognitive behavioural techniques applied by a dietitian to individuals who have quit smoking were effective on weight control. The secondary aim was to determine whether risky behaviours causing weight gain had changed in the individuals even if there was no change in weight. Material and Methods: This study was designed as an interventional pre-post comparison. The population constituted of individuals aged 18-65 years who had applied to Ege University Public Health Department's Smoking Cessation Clinic in November, December 2017 and January 2018 and who had quit smoking since a month. The total sample size was calculated as 34 using an effect size of 0.5, error margin 5% and 0.8 power. The study was completed with 29 individuals. Permission was obtained from the ethics committee. The data were collected by a questionnaire prepared by the researcher and the Cognitive Patterns of Nutrition Assessment Form, the Risk Behaviours Scale, the Dutch Eating Behaviour Questionnaire (DEBQ), and the Global Physical Activity Questionnaire (GPAQ). The Smoking Cessation Policlinic Evaluation Form was also used. The researcher conducted an individual face-to-face interview with an average of 40 minutes including behaviour change counselling and evaluation. The primary outcome variables of the study were weight change and BMI change. Secondary outcome variables were changes in waist and hip circumference, Risk Behaviours Scale score, the Dutch Eating Behaviour Questionnaire score, Cognitive Patterns of Nutrition Assessment score. In the data analysis, the chi-square test in independent groups and Mc Nemar test in dependent groups was used. To compare means among dependent groups, Wilcoxon signed-rank test was applied. The Mann-Whitney U test was used to compare two independent means. The level of significance was set at p<0,05. Results: The research group consisted of 13 women and 16. The weight in the first dietitian appointment had increased by an average of 2.26 kg in about 6 weeks after smoking cessation (p <0.001). The follow up appointment was made face-to-face with 24 participants, and telephone interview with 5 participants. The weight in the control appointment had decreased by an average of -0,90 kg according to the weight of the first dietitian appointment (p=0,004). There was a significant decrease between BMI (27,45 ± 4,48) in the first appointment and BMI (27,14 ± 4,35) in the control appointment (p=0,003). There were positive significant changes in pre-post waist circumference (94,83±15,11 and 93,00±14,48), hip circumference (104,14±7,70 and 102,66±7,38), Risk Behaviours Scale score (21,69±6,70 and 15,62±5,68), DEBQ (restrictive eating, emotional eating and external eating) (101,97±26,06 and 128,83±23,16), GPAQ score (1824,41±4662,98 and 3501,66±5303,83) and sedentary time (423,10±241,12 and 366,21±172,22). Conclusion: There was weight gain after smoking cessation. Waist-hip circumference and BMI decreased significantly with personal education. Tendency to risky behaviour about nutrition had decreased. Restrictive, emotional and external eating behaviours were reduced. The results show that cognitive errors which affect nutritional behaviour had decreased. Physical activity had increased. There was reduction in time spent as sedentary. The intervention has been effective we can recommend that individuals who complete the first month of the smoking cessation clinic apply weight control education for behavioural changes. Keywords: Smoking cessation; behavioural disciplines and activities; diet; body weight changes; Body Mass Index