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.