Browse the evidence

Multicomponent lifestyle interventions (diet, exercise, behavioral strategies) are recommended for all women with PCOS and excess weight to achieve 5-10% weight loss, which significantly improves hormonal outcomes, insulin resistance, and quality of life.

If you have PCOS and carry extra weight, start with a plan that combines better eating, regular movement, and behavioral strategies like tracking your progress. Aim to lose just 5-10% of your body weight over six months; this small change significantly improves your hormones, insulin resistance, and how you feel. Work with a provider who respects your individual preferences and avoids weight stigma.

Wearable activity trackers lead to improvements in body composition, specifically bodyweight and waist circumference, with large effect sizes for bodyweight reduction.

Using a wearable activity tracker can help you lose weight, with an average reduction of 0.5 to 1.5 kg. This benefit is seen in both healthy adults and those with chronic conditions like diabetes or heart disease. The weight loss is a result of the increased physical activity driven by the tracker.

Intentional weight loss, particularly through bariatric surgery or significant lifestyle changes, reduces the risk of obesity-associated cancers, including endometrial and breast cancer.

If you are obese, losing weight can significantly lower your risk of endometrial and breast cancer. Even a modest loss of 20 pounds or more has been shown to reduce risk. Bariatric surgery, for those eligible, offers even greater protection.

Obesity and high-fat diets impair male fertility by increasing oxidative stress, reducing sperm concentration, motility, and DNA integrity, while moderate exercise and healthy diets (e.g., Mediterranean) can improve these parameters.

Maintaining a healthy weight through a balanced diet (like the Mediterranean diet) and regular moderate exercise can improve sperm quality by reducing oxidative stress. Avoid high-fat diets and sedentary behavior.

Weight loss, achieved through lifestyle modifications (diet, exercise) or bariatric surgery, significantly improves or resolves Obstructive Sleep Apnea (OSA) and its associated metabolic derangements.

Losing weight is the most effective way to treat OSA. This can be done through lifestyle changes (diet and exercise) or, if those fail, through bariatric surgery. Both methods significantly improve OSA symptoms and metabolic health. If you have OSA, prioritize weight loss as a primary treatment strategy alongside or instead of just using CPAP.

Discontinuation of physical exercise during confinement is associated with weight gain, whereas maintaining or starting exercise is associated with weight loss.

Keep exercising or start moving if you haven't. Stopping exercise is linked to gaining about 1 kg, while continuing or starting helps you lose nearly 1 kg during confinement.

Vigorous aerobic exercise (≥3 days/week, 30+ min, ≥60% VO2max) and combined resistance training improve insulin sensitivity and androgen levels in adolescents with PCOS.

Teens with PCOS should aim for at least 3 days of vigorous aerobic exercise (keeping heart rate at 60% of max) and 3 days of strength training per week. This combination is more effective for improving androgen levels than exercise alone.

Bariatric surgery induces a significant decrease in Total Daily Energy Expenditure (TDEE) and metabolic adaptation at 8 weeks post-intervention, but this metabolic suppression is reversed by 52 weeks, coinciding with a sustained increase in free-living physical activity.

If you have had bariatric surgery, expect your energy expenditure to drop significantly in the first two months as your body adjusts to its new size. This 'metabolic adaptation' is normal but not necessarily permanent. The key to long-term success appears to be increasing your daily physical activity, which may help counteract this drop in energy expenditure and allow your metabolism to normalize over the course of a year.

Low physical activity (defined as ≤600 MET min/week) is highly prevalent (69.4%) in the Saudi adult population and is a primary driver of elevated cardiovascular disease risk, particularly when combined with obesity and unhealthy diet.

In this population, nearly 7 out of 10 adults do not meet basic physical activity guidelines. This is a major contributor to heart disease risk. Prioritize increasing daily movement, even if it starts with small steps like walking, to counteract the high prevalence of inactivity.

Obesity (BMI ≥30) affects nearly half (49.6%) of the Saudi adult population, with women having significantly higher rates of obesity (BMI >35) and central obesity compared to men.

Obesity is a major health issue in Saudi Arabia, affecting nearly half of adults. Women are disproportionately affected by severe obesity and central adiposity. Addressing environmental barriers to exercise and promoting safe spaces for physical activity can help mitigate this risk.

Energy compensation occurs primarily at the within-individual level (reversible trade-offs over time) rather than the between-individual level (genetic/permanent differences), meaning active periods lead to lower basal rates for the same person.

Your metabolism is not fixed. When you are active, your body lowers your resting burn. When you are less active, your resting burn may increase. This dynamic adjustment means that long-term changes in activity levels will trigger metabolic adaptations, making weight management a moving target.

Ketogenic interventions, including Medium Chain Triglycerides (MCTs) and coconut oil, provide an alternative energy source for the brain by increasing ketone bodies, which may benefit individuals with Alzheimer's disease or insulin resistance.

For individuals with cognitive decline or insulin resistance, consider adding Medium Chain Triglycerides (MCTs) or coconut oil to the diet. This may provide an alternative energy source for the brain and support cognitive function, especially if glucose utilization is impaired.

An energy surplus enhances fat-free mass (FFM) gains during resistance training compared to energy balance, but the exact magnitude of the surplus required is unknown and varies by individual.

If you are struggling to gain muscle despite consistent training, try adding a small energy surplus of 1,500-2,000 kJ (approx. 350-480 kcal) per day. Monitor your body composition and strength. If you gain too much fat, reduce the surplus. This is particularly useful for those who find it hard to gain lean mass.

