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Article History

Accepted: 21 December 2025

First Online: 24 January 2026

Declarations

:

: The study was supported by the Novo Nordisk Foundation (NNF16OC0019968 and NNF15CC0018486), the Novo Nordisk Foundation Center for Basic Metabolic Research, Helsefonden, the Faculty of Health and Medical Sciences at the University of Copenhagen, the Department of Biomedical Sciences at the University of Copenhagen, and the Danish Diabetes Academy. Novo Nordisk A/S supplied Saxenda (liraglutide) and placebo pens, and Cambridge Weight Plan supplied low-calorie meal replacement products. Simon Birk Kjær Jensen. is funded by the Danish Cardiovascular Academy, which is funded by the Novo Nordisk Foundation (NNF20SA0067242) and the Danish Heart Foundation. Rasmus Michael Sandsdal is funded by the Danish Diabetes and Endocrine Academy, which is funded by the Novo Nordisk Foundation (NNF22SA0079901).

: Jens Juul Holst is on the advisory board of Novo Nordisk A/S. Sten Madsbad (last 5 years) has been on the advisory boards of AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Sanofi, and Bayer; has received lecture fees from AstraZeneca and Novo Nordisk; has been a research grant recipient of Novo Nordisk and Boehringer Ingelheim; and has received support for attending meetings and/or travel from Novo Nordisk and Boehringer-Ingelheim. Signe Sørensen Torekov has received research grants and lecture fees and been on the advisory board for Novo Nordisk, and received a lecture fee Merck. Thomas Bandholm’s spouse works at Novo Nordisk, and they both own Novo Nordisk stock. Simon Birk Kjær Jensen, Matteo Fiorenza, Christian Rimer Juhl, Rasmus Michael Sandsdal, Emma Jensen, Søren Sonnenborg Seier, Charlotte Janus, Julie Rehné Jørgensen, Martin Bæk Blond, and Bente Merete Stallknecht have no conflicts of interest that are directly relevant to the content of this article.

: The trial was approved by the Regional Ethics Committee for the Capital Region of Denmark (H-16027082) and the Danish Medicines Agency. The trial was conducted in accordance with the standards of ethics outlined in the Declaration of Helsinki.

: Participants signed a written informed consent form before they participated.

: Not applicable.

: Data from the study are not available for download because of restrictions under the General Data Protection Regulation. De-identified data, under the General Data Protection Regulation and local regulations of Denmark and the University of Copenhagen, may be available for research collaboration purposes upon reasonable request to the corresponding author, and will require the approval of the corresponding author and the completion of a data processing agreement.

: Not applicable.

: SST conceived the study. SST, SBKJ, TB, SM, JJH, BMS, JRJ, and CJ contributed to the study design. SBKJ, MF, and SST wrote the first draft. SBKJ, CJ, JRJ, CRJ, and RMS contributed to the conduct of the trial. SBKJ, MF, MBB, TB, and SST wrote the statistical analysis plan. SBKJ, MF, EJ, and SSS analyzed the fitness outcomes. SBKJ and MF performed the statistical analyses. SBKJ performed the experimental testing related to physical fitness. SBKJ and MF made visualizations. SST, SBKJ, and MF had full access to the data in the study. All authors critically revised the work for important intellectual content, agreed to be accountable for all aspects of the work, and approved the final version to be published.