Efficacy of Two Novel Behavioral Post-cessation Weight Gain Interventions

Study Overview
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Brief Summary
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The study aims to randomize 400 participants to 1 of 3 arms: a) a weight stability intervention prior to smoking cessation (Group 1); b) a weight loss intervention prior to smoking cessation (Group 2); or c) a self-guided weight management prior to cessation (Group 3) and to determine the efficacy of the interventions on preventing weight gain at 12 month follow-up. All 3 conditions receive a highly efficacious behavioral smoking cessation program and 6 months of varenicline pharmacotherapy (ChantixTM), the most efficacious medication for smoking cessation.

Detailed Description
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While smoking cessation leads to significant improvements in mortality and morbidity, weight gain post-cessation partially attenuates this benefit. Furthermore, concerns about postcessation weight gain are common and are often cited as a reason to delay cessation attempts. In addition, postcessation weight gain is associated with smoking relapse. Thus, although the health benefits of smoking cessation outweigh the negative impact of weight gain, ideally there would be intervention packages that would not require that people choose between smoking cessation and nontrivial weight gain. Thus, in the proposed study, the investigators will determine whether two very promising methods of reducing postcessation weight gain, namely a weight stability intervention (based on the evidence-based Small Changes intervention) versus a weight loss intervention (based on the evidence-based Look AHEAD intensive lifestyle intervention) followed by a smoking cessation intervention are efficacious for reducing postcessation weight gain. The investigators will randomize 400 smokers to one of three arms: a) a weight stability intervention prior to cessation (Group 1); b) a weight loss intervention prior to cessation (Group 2), or c) a self-guided intervention prior to cessation (Group 3) and to determine the efficacy of the interventions on preventing weight gain at 12 month follow-up. All three conditions receive a highly efficacious in-person smoking cessation behavioral intervention and six months of Varenicline (ChantixTM) pharmacotherapy. Those participants randomized to the Group 1 and Group 2 conditions will receive monthly booster weight management sessions, after completing the behavioral smoking cessation intervention. The primary outcomes will be weight change and smoking cessation at 12 month follow-up. In addition, the investigators will gather process data on mediators of treatment outcome via measures of treatment engagement (e.g., session attendance, varenicline utilization). The investigators will be able to determine whether a weight stability intervention or a weight loss intervention is efficacious in reducing post-cessation weight gain. The intervention results, if successful, could be disseminated and make a significant contribution towards curtailing obesity in this vulnerable population.

Official Title
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Efficacy of Two Novel Behavioral Post-cessation Weight Gain Interventions

Conditions
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Weight Change, Body, Smoking Cessation

Intervention / Treatment
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* Behavioral: Weight gain prevention (Group 1)
* Behavioral: Weight loss intervention (Group 2)
* Behavioral: Self-guided intervention (Group 3)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must wish to quit smoking in the next 30 days Have smoked 5 or more cigarettes a day for at least 1 year Participants must be 18 years or older as the safety and efficacy of varenicline therapy has not been established for pediatric patients Participants must have a BMI of 22 kg/m2 or greater, as it would not be recommended to have those who are underweight or the lower end of the normal BMI range attempt a 5% weight loss (if assigned to the Group 2 condition) Participants must have access to a telephone and daily access to email, if using a cell phone, participants must be willing to use their cell phone minutes for weekly phone interventions Participants must have the ability to understand consent process in English If female and of childbearing age, participant must have a negative pregnancy test and must agree to use contraception during participation in the study All participants must be willing to be randomized to the study conditions and wait eight weeks prior to beginning smoking cessation (during which they will participate in the weight management intervention to which they are assigned). Participants must have BP < 150/95 and a heart rate of >40 beats per minute and <120 beats per minute. Exclusion Criteria: Participants must not have a known contraindication, allergy or hypersensitivity to varenicline therapy Participants must not currently (in the previous 30 days) be participating in other behavioral or pharmacologic weight or smoking cessation interventions Participants must not have had weight loss surgery (hx of gastric bypass, stomach stapling or banding) Participants must not have lost > or equal to10 lbs in the past 6 months Participants must not be taking a medication that impacts weight Participants must not have used an investigational drug within the last 30 days Participants must not have current suicidal thoughts or have a lifetime history of a suicide attempt as defined by the Columbia-Suicide Severity Rating Scale (C-SSRS) Participants must not self-report a history of psychosis, bipolar disorder, or anorexia nervosa Participants must not have self-reported current alcohol abuse or illicit substance use Participants must not have kidney or liver disease, unstable cardiovascular conditions, HIV, or history of cancer in last 5 years Participants must not have another member of their household already participating in this study Participants must not be currently pregnant or lactating or planning to become pregnant in the next 12 months, or have been pregnant within the last 6 months Weight limit of 385 pounds

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Weight gain prevention (Group 1)<br>Small Changes weight stability intervention | Behavioral: Weight gain prevention (Group 1)<br>* Participants will be asked to keep their weight stable during the initial 8 weeks of the study. Intervention Components: Lesson materials adapted from the Small Changes intervention, which will provide guidance for meeting the goals of this intervention (i.e., increasing steps by 2000 steps per day, making one Small dietary Change each day). Daily self-monitoring of steps and number of Small Changes Daily weight self-monitoring on the BodyTraceTM e-scale Fit Bit Alta activity trackers to self-monitor steps<br>|
| Experimental: Weight loss intervention (Group 2)<br>Look AHEAD weight loss intervention | Behavioral: Weight loss intervention (Group 2)<br>* Participants will be asked to achieve a weight loss goal of at least 5% of their baseline weight by week 8. Intervention Components: Tailored calorie and fat goals based on their baseline weight. Daily dietary intake and physical activity self-monitoring using a website or app. Daily weight self-monitoring on the BodyTraceTM e-scale Lesson materials for each session, drawn from the Look AHEAD intensive lifestyle intervention Meal replacements for two meals and one snack for 8 weeks as a method to achieve the study's calorie and fat goals and as a strategy to control portions Graded physical activity goals of 175 minutes of moderate intensity exercise (e.g., brisk walking) per week, or 10,000 steps per day Fit Bit Alta activity trackers to self-monitor steps<br>|
| Active Comparator: Self-guided intervention (Group 3)<br>Self-guided weight management with the EatingWell Diet book | Behavioral: Self-guided intervention (Group 3)<br>* Participants randomized to Group 3 will wait for 8 weeks before initiating the same smoking cessation intervention as the other two conditions, while they review the provided weight management focused book. Intervention Components: EatingWell Diet book. Daily weight self-monitoring on the BodyTraceTM e-scale<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Weight | At all measurement visits, weight will be recorded in kilograms. Weight will be measured on a calibrated digital scale in duplicate, with the participant wearing light clothing and no shoes. | 12 months from randomization | 
| Point Prevalence Tobacco Abstinence | Point prevalence (7 days without a cigarette, not even a puff) is an appropriate measure in measuring long term outcome in cessation induction trials. | 12 months from randomization |