Browse the evidence

48 weeks of tirzepatide treatment significantly improves liver steatosis, liver enzymes, and surrogate markers of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM).

For patients with both fatty liver disease and type 2 diabetes, tirzepatide is a well-tolerated treatment that significantly reduces liver fat, improves liver enzyme levels, and slows down fibrosis markers over 48 weeks. While gastrointestinal side effects like nausea are common, they are typically mild and do not force most patients to stop the medication. The benefits extend beyond just weight loss, likely due to the specific dual-action mechanism of the drug on liver metabolism.

Lanifibranor (800-1200 mg daily) significantly improves MASH resolution and fibrosis regression in patients with noncirrhotic MASH compared to placebo.

Lanifibranor (800-1200mg daily) is a promising late-stage drug for MASH that targets multiple metabolic pathways. It significantly improves liver health scores compared to placebo, though monitor for mild weight gain and GI issues.

Saroglitazar (4 mg daily) significantly improves liver enzymes and liver fat content in patients with MASLD/MASH.

Saroglitazar (4mg daily) is approved in India for MASH. It significantly lowers liver enzymes and liver fat. It is currently in Phase 2b trials in the US and other regions.

Tirzepatide therapy significantly improves metabolic control (HbA1c, fasting glucose) and lipid profiles (LDL, HDL, triglycerides) in patients with heart failure.

If you have heart failure and are prescribed tirzepatide, you may see significant improvements in your blood sugar control and lipid profile within six months. This includes lower HbA1c, LDL cholesterol, and triglycerides, and higher HDL cholesterol. These improvements contribute to better long-term cardiovascular health. Discuss these potential benefits with your healthcare provider.

The novel long-acting glucagon analogue HM15136 causes dose-dependent fasting plasma glucose elevation and mild weight loss in overweight/obese patients, with hyperglycemia limiting tolerability at higher doses (0.06 mg/kg) in patients with Type 2 Diabetes.

HM15136 is a weekly injection that causes mild weight loss (approx 2-3%) but significantly raises blood sugar. It is not recommended for obesity treatment, especially for those with Type 2 Diabetes, due to safety concerns regarding hyperglycemia. It may be explored for chronic hypoglycemia or in combination with other drugs.

Regular physical activity reduces the incidence of type 2 diabetes by improving insulin sensitivity and glucose uptake.

To prevent or manage type 2 diabetes, aim for at least 150 minutes of moderate exercise like brisk walking or biking each week. This can reduce your risk of developing diabetes by up to 40%. Combine this with a healthy diet and a goal of losing 7% of your body weight for the best results.

Moderate (~10%) weight loss achieved through diet and exercise reduces pro-inflammatory M1-like macrophages in abdominal subcutaneous adipose tissue (SAT) in adults with adult-onset obesity (AO), but fails to alter these immune cell profiles in those with childhood-onset obesity (CO).

If you developed obesity as an adult, moderate weight loss (around 10%) through diet and exercise may help reduce inflammation in your abdominal fat. However, if you have been obese since childhood, the same level of weight loss might not change the inflammatory state of your fat tissue, even if you lose weight and improve blood markers like insulin. This suggests that long-term obesity history creates a 'memory' in fat tissue that is harder to reverse with standard lifestyle changes alone.

Moderate weight loss increases CD3+CD4+ T cells in both abdominal and femoral subcutaneous adipose tissue in adults with adult-onset obesity (AO), but not in those with childhood-onset obesity (CO).

If you developed obesity as an adult, moderate weight loss may trigger an increase in CD4+ T cells in your fat tissue, which could include regulatory T cells that help manage inflammation. If you have been obese since childhood, this specific immune shift may not occur with the same degree of weight loss. This highlights that long-term obesity history creates a 'memory' in fat tissue that is harder to reverse with standard lifestyle changes alone.

High-volume static stretching improves glycemic control (post-prandial glucose and HbA1c) in individuals with Type 2 Diabetes, potentially by increasing GLUT-4 translocation via AMPK and CaMK pathways.

If you have Type 2 Diabetes, incorporating static stretching into your routine may help lower blood sugar levels, especially after meals. It works by helping your muscles take up glucose without needing as much insulin. It is not a replacement for medication but a helpful addition.

Metformin augmentation for non-responders to initial behavioral interventions provides a potential rescue effect but is associated with gastrointestinal side effects that challenge adherence.

If behavioral changes alone don't improve your insulin sensitivity, adding metformin might help, but be prepared for potential stomach issues. Starting with a low dose and using extended-release versions can help manage side effects.

Maintaining weight loss induced by anti-obesity drugs may require lifelong use unless effective adjunct strategies for weight maintenance are available.

If you use medication for weight loss, understand that it may need to be long-term. This is similar to managing other chronic conditions. The goal of research like POWERS is to find adjunct strategies that might reduce this dependency.

GLP-1 receptor agonists (Liraglutide, Semaglutide) and dual agonists (Tirzepatide) are viable and promising options for weight loss in people living with HIV, with minimal drug-drug interaction risks compared to Orlistat.

GLP-1 agonists like Liraglutide and Semaglutide are effective and generally safe for people with HIV, with fewer drug interactions than older drugs like Orlistat. They require injections (or new oral forms in development). Discuss these options with your provider if lifestyle changes alone are insufficient.

Mazindol, an anorexiant approved in Japan for short-term weight loss, significantly reduces body weight and total cholesterol compared to placebo in Japanese adults with obesity, but is associated with higher adverse event rates.

