Prior metabolic surgery attenuates the weight-loss efficacy of liraglutide in patients with mild obesity.

BACKGROUND: Liraglutide effectively manages mild obesity, but individual weight loss outcomes vary significantly. We aimed to identify clinical predictors influencing differential treatment responses in patients with mild obesity. METHODS: A retrospective analysis was conducted on 64 adults (BMI 28-32.5 kg/m²) undergoing a 12-week liraglutide intervention. Participants were categorized based on therapeutic success: those achieving composite endpoints (≥5% total weight loss [TWL] and BMI normalization to <28 kg/m²) versus suboptimal responders. Comprehensive biometric and biochemical assessments were performed, and multivariate predictive modeling was applied. RESULTS: Responders (n=37, 75.7% female) showed significantly better metabolic outcomes than non-responders (n=27, 77.8% female), with notable differences in %TWL (11.0 ± 3.6% vs 4.2 ± 2.6%), total weight loss (9.04 ± 3.32 kg vs 3.55 ± 2.20 kg), and BMI reduction (3.3 ± 1.1 vs 1.4 ± 0.9 kg/m²) (all p's <.01). Responders also demonstrated improved glucolipid metabolism, and reduced metabolic-associated fatty liver disease (p <.05). Regression analysis identified a history metabolic surgery (MS) and a baseline BMI ≥30.5 kg/m² as significant negative predictors of success. Adjusted odds ratios indicated strong inverse associations, with MS history showing an OR of 6.78 (95% CI: 1.95-23.61; p <.01) and elevated BMI (≥30.5 kg/m²) yielding an OR of 4.79 (95% CI: 1.46-15.71; p <.01). CONCLUSION: A history of MS significantly affects liraglutide's responsiveness in patients with mild obesity, emphasizing the need for personalized therapeutic strategies in post-surgical patients. These findings highlight the importance of a comprehensive medical history in guiding obesity pharmacotherapy.