• Julie R Lundgren, Charlotte Janus, Simon B K Jensen, Christian R Juhl, Lisa M Olsen, Rasmus M Christensen, Maria S Svane, Thomas Bandholm, Kirstine N Bojsen-Møller, Martin B Blond, JensenJens-Erik BJBFrom the Department of Biomedical Sciences (J.R.L., C.J., S.B.K.J., C.R.J., L.M.O., R.M.C., M.B.B., B.M.S., J.J.H., S.S.T.), the Novo Nordisk Foundation Center for Basic Metabolic Research (J.R.L., C.J., S.B.K.J., C.R.J., L.M.O., R.M.C., Bente M Stallknecht, Jens J Holst, Sten Madsbad, and Signe S Torekov.
• From the Department of Biomedical Sciences (J.R.L., C.J., S.B.K.J., C.R.J., L.M.O., R.M.C., M.B.B., B.M.S., J.J.H., S.S.T.), the Novo Nordisk Foundation Center for Basic Metabolic Research (J.R.L., C.J., S.B.K.J., C.R.J., L.M.O., R.M.C., J.J.H., S.S.T.), the Department of Clinical Medicine (T.B., J.-E.B.J.), University of Copenhagen, and the Departments of Endocrinology (M.S.S., K.N.B.-M., J.-E.B.J., S.M.) and Clinical Research (T.B.), Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, and the Steno Diabetes Center Copenhagen, Gentofte (M.B.B.) - all in Denmark.
• N. Engl. J. Med. 2021 May 6; 384 (18): 171917301719-1730.

BackgroundWeight regain after weight loss is a major problem in the treatment of persons with obesity.MethodsIn a randomized, head-to-head, placebo-controlled trial, we enrolled adults with obesity (body-mass index [the weight in kilograms divided by the square of the height in meters], 32 to 43) who did not have diabetes. After an 8-week low-calorie diet, participants were randomly assigned for 1 year to one of four strategies: a moderate-to-vigorous-intensity exercise program plus placebo (exercise group); treatment with liraglutide (3.0 mg per day) plus usual activity (liraglutide group); exercise program plus liraglutide therapy (combination group); or placebo plus usual activity (placebo group). End points with prespecified hypotheses were the change in body weight (primary end point) and the change in body-fat percentage (secondary end point) from randomization to the end of the treatment period in the intention-to-treat population. Prespecified metabolic health-related end points and safety were also assessed.ResultsAfter the 8-week low-calorie diet, 195 participants had a mean decrease in body weight of 13.1 kg. At 1 year, all the active-treatment strategies led to greater weight loss than placebo: difference in the exercise group, -4.1 kg (95% confidence interval [CI], -7.8 to -0.4; P = 0.03); in the liraglutide group, -6.8 kg (95% CI, -10.4 to -3.1; P<0.001); and in the combination group, -9.5 kg (95% CI, -13.1 to -5.9; P<0.001). The combination strategy led to greater weight loss than exercise (difference, -5.4 kg; 95% CI, -9.0 to -1.7; P = 0.004) but not liraglutide (-2.7 kg; 95% CI, -6.3 to 0.8; P = 0.13). The combination strategy decreased body-fat percentage by 3.9 percentage points, which was approximately twice the decrease in the exercise group (-1.7 percentage points; 95% CI, -3.2 to -0.2; P = 0.02) and the liraglutide group (-1.9 percentage points; 95% CI, -3.3 to -0.5; P = 0.009). Only the combination strategy was associated with improvements in the glycated hemoglobin level, insulin sensitivity, and cardiorespiratory fitness. Increased heart rate and cholelithiasis were observed more often in the liraglutide group than in the combination group.ConclusionsA strategy combining exercise and liraglutide therapy improved healthy weight loss maintenance more than either treatment alone. (Funded by the Novo Nordisk Foundation and others; EudraCT number, 2015-005585-32; ClinicalTrials.gov number, NCT04122716.).Copyright © 2021 Massachusetts Medical Society.

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