Ziyad Ben Taleb, Kenneth D. Ward, Taghrid Asfar, Rana Jaber, Raed Bahelah, Wasim Maziak

In high-income countries, quitting cigarette smoking is associated with weight gain, which can reduce motivation to abstain. Whether smoking cessation is associated with weight gain in a low-income country context has never been investigated. We aimed to determine the post-cessation changes in body mass index (BMI) and its predictors among smokers who received a smoking cessation intervention in a low-income country setting. We performed post hoc analyses of data from 269 smokers who participated in a two-group, parallel-arm, double-blind, placebo-controlled randomized trial of combined nicotine replacement therapy (NRT) and behavioral counseling in primary care clinics in Aleppo, Syria. We used generalized estimating equation (GEE) modeling to identify predictors of changes in BMI at 6 weeks and 6- and 12-month follow-ups after quit date. The mean pre-cessation BMI of the sample was 27.9 kg/m2 (SD= 5.2). Over 12 months of follow-up, BMI of smoking abstainers averaged 1.8 BMI units (approximately 4.8 kg) greater than non-abstainers (P=0.012). Throughout the study, greater BMI was associated with being female (P=0.048), reporting smoking to control weight (P<0.001) and having previously failed to quit due to weight gain (P=0.036). Similar to findings from high-income countries, smoking cessation in Syria is associated with weight gain, particularly among women and those who have weight concerns prior to quitting. This group of smokers may benefit from tailored cessation interventions with integrated body weight management elements that take into consideration the prevailing local and cultural influences on diet and levels of physical activity.