Browse the evidence

Laparoscopic sleeve gastrectomy (LSG) provides 60–70% excess weight loss and 50–60% type 2 diabetes remission at 5–7 years, with efficacy comparable to Roux-en-Y gastric bypass (RYGB) and superior safety for super-obese patients (BMI > 60).

Sleeve gastrectomy is currently the most common and effective surgical option for severe obesity, offering significant long-term weight loss and diabetes remission rates comparable to more complex bypass surgeries, with a strong safety profile especially for patients with very high BMI.

Lifestyle modifications, specifically calorie restriction of 500-750 kcal/day and ≥ 150 minutes of exercise per week, are the first-line treatment for obesity, though long-term maintenance is challenging without pharmacological or surgical support.

Start with a daily calorie deficit of 500-750 kcal and aim for at least 150 minutes of exercise per week. This is the first step in managing obesity. Remember, long-term success is often about finding a sustainable lifestyle you can stick to, rather than a specific 'magic' diet.

Intragastric balloons (Obalon, Orbera, ReShape Duo) provide temporary weight loss (12-25% EWL) when combined with lifestyle modifications.

Intragastric balloons are temporary devices placed in the stomach to help with weight loss. They work by taking up space, making you feel full sooner. Clinical trials show they can lead to 12-25% excess weight loss when combined with lifestyle changes, significantly outperforming lifestyle changes alone. They require an endoscopic procedure and are typically removed after 6 months.

Lifestyle interventions involving ≥150 minutes of exercise per week combined with caloric restriction are associated with the highest odds of long-term weight loss maintenance (5-10%).

To keep weight off long-term, aim for at least 150 minutes of exercise per week, ideally closer to 275 minutes, while maintaining a healthy diet. This combination offers the best chance of keeping 5-10% of your weight off permanently.

The median total weight loss percentage after eight weeks was 10.2%.

Practitioners can expect an average weight loss of around 10% in similar programs.

Intake of one serving per day of combined plant protein sources (nuts, legumes, and soy) is associated with a lower risk of CHD compared to red meat.

Incorporating plant proteins may be beneficial for heart health.

Current cardiovascular guidelines emphasize lifestyle modifications for weight loss.

Clinicians should incorporate lifestyle changes as a primary strategy for weight loss.

Increased physical activity in the ICU shows a positive effect on muscle mass and function.

Encouraging physical activity in ICU patients may help improve muscle mass and function.

Post-menopausal females should ingest at least the RDA of 0.8 g·kg−1·d−1 of protein.

Practitioners should recommend a minimum protein intake of 0.8 g·kg−1·d−1 for post-menopausal women.

Following dietary recommendations as a whole is important.

Practitioners should promote comprehensive dietary guidelines rather than isolated food groups.

Creatine monohydrate supplementation provides additive benefits to resistance training in older adults by increasing intramuscular phosphocreatine stores and enhancing high-intensity exercise capacity.

If you are doing resistance training, adding creatine monohydrate is one of the most effective ways to get more out of your workouts. It helps your muscles produce energy for high-intensity efforts, allowing you to train harder and build more muscle over time.

Beta-alanine supplementation increases intramuscular carnosine levels by 40-80% over 4-6 weeks, which buffers hydrogen ions during high-intensity exercise to delay fatigue in efforts lasting 1-4 minutes.

If you do short, intense cycling efforts (1-4 minutes), take 3.2-6.4g of beta-alanine daily for at least 4 weeks. Expect some tingling, which is harmless. This will help you delay fatigue in those specific efforts.

Sodium bicarbonate supplementation of 0.2-0.3 g/kg body weight, taken 60-90 minutes before exercise, buffers acid buildup to improve high-intensity cycling performance (1-10 minutes).

For races or efforts under 10 minutes, take 0.2-0.3g of sodium bicarbonate per kg of body weight 60-90 minutes before starting. Be aware it can cause stomach issues, so practice with it in training.

Dietary nitrates (300-600 mg nitrate, ~500 ml beetroot juice) taken 2-3 hours before exercise enhance endurance and reduce oxygen cost during submaximal exercise by promoting vasodilation and improved muscle efficiency.

If you do long rides or time trials, try 300-600mg of nitrate (e.g., beetroot juice) 2-3 hours before. It can help you use oxygen more efficiently. Be aware it may lower blood pressure.

