Browse the evidence

Dispensing rates for GLP-1 RAs are significantly lower for obesity (AOM) indications compared to diabetes (ADM) indications, with a large gap in 60-day initiation rates.

Even if prescribed, GLP-1 RAs for weight loss are less likely to be filled than those for diabetes, largely due to insurance coverage issues. If you are prescribed an AOM GLP-1 RA, proactively check your insurance coverage and explore assistance programs to ensure you can access the medication.

Dispensing rates for GLP-1 RAs are lower in patients aged 65+ compared to those aged 18-64, particularly for AOM indications.

Older adults (65+) are less likely to fill GLP-1 RA prescriptions for weight loss compared to younger adults, largely due to Medicare not covering these medications. If you are 65 or older, discuss alternative coverage options or patient assistance programs with your healthcare provider.

A lifestyle pattern characterized by high consumption of food, alcohol, and cigarettes is associated with higher triglycerides, gamma-glutamyl transpeptidase (GTP), and diastolic blood pressure in T2DM patients.

For T2DM patients, high intake of alcohol, cigarettes, and large meals contributes to liver stress and high triglycerides. Reducing these specific behaviors can improve liver enzyme levels and blood pressure, even if blood sugar control remains stable.

Current standard-of-care structured lifestyle modification (500 kcal deficit + 150 min activity) added to obesity pharmacotherapy lacks evidence of improving drug response and may act as a barrier to care by reinforcing stigma.

If you are starting obesity medication, you do not need to complete a mandatory lifestyle program to access or benefit from it. Current evidence does not show that mandatory calorie counting and exercise improve drug results. Focus on your health and well-being; if you choose to make lifestyle changes, do so for yourself, not as a requirement for your medication.

Adherence to an ultra low-fat diet (ULF) leads to a compensatory increase in refined grain intake, which may undermine the cardioprotective potential of fat restriction.

If you choose a low-fat diet, be aware that your body may crave carbohydrates. You must actively replace the calories from fat with vegetables and whole foods, not refined grains or sugars. If you find yourself eating more bread or pasta to feel full, your heart health benefits may be negated by the increased refined carbohydrate intake.

An 8-week combined functional strength and nutrition education program does NOT significantly improve gait speed, health-related quality of life (HRQoL), or protein intake in older adults with pre-frailty and frailty, although exploratory analysis suggests potential trends.

Knowing you need more protein doesn't always mean you will eat more, especially if you live in a facility with limited menu choices. Focus on practical strategies like adding specific high-protein snacks or choosing protein-rich options from existing menus, rather than trying to completely change your diet overnight. Combine this with strength training for the best functional results.

Obstetrician-gynecologists generally perceive plant-based dietary patterns as safe and health-promoting for pregnant and lactating patients, yet a significant majority feel inadequately trained to provide nutrition counseling, leading to a discrepancy between positive attitudes and actual clinical recommendations.

For OB/GYNs: Recognize that your positive view of plant-based diets is supported by evidence, but your lack of training is the main barrier to recommending them. Seek out specific nutrition education or refer patients to dietitians to ensure safe implementation during pregnancy.

Electronic message (SMS/email) nudges consisting of 3-4 weekly questions about diet adherence and emotional state do not significantly improve class attendance, diet adherence, or weight loss maintenance compared to historical controls in the second half of a weight loss trial.

If you are trying to stick to a diet plan, simple automated text messages asking about your progress are unlikely to be enough on their own to keep you on track. To maintain adherence, especially when in-person support drops off, you likely need more interactive, varied, or personalized feedback mechanisms rather than just generic reminders.

Physical activity level is not significantly associated with blood lipid profiles in patients with coronary heart disease.

Contrary to common belief, this study found that physical activity levels did not significantly correlate with blood lipid profiles in CHD patients. While you should still stay active for overall heart health, do not rely on exercise alone to fix high cholesterol or triglycerides. Focus your primary efforts on managing your intake of fats and carbohydrates.

Moderate alcohol consumption (≤2-3 drinks/day for men, ≤1-2 for women) is associated with lower cardiovascular morbidity and all-cause mortality, but does not justify starting to drink for health reasons.

If you already drink moderately (up to 2-3 drinks for men, 1-2 for women), you can likely continue without worry regarding heart health. Do not start drinking if you don't already, as the risks (especially breast cancer in women) outweigh the benefits. Binge drinking should be strictly avoided.

Aspartame and other non-nutritive sweeteners (NNS) do not promote weight gain, contrary to common belief that they stimulate appetite or cause metabolic harm.

If you use aspartame, don't worry about it causing weight gain. It does not appear to trigger the compensatory eating that some fear.

Large-scale precision nutrition interventions targeting individual behavioral modification are unlikely to reduce obesity at a population level because they ignore the structural and environmental causes of incidence.

Do not rely solely on personalized diet apps or genetic testing to solve obesity. These tools focus on individual behavior, which is heavily constrained by your environment (food availability, cost, marketing). To effectively manage weight, you must combine personalized advice with structural changes to your environment, such as advocating for policy changes or modifying your immediate food access, rather than expecting data-driven advice alone to overcome an obesogenic environment.

