Browse the evidence

Tirzepatide treatment (5-15 mg weekly) significantly reduces serum uric acid (SUA) levels in adults with obesity or overweight, with weight reduction explaining 72.7% of this effect.

If you have obesity or overweight and are concerned about gout or high uric acid, tirzepatide (a once-weekly injection) can significantly lower your uric acid levels. Most of this benefit comes from the weight loss it causes, but it may also have direct effects. This makes it a potentially useful tool for managing gout risk in people with obesity, in addition to helping with weight loss.

Ramadan fasting significantly impairs anaerobic power (Wingate peak and mean power) and upper-body strength (bench press), but does not significantly affect lower-body maximal strength (leg press), explosive power (countermovement jump), or isometric strength (handgrip).

During prolonged fasting, expect a drop in your ability to perform high-intensity, short-duration efforts (like sprints or heavy upper-body lifts). Your leg strength and vertical jump may remain stable, but prioritize recovery and nutrition strategies for anaerobic tasks.

Exercise therapy reduces AHI and improves daytime sleepiness in OSA patients, often independently of significant weight loss, through mechanisms such as reduced leg fluid shift and improved upper airway neuromuscular control.

Incorporate 150 minutes of moderate aerobic exercise (like brisk walking) and resistance training twice a week into your routine. This can reduce the severity of your sleep apnea and improve daytime sleepiness, even if you don't lose a lot of weight. The benefits come from improved airway muscle control and reduced fluid shifts in your neck.

Modest weight loss (5%) in Type 2 Diabetes improves cardiovascular risk factors (lipids, glucose) but evidence for reducing actual cardiovascular mortality or events is mixed and inconclusive.

Losing 5% of your body weight if you are overweight with Type 2 Diabetes is highly recommended to improve your blood sugar, cholesterol, and overall heart health profile. However, do not assume this single change will eliminate your risk of heart attack or stroke; it works best when combined with blood pressure and glucose management.

Caloric restriction interventions produce significant short-term weight loss but are associated with significant weight regain and increased hunger/appetite over the long term (12+ months).

If you use calorie counting, expect your hunger to increase as you lose weight. This is a biological defense mechanism, not a lack of willpower. To avoid the 'yo-yo' effect, prioritize moderate deficits (e.g., 1300-1500 kcal) over extreme ones, and focus on high-satiety foods. Long-term success requires a plan that manages hunger, not just a number on a scale.

Ketogenic diets produce greater short-term weight loss compared to control diets when caloric intake is not restricted (ad libitum), but this advantage disappears when calories are matched, resulting in weight loss similar to control diets.

If you choose a ketogenic diet, expect faster initial weight loss likely due to reduced calorie intake, not magic. If you match your calories to a standard diet, you will lose weight at the same rate. Focus on maintaining a caloric deficit regardless of macronutrient ratio.

Moderate breakfast energy intake is associated with a reduced risk of major cardiovascular events and stroke, regardless of whether breakfast is skipped.

Eating a moderate amount of calories at breakfast is associated with lower heart disease and stroke risk. It is not just about eating breakfast, but about how much you eat.

Bariatric surgery is the most effective, sustainable, and generally safe therapy for severe obesity (BMI ≥ 35 kg/m²) when lifestyle and pharmacological treatments have failed.

For severe obesity (BMI ≥ 35) where lifestyle and drug treatments have failed, bariatric surgery is the most effective and sustainable option. It is indicated for BMI > 30 with type 2 diabetes. Risks must be carefully weighed against benefits, and lifelong follow-up is required.

Bariatric surgery (Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass) provides effective and sustainable weight loss, with Roux-en-Y showing greater long-term excess weight loss but higher morbidity.

If you have severe obesity (BMI >40 or >35 with health issues), surgery is a highly effective option. Gastric Bypass leads to more weight loss than Sleeve Gastrectomy but has higher risks. Discuss the trade-offs with your surgeon.

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.

Greater adherence to the Healthy Eating Index 2015 (HEI-2015) is associated with a 19% lower risk of total mortality (HR 0.81).

Encouraging adherence to the HEI-2015 may help reduce mortality risk in the population studied.

Adherence to the Alternate Mediterranean Diet (AMED) score is associated with a 18% lower risk of total mortality (HR 0.82).

Promoting adherence to the AMED may contribute to lower mortality risk.

All dietary scores examined were significantly inversely associated with death from cardiovascular disease, cancer, and respiratory disease.

Encouraging healthy eating patterns may reduce the risk of major diseases.

Modifiable risk factors collectively contribute to 59% of the population-attributable fraction (PAF) for CVD and 56% for death in China.

Addressing modifiable risk factors could significantly reduce CVD and mortality rates.

The modifiable risk factors studied contributed to approximately 64% of the population attributable fraction (PAF) for CVD and 69% of the PAF for death.

Addressing these modifiable risk factors could significantly reduce CVD and mortality rates.

Men have a higher incidence of CVD and mortality rates compared to women.

Gender-specific strategies may be needed to address higher CVD risk in men.

Approximately 72% of the population attributable fraction (PAF) for CVD and 69% of the PAF for deaths are attributable to 12 modifiable risk factors.

Addressing modifiable risk factors could significantly reduce CVD and mortality rates.

Increases in glycemic index and glycemic load were positively associated with weight gain.

Consider the glycemic index/load of carbohydrates when managing weight.

A 100 g/day increase in starch or added sugar was associated with 1.5 kg and 0.9 kg greater weight gain over four years, respectively.

Reducing starch and added sugar intake may help mitigate weight gain.

Increased carbohydrate intake from whole grains, fruit, and non-starchy vegetables was inversely associated with weight gain.

Encouraging whole grains, fruits, and non-starchy vegetables may aid in weight control.

Each 1-SD increase in TLCD score was associated with 0.06 kg more weight gain over 4 years.

Practitioners should consider the impact of total carbohydrate intake on weight management.