Browse the evidence

Long-term use of FDA/Health Canada-approved obesity pharmacotherapies (semaglutide, tirzepatide, liraglutide, naltrexone-bupropion, orlistat) combined with health behavior changes produces clinically meaningful weight loss and prevents weight regain upon discontinuation.

If you have obesity (BMI ≥ 30, or ≥ 27 with health issues), talk to your doctor about FDA/Health Canada-approved weight loss medications like semaglutide or tirzepatide. These work best when combined with diet and exercise changes. Crucially, these are long-term treatments; stopping them usually leads to regaining the weight, so view them as a permanent tool for managing your health, not a quick fix.

Tirzepatide (5-15 mg weekly) produces superior weight loss compared to semaglutide and placebo in adults with obesity, with dose-dependent efficacy.

Tirzepatide is a weekly injection that can lead to significant weight loss (up to ~21% in trials). It works by targeting two hormones (GIP and GLP-1). Side effects like nausea are common but often temporary. It is approved for adults with obesity or overweight with health issues.

Once-weekly subcutaneous semaglutide 2.4 mg produces significant, sustained weight loss (mean 11.80% body weight reduction) and improves cardiometabolic markers in non-diabetic overweight or obese adults compared to placebo.

For non-diabetic adults with obesity, once-weekly 2.4 mg subcutaneous semaglutide is a highly effective intervention for significant weight loss (approx. 12% body weight) and metabolic improvement. While gastrointestinal side effects are common, they are generally manageable and transient.

Injectable semaglutide 2.4 mg once weekly produces significant weight loss (mean 15.2% over 104 weeks) and improves cardiometabolic risk factors in adults with obesity.

If you have obesity and struggle to lose weight through diet and exercise alone, ask your doctor about injectable semaglutide (2.4 mg once weekly). It is clinically proven to help you lose an average of 15% of your body weight over two years and improves heart health markers. Be prepared for a slow start to minimize stomach upset, and stick with it as the benefits are significant.

Administering tirzepatide (10 or 15 mg once weekly) to adults with overweight or obesity who have already achieved ≥5% weight loss through intensive lifestyle intervention results in substantial additional weight reduction (mean -18.4% from randomization) and prevents weight regain compared to placebo.

If you have successfully lost at least 5% of your body weight through diet and exercise, adding once-weekly tirzepatide (10 or 15 mg) can help you lose an additional ~18% of your body weight and prevent the typical weight regain seen after lifestyle interventions. This approach is particularly relevant if you have obesity-related complications, as it offers superior cardiometabolic benefits compared to lifestyle changes alone.

Semaglutide 2.4 mg improves anthropometric measures (waist circumference, waist-to-height ratio, BMI category) and reduces serious adverse events in patients with obesity and cardiovascular disease, regardless of baseline BMI category.

Semaglutide 2.4 mg not only reduces overall weight but also specifically targets visceral fat (waist circumference) and improves waist-to-height ratio, which are key markers for cardiovascular risk. These benefits, along with a reduced rate of serious adverse events, are consistent across all obesity classes, including those with a BMI just over 30.

Long-acting GLP-1 receptor agonists significantly reduce glycated hemoglobin (HbA1c) levels and body weight in adults, with greater efficacy observed in patients with type 2 diabetes compared to non-diabetic overweight individuals.

Long-acting GLP-1 receptor agonists (like semaglutide or liraglutide) are effective for lowering blood sugar and reducing body weight in adults. The effect is more pronounced in people with type 2 diabetes. Common side effects include gastrointestinal issues, which may vary by individual. Consult a healthcare provider to determine if these medications are appropriate for your specific health profile.

There is a negative correlation between glycemic control (HbA1c reduction) and body weight reduction at the between-study level in all participants, but a positive correlation exists when analyzing patients with diabetes or non-diabetic participants separately.

For people with diabetes, GLP-1 RAs tend to improve both blood sugar and weight loss together. For non-diabetic individuals, these drugs still cause weight loss, but this may not translate to improved blood sugar markers since their levels are already normal. The relationship between weight loss and glycemic control is complex and depends on your starting health status.