Caloric restriction is the primary determinant of diet-based weight loss, whereas macronutrient composition is secondary; adherence to the caloric deficit is the key factor for success.

To lose weight, you must create a caloric deficit. The specific type of diet (low-carb, low-fat, etc.) matters less than your ability to stick to the caloric restriction. Choose a macronutrient profile that you can maintain while staying in a deficit.

Physical activity alone is rarely effective for treating obesity, but when combined with diet, it produces greater weight loss than diet alone and provides significant weight-loss-independent health benefits.

Do not rely on exercise alone to lose weight. Combine at least 150 minutes of moderate aerobic activity per week with a caloric deficit. Exercise will help you lose a bit more weight than diet alone and offers major health benefits regardless of weight change.

Weight loss interventions, including lifestyle changes and bariatric surgery, reduce blood pressure, glomerular hyperfiltration, and proteinuria in obese patients with chronic kidney disease.

If you have kidney disease and are overweight, losing weight is one of the best things you can do for your kidneys. It lowers blood pressure and reduces the strain on your kidney filters. Work with your doctor to create a safe weight loss plan that includes diet and exercise, as this can slow the progression of kidney damage.

Intensive lifestyle intervention, including weight loss and physical activity, reduces the risk of Major Cardiovascular Events (MACE) in patients with type 2 diabetes.

Engage in intensive lifestyle changes focusing on weight loss and physical activity. According to the Look AHEAD trial, this significantly reduces the risk of major cardiovascular events in people with type 2 diabetes. Focus on achieving and maintaining body weight goals and delaying complications.

In adults with obesity, sustained weight loss reduces the risk of coronary heart disease (CHD) and myocardial infarction, whereas in normal weight adults, both weight loss and weight gain increase the risk of cardiovascular disease (CVD).

If you have obesity, losing weight significantly lowers your risk of heart attacks and coronary heart disease. However, if you are already normal weight, losing weight actually increases your risk of heart disease and heart failure. Focus on maintenance if you are normal weight, and sustainable loss if you are obese.

For obese diabetic patients, a moderate caloric deficit (reducing intake by 500 kcal/day to achieve ~0.5 kg/week loss) is the recommended standard, whereas extremely low-calorie diets (VLCD) are not recommended due to unverified long-term effectiveness and increased risks of hypoglycemia and ketoacidosis.

Aim to reduce your daily calorie intake by 500 calories from what you currently eat. This should result in losing about 0.5 to 1 kilogram per week. Do not use extremely low-calorie diets (like under 800 kcal/day) without strict medical supervision, as they can cause dangerous blood sugar drops or ketoacidosis in diabetic patients. Adjust your target based on your activity level and body size.

Intentional pre-surgical weight loss, when achieved, is associated with improved surgical outcomes, including reduced complications and shorter hospital stays.

If you can safely lose weight before surgery, it may reduce your risk of complications and shorten your hospital stay. However, do not let the pressure to lose weight delay your surgery if you are unable to do so, as the delay itself carries risks.

Sustained weight loss of at least 10% in the first year significantly reduces the incidence of cardiovascular disease in individuals with type 2 diabetes, whereas weight fluctuation without sustained loss increases risk.

If you have type 2 diabetes, aim to lose at least 10% of your body weight within the first year through a structured lifestyle program. Crucially, focus on keeping that weight off. Avoiding the 'yo-yo' effect of gaining it back quickly is just as important as the initial loss for protecting your heart.

A dose-response relationship exists between reduced caloric intake and weight/BMI loss, where every 100 kcal/day decrease is associated with 0.16 kg weight loss and 0.06 kg/m2 BMI decrease.

To lose weight, focus on reducing your daily caloric intake by small, manageable amounts. The study shows that cutting just 100 calories a day leads to a measurable decrease in weight (0.16 kg) and BMI (0.06 kg/m2) over 12 months. This suggests that small, consistent changes are effective for weight management.

Weight reduction of 5-15% in obese patients with cardiovascular disease leads to dose-dependent improvements in cardiometabolic risk factors, including blood pressure, lipid profiles, and glycemic control.

Aim to lose 5-15% of your current body weight through a moderate daily calorie deficit (500-600 kcal) combined with regular exercise. You do not need to reach a 'normal' BMI to see significant improvements in blood pressure, cholesterol, and blood sugar. Consistency is more important than extreme restriction.