Treatment Hurdle: Substance Abuse

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.



Many patients are hesitant to try to quit smoking and undertake a weight-management effort simultaneously. Indeed, smoking cessation is associated with small amounts of weight gain, but the benefits of smoking cessation clearly outweigh the risk of gaining a few pounds.

If a patient is interested in quitting smoking but is also concerned about weight gain, buproprion may be a reasonable pharmacologic aid. Buproprion is associated with weight loss when used in the treatment of depression and may blunt the weight gain associated with smoking cessation.


Alcohol is a significant source of calories. At 7 kcal per gram, one large glass of wine a night adds up to 65,700 kcal per year (the equivalent of nearly 9 kg [20 lbs] in weight gain), and has no effect on satiety. In most situations, there is no compensatory reduction in other calories consumed. Alcohol can produce a positive fat balance, as it has a sparing effect on fat oxidation and promotes fat storage. Alcohol is also an appetite stimulant, often used as an aperitif, and has a tendency to reduce a person’s resolve. Many patients consider their glass of wine to be a heart-healthy habit, but if they are not at a healthy weight, the health risk of additional calories outweighs the potential benefits of moderate drinking.

Marijuana and Hashish

Cannabis users may experience weight gain due to increased appetite (“the munchies”) and caloric intake, as the drug stimulates cannabinoid receptor–1 (CB1) activity. These receptors are found in several areas of the brain, including the hypothalamus, where appetite and satiety are regulated. Because of this effect on appetite, long-term weight management may prove far more difficult for regular cannabis users.

Blocking the CB1 receptor has been proposed as a novel mechanism to reduce appetite and treat obesity. A number of drug companies pursued CB1 receptor antagonists in clinical weight management, however, due to an unexpectedly high rate of psychiatric side effects they have been withdrawn from use worldwide.

Illicit Drugs

Obesity has not been specifically associated with an increased risk of illicit drug abuse. However, it is important to identify and treat dependencies on illicit drugs before starting a weight-management plan.

Diuretics and Laxatives

The use of diuretics and laxatives should be investigated. These drugs are frequently used for purging by patients with eating disorders, which should always be treated before starting a weight-management plan.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

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