Browse the evidence

Incretin receptor agonists (GLP-1RA, dual/triple agonists) and SGLT2 inhibitors reduce the risk of progression to type 2 diabetes and improve cardiovascular outcomes in patients with prediabetes, primarily through weight loss and reduction of visceral ectopic fat.

If you have prediabetes along with obesity, heart failure, or kidney disease, your doctor may consider newer medications like GLP-1 agonists (e.g., semaglutide) or SGLT2 inhibitors. These drugs help with weight loss and reduce cardiovascular risk. They are not yet first-line for all prediabetes patients due to cost and lack of formal indications, but they can be very effective for high-risk individuals.

Intensive lifestyle interventions (ILIs) targeting fat reduction (specifically visceral and body fat mass) significantly improve complete remission rates in overweight patients undergoing fertility-sparing treatment for endometrial cancer and intraepithelial neoplasia.

For overweight patients undergoing fertility-sparing treatment for endometrial precancer, intensive lifestyle changes focusing on fat loss (not just scale weight) significantly improve remission rates. This involves a caloric deficit, daily moderate aerobic exercise, and resistance training to protect muscle mass. Aim for a modest ~3% weight loss, as excessive loss may reduce efficacy by depleting muscle.

Fluid ingestion during high-intensity cycling in the heat prevents performance impairment caused by low-level dehydration (<2% body mass loss), primarily by reducing ratings of perceived exertion (RPE) and plasma vasopressin (ADH) rather than by altering core temperature or plasma volume.

If you are cycling hard (near race pace) in the heat, do not wait until you are thirsty or feel dehydrated. Even a small loss of body weight (under 2%) will increase how hard the exercise feels (RPE) and cut your performance short. Drink a sodium-containing solution (20 mmol/l) in small, frequent amounts (e.g., 120ml every 10 minutes) during your warm-up or moderate-intensity phase to ensure you have fluid available for the high-intensity finish. This prevents the mental and hormonal strain of dehydration, allowing you to sustain power longer.

Treatment-resistant type 2 diabetes, defined as failure to achieve HbA1c targets despite triple oral therapy (metformin, sulfonylurea, and a third agent), can be effectively managed by adding a DPP-4 inhibitor and an SGLT2 inhibitor to metformin, or by combining basal insulin with a GLP-1 receptor agonist or SGLT2 inhibitor.

If your blood sugar remains high despite taking three oral diabetes medications (metformin, a sulfonylurea, and another), ask your doctor about adding a DPP-4 inhibitor and an SGLT2 inhibitor. These oral drugs work together to lower blood sugar effectively. If you are already on insulin, adding a GLP-1 receptor agonist or an SGLT2 inhibitor can improve control, reduce insulin dosage, and help with weight loss without increasing hypoglycemia risk.

Low-carbohydrate diets can induce remission of type 2 diabetes, with clinical trials showing >50% remission rates in some studies.

If you have type 2 diabetes, a ketogenic diet (20-50g carbs/day) can potentially lead to remission. Work with your doctor to monitor blood sugar and adjust medications, as many patients reduce or stop medications within weeks.

Obesity causes secondary hormonal changes (elevated TSH, insulin/leptin resistance) that mimic hypothyroidism; weight loss alone can normalize these hormone levels without thyroid medication.

If you are obese and have slightly high TSH, it might be because of your weight, not a broken thyroid. Losing weight can often fix these hormone levels without medication. Ask your doctor if your thyroid issue is 'secondary' to obesity.

GLP-1 receptor agonists (e.g., tirzepatide) and bariatric surgery are highly effective for weight loss in patients with thyroid disease and should be considered when behavioral therapy fails, as they do not increase thyroid cancer risk in non-MTC patients.

If diet and exercise aren't enough, GLP-1 drugs or surgery are safe and effective options even if you have thyroid disease (unless you have a specific family history of thyroid cancer). These treatments cause significant weight loss (5-20%+) and improve cardiovascular health.

