SCALE Maintenance

SCALE Maintenance tested a question that comes after the diet, not during it. Participants first completed a low-calorie diet run-in and lost a mean 6.0% of their screening weight. The 422 who succeeded were then randomized to liraglutide 3.0 mg or placebo for 56 weeks, with the question being whether the drug could hold — and extend — a loss already achieved. Wadden and colleagues published it in the International Journal of Obesity in 2013.

From randomization onward, the liraglutide group lost a further 6.2% while the placebo group lost 0.2%. More telling is the maintenance measure: 81.4% of the liraglutide group held onto at least the 5% they had lost during the run-in, compared with 48.9% on placebo. Half the placebo group could not keep what they had already worked for.

That is the finding to carry forward. Maintenance is not a passive state you enter after losing weight; it is an active fight against a body that is defending its former set point. STEP 4 showed the same thing from the withdrawal direction with semaglutide, and SURMOUNT-3 showed it with tirzepatide after a lifestyle lead-in.

The common confusion is reading this as a reason to treat medication as a temporary bridge. The trials point the other way — the effect persists while the drug does, and fades when it stops. Gastrointestinal side effects were more frequent on liraglutide, though most were transient and mild or moderate.

Worth asking your clinician: what the maintenance plan is before you start, not after you plateau; whether a lower maintenance dose is a realistic long-term option; and what structured support (weighing frequency, protein target, resistance training) will be in place once the losing phase ends. Our SCALE Maintenance deep dive, Saxenda drug page and plateau questions hub cover what comes next.