For Japanese adults with obesity, mazindol is an approved short-term treatment that significantly reduces body weight and total cholesterol compared to placebo. It acts by suppressing appetite. Patients should be aware of higher adverse event rates and the need for short-term use.

Semaglutide treatment in patients with chronic ankle instability (CAI) significantly improves patient-reported functional outcomes (FAAM, FAOS, CAIT) and reduces the incidence of recurrent ankle sprains and surgery, with approximately one-third of the benefit mediated by weight loss.

For patients with chronic ankle instability, especially those who are overweight or have type 2 diabetes, semaglutide may offer benefits beyond metabolic control. It is associated with improved ankle function, fewer sprains, and lower surgery rates. While weight loss contributes to this, it is not the only factor. Patients should discuss this potential orthopedic benefit with their prescribing physician, particularly if they are considering surgical intervention for ankle instability.

Semaglutide use for rapid weight loss causes 'semaglutide face,' characterized by facial hollowing, skin sagging, and premature aging due to subcutaneous fat loss, collagen depletion, and muscle mass reduction.

If you are using semaglutide for weight loss, be aware that rapid fat and muscle loss can cause your face to look hollow or sagged. This is a known side effect called 'semaglutide face.' You can discuss preventative or corrective measures like dermal fillers, PRP, or radiofrequency microneedling with your provider to maintain your appearance while losing weight.

GLP-1 receptor agonists (GLP-1RAs) are perceived by primary care providers as effective and promising tools for managing recurrent weight gain after metabolic bariatric surgery (MBS), offering renewed optimism and life-changing results for patients.

If you have had bariatric surgery and are regaining weight, GLP-1 medications like semaglutide are a viable and effective option to help you lose weight again. However, they are not a magic bullet; you must continue to focus on diet and exercise. The main barrier is cost, so work with your provider to navigate insurance coverage or assistance programs.

GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) significantly suppress hunger, reduce 'food noise' (intrusive thoughts about food), and increase early satiety during the dynamic weight loss phase, leading to reduced portion sizes and cravings.

When starting GLP-1 medications, expect a significant reduction in hunger and intrusive thoughts about food ('food noise'). This is a biological effect, not just willpower. You may feel full faster and eat smaller portions. This effect is strongest in the first few months (dynamic phase). If you stop the medication, hunger and food noise typically return, so long-term adherence is often necessary for sustained benefits.

Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), significantly improves psoriasis symptoms and quality of life, with effects potentially linked to increased GLP-1 levels post-surgery.

If you have severe obesity and psoriasis, and lifestyle changes plus medications haven't worked, bariatric surgery (especially gastric bypass) can be a powerful option. It not only helps with weight but can significantly improve your psoriasis symptoms, likely by boosting your body's natural GLP-1 levels. This is a major step, so it's reserved for those with higher BMI or uncontrolled comorbidities.

Testosterone Replacement Therapy (TRT) increases lean body mass and improves body composition in men with documented low testosterone, but no trials have evaluated its combined use with GLP-1 RAs.

If you are a man with low testosterone, TRT can help preserve muscle. However, doctors should check your levels before starting, and there is no proof yet that taking TRT alongside GLP-1s prevents muscle loss better than TRT alone.

The Russian semaglutide-based drug Velgia® (WRYC12301) demonstrates bioequivalence, high safety, and lack of immunogenicity compared to the reference drug Wegovy® at doses of 0.25 mg and 2.4 mg.

This study confirms that the Russian semaglutide product Velgia® is bioequivalent to the brand-name Wegovy® at both 0.25 mg and 2.4 mg doses. It has a comparable safety profile with mild side effects and no detected immunogenicity (antibody formation). For patients seeking this treatment, this generic option offers the same pharmacokinetic exposure as the reference drug.

Supplementation with specific probiotics (e.g., Lactobacillus gasseri SBT2055, Lactobacillus curvatus HY7601, and Lactobacillus plantarum KY1032) reduces abdominal adiposity and body weight in overweight or obese individuals.

Consuming fermented milk containing specific probiotic strains like Lactobacillus gasseri SBT2055 (10^8 cfu/day) may help reduce abdominal fat in adults with large visceral fat areas.

Prebiotic supplementation (inulin, oligofructose, galactooligosaccharides) modulates gut microbiota (increasing Bifidobacterium) and improves metabolic markers in overweight or obese individuals.

Supplementing with prebiotics like inulin or oligofructose (e.g., 50/50 mix) for 16 weeks can help reduce body fat and trunk fat in overweight or obese individuals, including children, by improving gut microbiota composition.

Discontinuation of semaglutide or tirzepatide prior to pregnancy leads to expected weight regain, which may cause fetal macrosomia and negate the metabolic benefits of prior weight loss.

If you are using semaglutide or tirzepatide and planning pregnancy, you must stop the medication 1-2 months before trying to conceive. Be aware that you will likely regain some weight during this time, which can increase the risk of the baby being too large (macrosomia). To minimize this, focus on strength training and high-protein nutrition immediately after stopping the drug.

A history of metabolic surgery (specifically sleeve gastrectomy) significantly attenuates the weight-loss efficacy of liraglutide in patients with mild obesity, resulting in substantially lower total weight loss compared to non-surgical patients.

If you have had weight-loss surgery (especially sleeve gastrectomy), standard doses of liraglutide may not work as well as they do for others. Your doctor might need to increase your dose to 3.0 mg (if approved/available) or switch you to a different medication like tirzepatide to achieve similar weight loss results. Do not assume the standard dose will be sufficient.