Once-weekly subcutaneous semaglutide 2.4 mg significantly reduces ad libitum energy intake, suppresses appetite, and improves control of eating in adults with obesity, leading to clinically meaningful weight loss, without evidence of delayed gastric emptying at steady state.

Take 2.4 mg of subcutaneous semaglutide once weekly. Start with the lowest dose (0.25 mg) and escalate every 4 weeks as directed to minimize side effects. Expect a significant reduction in hunger, food cravings, and overall calorie intake, leading to weight loss without needing to manually restrict calories.

Once-weekly semaglutide 2.4 mg significantly improves control of eating (specifically craving control and craving for savory foods) and sustains these improvements over 104 weeks, facilitating substantial weight loss in adults with overweight or obesity.

If you struggle with food cravings and hunger, especially when trying to lose weight, semaglutide 2.4 mg can help. It improves your ability to control what and how much you eat, particularly cravings for savory foods, and this effect lasts for at least two years. This helps you lose more weight and keep it off compared to lifestyle changes alone.

Semaglutide (GLP-1 receptor agonist) significantly reduces body weight, BMI, and waist circumference in overweight or obese adults, with or without type 2 diabetes, compared to placebo or other glucose-lowering medications.

If you are overweight or obese (BMI ≥24), semaglutide is a highly effective medical intervention for weight loss, working for both diabetic and non-diabetic individuals. It significantly reduces body weight, BMI, and waist circumference compared to placebo. While it can cause gastrointestinal side effects like nausea, serious adverse events are not more common than with a placebo. Be aware that stopping the medication may lead to weight regain, so long-term management and lifestyle changes are crucial.

Semaglutide increases the proportion of patients achieving significant weight loss thresholds (>5%, >10%, >15%, and >20%) compared to control groups.

Semaglutide significantly increases the likelihood of achieving major weight loss milestones (5%, 10%, 15%, 20%) compared to placebo or other treatments.

Cagrilintide-Semaglutide (CagriSema) produces superior weight loss and metabolic improvements compared to monotherapies and placebo in adults with overweight or obesity, with or without type 2 diabetes.

CagriSema is a potent, non-surgical weight loss option that significantly outperforms current GLP-1 monotherapies. It requires weekly (implied) injections and lifestyle changes. Expect transient GI side effects that usually subside. It is suitable for those with BMI ≥30 (or ≥27 with comorbidities), including those with T2D.

Increased dietary fiber intake increases postmeal satiety and decreases subsequent hunger, regardless of whether the fiber is soluble or insoluble, or derived from food or supplements.

To feel fuller and eat less, increase your fiber intake. It does not matter if you choose soluble (e.g., oats, fruits) or insoluble (e.g., whole grains) fiber, or if you get it from food or supplements; all forms tend to increase satiety and reduce hunger.

Exercise improves cardiovascular risk factors (blood pressure, lipids, glucose) in overweight/obese individuals, even in the absence of significant weight loss.

Even if you do not lose weight, regular exercise will lower your blood pressure, improve your cholesterol profile (specifically increasing HDL and lowering triglycerides), and improve your fasting blood glucose. These are independent benefits of exercise.

Pharmacotherapy (sibutramine, orlistat) is effective for weight loss only when used in combination with lifestyle modifications (diet and exercise).

If you meet the medical criteria (BMI >=30 or >=27 with comorbidities), medications like sibutramine or orlistat can help. However, they are not magic bullets. They work best when you also make changes to your diet and exercise habits. Consult a physician to determine if pharmacotherapy is appropriate for you.

Behavioral interventions, orlistat, and metformin all reduce diabetes incidence in patients with prediabetes or elevated risk, with behavioral interventions cutting incidence by about 50% or more over 2-3 years.

If you have prediabetes, behavioral weight loss programs can cut your risk of developing type 2 diabetes by half or more over 2-3 years. Orlistat and metformin also reduce risk, but behavioral interventions are the most robustly supported for this outcome.

