Browse the evidence

Semaglutide treatment significantly reduces body weight and BMI in patients with acquired hypothalamic obesity, with effects stabilizing after 12 months.

For patients with hypothalamic obesity, semaglutide (weekly injection) is an effective treatment for significant weight loss, even with prior hypothalamic damage. Treatment should be titrated to a tolerated dose (up to 2.5 mg), and patients should be aware that stopping treatment leads to rapid weight regain, so adherence and side-effect management are critical.

Phentermine/Topiramate combination therapy significantly reduces the rate of weight regain in patients who have undergone Roux-en-Y gastric bypass (RYGB).

If you are regaining weight after gastric bypass, ask your doctor about Phentermine/Topiramate. It is an oral medication that can help slow down weight regain. It requires a gradual dose increase to minimize side effects like dry mouth or tingling. While not as new as GLP-1 drugs, it has shown promise in keeping weight off in the years following surgery.

Deprescribing GLP-1 agonists in patients with Type 2 Diabetes does not result in weight regain or loss of glycemic control if the patient maintains Carbohydrate Restricted Nutrition Therapy (CRNT) supported by continuous remote care.

If you are taking a GLP-1 drug (like Ozempic or Wegovy) for Type 2 Diabetes, you may be able to stop the medication without regaining weight or losing blood sugar control, provided you switch to a strict low-carbohydrate diet (under 30g carbs/day) and maintain nutritional ketosis. This approach mimics the drug's hormonal effects on hunger and satiety. You should work with a healthcare provider to monitor your progress and determine if you are a candidate for deprescription.

Carbohydrate Restricted Nutrition Therapy (CRNT) induces hormonal changes (lower ghrelin, higher GLP-1/CCK) that reduce hunger and appetite, thereby supporting weight maintenance after GLP-1 deprescription.

The reason low-carb diets help you stay full is not just willpower; they biologically alter your hunger hormones. Ketosis lowers ghrelin (the hunger hormone) and increases satiety hormones, making it easier to maintain weight loss without constant hunger.

GLP-1 receptor agonists (liraglutide, semaglutide) and dual GLP-1/GIP agonists (tirzepatide) are the most promising pharmacological treatments for obesity in older adults, offering favorable efficacy and safety profiles, though specific guidelines are currently lacking.

For older adults with obesity, GLP-1 agonists like liraglutide and semaglutide are currently the most effective pharmacological options. They work by mimicking hormones that regulate appetite and blood sugar. While they cause significant weight loss, there is a risk of muscle loss, so these medications should ideally be used alongside resistance exercise and adequate protein intake. Start with a low dose and increase slowly to manage stomach side effects. Note that data for those over 75 is limited.

Dietary intervention (weight loss maintenance) increases circulating Heme-oxygenase-1 (HO-1) levels, with a non-significant trend toward greater increases on Low Glycemic Index diets.

Weight loss maintenance increases HO-1, an enzyme that may help reduce oxidative stress. While the type of diet matters less for HO-1, Low Glycemic Index diets showed a trend toward higher increases. This is a minor benefit of weight loss.

Oral semaglutide administration in patients with type 2 diabetes significantly reduces body weight, HbA1c, and total cholesterol within 3-6 months, with additional systolic blood pressure reduction observed by 6-12 months.

If you have Type 2 Diabetes, oral semaglutide can significantly improve your weight, blood sugar (HbA1c), and cholesterol levels within the first 6 months, with blood pressure improvements continuing up to a year. While gastrointestinal side effects like nausea are common and may lead some to stop the medication, serious safety issues were not observed in this real-world study. It serves as a viable alternative to injectable GLP-1s, particularly for those who prefer oral medication or have needle phobia.

GLP-1 receptor agonists may improve psoriasis symptoms (PASI score) in patients with Type 2 Diabetes, though evidence from randomized controlled trials is mixed.

If you have psoriasis and Type 2 Diabetes, GLP-1 medications might help improve your skin symptoms, but this is not guaranteed. The most reliable benefit is the protection against heart disease and stroke. Discuss with your doctor if the potential skin benefits, combined with cardiovascular protection, outweigh the need for an injection.

Once-weekly subcutaneous administration of the glucagon/GLP-1 receptor co-agonist NNC9204-1177 produces dose-dependent, clinically significant body weight loss in adults with overweight or obesity, but is associated with unacceptable safety concerns including increased heart rate, hepatic disturbances, and impaired glucose tolerance.

This specific drug (NNC9204-1177) is not available for clinical use because it caused unacceptable side effects like increased heart rate and liver issues, despite causing significant weight loss. However, it highlights that combining GLP-1 and glucagon pathways can lead to substantial weight loss, which is why other approved GLP-1 medications exist. If you are considering GLP-1 therapy, discuss the specific safety profile of the approved options with your healthcare provider.

Oral semaglutide (up to 7 mg/day) produces significant weight loss (mean 4.5 kg) and BMI reduction in psychiatric patients with antipsychotic-induced weight gain over 16 weeks, with a safety profile comparable to metformin.

For psychiatric patients struggling with weight gain from antipsychotics, oral semaglutide is a viable treatment option. Start with 3 mg daily for the first month, then increase to 7 mg daily if tolerated. Expect about 4.5 kg (10 lbs) of weight loss over 4 months. Side effects like nausea are common but usually mild and go away. This treatment does not worsen psychiatric symptoms and may even improve quality of life.

Combined blockade of GDF8 (myostatin) and Activin A using monoclonal antibodies significantly increases lean muscle mass and decreases fat mass in postmenopausal women, with effects reversing to baseline upon cessation of treatment.

