Browse the evidence

Preobese individuals with a low relative resting metabolic rate (RMR) normalized for fat-free mass are at higher risk for future weight gain and obesity.

If you are preobese, your metabolic rate relative to your muscle mass might be lower than average, making you more prone to weight gain. Monitoring your metabolic rate or focusing on building fat-free mass could be beneficial strategies for prevention.

Lifestyle interventions (caloric deficit and exercise) remain the cornerstone of obesity care but are often insufficient for long-term maintenance without pharmacotherapy.

Start with a 500-750 kcal daily deficit and 150 minutes of moderate exercise per week. Aim for 5-10% weight loss in 6 months. If you struggle to maintain this, consider adding pharmacotherapy, as lifestyle changes alone are often insufficient for long-term maintenance.

Bariatric surgery still outperforms pharmacotherapy in terms of absolute weight loss magnitude and durability, with surgery yielding approximately five times more weight loss in real-world cohorts.

While incretin drugs are powerful, bariatric surgery still achieves greater weight loss on average (25-35% vs 15-22%). If your goal is maximum possible weight loss and you are a surgical candidate, surgery may still be the most effective option. However, if you fear surgery or have contraindications, polyagonists offer a highly effective, non-surgical path to significant weight loss.

Metabolic bariatric surgery (MBS) is more cost-effective than continuous GLP-1 pharmacotherapy, saving an average of $11,689 per patient over 2 years, while providing a definitive metabolic reset.

Bariatric surgery (like sleeve gastrectomy or gastric bypass) is not just a weight loss tool but a metabolic reset. While it has higher upfront costs, long-term data suggests it saves money compared to staying on GLP-1 medications indefinitely, as drug costs remain high while surgical maintenance costs drop. It works by altering your gut hormones to reduce hunger and improve insulin sensitivity.

Semaglutide treatment is associated with improvements in quality of life (DLQI) and depressive symptoms (BDI) after 6 months.

Improving psoriasis treatment may also enhance mental health and quality of life.

Emerging evidence suggests that combining IF and KD may offer synergistic metabolic effects.

Practitioners may explore the combination of IF and KD for enhanced metabolic benefits in patients.

The study utilized a multivariable Cox proportional hazards model to analyze the relationship between lifestyle habits and health outcomes.

Understanding the methodology can help practitioners evaluate the reliability of the findings.

72.2% of patients achieved ≥ 20% total weight loss (TWL) by week 52 on liraglutide.

Practitioners can expect a significant proportion of patients to achieve substantial weight loss with liraglutide.

Patients achieved a calorie deficit of 651 kcal/day while on liraglutide.

Practitioners should encourage calorie tracking to support weight loss efforts in patients using liraglutide.

Protein supplementation improves endurance performance and muscle strength compared to placebo, but these benefits are likely attributable to unmatched energy intake rather than protein itself.

If you are an athlete, protein supplements may help performance, but likely only because they add calories. If you already meet your energy needs, adding protein powder on top of it may not offer extra performance gains compared to a placebo with the same calories. Focus on total energy intake first.

Long-term adherence to low-carbohydrate diets, regardless of carbohydrate quality, is associated with a greater annual increase in waist circumference compared to higher-carbohydrate diets.

Be aware that long-term low-carbohydrate diets may be associated with increased waist circumference, even if other cardiometabolic markers improve. Monitor your waist circumference and consider adjusting your diet if you notice an increase.

Higher levels of moderate and moderate-vigorous physical activity are associated with accelerated thickening rates of the ganglion cell-inner plexiform layer (GCIPL) and macular thickness (MT) across the full course of diabetic retinopathy, suggesting a neuroprotective structural benefit.

Regular exercise helps preserve the physical structure of your retina. Studies show that higher activity levels are linked to better maintenance of retinal layer thickness, which is crucial for preventing vision loss in diabetes. This structural benefit works alongside the risk reduction from morning exercise timing.

Body Mass Index (BMI) partially mediates the protective effect of physical activity on diabetic retinopathy, accounting for 35.7% to 58.7% of the total benefit, indicating that weight loss is a significant but not exclusive mechanism.

Exercise protects your eyes through two main paths: helping you lose weight (which accounts for about half the benefit) and improving your metabolism directly (the other half). Even if you struggle to lose weight, staying active still provides significant protection against diabetic eye disease through improved blood sugar and reduced inflammation.

