GLP-1 Analogs for Weight Loss- Also Diminish Nicotine Addiction?
by Steven Lippmann, MD, Sarah Charania, MBBS, Oghenevese Jefia, MD & Pratiksha Paudel, MBBS
During medicine rounds at the University of Louisville Hospital in January 2026, we encountered a male patient, Mr. X, 38, with morbid obesity( BMI: 35 kg / m 2), obstructive sleep apnea and recurrent exacerbations of chronic obstructive pulmonary disease requiring multiple hospitalizations. He had a long history of nicotine use and alternated between smoking cigarettes, vaping and cannabis, with occasional alcohol consumption.
Due to his obesity-related comorbidities and repeated hospitalizations, he was prescribed the GLP-1 receptor agonist, semaglutide( 1 mg injection / week). Over the subsequent month, the patient happily reported significant weight loss, accompanied by his unexpected reduction in cravings for nicotine and cannabis. He described a diminished urge to smoke or vape despite not intending to quit. He noted that he no longer felt the need to“ reach for a blunt,” a change he found both surprising and motivating.
Beyond the physical benefits, the patient reported improved self-esteem, reduced financial burden from substance use and a positive impact on his relationships with his family and partner. While this observation is anecdotal and does not establish causality, it raised an important question, could GLP-1 receptor agonists influence reward pathways involved in nicotine and substance use?
Nicotine addiction is a major public health concern induced by the desire for tobacco and vaping products. A substantial component of addiction lies not only in chemical dependence, but also in the pursuit of reward, emotional regulation and a sense of belonging. There are several pharmaceutical therapies approved to help people mitigate nicotine addiction, such as nicotine replacement, bupropion and varenicline. However, many individuals who quit nicotine use often are troubled by subsequent weight gain. This makes abstinence more difficult to sustain.
Glucagon-like peptide-1( GLP-1) analog drugs are prescribed to patients as pharmacotherapies for diabetes and weight loss. They also are documented to help people diminish nicotine addictions. 1 These medications release gamma-aminobutyric acid( GABA) in the amygdala and the infralimbic cortex which assist in reducing nicotine craving, inducing weight loss and mitigating post-cessation weight gain. 1, 2
20 LOUISVILLE MEDICINE