Browse the evidence

The paper developed the first consensual definition of functional training using an international e-Delphi method.

Practitioners can refer to this consensual definition for clarity in functional training.

A proposal was made to avoid the distinction between functional training and the general concept of training.

Practitioners should consider this proposal when defining and applying functional training.

Resting energy expenditure (REE) is primarily determined by the mass and specific metabolic rates of organs and tissues, with fat-free mass (FFM) explaining the majority of variance in REE.

Your resting metabolic rate is largely dictated by your body composition, specifically your fat-free mass (muscle, organs, bone). Maintaining muscle mass is key to preserving metabolic rate.

Obesity is fundamentally a chronic metabolic disease characterized by disturbances in energy homeostasis and excessive fat accumulation, driven by a complex interplay of genetic, epigenetic, biological, psychological, and environmental factors.

Understand that obesity is a complex chronic disease, not a moral failing. Effective management requires addressing biological, genetic, and environmental factors, often necessitating medical interventions alongside lifestyle changes.

Energy expenditure can be increased through specific physiological mechanisms independent of physical activity, including UCP1-dependent thermogenesis in brown/beige fat, futile cycling of substrates (creatine, glucose, lipids), and ion pumping (Na+/K+-ATPase, SERCA).

Your body burns calories through several active processes beyond just moving around. These include generating heat in fat tissue (thermogenesis), running 'futile' metabolic cycles that burn energy as heat, and maintaining electrical gradients in cells. While you can't easily control these directly, understanding them helps explain why some medications work better than others. Future treatments may target these specific pathways to help you burn more calories passively.

Body weight regulation is not governed by a single fixed set-point, but rather by a dynamic equilibrium where energy expenditure passively adjusts to match intake, creating a 'zone of indifference' bounded by upper and lower intervention points.

Do not assume your body has a rigid 'set point' that fights against you. Your weight settles at a level where your energy expenditure matches your intake. If your environment changes (e.g., more food, less activity), your weight will drift until your expenditure rises to match the new intake. Understanding this passive feedback helps explain why small, sustained environmental changes lead to gradual weight gain over years.

Intermittent energy restriction (IER) diets (time-restricted eating, alternate-day fasting, and 5:2 diet) do not produce superior improvements in body weight, fat mass, or cardiometabolic risk markers compared to continuous energy restriction (CER) when total energy intake is matched.

If your goal is weight loss or better metabolic health, you do not need to adopt a complex intermittent fasting schedule. A standard daily calorie restriction diet is equally effective. Focus on maintaining a consistent caloric deficit rather than restricting your eating window, unless you personally prefer the structure of fasting.

Chronic treatment with GDF15 promotes greater weight loss and reduces NAFLD compared to caloric restriction alone by maintaining energy expenditure and preventing adaptive thermogenesis in skeletal muscle.

This research suggests that GDF15 therapy could help overcome the metabolic slowdown (adaptive thermogenesis) that typically halts weight loss during dieting. By maintaining energy expenditure, particularly through fatty acid oxidation in muscle, GDF15 allows for greater fat loss than dieting alone. This is relevant for individuals who hit weight loss plateaus despite strict caloric restriction.

GDF15 maintains energy expenditure and promotes weight loss through a GFRAL-dependent signaling axis that activates beta-adrenergic receptors in skeletal muscle, increasing fatty acid oxidation and calcium futile cycling.

The weight loss benefits of GDF15 rely on a specific biological pathway involving the GFRAL receptor and beta-adrenergic signaling in muscles. If this pathway is blocked or missing, the energy expenditure benefits are lost.

Bariatric/metabolic surgery (BMS) is the most effective strategy for significant and sustained body weight reduction (14-25%) and reduces the risk of hypertension, diabetes, and mortality, but remains underused.

For extreme obesity (BMI ≥ 40 or ≥ 35 with comorbidities), bariatric surgery is the most effective treatment, producing 14-25% weight loss and significantly reducing the risk of heart disease, diabetes, and death. Despite its effectiveness, it is underused. If lifestyle and medication fail, discuss surgery with your doctor as a viable, life-saving option.

Bariatric surgery is currently the most effective treatment for obesity in terms of mortality reduction and comorbidity resolution, but it is restricted to higher BMI classes and not suitable for all patients.

Bariatric surgery is the most effective treatment for obesity, significantly reducing mortality and type 2 diabetes risk, but it is generally reserved for patients with Class II or III obesity (BMI ≥ 35 or ≥ 40) and is not suitable for everyone due to surgical risks and access issues.

Metabolic and bariatric surgery (MBS) is the most effective treatment for obesity and type 2 diabetes, producing superior long-term weight loss and remission rates compared to lifestyle or pharmacologic interventions.

If you have severe obesity or type 2 diabetes, consider metabolic surgery. It is the most effective treatment for long-term weight loss and diabetes remission, far surpassing lifestyle changes or medications alone.

The prevalence of obesity among primary care patients increased from 39.2% in 2017 to 40.7% in 2019.

Healthcare providers should be aware of the rising obesity rates among their patients.

Nonalcoholic fatty liver disease (NAFLD) affects more than 25% of adults worldwide.

Healthcare providers should be aware of the high prevalence of NAFLD in adult populations.

The majority of patients with NAFLD are unaware of their condition.

Awareness and screening for NAFLD should be prioritized in clinical practice.

There is no consensus definition of sarcopenia despite its evolving criteria.

Practitioners should be aware of the lack of consensus in defining sarcopenia when diagnosing and treating patients.

Overall relative search volume (RSV) for 'Ozempic' grew exponentially in the United States between March 2018 and February 2023.

Practitioners should be aware of the increasing public interest in Ozempic for weight loss.

Statistically significant differences in search popularity were found between 'Ozempic', 'Wegovy', and 'Mounjaro' from December 2021 to February 2023.

Surgeons should consider the varying popularity of these medications in their practice.

In 2018, the mean global intake per person of unprocessed red meat was 51 g/day, with 17 countries having mean intakes of at least one serving (100 g) per day.

Practitioners should be aware of the significant global consumption of unprocessed red meat and target interventions accordingly.

Between 1990 and 2018, global intakes of unprocessed red meat, eggs, milk, processed meat, seafood, and cheese increased.

This trend indicates a growing consumption of certain animal-source foods, which may have implications for public health and nutrition policies.

There is a need for the development of highly efficacious and safe new agents for obesity treatment.

Healthcare providers should advocate for and support the development of new obesity treatments.

Substituting water for SSBs was not associated with any outcome.

Practitioners should note that water substitution does not yield measurable benefits in this context.

There are significant research disparities in the data available on Asian American adults in risk prediction models, national surveillance surveys, and clinical trials.

More inclusive research efforts are needed to address health disparities in Asian American populations.

Significant disproportionality was detected for semaglutide-associated suicidal ideation (ROR, 1.45; 95% CI, 1.18-1.77; IC, 0.53; 95% CI, 0.19-0.78).

Clinicians should be aware of the potential risk of suicidal ideation in patients treated with semaglutide.