Browse the evidence

Positive Airway Pressure (PAP) therapy, while effective for reducing AHI and improving symptoms, has not demonstrated a benefit on composite cardiovascular endpoints in randomized controlled trials.

PAP is the standard treatment for OSA and effectively reduces breathing interruptions and daytime sleepiness. However, it does not appear to reduce long-term cardiovascular risks like heart attacks or strokes in large studies, and many patients struggle with adherence due to discomfort. It remains a good option for symptomatic relief and blood pressure control, but may not be a 'one-size-fits-all' solution.

Discontinuation of GLP-1 receptor agonists (GLP-1 RA) is significantly higher and reinitiation is significantly lower in patients without type 2 diabetes (T2D) compared to those with T2D, driven largely by insurance coverage and cost barriers rather than efficacy.

If you are taking a GLP-1 RA for weight loss without diabetes, be aware that insurance coverage is a major hurdle. Discontinuation rates are significantly higher for non-diabetics, often due to cost. If you face financial barriers, discuss coverage options or assistance programs with your provider immediately, as these factors heavily influence long-term adherence.

Obesity lacks standardized diagnostic criteria and treatment targets compared to T2DM, leading to inconsistent care, underdiagnosis, and undertreatment.

If your doctor only uses BMI to diagnose obesity, ask for a more comprehensive assessment. This should include metabolic markers (blood pressure, lipids, glucose) and possibly the Edmonton Obesity Staging System to determine the severity of your condition and the appropriate treatment.

For individuals with obesity and prediabetes who fail to achieve early weight loss (<2.5% at 4 weeks), adding exercise counseling or time-restricted eating (TRE) counseling does not significantly improve weight loss or glycemic outcomes compared to continuing the initial diet alone.

If you are not losing weight in the first month of a diet, simply adding more exercise counseling or trying a new eating window might not be enough. You may need more intensive support, such as provided meals or supervised exercise, rather than just advice.

GLP-1 monotherapy (liraglutide, semaglutide) is associated with high discontinuation rates due to gastrointestinal side effects, limiting long-term adherence.

Be aware that GLP-1 monotherapy can cause significant gastrointestinal side effects, leading to high discontinuation rates. Discuss titration strategies with your provider to minimize these effects.

An intensive, early post-bariatric lifestyle intervention combining nutritional-behavioral tele-counseling and supervised exercise does not improve weight loss or secondary health outcomes compared to standard care alone.

If you have had bariatric surgery, standard post-operative care is likely sufficient for optimal weight loss. Adding an intensive, early lifestyle program with frequent counseling and exercise sessions does not improve results and may be unnecessarily burdensome. Focus on sustainable habits rather than intensive early intervention.

In real-world commercial insurance populations without diabetes, one-year persistence on GLP-1 receptor agonists for obesity treatment is low (32.3%), with significant variation by product, contradicting high persistence rates reported in clinical trials.

If you are using a GLP-1 medication for weight loss, expect that staying on it for a full year is challenging. Real-world data shows only about 1 in 3 people stay on therapy for a year, and this varies by drug. Weekly injections (like semaglutide) tend to have better persistence than daily ones (like liraglutide). Discuss any side effects or supply issues with your doctor immediately rather than stopping abruptly, as discontinuation often leads to weight regain.

High cost or insurance-related barriers are the primary drivers of discontinuation for obesity pharmacotherapy with semaglutide or tirzepatide in clinical practice, accounting for nearly half of all early and late discontinuations.

If you are stopping semaglutide or tirzepatide, the most likely reason is cost or insurance issues, not that the drug didn't work. Check your insurance coverage, look for manufacturer coupons, and talk to your doctor about financial assistance programs before assuming the treatment is unsuitable for you.

Intensive dietary counseling targeting sodium reduction to <2.3 g/day fails to sustainably reduce sodium intake, blood pressure, or cardiorenal biomarkers in individuals with moderate baseline sodium intake over a two-year period.

If you currently eat a moderate amount of sodium (around 3 grams/day), trying to drastically cut it down to less than 2.3 grams through intense counseling is unlikely to work long-term. You might see a small, short-term drop in blood pressure, but it won't last, and it won't improve your heart or kidney health markers. The effort required to maintain such a low intake is likely too high for sustainable results in this group.

Adherence to liraglutide 3.0 mg for obesity treatment is extremely low (84.9% of patients exhibit low adherence), with only 15.1% achieving high adherence (PDC ≥80%) after 6 months.

If you are prescribed liraglutide 3.0 mg for weight loss, expect that most people stop taking it consistently within 6 months. High adherence (taking it daily as prescribed) is rare (15%). To succeed, you must actively manage side effects and address the burden of daily injections, possibly with dietitian support, as these are key predictors of sticking with the treatment.

Socioeconomic deprivation is strongly correlated with higher prevalence of obesity (BMI ≥40) and higher mortality rates, with the most deprived areas facing the greatest healthcare burden.

Obesity and its associated health risks are significantly higher in socioeconomically deprived areas. Public health interventions should target these areas, as they bear the greatest burden of obesity-related mortality and healthcare costs.

Individuals with greater personal success in weight loss without medication exhibit higher obesity stigma and less favorable attitudes toward anti-obesity medications.

Healthcare providers should recognize that patients who have successfully lost weight through diet and exercise may be skeptical of or stigmatizing toward GLP-1 medications. Counseling should validate their success while explaining that biological factors can persist despite lifestyle efforts, making medication a valid and effective tool for others.