Large-scale precision nutrition interventions are likely to exacerbate socioeconomic inequalities in obesity because socially privileged groups are more likely to adopt and benefit from these interventions.

Be aware that personalized health advice often works best for those with higher socioeconomic status. If you are from a lower socioeconomic background, personalized advice alone may not be enough due to structural barriers like cost and access. Advocate for policies that make healthy choices easier and cheaper for everyone, rather than relying solely on individualized digital interventions.

High-volume and high-intensity exercise may increase the risk of atrial fibrillation (AF) in athletes, suggesting a J-shaped relationship between exercise volume and AF risk.

While exercise is crucial for heart health, extremely high volumes of intense exercise may increase the risk of atrial fibrillation in athletes. Aim for moderate-volume exercise (5-20 MET hours/week) for optimal protection against AF.

Population-wide fiscal measures, such as taxes on sugar-sweetened beverages and unhealthy foods, can reduce purchases of taxed items and prevent childhood obesity cases, though their immediate impact on population health outcomes is limited and requires sustained implementation.

Government taxes on sugary drinks and unhealthy foods can reduce their purchase, but these policies are often weakened by industry opposition. For individuals, this means these products may remain accessible, so personal choices remain critical.

Intentional weight loss in overweight or obese diabetic patients is not associated with a significant change in all-cause mortality compared to weight stability.

If you are diabetic and obese, attempting to lose weight intentionally (through diet and exercise) does not appear to increase your risk of death compared to staying the same weight. However, ensure you are not losing muscle mass and are maintaining good glycemic control.

Patients with severe obesity perceive obesity as a disease due to a lack of control and addiction-like mechanisms, yet simultaneously maintain a belief in personal responsibility and self-blame, creating a barrier to accepting the disease label fully.

Understand that accepting obesity as a disease is complex for many patients. While biological factors like genetics and appetite dysregulation play a huge role, many patients still feel personal responsibility. This internal conflict can hinder treatment. Healthcare providers should address this shame and the 'addiction' narrative to help patients accept medical interventions without feeling they are failing morally.

Continuous Positive Airway Pressure (CPAP) therapy has mixed and often limited effects on improving glycemic control (A1c, fasting glucose) and liver fat content in patients with OSA, T2DM, and MASLD, despite reducing sympathetic activity.

CPAP is essential for treating OSA and improving blood pressure, but it may not significantly lower blood sugar or liver fat on its own. If you have diabetes or fatty liver, focus on weight loss and medications, as CPAP alone may not reverse these conditions.

Intensive lifestyle intervention (ILI) involving weight loss and increased physical activity does not reduce the rate of major cardiovascular events in adults with type 2 diabetes and a history of cardiovascular disease, and may be associated with a higher incidence of nonfatal myocardial infarction compared to diabetes support and education.

If you have type 2 diabetes and a history of heart disease, intensive lifestyle changes focusing on heavy weight loss and high-volume exercise may not protect your heart and could potentially increase the risk of a non-fatal heart attack compared to standard education. Consult your doctor before starting intense exercise programs to ensure they are safe for your specific cardiac condition.

Generic public health messaging encouraging adults to 'eat less' or reduce caloric intake is ineffective and potentially harmful because it fails to provide actionable strategies, ignores complex social and environmental barriers, and can trigger negative psychological outcomes in vulnerable populations.

Stop telling people to 'eat less' or count calories, as this induces fear and confusion. Instead, provide specific, actionable instructions on how to increase nutrient-dense foods (like vegetables) to naturally crowd out calorie-dense options. Use trusted sources like healthcare providers to deliver these clear, behavior-based messages.

Calorie reduction messaging is counterproductive and potentially harmful for individuals with food insecurity or eating disorders, as it can reinforce distorted logic, rationalize harmful behaviors, or ignore survival priorities.

Do not use generic calorie reduction campaigns for food-insecure communities or individuals with eating disorders. For food-insecure groups, focus on access and quality, not restriction. For those with eating disorders, such messages can be dangerous and should be excluded or carefully managed by mental health professionals.

College students overwhelmingly perceive no-fat food preparations as healthier than those containing unsaturated or saturated fats, despite nutritional guidelines recommending unsaturated fats.

Stop avoiding fat. Choose foods with unsaturated fats (like olive oil, nuts, avocados) over no-fat options. The type of fat matters more for your health than simply removing fat from your diet.

Integrating structured intake tools (like the Obesity Brief HPI) into electronic medical records can increase the identification and prioritization of weight management visits, although adoption was zero in this baseline period.

Health systems are starting to use digital tools to make weight management easier. If your clinic uses these tools, expect a questionnaire before your visit. This is designed to help your doctor understand your history better, not to burden you.

Physical activity time and variability are not significantly associated with glycemic variability indices (MAGE, CONGA, MODD) in overweight or obese adults.

Do not rely on exercise alone to stop blood sugar spikes or swings if you are overweight. While exercise helps lower your average blood sugar, this study suggests it may not reduce the magnitude of glucose fluctuations. Focus on total movement time rather than expecting it to smooth out glucose curves.