Obesity Prevention After Smoking Cessation in Menopause

Middle-aged women, especially African Americans, who quit smoking are at high risk for weight gain, overweight, and obesity. Postcessation weight gain has been attributed to increased food intake, which in turn, has been ascribed to a selective increase in high-sugar and other high-carbohydrate foods with a high-fat content. This study compares the relative effectiveness, for postmenopausal Caucasian and African American women, of following an empirically validated smoking cessation program with either 1) a group cessation maintenance program with standard exercise advice and food pyramid instructions for healthy eating or 2) an individually tailored, dietary-control, exercise, weight-management and cessation-maintenance program. Effectiveness is assessed by weight change from baseline to postcessation months 6, 12, and 20.

The second aim is to assess overall fat and other specific macronutrient intake (sugar, complex carbohydrates, and protein) and total caloric intake with the use of a novel macronutrient self-selection paradigm in Caucasian and African-American postmenopausal women at baseline prior to smoking cessation, after being abstinent for one week, and again at 6, 12, and 20 months postcessation.

The third aim is to assess whether there is differential responsiveness on the above measures in postmenopausal Caucasian vs. African-American women.

Inclusion criteria

• Female aged 45 - 59 at time of enrollment
• African-American or Caucasian; able to confirm racial heritage of past two generations in family
• Postmenopausal
• Smokers (more than 10 cigarettes per day for 1 year or more)
• Written physician approval to participate in program and medical clearance that use of over-the-counter nicotine replacement is not contraindicated based on patient's medical status

Exclusion criteria

• Men
• Age below 45 or above 59
• Nonsmokers
• Currently in a standardized weight-reduction program or taking medications for weight loss
• History or presence of significant psychiatric illness (e.g., eating disorders, psychosis, psychoactive substance abuse, major depression)
• History of presence of severe physical illness (e.g., renal failure, hepatic failure, cancer, immunological disease)
• Unable to complete long-term study commitment, including anticipating moving out of study area prior to completion of the study
• Unable to confirm racial heritage of past two generations in family.