Male sex, older age (≥65 years), lower socioeconomic status (lower income, less education, higher area deprivation), and lack of insurance are associated with significantly lower odds of receiving anti-obesity medication (AOM) prescriptions and metabolic and bariatric surgery (MBS).

If you are male, older, or have limited income/insurance, you face significant systemic barriers to accessing obesity treatments like GLP-1s or surgery. This is not a reflection of your medical need but of socio-economic disparities. Seek providers who are aware of these disparities and advocate for coverage options or financial assistance programs.

Concerns about side effects, long-term health risks, and potential for weight regain are significant barriers to patient interest in incretin-based anti-obesity medications, with higher endorsement of these barriers associated with lower interest in using the therapies.

If you are considering incretin-based weight loss medications, know that your concerns about side effects, long-term risks, and weight regain are common and valid. These concerns directly impact your interest in the treatment. To overcome these barriers, engage in open discussions with your healthcare provider about the relative risks of the medication versus the risks of untreated obesity, and inquire about support for lifestyle programs designed for medication users.

Using percent body weight loss as the sole target for obesity management is not ideal because it is often not feasible or sustainable for most participants and fails to capture holistic health outcomes.

Stop fixating on a specific percentage of weight loss as the only measure of success. For many people, achieving even a modest weight loss is not sustainable. Instead, focus on patient-centered outcomes like improved blood pressure, better glycemic control, and increased quality of life, which can be achieved through various lifestyle changes regardless of the final number on the scale.

The Behavioral Change Technique 'Instruction on how to perform behaviour' is associated with weight GAIN (mean weight change +2.53 kg) rather than loss, suggesting it may be counterproductive in brief, opportunistic primary care advice.

Avoid using 'Instruction on how to perform behaviour' (like handing out leaflets or directing to websites) as a primary strategy in brief weight loss advice. This study found it was associated with weight gain, likely because it is used as a 'simple way to intervene' with patients who are less ready to change. Instead, focus on motivational feedback and follow-up.

Standard-of-care weight management in primary care is characterized by extremely low rates of active treatment, with only 12% of eligible patients receiving a weight-prioritized visit and less than 6% receiving any weight-related referral or anti-obesity drug prescription.

If you have a BMI over 25, do not assume your regular doctor is actively treating your weight. In standard practice, most patients like you are not getting referrals or medications. You must explicitly request a 'weight-prioritized visit' or ask for specific interventions (referrals, medications) to break through the system's inertia.

Obesity is a chronic disease characterized by complex abnormalities in body weight regulation, and weight-related stigmatization is a key barrier to effective care.

Healthcare providers should treat obesity as a chronic disease, not a moral failing. Avoid stigmatizing language to build trust and encourage patients to seek and adhere to treatment.

Weekly injectable semaglutide demonstrates very low persistence in real-world Colombian patients, with a mean duration of use of only 93.7 days and less than 1% persistence at 12 months.

If you are starting weekly injectable semaglutide, be aware that persistence is very low in real-world settings. Most people stop within 3 months. To stay on the medication, ensure you have good access, receive proper education on how to inject, and have regular follow-up with your doctor to manage tolerability.

Access to effective obesity pharmacotherapy is severely limited by cost, insurance prior authorization, and systemic inequities, leading to high discontinuation rates.

Even if your doctor prescribes a weight loss drug, insurance may not cover it, or it may be too expensive. You might face delays due to prior authorizations. Ask your doctor about manufacturer assistance programs or alternative coverage options.

Existing patient-reported outcome (PRO) measures inadequately capture the full spectrum of emotional impacts of obesity and weight loss, specifically missing concepts such as feeling happy, energetic, proud, or joyful, as well as negative emotions like grief, disappointment, or skepticism.

If you are tracking the success of your weight loss journey, standard health surveys might not reflect how you truly feel. This research suggests that specific emotional changes—like feeling more energetic, confident, or joyful—are real and significant benefits of treatment, but they are often missed by standard medical questionnaires. To get a complete picture of your progress, use or advocate for tools specifically designed to measure emotional well-being in the context of weight, such as the Weight and Emotions Scale (WES).

In real-world clinical practice, approximately half of patients initiating oral semaglutide for Type 2 Diabetes Mellitus remain on their initial treatment regimen without change for at least 6 months.

If you start oral semaglutide for Type 2 Diabetes, there is a roughly 50% chance you will stay on that exact treatment plan for the next six months without needing to switch or add other diabetes medications. This stability is a common and successful real-world outcome, not a sign that treatment is failing.

Stronger corporate nutrition-related commitments in the French food industry do not translate into better product portfolio healthiness or marketing practices.

Do not rely on a company's stated 'health goals' or 'commitments' as a proxy for product quality. The data shows these promises do not correlate with the actual nutritional content of their products. Focus on the product itself (e.g., Nutri-Score, ingredient list) rather than the company's public relations.

Increasing the price of meat, dairy, and oils/fats reduces saturated fat intake, but the demand is inelastic, meaning substantial price increases (e.g., 100% tax) are required to achieve modest reductions in intake.

If you are a policymaker, know that simply raising prices on fats will not drastically change diets because people are not very sensitive to price changes for these items. You would need extremely high taxes (doubling the price) to see any real drop in saturated fat intake, and even then, the drop is small. Focus on meat taxes in high-income countries where sensitivity is higher, but expect limited results overall.