Browse the evidence

Overfeeding-induced insulin resistance is driven by the depletion of small, peripherally located intramyocellular lipid droplets and the subsequent accumulation of large lipid droplets and ceramides, rather than by an increase in total intramyocellular lipid content.

If you are concerned about insulin resistance, focus on maintaining physical activity levels that preserve small, peripheral muscle lipid droplets. High physical activity and efficient lipid oxidation are associated with resistance to weight gain and better insulin sensitivity, even during periods of overfeeding. The total amount of fat in your muscles matters less than how your body organizes that fat.

SGLT-2 inhibitors provide kidney protection (slowing eGFR decline, reducing albuminuria) but have limited or no impact on body weight, making them distinct from GLP-1s in treating obesity-related kidney disease.

SGLT-2 inhibitors protect the kidneys by slowing function decline and reducing protein in urine. They are not primarily weight-loss drugs, so they should be used alongside lifestyle changes for obesity.

GLP-1 receptor agonism (liraglutide) sensitizes hypothalamic POMC neurons and ventral tegmental area (VTA) dopaminergic neurons to nicotine, increasing their excitability and contributing to weight loss.

GLP-1 drugs may work better for smokers because they make the brain's reward and hunger centers more responsive to nicotine. This interaction increases the activity of neurons that suppress appetite and burn energy.

Acute systemic hypoglycemia gates and enhances the entry and action of GLP-1 receptor agonists into the brain, leading to increased whole-body lipid oxidation.

If you are using a GLP-1 medication, maintaining stable or slightly lower blood glucose levels (without dangerous hypoglycemia) may help the drug work more effectively in your brain to burn fat. The drug's ability to enter the brain and boost fat burning is significantly enhanced when blood sugar is low, a mechanism that is often impaired in obesity.

Obesity and high-fat diets uncouple the mechanism by which low blood glucose enhances GLP-1 receptor agonist entry into the brain.

If you are obese or eat a high-fat diet, the mechanism that helps GLP-1 drugs enter your brain to burn fat may be less effective. Managing blood glucose and reducing high-fat intake might help restore this natural gating mechanism.

Leptin, amylin, and adiponectin are recommended as core biomarkers for obesity trials to assess energy homeostasis and predict treatment response.

Obesity trials should measure leptin, amylin, and adiponectin to understand energy homeostasis. Leptin reflects fat stores, amylin promotes satiation, and adiponectin is linked to insulin sensitivity and inflammation.

Intensive glycaemic control reduces microvascular complications (retinopathy, nephropathy, neuropathy) but has limited or potentially harmful effects on macrovascular outcomes and all-cause mortality.

Intensive blood sugar control helps prevent eye, kidney, and nerve damage, but it doesn't significantly prevent heart attacks and may increase the risk of low blood sugar events. Work with your doctor to find a safe blood sugar target that minimizes risks.

Long-term remission of Type 2 Diabetes following metabolic surgery is not sustained for the majority of patients, with remission rates dropping significantly after 5 years.

While surgery often puts Type 2 Diabetes into remission initially, this effect often wears off after several years. Most patients will eventually need to restart diabetes medications to maintain blood sugar control, meaning surgery is a tool for disease management rather than a permanent cure.

There is no evidence supporting the practice of periodizing resistance exercise training for females according to specific phases of the menstrual cycle to promote greater hypertrophic adaptations.

Do not waste time or energy trying to periodize your training based on your menstrual cycle. There is no evidence that training differently in the follicular vs. luteal phase leads to better muscle growth. Stick to a consistent, progressive resistance training program regardless of where you are in your cycle.

Low sleeping energy expenditure (SleepEE) in early pregnancy is associated with insulin resistance and low triiodothyronine (T3) concentrations.

For obese pregnant women, a lower-than-expected metabolic rate is linked to higher insulin resistance and lower thyroid hormone (T3) levels. This suggests that metabolic health issues may drive lower energy expenditure, contributing to weight gain risk.

Vagus nerve stimulation (VNS) and GLP-1 analogs are emerging therapeutic tools that harness brain-body communication to treat obesity and diabetes, though more invasive and long-lasting approaches are needed.

If lifestyle changes are insufficient, medical interventions like GLP-1 analogs (e.g., semaglutide) and vagus nerve stimulation are proven to help reverse metabolic disease by targeting brain-body signals. These are powerful tools, but they may be invasive or expensive. Work with your healthcare provider to determine if these options are appropriate for your specific situation, keeping in mind that more accessible long-term solutions are still being developed.

Current clinical evidence from randomized controlled trials and meta-analyses does not support a causal link between GLP-1 receptor agonist use and an increased risk of thyroid cancer in humans.

If you are considering or taking a GLP-1 medication (like Ozempic or Wegovy) and are worried about thyroid cancer, know that large human studies have not found a proven link. The warning on the label comes from animal studies, not human outcomes. While you should be aware of symptoms, the proven benefits for weight loss and heart health generally outweigh this unproven risk. Do not stop your medication without talking to your doctor, especially if you have a family history of specific thyroid cancers (MTC), which is a separate contraindication.

Setmelanotide treatment is associated with a high incidence of skin hyperpigmentation and injection site reactions, though these are generally mild and manageable.