Bariatric surgery is an effective and durable weight-loss intervention that reduces major adverse liver outcomes (MALO) and cardiovascular events in patients with MASH, though data in advanced cirrhosis is limited.

Bariatric surgery offers significant long-term benefits for liver and heart health in MASH patients. It should be considered for eligible patients, especially when other treatments fail, despite limited data in advanced cirrhosis.

Low-carbohydrate diets lead to significant short-term reductions in body weight, BMI, and waist circumference in overweight/obese T2DM patients, but these advantages may attenuate over the long term (6-24 months) compared to balanced low-calorie diets.

You can expect to lose weight, BMI, and waist circumference quickly in the first few months on a low-carb diet. However, do not be discouraged if your weight loss slows down after 6 months; studies show that over the long term, your results will likely be similar to those of any balanced, calorie-controlled diet. The key is sustainability and adherence rather than expecting indefinite rapid loss.

SGLT2 inhibitors reduce body weight and blood pressure, contributing to their overall benefit in CRM syndrome.

SGLT2 inhibitors typically lead to a modest weight loss of 1.5-3 kg over 1-2 years, which is a beneficial side effect for managing metabolic syndrome.

Skeletal muscle loss during pharmacologically induced weight loss is clinically significant because excessive SMM loss reduces resting energy expenditure (REE), making weight maintenance more difficult.

To maintain weight loss, preserving muscle is critical because muscle burns calories at rest. If you lose too much muscle, your metabolism slows down, making it harder to stay lean. Ensure your weight loss plan includes adequate protein and resistance training to protect muscle mass.

Dietary capsinoids (9 mg/day) increase resting energy expenditure and brown adipose tissue density in healthy and overweight middle-aged adults.

Take 9 mg of capsinoids daily. This simple supplement has been shown in human trials to increase your resting energy expenditure and increase the amount of active brown fat, even in overweight individuals. It is a low-effort way to slightly boost your metabolic rate.

Caffeine (375 mg capsule or equivalent from coffee/tea) increases energy expenditure and brown adipose tissue activity in physically active humans.

Consume 375 mg of caffeine (or equivalent from coffee/tea) 30 minutes before activity. This has been shown to increase energy expenditure and activate brown fat, particularly in physically active men. It is a practical way to leverage a common substance for metabolic benefit.

Dietary weight loss interventions result in a consistent percentage of lean mass loss (approximately 29-30%) regardless of the total magnitude of weight lost, provided the loss exceeds 5% of baseline body weight.

If you lose weight through diet, expect to lose about 30% of that weight as lean mass, regardless of whether you lose 5% or 15% of your body weight. This is a consistent biological response to caloric restriction, not a failure of your diet. To mitigate this, incorporate resistance training, as the paper notes this is a benchmark for 'dietary modifications' without medication.

Total daily energy expenditure (TDEE) declines significantly with age in both males and females, primarily driven by reductions in fat-free mass and increases in fat mass, with the most substantial drop occurring during the transition from middle age to older adulthood.

Your daily calorie needs drop as you age, especially after 55. This isn't just 'hormones'; it's largely because you lose muscle (fat-free mass) and gain fat. To maintain your weight, you must adjust your caloric intake or increase activity to match this lower expenditure. Focus on preserving muscle mass through resistance training to keep your metabolic rate higher.

Females have a higher percentage of body fat and fat mass, and lower fat-free mass compared to males across all age groups, but the trajectory of body composition change with age is similar between sexes.

Women naturally carry more fat and less muscle than men, which lowers their baseline calorie needs. However, as you age, your body composition changes (losing muscle, gaining fat) in a pattern very similar to men. Focus on strength training to preserve muscle mass; this is the most effective way to counteract the age-related drop in energy expenditure for both sexes.

Orlistat is an affordable option with lower effectiveness, making it a practical alternative in resource-limited settings.

Orlistat (120 mg three times daily) is an affordable option for weight loss, but it has lower effectiveness compared to newer drugs like Semaglutide, making it a practical choice primarily in resource-limited settings.

Bariatric surgery results in greater weight loss and improvement in cardiac troponins compared to intensive lifestyle intervention alone in patients with severe obesity.

For severe obesity, bariatric surgery is more effective than lifestyle changes alone for weight loss and improving heart health markers like cardiac troponins. It is considered when other treatments fail.