Acute carbohydrate ingestion significantly increases total resistance training session volume, but this ergogenic benefit is conditional on session duration exceeding 45 minutes and/or a pre-exercise fast duration of 8 hours or more.

If your resistance training session lasts longer than 45 minutes, or if you train fasted for 8+ hours (e.g., early morning), consume carbohydrates before or during the workout to increase the total volume you can complete. For short sessions (<45 min) or well-fed states, carbohydrate ingestion provides no significant performance benefit. The specific dose is less important than the total number of maximal effort sets performed.

Carbohydrate ingestion elevates post-exercise blood lactate and glucose levels, but this metabolic response may come at the cost of extended recovery time due to the increased training volume performed.

Expect higher blood lactate and glucose after carb-fueled workouts. This is normal and reflects the higher volume you completed. Be aware that this increased volume may lead to longer recovery times, so adjust your training frequency or intensity accordingly.

Slower rates of body mass loss (approx. 0.5% per week) combined with longer diet durations result in a lower estimated energy deficit (EED) and higher energy availability compared to faster weight loss rates, thereby better preserving lean body mass in natural bodybuilders.

If you are a natural athlete preparing for a physique event, aim to lose no more than 0.5% of your body weight per week. This slower rate, often requiring a longer diet duration (e.g., 28+ weeks), helps maintain higher energy availability compared to faster 0.7-1.0% loss rates. This metabolic advantage is critical for preserving the lean muscle mass you have worked to build, as faster rates are associated with greater lean tissue loss.

Sustained remission of type 2 diabetes (via weight loss or bariatric surgery) reduces the risk of microvascular and macrovascular complications compared to standard care.

Achieving remission through sustained weight loss or surgery not only normalizes blood sugar but also significantly reduces your risk of heart disease, kidney damage, and eye problems over the long term. This benefit is likely greater than just controlling blood sugar with medication alone.

Gut microbiota composition influences energy metabolism and food intake, and specific microbial signatures may predict response to dietary interventions and bariatric surgery.

Your gut bacteria play a role in how your body processes food and regulates energy. While specific 'microbiome diets' are not yet proven, dietary changes and bariatric surgery can positively alter microbiome diversity, which may contribute to weight loss and metabolic health.

High Body Mass Index (BMI) is the leading risk factor for T2DM-related mortality globally, particularly in Low- and Middle-Income Countries, although trends in High-Income Countries showed a decrease between 2005 and 2015.

Maintain a healthy body weight, as high BMI is the leading risk factor for T2DM mortality worldwide. This is especially critical if you live in a middle- or low-income country where obesity rates are rising. While BMI isn't perfect, managing your weight through diet and activity is the most impactful step you can take to reduce your diabetes risk.

Time-restricted eating (16/8) with ad libitum intake reduces body weight and improves lipid profiles (total cholesterol and LDL-C) in overweight females, but does not significantly reduce body fat percentage or improve diet quality compared to energy-restricted diets.

If you are an overweight female looking to lose weight and improve cholesterol, a 16/8 fasting window is effective for weight loss and lipid improvement. However, do not expect it to significantly reduce body fat percentage or improve your overall diet quality compared to a structured calorie-restricted diet. You must maintain your current activity level.

Energy-restricted diets (ERD) are superior to Time-Restricted Eating (TRE) for improving diet quality and reducing body fat percentage in overweight females, despite both interventions yielding similar weight loss.

If your primary goal is to lose body fat and improve your diet quality, a structured energy-restricted diet is more effective than time-restricted eating. Calculate your maintenance calories, subtract 500, and follow a balanced macronutrient distribution. This approach will yield better body composition results than simply restricting your eating window without counting calories.

Orlistat is effective in promoting weight loss in patients who have undergone Laparoscopic Adjustable Gastric Banding (LAGB) and have plateaued, but its use is not recommended after malabsorptive surgeries.

If you had gastric banding and your weight loss has stopped, Orlistat might help. It is an oral pill taken with meals that blocks fat absorption. It can lead to significant weight loss, but you must strictly limit fat in your diet to avoid unpleasant gastrointestinal side effects like diarrhea. It is not suitable for patients who had malabsorptive surgery.

High-intensity interval training (HIIT) or resistance training (RT) is safe and effective for patients with muscle Carnitine Palmitoyl-Transferase II (CPTII) deficiency because these activities rely on glycogen/phosphocreatine pathways rather than long-chain fatty acid oxidation, thereby avoiding rhabdomyolysis triggers.

If you have CPTII deficiency, do not avoid exercise entirely. Instead of long, steady-state cardio (like running or cycling) which relies on fat burning, focus on resistance training and high-intensity intervals (like sprints or circuit training). These activities use glycogen, which your muscles can still process safely. Start with moderate intensity (around 70% of your max capacity) and build up gradually under supervision.

In BDNF rs10835211 GG genotype carriers, higher daily energy intake (>1800 kcal) is associated with lower fasting insulin, lower HbA1c, and lower HOMA-IR compared to lower energy intake, despite similar or higher body weight.

If you carry the BDNF rs10835211 GG genotype, restricting calories too severely (<1800 kcal) might be associated with higher insulin resistance and HbA1c. Ensure you are eating enough to support your metabolic health, as this group may respond differently to caloric restriction.