Browse the evidence

Long-term semaglutide treatment (0.5–2 mg weekly) induces significant weight loss (up to 14.4%) and appetite suppression in Prader-Willi syndrome (PWS) patients without diabetes, though efficacy is variable and weight regain occurs upon discontinuation.

For PWS patients, semaglutide (0.5-2mg weekly) is a viable option for weight loss and appetite control, even after bariatric surgery. However, results vary, and stopping the drug leads to weight regain. It should be used as a long-term maintenance therapy alongside strict dietary controls, not as a one-time fix.

Short-term intensive insulin therapy improves beta-cell function and insulin sensitivity, increasing the likelihood of achieving type 2 diabetes remission compared to oral hypoglycemic agents alone.

For early-stage Type 2 Diabetes, short-term intensive insulin therapy can help restore your pancreas's ability to produce insulin. This approach is more effective for achieving remission than oral medications alone, though it requires strict adherence and monitoring during the intensive phase.

Once-weekly subcutaneous retatrutide significantly reduces body weight, BMI, and waist circumference in patients with overweight, obesity, and/or type 2 diabetes compared to placebo.

If you have obesity or type 2 diabetes, once-weekly retatrutide injections can lead to significant weight loss (averaging over 10 kg in these studies) and improved blood sugar control compared to no treatment. Be prepared for potential nausea or vomiting, which are common but usually not severe. The benefits are substantial, but the treatment requires adherence to a weekly injection schedule and dose escalation.

Retatrutide significantly improves glycemic control, including reductions in HbA1c, fasting glucose, and daily mean blood glucose, in patients with obesity and/or type 2 diabetes.

For those with type 2 diabetes or obesity, retatrutide helps lower blood sugar levels (HbA1c, fasting glucose) effectively. This is achieved through weekly injections that mimic natural hormones to regulate glucose. The benefit is particularly pronounced for those who already have diabetes.

Liraglutide is the only other anti-obesity medication that does not significantly differ in efficacy from phentermine for achieving ≥5% weight loss over 6 months.

Liraglutide (up to 3mg daily) is a viable alternative to phentermine for weight loss, showing similar efficacy in achieving 5% weight loss over 6 months when combined with lifestyle changes.

Naltrexone/bupropion, lorcaserin, and orlistat are significantly less effective than phentermine for achieving ≥5% weight loss over 6 months.

Naltrexone/bupropion, lorcaserin, and orlistat are less likely to produce significant weight loss (≥5%) compared to phentermine over 6 months when combined with lifestyle changes.

Completion of a 24-week milk-based low-energy liquid diet (LELD) in adults with severe obesity significantly reduces the leptin-to-adiponectin ratio (LAR), indicating decreased insulin resistance, with the magnitude of LAR reduction being proportional to the percentage of weight lost.

If you have severe obesity, a structured, low-calorie milk-based diet for 24 weeks can significantly improve your metabolic health markers, specifically by lowering the ratio of leptin to adiponectin, which indicates better insulin sensitivity. This improvement is directly tied to how much weight you lose. However, be aware that adherence is difficult, with high dropout rates, and long-term weight maintenance is not guaranteed, so this intervention should be viewed as a powerful metabolic reset rather than a permanent lifestyle solution.

The same 12-week program significantly improves metabolic health markers, including insulin resistance (HOMA index), lipid profiles (triglycerides, VLDL), and inflammatory markers (CRP, PINI), independent of the magnitude of weight loss.

Obesity management should target metabolic health, not just weight. This program improves insulin sensitivity, lowers bad fats (triglycerides/VLDL), and reduces inflammation, which are key risk factors for cardiovascular disease and diabetes.

Time-restricted eating (TRE) improves metabolic markers (insulin sensitivity, blood pressure) and aids weight loss, but its long-term efficacy is not yet fully established.

Try eating within an 8-hour window each day (e.g., 12 PM to 8 PM). This may improve your blood pressure and insulin sensitivity. Be cautious if you have diabetes or are pregnant. Adjust the window to fit your social life.

An 8-week stress management program comprising diaphragmatic breathing, progressive muscle relaxation, and guided visualization significantly enhances weight loss (BMI reduction) and improves mental health outcomes in adults with obesity compared to standard lifestyle instructions alone.

If you are struggling with obesity, adding a structured stress management routine to your standard diet and exercise plan may yield better weight loss results than diet and exercise alone. The study used an 8-week program involving breathing exercises, muscle relaxation, and visualization, practiced weekly with home reinforcement. This approach targets the hormonal and behavioral links between stress and weight gain, such as cortisol-driven abdominal fat storage and emotional eating.

Patients taking GLP-1 receptor agonists or dual GIP/GLP-1 agonists should continue these medications through the peri-operative period rather than withholding them, as evidence suggests withholding is insufficient to reduce aspiration risk.

If you take a GLP-1 or GIP/GLP-1 drug (like Ozempic, Wegovy, Mounjaro, Trulicity) for your upcoming elective surgery, do NOT stop taking it. Stopping it for a week or even three weeks does not guarantee your stomach is empty and may not reduce aspiration risk. Instead, tell your anesthesia team you are taking it so they can use specific techniques (like ultrasound or specific intubation methods) to keep you safe.

Patients taking SGLT2 inhibitors should omit these medications the day before and the day of surgery to prevent euglycemic diabetic ketoacidosis (DKA).

If you take an SGLT2 inhibitor (like Jardiance, Farxiga, or Invokana) for your upcoming elective surgery, stop taking it the day before your surgery and do not take it on the day of surgery. This is critical to prevent a rare but serious condition called euglycemic DKA. Your medical team will monitor your blood sugar closely during your stay and manage it with insulin if necessary, which is the safest approach.

