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GENERAL PRACTICE: Tobias Danielsson, Stephan Rössner, Åke Westin, and Kevin Jones Open randomised trial of intermittent very low energy diet together with nicotine gum for stopping smoking in women who gained weight in previous attempts to quit • Commentary: results are unlikely to be as good in routine practice BMJ 1999; 319: 490-494 [Abstract] [Full text]

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Bias of non-equal intervention?

Vasiliy Vlassov   (21 August 1999)

Weight loss and smoking cessation

Garry Egger   (2 November 1999)

Bias of non-equal intervention? 21 August 1999
Vasiliy Vlassov, Professor Saratov Medical University Send response to journal: Re: Bias of non-equal intervention?	Despite results of the study appear encouraging, the possible biases mentioned by Dr jones makes the prospects of the application of the results not a brilliant. In addition to very special character of the group and special encouragement by free diets, it is worth to mention that group on diet got higher 'dose' of behavioral intervention (pressure or support) from research staff. Probably that is enough for doubts that that is a diet what explains the difference between two groups.
Weight loss and smoking cessation 2 November 1999
Garry Egger Send response to journal: Re: Weight loss and smoking cessation	Sir The article by Danielsson, Rossner and Westin[1] on the influence of low calorie diets on quitting smoking brings up an interesting ethical dilemma. It is our experience (although so far undocumented) through 'GutBusters' one of the largest men's 'waist loss' programs in the world,[2] that both weight loss and smoking cessation as lifestyle changes where both are indicated, are completed more successfully if the former precedes, rather than even accompanies the latter. The reasons for this, at least with male patients, appear to be twofold: 1 After the immediate improvements that occur with even small weight losses (eg. decreased sleep apnea, improved alertness, increased fitness), there is less enticement to continue smoking and more incentive to add to the subjective feelings of well-being by quitting. 2 If smoking cessation precedes, or even accompanies the introduction of weight loss initiatives, metabolic and psychological factors contribute to making both behaviour changes more difficult. This conflicts with established recommendations, based on ethical considerations, that advice on smoking cessation should precede weight loss initiatives.[3] However, it is an issue in which the potential practical outcome may outweigh (no pun intended) initial ethical concerns. Garry Egger MPH PhD Adjunct Professor of Health Sciences Deakin University Melbourne, Australia 1 Danielsson T, Rossner S, Westin A. Open randomised trial of intermittent very low energy diet together with nicotine gum for stopping smoking in women who gained weight in previous attempts to quit. BMJ, 1999; 319: 490-4. 2. 2 Egger G. et al. Effectiveness of an abdominal obesity reduction programme in men: the GutBuster 'waist loss' programme. Int J Obes 1996;20:227-231. 3 SIGN. Obesity in Scotland: Integrating prevention with weight management. Scottish Intercollegiate Guidelines Network, Edinburgh., 1996.