In this study, adults with obesity first followed a very low-calorie diet and lost at least 5% of their body weight. In contrast, those who took liraglutide without exercise did not see meaningful improvements in physical performance, even though they maintained weight loss. Overall, the findings highlight that exercise plays a central role in long-term health after weight loss. This adds to existing evidence that adolescence is a critical window for preventing long-term health damage from smoking. Early age at smoking initiation is associated with elevated cardiovascular disease and mortality risk in a nationwide population-based cohort.