Optimal Timing for Initiating Liraglutide 3.0 mg in Patients With Persistent Obesity Six Months After Metabolic and Bariatric Surgery.

OBJECTIVES

To determine the optimal timing for initiating liraglutide in patients with persistent obesity (BMI ≥ 28 kg/m² in China) six months after metabolic and bariatric surgery, a key gap in postoperative weight management.

METHODS

In this prospective study, 100 patients were allocated to receive liraglutide (3.0 mg/day) starting at 6 (LG-6), 9 (LG-9), or 12 (LG-12) months post-surgery, or standard care without liraglutide (n = 25 each). The primary endpoint was percent total weight loss (%TWL) at 18 months. Secondary outcomes included changes in body composition and remission of obesity-related comorbidities.

RESULTS

All three liraglutide groups showed greater %TWL (LG-6 16.3 ± 5.7%, LG-9 13.7 ± 5.3%, LG-12 12.6 ± 6.0%) compared with controls (5.3 ± 5.2%; P < 0.05). Higher proportions of patients in liraglutide groups achieved BMI < 28 kg/m² (LG-6 40%, LG-9 52%, LG-12 36%) and ≥ 15% TWL (64%, 32%, 28%) versus controls (16%, 4%; P < 0.05). The LG-6 group showed the highest proportion reaching ≥ 20% TWL (24% vs. 0% in controls; P < 0.05). Reductions in fat mass and alanine transaminase, preservation of muscle mass, and remission of metabolic dysfunction-associated steatotic liver disease and hyperuricaemia were observed in association with liraglutide treatment.

CONCLUSIONS

Early liraglutide initiation, particularly at six months post-surgery, was linked to greater weight loss and more favourable metabolic profiles compared with standard care. These findings suggest that timely pharmacotherapy may be associated with improved long-term weight management outcomes, though causality remains to be established.