Many smokers quit before weight-loss surgery but start up again afterward

(Reuters Health) - Even though many smokers quit before having weight-loss surgery, a new study suggests that a lot of them will eventually relapse.

Researchers followed 1,770 people for one year prior to weight-loss surgery and for seven years afterward. Roughly one in seven smoked at the start of the study, and nearly all quit before surgery.

But seven years after surgery, roughly one in seven patients smoked, including some former smokers who relapsed as well as some people with no history of smoking.

“Those who smoked more recently, younger adults, patients with low income and patients who were married were more likely to smoke post-surgery, which may help with targeted smoking-cessation maintenance efforts,” said lead study author Wendy King of the University of Pittsburgh in Pennsylvania.

“Smoking increases risk of short-term postoperative complications, such as wound complications, respiratory complications and sepsis,” King said by email.

More than 45% of the participants had some history of smoking prior to surgery and 14% were smokers when they joined the study. By the time they had surgery, only 2% of patients smoked, and some of these individuals reported smoking to aid weight loss.

One year later, however, almost 10% smoked and by the time seven years passed 14% were smokers. After surgery, 2%-3% of participants reported smoking to aid weight loss.

The results suggest that patients need more support for smoking cessation, said Dr. Carlos Roberto Jaen, a researcher at UT Health San Antonio in Texas who wasn’t involved in the study.

“Tobacco use disorder is a chronic disease that is not treated by bariatric surgery, unlike diabetes or hypertension, so to expect a surgical intervention will treat tobacco use is unrealistic,” Jaen said by email. “The condition needs to be treated actively and aggressively before and after surgery with known effective treatments that include medications and counseling interventions including telephone counseling, text messaging program or other interactive approaches.”

Patients in the study were severely obese before surgery, and they all had procedures known as a Roux-en-Y gastric bypass, which can reduce the size of the stomach from about three pints to roughly the size of a shot glass.

All participants had surgery, making it impossible to know how smoking cessation patterns might differ for similar obese individuals who didn’t get weight-loss operations, the study team notes in the Annals of Surgery.

Researchers also lacked data on whether surgeons or other clinicians encouraged patients to stop smoking or provided resources to help.

Still, the relapse rates following bariatric surgery are similar to what’s been seen with other major medical events like a heart attack or cancer treatment, said Jodi Prochaska, a researcher at Stanford University in California who wasn’t involved in the study.

Patients should get counseling and access to smoking cessation aids, Prochaska, who wasn’t involved in the study, said by email. They should also try changing their daily habits to help reduce their reliance on cigarettes as much as possible.

“Behavioral strategies to address cravings to smoke are numerous and include physical activity, drinking water, chewing on a straw or toothpick, brushing your teeth, deep breathing, meditation, relaxation and distractions like holding an ice cube,” Prochaska said.

And there are things people can do to avoid weight gain when they quit.

“Cessation medications such as nicotine gum and bupropion have been found to delay cessation-associated weight gain,” Prochaska said.

SOURCE: Annals of Surgery, online February 20, 2020.