Patients should expect skin darkening (hyperpigmentation) and injection site reactions as common side effects of Setmelanotide. These are generally mild, do not indicate serious harm, and do not necessarily require discontinuation of therapy, but patients should be counseled on these expected outcomes.

Chronic consumption of high-calorie/obesogenic diets causes maladaptive perturbations in gut-brain signaling, leading to desensitization of vagal afferents and reduced efficacy of appetite-suppressing gut hormones (GLP-1, CCK, PYY), which contributes to the exacerbation of metabolic dysregulation and obesity.

If you have a history of obesity or high-calorie eating, your body's natural 'stop eating' signals (hormones and nerve feedback) may be desensitized. This isn't a failure of willpower; it's a physiological state. To counter this, focus on strategies that naturally stimulate these pathways, such as consuming protein and fiber before carbohydrates (meal sequencing), which has been shown to enhance GLP-1 secretion and improve metabolic control.

High-fat diets, specifically saturated lipids like palmitic acid, disturb gastrointestinal feedback and promote overconsumption independently of food palatability.

Be mindful of high-saturated-fat foods (like those high in palmitic acid). They can disrupt your body's natural 'fullness' signals, leading you to eat more than you need, regardless of how tasty they are. Balancing fats with fiber and protein can help mitigate this effect.

Sympathomimetic drugs (e.g., phentermine) reduce hunger and increase energy expenditure but are limited by adverse cardiovascular and central nervous system effects, leading to withdrawal of many agents from the market.

Older stimulant-based weight loss drugs can work by suppressing appetite and increasing energy expenditure, but they carry higher risks of heart and nervous system side effects. Many have been removed from the market. If prescribed, they are typically for short-term use (12 weeks) and require careful monitoring.

ChREBP acts as a central regulator linking carbohydrate intake to metabolic disease; its overexpression causes fatty liver and insulin resistance, while its deletion prevents obesity and fatty liver but may cause other metabolic issues like insulin resistance in adipose tissue.

While high sugar intake drives disease via ChREBP, completely eliminating carbohydrates or targeting this pathway aggressively may have unintended metabolic consequences. A balanced approach focusing on reducing HFCS while maintaining adequate complex carbohydrate intake is likely optimal.

GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide) reduce the risk of macroalbuminuria and renal function decline in patients with Type 2 Diabetes.

GLP-1 medications like semaglutide and liraglutide are not just for blood sugar; they also protect your kidneys. Studies show they significantly lower the risk of developing macroalbuminuria, a key marker of kidney damage.

Leptin therapy is effective for weight loss only in patients with leptin deficiency (low circulating levels), not in those with leptin resistance (high levels).

Leptin injections are only effective for people with a specific genetic deficiency causing low leptin levels. For most people with obesity, leptin levels are high, and leptin injections do not work.

Patients with severe obesity and Type 2 Diabetes experience a greater reduction in all-cause mortality from bariatric surgery compared to those with severe obesity alone.

If you have severe obesity and Type 2 Diabetes, bariatric surgery offers an even greater survival benefit than for those with obesity alone. This makes it a particularly strong consideration for managing your health and longevity.

Loss of GIP receptor (GIPR) signaling specifically in GABAergic neurons enhances the body weight loss efficacy of GLP-1 receptor agonists (such as semaglutide or tirzepatide) and dual incretin agonists.

Current obesity medications that target both GLP-1 and GIP receptors (like tirzepatide) work partly by engaging specific brain neurons (GABAergic neurons expressing GIPR). Research suggests that the body's natural GIP signaling in these neurons might actually limit how much weight you can lose with GLP-1 drugs alone. This implies that future treatments might be optimized by either stimulating or blocking GIP signaling in these specific brain cells to maximize weight loss while managing side effects like nausea.

Systemic inhibition of the chromatin modifier LSD1 using GSK-LSD1 or SP2509 reduces body weight, improves insulin sensitivity, and reverses nonalcoholic fatty liver disease (NAFLD) in obese mouse models, independent of reduced food intake.

Targeting the enzyme LSD1 appears to fix the underlying metabolic dysfunction in obesity, not just cause weight loss. It reduces fat tissue inflammation and stops fat from flooding the liver, improving insulin sensitivity directly. This suggests that future drugs targeting LSD1 could treat obesity and its complications like fatty liver and diabetes simultaneously, rather than just suppressing appetite.

Semaglutide treatment for type 2 diabetes does not directly cause retinal damage; observed early worsening of diabetic retinopathy is primarily driven by the magnitude and speed of HbA1c reduction rather than the drug itself.

If you have type 2 diabetes and are starting semaglutide, do not avoid it out of fear of blindness. The risk of retinopathy worsening is linked to how fast your blood sugar drops, not the drug itself. To stay safe, your doctor should check your eyes before starting, and may reduce your insulin or sulfonylurea dose to prevent a rapid glucose drop. Regular eye exams are essential.

SGLT2 inhibitors reduce cardiovascular mortality and heart failure hospitalization in insulin-resistant patients by promoting ketone body production and reducing sympathetic overdrive.

If you have Type 2 Diabetes and heart issues, ask your doctor about SGLT2 inhibitors (like Jardiance or Farxiga). They are proven to protect your heart and reduce hospital stays, not just lower blood sugar. The benefit comes from how they change your heart's energy use and stress levels.