OBJECTIVES: To examine differences in cessation medication prescribing among smokers with different body weight levels using the National Ambulatory Medical Care Survey (NAMCS) data. METHODS: A retrospective cross-sectional study was conducted using the NAMCS data from 2005 to 2008.  The study included visits with smokers aged ≥ 18 and self-reported current tobacco use.  The outcome variable was being prescribed a cessation medication (Bupropion or Varenicline) vs. not.  The independent variables included body mass index (BMI), gender, age, race, education, insurance type, tobacco counseling, and health status.  BMI splines were used to describe different body levels.  The knots of the BMI spline included normal, overweight, obesity class I, II and III.  Multivariate logistic regression analyses were conducted to assess the association between the main independent variable of BMI, as BMI splines in one model and a categorical variable in another model, as well as socio-demographic and general health status characteristics with the outcome variable. RESULTS: A total of 11,829 adult smoker visits were included.  Among normal weight visits, 6.28% had cessation medication prescriptions, while 4.70% and 3.89% among overweight and obese visits respectively had prescriptions.  Logistic regression showed that overweight (OR: 0.589, 95% CI: 0.351 – 0.987) and obese class III (OR: 0.399, 95% CI: 0.228 – 0.698) smokers were less likely to be prescribed cessation medications compared to those with normal weight.  The weight spline had a significant decrease in the interval of overweight (OR: 0.853, 95% CI: 0.729-0.999).  Male smokers, aged ≤ 65 years, white race, having private insurance, having depression, cardiovascular diseases diagnosis, and tobacco counseling, were significant predictors of having a smoking cessation prescription. CONCLUSIONS: Overweight or obese smokers were less likely to be prescribed cessation medications.  Future research is needed to investigate the reasons behind this difference and develop interventions to help overweight and obese smokers quit.