What can a 45-year-old smoker take to help increase her appetite?

Smoking Cessation is the Primary Recommendation for Appetite Stimulation in a 45-Year-Old Smoker

The most effective intervention for improving appetite in a 45-year-old smoker is smoking cessation, as quitting smoking will naturally restore appetite while significantly reducing morbidity and mortality risks.

Understanding the Relationship Between Smoking and Appetite

Smoking significantly affects appetite through multiple mechanisms:

• Nicotine acts as an appetite suppressant
• Smoking alters taste perception and enjoyment of food
• Cigarette chemicals interfere with normal hunger signals

Primary Recommendation: Smoking Cessation

Smoking cessation should be the first-line approach for several reasons:

• Quitting smoking naturally restores appetite within days to weeks
• Smoking is the leading preventable cause of death and disease 1
• All healthcare providers should take every opportunity to encourage smoking cessation 1

Effective Smoking Cessation Approach (5 A's):

1. ASK: Identify tobacco use status
2. ADVISE: Provide clear, strong, personalized advice to quit
3. ASSESS: Determine willingness to quit
4. ASSIST: Provide counseling and pharmacotherapy
5. ARRANGE: Schedule follow-up 1

Pharmacotherapy Options:

• First-line medications (double the odds of successful quitting):

  • Nicotine replacement therapy (NRT): Most effective when combining long-acting patch with short-acting product (gum, lozenge)
  • Varenicline: 1 mg twice daily for 12 weeks
  • Bupropion: 150-300 mg daily 1, 2

• Counseling support:

  • Telephone quit lines (free national network)
  • Individual or group counseling
  • Behavioral support increases success rates 2

Managing Weight Concerns During Smoking Cessation

Weight gain is a common concern when quitting smoking and may affect the patient's willingness to quit:

• Average weight gain after quitting is approximately 5 kg
• Health benefits of quitting far outweigh risks from weight gain 1
• Combining smoking cessation with dietary counseling and exercise can help manage weight 3

Alternative Appetite Stimulants (Only After Smoking Cessation Attempts)

If appetite remains problematic after smoking cessation efforts:

1. Non-pharmacological approaches:

   • Moderate physical activity (3 sessions/week, 10-60 minutes)
   • Small, frequent meals (5-6 per day)
   • Including healthy fats (nuts, avocados, olive oil) 4

2. Pharmacological options (if non-pharmacological approaches fail):

   • Megestrol acetate (400-800 mg/day): Most effective appetite stimulant with evidence for weight gain, but monitor for thromboembolic events and fluid retention 1, 4
   • Mirtazapine (15-30 mg daily): May stimulate appetite with additional benefits for sleep difficulties or mood disorders 4

Monitoring and Follow-up

• Regular weight monitoring to assess response to interventions
• Reassess nutritional status after 2-4 weeks of therapy
• Monitor for complications of pharmacological treatments
• Discontinue ineffective treatments rather than continuing indefinitely 4

Important Caveats

• Smoking cessation is the most important intervention for both appetite and overall health
• Pharmacological appetite stimulants should only be considered after smoking cessation efforts
• Weight gain concerns should be addressed but not prevent smoking cessation attempts
• Combining behavioral support with pharmacotherapy doubles success rates for quitting
• A chronic disease management model is most effective for treating tobacco dependence 2