GLP-1 receptor agonists (semaglutide, tirzepatide) and bariatric surgery produce substantial weight loss (>10-15%) and improve cardiometabolic risk factors, but weight regain is common upon discontinuation, often necessitating lifelong treatment.

GLP-1 medications and surgery are currently the most effective tools for significant weight loss and metabolic improvement. However, they are not 'cures'; stopping them typically leads to weight regain. If you choose this path, prepare for it to be a long-term or lifelong commitment, and verify insurance coverage or affordability before starting.

Testosterone therapy in older men with low testosterone and symptoms improves sexual function, anemia, and bone mineral density, and prevents type 2 diabetes in high-risk men, while demonstrating cardiovascular safety in large RCTs.

If you are an older man with low testosterone and symptoms, testosterone therapy can improve sexual function, blood counts, and bone density. For those at high risk of diabetes, it significantly reduces that risk. Large recent studies confirm it is safe for the heart and prostate, so discuss this with your doctor if you meet the criteria.

Weekly subcutaneous semaglutide (titrated to 2.0 mg) significantly reduces body weight in clozapine-treated patients with schizophrenia and obesity compared to placebo over 36 weeks.

This protocol outlines a clinical trial for using semaglutide to treat obesity in people with schizophrenia taking clozapine. It is not a general recommendation but a research study. If you are interested, consult your psychiatrist about eligibility for clinical trials, as this specific intervention is currently under investigation for this population.

Obesity pharmacotherapy reduces the risk of major adverse cardiovascular events (MACE) in patients with established atherosclerotic cardiovascular disease (ASCVD) and BMI ≥ 27, independent of diabetes status.

If you have heart disease and are overweight (BMI ≥ 27), ask your doctor about semaglutide (Wegovy). It has been proven to reduce the risk of heart attacks and strokes, in addition to helping with weight loss.

Semaglutide 2.4 mg/week administered as an add-on to hospital-based non-pharmacological obesity care significantly reduces adiposity (BMI) in young adults (18-28 years) with childhood-onset obesity who have demonstrated low or medium treatment response to prior behavioral interventions.

For young adults with obesity who have not lost enough weight through standard diet and exercise programs, adding weekly semaglutide (2.4 mg) to their existing care plan is a clinically validated strategy to further reduce body mass index. The treatment involves a gradual dose increase over 16 weeks to minimize side effects, followed by 52 weeks of maintenance, all while continuing behavioral counseling.

Tirzepatide facilitates significant weight loss and improves lipid profiles in individuals with spinal cord injury (SCI) who are refractory to standard dietary and exercise interventions.

If you have a spinal cord injury and have tried strict diet and exercise without success, ask your doctor about tirzepatide. It is a weekly injection that helped this patient lose 33 pounds and improve his cholesterol, even when standard lifestyle changes failed. Be aware that GI side effects are possible, though this patient tolerated them well.

Inpatient administration of GLP-1 receptor agonists (liraglutide and semaglutide) combined with a very low-calorie diet (800 kcal/day) produces rapid, substantial weight loss (25% of baseline) in severely obese patients (BMI > 100 kg/m2) who are hospitalized.

For severely obese patients (BMI > 100) who struggle with discharge or outpatient adherence, inpatient GLP-1RA therapy combined with a strict 800 kcal/day diet can produce rapid, substantial weight loss (approx. 25% in <8 months). This approach may serve as a bridge to bariatric surgery or functional independence when standard outpatient care fails due to socioeconomic or medical barriers.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) significantly reduce major adverse cardiovascular events (MACE) in non-diabetic adults with obesity, with benefits occurring through both weight-loss-dependent and independent mechanisms.

If you have obesity and are not diabetic, GLP-1 medications like semaglutide or liraglutide can significantly lower your risk of heart attack, stroke, and heart failure. This benefit is not just from losing weight; the drugs also directly protect your blood vessels and heart. While side effects like nausea are common, they are usually manageable with slow dose increases and dietary changes. For those who dislike injections, oral versions are also effective.