A high-carbohydrate, low-glycemic index (GI) diet optimizes both body fat loss and cardiovascular risk reduction (specifically LDL cholesterol) compared to high-protein or high-GI diets in overweight young adults.

To maximize fat loss and improve your cholesterol, focus on high-carbohydrate foods that have a low glycemic index (like legumes, whole grains, and non-starchy vegetables) rather than just cutting carbs or increasing protein. This approach helps manage blood sugar and insulin, which drives fat storage, while simultaneously lowering LDL cholesterol.

Lowering the Glycemic Index (GI) of a high-carbohydrate diet doubles fat loss in women compared to a high-GI high-carbohydrate diet, without compromising lean mass.

If you prefer eating carbohydrates, choose low-GI options like legumes, whole grains, and non-starchy vegetables. This strategy can double your fat loss compared to eating high-GI carbohydrates, while preserving your muscle mass.

VLCDs improve specific medical comorbidities (diabetes, hypertension, hyperlipidemia) more rapidly than LCDs, with some metabolic benefits (e.g., glycemic control in Type II diabetes) persisting even after weight regain.

If you have Type II diabetes or high blood pressure, a VLCD can improve your health markers faster than a standard diet. Crucially, some of these benefits (like better blood sugar control) may last even if you regain some weight, likely due to improved insulin function.

Intermittent fasting significantly reduces BMI and improves glucose metabolism (fasting glucose and HOMA-IR) compared to non-fasting controls in adults without diabetes.

If you are an adult without diabetes, trying intermittent fasting (like time-restricted feeding or alternate-day fasting) for at least 4 weeks can help lower your BMI and improve how your body handles blood sugar, even if you don't lose a massive amount of weight. It may be easier to stick to than daily calorie restriction.

Pramlintide (120 mcg t.i.d. or 360 mcg b.i.d.) combined with lifestyle intervention produces greater initial weight loss and enhances long-term maintenance of that weight loss over 12 months compared to lifestyle intervention alone in obese subjects.

If you are obese and struggling to maintain weight loss, adding pramlintide (120 mcg three times daily or 360 mcg twice daily) to a structured lifestyle program (diet and exercise) can help you lose more weight initially and, crucially, keep it off for at least a year. The medication is taken as a small injection before meals. While nausea is a common side effect, it is usually mild, decreases over time, and does not prevent weight loss. This approach is for non-diabetic obese individuals without other major health exclusions.

Liraglutide 3 mg daily induces significant weight loss in adults with obesity by slowing gastric emptying of solids and increasing satiation, with greater gastric emptying delay correlating with greater weight loss.

Take liraglutide 3 mg daily as prescribed, starting with a lower dose to minimize side effects. Expect some nausea initially, as this often signals the drug is working and may lead to greater weight loss. Combine with dietary counseling for best results. The medication works by slowing digestion and making you feel full sooner, helping you eat less.

Consuming three daily servings of dairy products during energy restriction significantly augments fat loss and trunk fat loss compared to low-calcium or high-calcium (supplement) diets, while preserving lean mass.

To maximize fat loss while dieting, include three servings of dairy (milk, cheese, or yogurt) daily. This approach, combined with a moderate calorie deficit, has been shown to double fat loss compared to low-calcium diets and is superior to taking calcium supplements alone. Ensure you are consuming enough protein and maintaining your usual activity level.

High-intensity interval training (HIIT) significantly reduces body weight, total fat mass, and abdominal fat mass in premenopausal women, with cycling being more effective than running.

If you are premenopausal, HIIT (3x/week, ≥8 weeks) is a highly effective strategy for losing fat, especially abdominal fat. Cycling HIIT may be superior to running. If you are postmenopausal, HIIT alone may not significantly reduce weight or abdominal fat due to hormonal changes; you may need longer durations or combined interventions.