Worldwide, the prevalence of obesity has nearly tripled since 1975. Today, there are 650 million people who qualify as obese, according to the World Health Organization (WHO). Obesity can lead to serious health conditions, like heart disease and type 2 diabetes, and treating obesity—that is, losing weight and keeping it off—is not easy.

A new study published in the New England Journal of Medicine endeavored to find the most effective way to maintain healthy weight loss. In a randomized clinical trial, the researchers looked at 215 participants with obesity and found that the most effective way to lose and maintain weight may be to initially control one’s diet and then combine moderate-to-vigorous exercise with appetite-reducing obesity medication.

The medication in question, an appetite-suppressing hormone called liraglutide, is prescribed in the U.S. under names like Saxenda and Trulicity. Liraglutide is an analog to a natural appetite-inhibiting hormone GLP-1, which is secreted by the intestines when we eat.

RELATED: 15 Underrated Weight Loss Tips That Actually Work

“Common side effects [of liraglutide] include nausea,” Professor Signe Sørensen Torekov, the lead researcher on the new study, tells Eat This, Not That! However, starting with a low dosage and increasing dosage slowly should help, she says.

Study participants were divided into four groups: two received placebo medication, and two received liraglutide. One of the groups receiving medication either performed vigorous exercise for 75 minutes a week or moderate activity for 150 minutes a week (or some combination of the two), while the other group did not have an exercise program. The same was true for the two placebo groups.

After a year, while participants in the placebo group with no exercise gained half their weight back, the participants who had exercise alone and medication alone both managed to maintain their weight loss. However, researchers found that the combination of exercise and liraglutide witnessed the most dramatic improvements. These participants lost more fat mass while retaining muscle mass. They also reported higher fitness ratings, reduced blood sugar levels, and improved quality of life.

While these results are promising, liraglutide is a prescription medication, and therefore not available to everyone. In fact, some registered dietitians, like Dr. Lisa Young, PhD, RDN, CDN may even advise against such appetite suppressants.

“I do not recommend appetite suppressants as your body gets used to them and you do not learn healthy behaviors,” she says.

As the study shows, even without liraglutide, participants who followed a moderate-to-vigorous exercise regimen were able to maintain their weight loss even without the appetite suppressant. Focusing on diet, as all the participants did during the first part of the study, is crucial.

“I recommend behavior modification, portion control, creating healthy habits, and choosing healthy foods which are not too calorie-dense. And of course, exercise is key too,” explains Young. “It’s important to create a lifestyle program you can sustain.”

For exercise tips, be sure to check out 3 Workouts Proven to Change Your Body Shape, Says Exercise Expert.

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The findings of a big, year-long weight loss study published today in The New England Journal of Medicine revealed some eye-opening news for obese people who struggle with not only losing weight but also keeping it off. After all, as any weight loss expert can tell you, the only thing that’s perhaps more difficult than losing weight in the first place is actually keeping it off—and avoiding the dreaded rebound weight gain. According to the researchers, the combination of moderate-to-vigorous exercise along with taking one weight loss drug were successful at helping people lose 20 pounds or more and keep it off for a full year. Read on for more, and if you’re in the market for a great new workout, see here for 3 Workouts Proven to Change Your Body Shape.

The study put the weight-loss drug Saxenda (liraglutide), a prescription anti-obesity drug that’s FDA-approved in the United States, to the test. The researchers who oversaw the clinical head-to-head trial recruited obese adults and put them all through an 8-week, low-calorie diet. After that, the study participants were randomly assigned into four groups.

Those in the first group were put on a “moderate-to-vigorous intensity exercise program” while taking a placebo. Group two took liraglutide (3mg per day) and didn’t exercise. Group three exercised and took liraglutide, while group four took a placebo and didn’t exercise. By “exercise,” here’s what the researchers mean: “The mean weekly duration of exercise was 118 minutes at an intensity of 78% of the maximum heart rate in the exercise group, and 111 minutes at an intensity of 79% of the maximum heart rate in the combination group,” observed Healio.

The program then went on for a full year.

At the end of a year, all of the people who exercised lost more weight than those in the placebo group. However, the study participants who combined exercise with liraglutide enjoyed the greatest weight loss of all. On average, participants who did both lost 12 more pounds that people who exercised alone. They also lost more weight than those who just took the drug.

“It is great news for public health that a significant weight loss can be maintained with exercise for approximately 115 minute per week performed mostly at vigorous intensity, such as cycling,” Signe S. Torekov, PhD, professor in the department of biomedical sciences at the University of Copenhagen, Denmark, explained to Healio. “By combining exercise with obesity medication, the effect is twice as good as each of the individual treatments.”

Saxenda (liraglutide) is an a prescription weight loss drug designed for obese people with a BMI of 30 or over that was approved by the FDA for use in the United States in late 2014. It’s an injectable drug—delivered through a pen. In 2017, researchers found that it was also effective in bolstering heart health.

It works by reducing your body’s leptin resistance and making you feel full. When you go on a diet, your hunger hormone leptin moves to increase your appetite and slow your metabolism. The hormone that triggers this process is leptin, and the more you try to diet, the more your leptin spikes, until you eventually develop a leptin resistance. Liraglutide works, the researchers say, by reducing that leptin resistance and allowing your weight loss to happen.

It’s worth noting that it’s quite pricey, and can cost upwards of $40/day.

Now, if you’re looking to lose 5 pounds before summer, this study doesn’t apply to you. But it’s a major breakthrough for obese people who are susceptible to diabetes and other health conditions, and who truly struggle to keep weight off in the long term.

Even if you don’t take the drug, the study shows that obese people can lose and maintain their weight by exercising alone.

“Our trial showed that 1 year of mostly vigorous-intensity exercise, performed approximately 2.4 times per week, as a weight-loss maintenance strategy was feasible in persons with obesity with a very low initial level of fitness,” conclude the researchers. “The finding that the 1-year trajectories with regard to body weight, waist-to-hip ratio and adherence were stable in the exercising groups—in which participants had a loss of fat mass and increase in lean mass, along with improved emotional well-being—also support feasibility.” And for more weight loss advice, see these Secret Exercise Tricks for Keeping Your Weight Down for Good.

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