Because cigarette smoking suppresses body weight, women with extreme concerns about body weight and shape may be at high risk for smoking and/or encounter special problems when attempting to quit. Since weight- control considerations motivate up to 40% of women smokers, a better understanding of the nature and needs of this population could make a substantial impact on a major public health problem for women.
The specific aims are to track the emergence of binge eating in susceptible subjects during cessation attempts, examine systematically the link between binge eating and excessive weight gain, and evaluate pharmacological and behavioral treatments likely to be helpful in managing postcessation eating problems and weight gain. Over a 3-year period, 120 women smokers selected for being at high risk for binge eating following cessation will be enrolled in a 6-week smoking cessation treatment using behavioral techniques and nicotine replacement, those who abstain in the last 2 weeks will participate in a 12-week protocol designed to determine the value of postcessation cognitive behavioral therapy (CBT) specifically targeted to binge eating (cognitive behavioral therapy; cue exposure; relapse prevention), in combination with fluoxetine, a pharmacological agent approved for binge eating. In a 2x2 design, subjects will be randomly assigned to: 1) placebo/ nonspecific patient contact; 2) placebo/CBT; 3) fluoxetine/nonspecific patient contact; or 4) fluoxetine/CBT. Subjects will be weighed weekly, binge- eating will be assessed via daily diaries, and food/nutrient intake will be assessed via unannounced 24-hour food recalls scheduled at critical timepoints. The long-term objective is to generate new knowledge about a common condition that may deter women smokers from quitting, foster relapse, and in those who do succeed, lead to substantial and disproportionate weight gain in amounts that, unlike normal, moderate postcessation weight gain, may actually have deleterious effects on cardiovascular health; and to weight cycling, which increases the risk for cardiovascular disease beyond that posed by excess weight alone.
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