For postmenopausal women seeking to increase muscle mass, blocking both myostatin and activin A via antibody therapy produces significant muscle growth and fat loss. However, this effect is not permanent; stopping treatment leads to a return to baseline muscle size within about 6 months. The treatment requires regular IV infusions and carries mild side effects like muscle spasms. It is not a lifestyle intervention but a medical therapy requiring clinical supervision.

Female resistance-trained athletes tend to spare more lean mass than males during caloric restriction, potentially due to differences in training experience, pre-diet volume, and energy deficit.

Female athletes may naturally preserve muscle better during a cut than males, but they should still prioritize high training volume to maximize this benefit.

Tirzepatide demonstrates superior efficacy compared to Semaglutide in reducing HbA1c levels, but shows no clear superiority in weight loss or FBS reduction.

If your current Semaglutide treatment is not lowering your HbA1c enough, switching to Tirzepatide may provide better blood sugar control. However, do not expect significantly more weight loss from this switch, as both drugs appear to offer similar weight reduction benefits in this analysis.

Switching from Liraglutide to Semaglutide results in significant additional weight loss and FBS reduction, but does not significantly impact HbA1c levels.

If you are currently on Liraglutide and struggling with weight or fasting blood sugar, switching to Semaglutide may help you lose more weight and lower your FBS. However, this switch is unlikely to significantly improve your HbA1c levels.

GLP-1 receptor agonists facilitate significant weight loss and metabolic improvement in non-pregnant women, but current evidence does not demonstrate that pre-pregnancy use improves pregnancy outcomes and may be associated with increased gestational weight gain.

GLP-1 drugs like Semaglutide cause significant weight loss in women with obesity. However, because there is no proof they improve pregnancy outcomes and animal studies suggest potential fetal growth restriction (likely due to maternal weight loss/nutrition), they are not currently recommended for improving pregnancy success. Women using these drugs should use effective contraception and stop the medication at least 6 weeks before trying to conceive, as advised by current guidelines.

Combining semaglutide with cilofexor or firsocostat improves liver steatosis more than semaglutide monotherapy in patients with NASH and mild-to-moderate fibrosis, without significantly affecting liver stiffness.

For patients with mild-to-moderate NASH fibrosis, adding cilofexor or firsocostat to semaglutide treatment can reduce liver fat more effectively than semaglutide alone. However, this combination does not appear to improve liver stiffness (fibrosis) and involves taking multiple daily medications alongside weekly injections.

Oral semaglutide (up to 14 mg daily) significantly reduces liver steatosis, liver enzymes, and body weight in patients with NAFLD and Type 2 Diabetes, correlating with weight loss.

Oral semaglutide (up to 14 mg daily) is an effective treatment for NAFLD in patients with Type 2 Diabetes, significantly reducing liver fat and enzymes. The benefits are closely linked to weight loss, and side effects are generally manageable with dose escalation.

High-Intensity Interval Training (HIT) may improve insulin sensitivity more effectively than moderate-intensity continuous training (MICT) in some studies, though evidence is less extensive.

Consider high-intensity interval training if you find moderate continuous exercise boring or time-consuming, as it may offer superior insulin sensitivity benefits in a shorter time.

Individual response to exercise training varies significantly, with 10-20% of people being 'non-responders' for specific metrics, but metabolic improvements often occur even without fitness gains.

Even if you don't feel fitter, exercise still improves your metabolism. Don't give up if you don't see immediate fitness gains.

A high-carbohydrate diet (60% of energy) lowers maximal adipose tissue mitochondrial respiration compared to moderate (40%) or low (20%) carbohydrate diets, potentially favoring fat storage over oxidation.

This research suggests that eating a diet very high in carbohydrates (60% of calories) might slow down how efficiently your fat cells burn energy, potentially making it easier to store fat. However, this was a small study in people who had already lost weight. It does not mean you should avoid carbs, but it hints that diet composition matters for how your body handles fuel, not just total calories.

GLP-1 receptor agonists (liraglutide, semaglutide, tirzepatide) administered as adjunct therapy to bariatric surgery significantly reduce BMI and total body weight in patients with insufficient weight loss or weight regain.

If you have had bariatric surgery but are not losing enough weight or are gaining it back, ask your doctor about adding a GLP-1 agonist (like semaglutide or tirzepatide) to your regimen. These medications, taken weekly or daily, have been shown to significantly boost weight loss and improve metabolic health (blood sugar, blood pressure) in this specific group. Be prepared for potential mild stomach issues, which usually subside, and discuss cost coverage with your provider.

GLP-1 receptor agonists improve metabolic outcomes, including glycemic control, blood pressure, and lipid profiles, in post-bariatric surgery patients.

Beyond weight loss, GLP-1 agonists can help normalize blood sugar, lower blood pressure, and improve cholesterol levels in patients who have had bariatric surgery. This makes them a valuable tool for managing overall metabolic health, not just weight.

GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) show promising results for MASH resolution and weight loss, though phase 3 histological data is still emerging.

GLP-1 agonists like semaglutide and tirzepatide are showing strong promise for resolving MASH and reducing liver fibrosis, especially in those with obesity or diabetes. While not yet universally endorsed for MASH alone, they are beneficial for comorbidities.

For individuals with type 2 diabetes on single non-insulin medication, the maximum justifiable cost for a weight loss maintenance intervention is lower (£88.14) than for those with high BMI alone (£104.64) at an ICER of £20,000 per QALY.

For a person with type 2 diabetes on medication, a weight loss maintenance program is considered cost-effective if it costs less than approximately £88 per person. This is a lower threshold than for non-diabetics because the potential for long-term health gains (QALYs) is smaller for those who already have the disease.