Tirzepatide (10-15 mg weekly) produces significantly greater total weight loss (-20.2%) compared to Semaglutide (1.7-2.4 mg weekly, -13.7%) in obese patients, as demonstrated in the SURMOUNT-5 trial.

If you are struggling with obesity and other medications have failed, Tirzepatide (10-15 mg weekly) offers superior weight loss compared to Semaglutide. Discuss this dual-agonist option with your doctor, especially if you have not achieved sufficient weight loss with other GLP-1 treatments.

Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) reduce HbA1c, fasting plasma glucose, and body weight in Type 2 Diabetic athletes, but pose risks of hypovolemia, dehydration, and euglycemic DKA.

If you take SGLT2 inhibitors (like empagliflozin or dapagliflozin) for Type 2 Diabetes, you will likely lose weight and improve your blood sugar control. However, these drugs make you urinate more, which can lead to dehydration and dizziness during exercise. Drink extra water, watch for signs of low blood pressure, and be aware of the rare risk of euglycemic DKA (diabetic ketoacidosis with normal blood sugar).

Tirzepatide (5, 10, or 15 mg weekly) produces superior, dose-dependent weight loss and glycemic improvements compared to insulin and GLP-1 receptor agonists in adults with type 2 diabetes and/or obesity.

Tirzepatide is currently the most potent pharmacological therapy for weight loss and blood sugar control in type 2 diabetes and obesity, outperforming both insulin and other GLP-1 drugs. It works by mimicking two gut hormones (GIP and GLP-1) to reduce appetite and improve insulin sensitivity. While effective, it carries a higher risk of gastrointestinal side effects like nausea compared to other treatments.

Once-weekly subcutaneous semaglutide 2.4 mg significantly improves cardiometabolic risk factors (waist circumference, blood pressure, fasting plasma glucose, insulin, and lipids) in adults with overweight or obesity without diabetes compared to placebo.

If you have overweight or obesity without diabetes, once-weekly semaglutide 2.4 mg, combined with lifestyle changes, significantly improves key health markers like blood pressure, blood sugar, and cholesterol compared to placebo. These benefits require continued use, as stopping the medication leads to a reversal of these improvements.

Tirzepatide, a dual GIP/GLP-1 receptor agonist, produces dose-dependent weight loss (up to 20.9% with 15 mg weekly dose) and is recommended for patients targeting 15-20% weight loss.

If you need to lose a significant amount of weight (15-20%), ask your doctor about tirzepatide. It is a once-weekly injection that works by mimicking two gut hormones (GIP and GLP-1). Start at a low dose to minimize side effects, and gradually increase it over several months to find the right dose for you. It is more potent than older GLP-1 drugs.

CagriSema (semaglutide + cagrilintide) produces superior weight loss (22.7% at 68 weeks) compared to semaglutide 2.4 mg alone (16.1%) or cagrilintide alone (11.8%).

If you have obesity and need maximum weight loss, ask your doctor about CagriSema. It combines two hormones (GLP-1 and amylin) into one weekly injection. Clinical trials show it can help you lose nearly 23% of your body weight, which is more than semaglutide or tirzepatide alone. It is currently in Phase 3 trials.

Benzodiazepines, benzodiazepine receptor agonists, and daridorexant are recommended for short-term treatment of insomnia (≤ 4 weeks), while orexin receptor antagonists may be used for up to 3 months or longer in some cases.

If CBT-I doesn't work well enough, your doctor may prescribe short-term sleep medication (like benzodiazepines or daridorexant) for up to 4 weeks. Do not exceed this duration without medical advice due to tolerance and dependence risks. Orexin antagonists may be used for up to 3 months in some cases.

Incretin-based therapies (e.g., semaglutide, tirzepatide) are advised for the optimal management of comorbidities like type 2 diabetes or obesity in adults with MASLD.

If you have type 2 diabetes or obesity, talk to your doctor about incretin-based therapies like semaglutide or tirzepatide, which can help manage these conditions and may benefit your liver.