Neeland IJ, Marso SP, Ayers CR, et al. - According to this randomised, double-blind, placebo-controlled, phase 4, single centre trial, over 40 weeks of treatment, once-daily liraglutide 3·0 mg plus lifestyle intervention significantly reduced visceral adipose tissue in persons with overweight or obesity at high cardiovascular disease risk. The improvements found on cardiovascular outcomes in prior trials with liraglutide among individuals with type 2 diabetes could be explained in part by visceral fat reduction.

• The authors recruited community-dwelling adults with BMI of at least 30 kg/m ² or BMI of at least 27 kg/m ² with metabolic syndrome but without diabetes and randomly assigned them, in a 1:1 ratio, to 40 weeks of treatment with once-daily subcutaneous liraglutide 3·0 mg or placebo, in addition to a 500 kcal deficient diet and guideline-recommended physical activity counselling.

• Between July 20, 2017, and February 21, 2020, 185 candidates were randomly assigned (n = 92 liraglutide, n = 93 placebo) and 128 (n = 73 liraglutide, n = 55 placebo) were included in the final analysis (92% female participants, 37% Black participants, 24% Hispanic participants, mean age 50·2 years (SD 9·4), mean BMI 37·7 kg/m ²).

• The mean change in VAT over the median 36·2 weeks with liraglutide was −12·49% compared with −1·63% with placebo, with an estimated treatment difference of −10·86%.

• The effects appeared to be consistent across age, gender, race/ethnicity, BMI, and baseline prediabetes subgroups.

• Gastrointestinal and upper respiratory tract infections were the most commonly reported side effects.