Researchers recommend GLP-1 drugs such as Wegovy be offered to all smokers who meet other criteria for eligibility

Smoking and obesity are the top two preventable causes of death in the United States. Many people are obese and smoke, putting them at much higher risk of death and chronic illness — not only because they have both risk factors, but also because the interaction between tobacco and obesity intensifies the severity of resulting conditions such as cardiovascular disease.

Fortunately, obesity has gained a formidable opponent: GLP-1 (glucagon-like peptide 1 receptor agonist) medications, which were originally created to treat Type 2 diabetes. Known by brand names such as Wegovy and Zepbound, these headline-making drugs have proved so effective at helping people shed pounds that they have revolutionized obesity treatment. And although they are not currently approved by the U.S. Food and Drug Administration to help people stop smoking, early studies suggest that these medications could help smokers quit. Studies in animal models have shown these drugs diminish the dopamine-related reward response in the brain created by nicotine. One pilot study in 2021 found that adding a GLP-1 drug to nicotine patch treatment nearly doubled the quit rate in prediabetic or overweight human smokers.

However, research led by the University of Kansas Medical Center and published in Diabetes Care showed that people who smoke who already have one of the currently approved “indications” for GLP-1 drugs — weight management, Type 2 diabetes or prevention of a cardiovascular disease — are actually less likely to receive a prescription for a GLP-1 medication than nonsmokers for whom a GLP-1 drug is indicated.

“We see a sort of disparity, such that there are higher rates of indications — greater disease is one way to think of that — in folks who are smokers relative to nonsmokers, but they are less likely to actually receive the GLP-1 prescription,” said Elly Leavens, Ph.D., assistant professor of population health at KU Medical Center and lead author on the study.

The researchers recommend that providers consider how patients who smoke and who are obese, or who have diabetes or cardiovascular disease, could doubly benefit from a GLP-1 drug to manage both their weight or condition and increase their odds of quitting tobacco. “Imagine a patient comes in and they’re on a GLP-1 for diabetes, but their record also indicates they’re a smoker,” said Leavens. “This is a great opportunity for the provider to say, ‘There’s emerging evidence that this medication you’re on will also help you quit smoking. Let’s get you the behavioral support to help you have the best chance possible of success.’”

The researchers conducted the study by looking at the electronic health records for adult patients receiving outpatient primary care at The University of Kansas Health System between September 2023 and September 2024. In their study, the adults who smoked were more likely to be eligible for a GLP-1 compared with nonsmokers (66.1% vs. 62.6%) but were less likely than nonsmokers to receive a prescription for a GLP-1 drug (20.4% vs. 23.2%). These findings were consistent no matter whether the GLP-1 prescription was to manage weight, treat diabetes or prevent cardiovascular disease.

More research is needed to determine the reasons for the disparity in prescription rates. One reason, Leavens said, could be that the people who smoked were less likely to have insurance that would cover a GLP-1, so they were less likely to get a prescription. Another possibility is that some of the non-smoking participants were in reality former smokers who quit because they got a prescription for a GLP-1, noted Kristy Brown, Ph.D., associate professor of cell biology and physiology at KU Medical Center and co-program leader for the Cancer Prevention and Control Program at KU Cancer Center, also an author on the study.

Brown also noted that smoking worsens metabolic defects associated with obesity. “Insulin resistance and diabetes risk are worsened by smoking. A GLP-1 (drug) will potentially tackle the smoking as well as the weight reduction that would lead to the restoration of metabolic health and reduced risk of diabetes and cardiovascular disease,” she said.

The researchers plan extensive further collaborative studies on smoking cessation and metabolic health.

“We know that smoking rates and obesity rates are above the national average in the state of Kansas, and so I think it's an exciting opportunity to address the two leading causes of preventable death and disease nationally, but also here, specifically in our state,” said Leavens.