Semaglutide for Post-Smoking Cessation Weight Management

Inclusion Criteria: * Ability to provide informed consent before any study-related activity, willing to comply with al study procedures, and be available for the duration of the study. * Body mass index (BMI) ≥30 kg/m2 or ≥27 kg/m2 with the presence of at least one of the following weight-related comorbidities (treated or untreated): hypertension (unless meets medical exclusion criterion 7), cardiovascular disease (unless meets medical exclusion criterion 6), dyslipidemia, or obstructive sleep apnea * Have been smoking ≥5 cigarettes per day for at least 1 year (prior to screening) and provide positive cotinine test. * Desire to quit smoking (defined as "intend to quit within one month") * Agree (if the participant is female and of child-bearing potential) to use effective contraceptive methods, unless the participant's male partner(s) is surgically sterile (underwent vasectomy). * Women of child-bearing potential must provide negative urine pregnancy tests prior to randomization. * Normal cognitive restraint (assessed as cognitive restraint score of \<4 from the Three Factor Eating Habits Questionnaire) * Have a medical history and a brief physical examination demonstrating no clinically significant contraindications for study participation, in the judgment of the Study Physician and the Principal Investigator Exclusion Criteria: Medical Exclusions * Personal or first-degree relative(s) history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2). * Acute pancreatitis within the past 6 months prior to screening. * History or presence of chronic pancreatitis. * Type 1 or type 2 Diabetes Mellitus (previously diagnosed or indicated by HbA1C ≥48 mmol/mol (6.5%) as measured by central laboratory at screening). * End stage renal disease (ESRD, previously diagnosed or indicated by estimated glomerular filtration rate (eGFR) value of eGFR \< 15 ml/min/1.73 m2 as measured by central laboratory at screening). * Any of the following: myocardial infarction, stroke, hospitalization for unstable angina or transient ischemic attack within the past 60 days prior to screening. * Systolic blood pressure (SBP) \>159 mmHg and/or diastolic blood pressure (DBP) \>99 mmHg) * History of malignant neoplasms within the past 5 years prior to screening. Basal and squamous cell skin cancer and any carcinoma in-situ are allowed. * Severe gastrointestinal disease (i.e., severe gastroparesis). * Known or suspected hypersensitivity to nicotine/nicotine patches; semaglutide, excipients, or related products. * Women who are currently pregnant, or plan to become pregnant, or lactating, or of childbearing potential and are not using medically accepted forms of contraception. * Have any illness or condition which in the opinion of the Principal Investigator and/or the Study Physician would preclude safe and/or successful completion of the study. Psychiatric / Substance Use Exclusions * Psychoactive substance abuse or dependence (excluding nicotine dependence) within the past 3 months prior to screening (existing diagnosis or as determined by the structured interview). * Urine drug test positive, before randomization, for any of the following substances: 1. benzodiazepines 2. cocaine 3. opioids 4. amphetamines 5. methamphetamine 6. buprenorphine 7. barbiturates 8. 3,4-methylenedioxy-methamphetamine (MDMA) 9. Tetrahydrocannabinol (THC) * Psychotic or bipolar disorder, or mood disorder with psychotic features; or eating disorder (existing clinical diagnosis or as determined by the structured interview) * Moderate to high risk for suicidality (as determined by the structured interview). Weight-Related Exclusions * Previously undergone bariatric surgery * Gained/lost ≥4.5 kg over the past 6 months (prior to screening) * Currently enrolled in a behavioral weight management plan * Uncontrolled thyroid disease (the criterion will be assessed at the Study Physician's and the Principal Investigator's discretion) Smoking-Related Exclusions -Currently using other combustible (e.g., cigars), other (e.g., chewing tobacco, snuff, snus) or alternative (e.g., electronic cigarettes) tobacco products Medication-Related Exclusions * Currently using oral or injectable glucose lowering medications * Currently using pharmacotherapy for smoking cessation (NRT, varenicline, or bupropion) * Currently or recently (last 90 days prior to screening) taking medication used for weight management (i.e., orlistat, lorcaserin,vi naltrexone-bupropion, liraglutide, phentermine, topiramate, benzphetamine, diethylpropion, phendimetrazine) * Currently or recently (within the past 14 days prior to screening) taking medication(s) known to impact appetite and/or weight (i.e., corticosteroids, excluding inhaled) General Exclusions * Current, anticipated, or pending enrollment in another research study during this trial that could potentially affect participant safety and/or the study data/design as determined by the Principal Investigator and/or Study Physician. * Not planning to live in the area for the duration of this trial. * Surgery scheduled for the duration of the trial, except for minor surgical procedures, in opinion of the Principal Investigator and/or the Study Physician. * Unable to communicate (read, write, and speak) fluently in English.