Early Liraglutide 3.0 mg initiation at 6 months post-bariatric surgery significantly boosts weight loss and metabolic health

Despite the effectiveness of metabolic and bariatric surgery (MBS) for severe obesity, a significant proportion of patients experience weight regain or insufficient weight loss, leading to persistent obesity and related comorbidities. Current postoperative management often lacks clear guidelines for pharmacotherapy initiation, leaving a critical gap in optimizing long-term outcomes. GLP-1 receptor agonists like liraglutide have proven efficacy in weight management and improving metabolic profiles, making them promising candidates for adjunctive therapy post-MBS, but the optimal timing for their introduction remains undefined.

This prospective study enrolled 100 patients with persistent obesity (BMI ≥ 28 kg/m² in China) six months after metabolic and bariatric surgery. Patients were allocated into four groups (n=25 each): liraglutide 3.0 mg/day initiated at 6 months (LG-6), 9 months (LG-9), or 12 months (LG-12) post-surgery, or a standard care control group without liraglutide. The primary endpoint was percent total weight loss (%TWL) measured at 18 months post-surgery. Secondary outcomes included changes in body composition (e.g., fat mass, muscle mass) and remission rates of obesity-related comorbidities like metabolic dysfunction-associated steatotic liver disease (MASLD) and hyperuricaemia.

All three liraglutide groups demonstrated significantly greater %TWL at 18 months compared to the control group (P < 0.05). The LG-6 group achieved a %TWL of 16.3 ± 5.7%, LG-9 13.7 ± 5.3%, and LG-12 12.6 ± 6.0%, while controls showed only 5.3 ± 5.2% %TWL.

The LG-6 group exhibited the highest proportion of patients reaching ≥20% TWL (24% vs. 0% in controls; P < 0.05), highlighting the benefit of early intervention. Higher proportions of patients in the liraglutide groups achieved a BMI < 28 kg/m² (LG-6 40%, LG-9 52%, LG-12 36%) compared to controls (16%; P < 0.05). Similarly, ≥15% TWL was achieved by 64% of LG-6, 32% of LG-9, and 28% of LG-12 patients, versus only 4% in controls (P < 0.05). Liraglutide treatment was also associated with favorable metabolic changes, including reductions in fat mass and alanine transaminase (ALT) levels, preservation of muscle mass, and improved remission rates for MASLD and hyperuricaemia.