CBT, Contingency Management for Smoking Cessation in Adults With Obesity

The researchers sought to evaluate the accessibility and acceptability of a cognitive-behavioral treatment alongside contingency management for quitting smoking and weight control among adults with overweight or obesity.

Among adults with a body mass index (BMI) of at least 25 who want to quit smoking but worry about weight gain after quitting, offering interventions to control weight gain in a smoking cessation treatment program was found to be practical and acceptable. These are the findings published in the journal Drug and Alcohol Dependence.

Maintaining a healthy weight and not smoking are independently main factors in preventable illness and death. Worldwide, a total of 1.3 billion adults who smoke tobacco are classified as overweight or obese. Combining factors, the risk of disability or death increases among this population.

In the effort to quit smoking, subsequently gaining weight can lead to a setback among adults with overweight or obesity. In the current study, researchers sought to investigate the likelihood among smokers with overweight or obesity to accept therapies to change automatic negative thoughts and to reinforce desired behavioral change for quitting smoking while controlling weight gain.

To accomplish this, researchers conducted a randomized clinical trial in Spain at the Clinical Unit of Addictive Behaviors of the University of Oviedo between September 2020 and February 2021. The study included 51 adults who smoked at least 10 cigarettes per day within the last year, met the diagnostic criteria for dependence on nicotine, with a BMI of at least 25 who were recruited, of whom 41 (mean BMI 31.86±4.70) agreed to participate. The 41 participants (mean 52.73±10.91 years of age; 56.1% female) were offered cognitive-behavioral treatment (CBT) to quit smoking and to avoid weight gain, and 37 (90.24%) completed the treatment attending 13.20±3.1 out of 15 sessions. Of the 41 participants, a cohort of 17 also received positive reinforcement — contingency management — in the form of incentives to maintain weight control and continue abstinence from smoking.

The contingency management cohort maintained higher rates of abstinence compared with the CBT only cohort (100% vs 58.33%; P =.007). Baseline body weight increased among all participants 1.25±1.79 kg, however, examined by treatments, while the contingency management cohort significantly increased body weight (Mbaseline = 87.62±14.61; MEOT = 88.91±14.54; P =.008), the CBT-only cohort maintained their weight (Mbaseline = 90.44±13.96; MEOT = 90.66±15.61; P =.059).

Study limitations included a small sample size and unaccounted for COVID-19 pandemic effects on attendance, weight, and smoking.

Researchers concluded that, “Providing weight gain prevention strategies and CM [contingency management] within a smoking cessation treatment seems feasible and acceptable,” however, contingency management offered no benefit for weight control.


García-Fernández G, Krotter A, García-Pérez Á, Aonso-Diego G, Secades-Villa R. Pilot randomized trial of cognitive-behavioral treatment plus contingency management for quitting smoking and weight gain prevention among smokers with overweight or obesity. Drug Alcohol Depend. Published online April 29, 2022. doi:10.1016/j.drugalcdep.2022.109477