A reduction in the FibroScan-aspartate aminotransferase (FAST) score of at least 0.22 points after 72 weeks of semaglutide treatment is associated with achieving the primary histological endpoint of NASH resolution without worsening of fibrosis.

If you are being treated for NASH with semaglutide, a reduction in your FAST score of 0.22 points or more after 72 weeks is a strong indicator that your liver is improving histologically (NASH resolution without worsening fibrosis). This non-invasive metric may help doctors monitor your progress without requiring repeated liver biopsies, although further validation is needed.

Preoperative administration of GLP-1 receptor agonists (OMMs) serves as an effective bridging therapy for super-obese patients, facilitating technical operability and reducing perioperative complications compared to non-pharmacological methods.

If you are waiting for bariatric surgery and have a very high BMI, ask your doctor about using GLP-1 medications (like liraglutide) beforehand. This can help you lose weight faster and reduce surgical risks, potentially making you eligible for surgery sooner than if you waited without medication.

Exercise stimulates the release of 'exerkines' (signaling molecules like IL-6, 12,13-diHOME, and musclin) that mediate systemic health benefits, including improved cardiac function and metabolic flexibility.

Engaging in regular exercise triggers the release of beneficial signaling molecules (exerkines) from your muscles, fat, and liver that protect your heart and metabolism. You don't need to manage these molecules directly; consistent physical activity is the key to activating them.

Integrating passive stretch into the inter-set rest period of resistance training enhances muscle hypertrophy compared to standard passive rest, particularly in type I muscle fibers, without compromising strength gains.

To potentially maximize muscle growth without extending your workout time, hold a passive stretch for 20-30 seconds immediately after your last rep of each set, during your rest period. Aim for a discomfort level of 8 out of 10. This strategy appears most beneficial for slower-twitch (Type I) muscle fibers and does not appear to negatively impact long-term strength gains.

GLP-1 receptor agonists (GLP-1RAs) induce weight loss and improve metabolic function in patients with hypothalamic obesity (HO), with efficacy potentially independent of the extent of hypothalamic damage.

If you have hypothalamic obesity, standard diets and exercise often fail because the brain's 'thermostat' is broken. GLP-1 medications (like semaglutide or liraglutide) work by targeting brain areas outside the damaged hypothalamus to signal fullness. While results vary, many patients experience significant weight loss and metabolic improvement, especially if the medication is started at a low dose and increased slowly to manage side effects.

GLP-1 receptor agonists accelerate preoperative weight loss in obese patients undergoing elective hernia repair, significantly reducing time to surgery compared to lifestyle modifications alone, without increasing postoperative complication rates.

If you are obese and need hernia surgery, using GLP-1 medications (like semaglutide) alongside diet and exercise can help you reach your weight loss goal much faster than diet and exercise alone. This means you can get your surgery sooner without increasing your risk of complications. Talk to your surgeon about whether this is an option for you, keeping in mind that insurance coverage and cost may be barriers.

Targeting the Ghrelin Receptor (GHSR1a) with inverse agonists or antagonists like LEAP2 reduces food intake and postprandial glucose, offering a potential treatment for type-2 diabetes and obesity.

A new approach to blocking hunger involves a natural peptide called LEAP2. In a small study, giving LEAP2 intravenously reduced how much people ate and lowered their blood sugar after meals. This suggests it might help people with type-2 diabetes or obesity, but more research is needed to see if these benefits last long-term.

Time-restricted eating (TRE), specifically early TRE, can improve cardiometabolic markers such as blood pressure and glucose control even in the absence of weight loss (eucaloric conditions).

If you have prediabetes, try eating within an early window (e.g., 8 am to 4 pm) without changing your total calories. You might see improvements in blood pressure and blood sugar control even if your weight stays the same.

Tirzepatide significantly reduces HbA1c and body weight in adults with Type 1 Diabetes (T1D) without increasing the risk of diabetic ketoacidosis (DKA) or time below range.

If you have Type 1 Diabetes and struggle with weight or high blood sugar despite insulin, ask your doctor about tirzepatide. This study shows it can lower your A1c and help you lose significant weight (over 10% in some cases) without increasing the risk of dangerous ketones or low blood sugar, provided it is managed carefully by a specialist.

Newer emerging anti-obesity medications, specifically GLP-1/GIP/Glucagon receptor agonists (e.g., tirzepatide, retatrutide), demonstrate superior weight loss efficacy compared to older single-mechanism drugs.

Newer drugs like tirzepatide (Mounjaro/Mounjaro) can lead to nearly 21% weight loss in some patients, significantly higher than older drugs. These require weekly injections and are more expensive. Discuss with your doctor if the higher efficacy justifies the cost and injection burden for your specific health goals.

A ketogenic diet (KD) improves insulin sensitivity and reduces insulin requirements in patients with type 2 diabetes and obesity by lowering glycemic response and reducing pancreatic insulin secretion.

To improve insulin sensitivity, restrict carbohydrates to under 50g per day while maintaining high fat intake (approx 75% of calories) and moderate protein (1-1.4g/kg). Expect initial side effects like fatigue or 'keto flu' due to electrolyte shifts, which typically resolve as your body adapts.

GLP-1 receptor agonists (semaglutide, tirzepatide) and bariatric surgery (RYGB) extend the duration of weight loss prior to plateau by weakening the physiological appetite feedback control circuit, whereas diet restriction fails to weaken this circuit and thus plateaus within ~12 months.

If you are using GLP-1s or had surgery, your prolonged weight loss is due to a physiological change in how your body regulates appetite, not just willpower. Dieting alone triggers a strong appetite feedback loop that causes early plateaus; these interventions bypass that loop.