Browse the evidence

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.

Telemedicine-based health coaching improves insulin sensitivity (HOMA-IR) in obese, nondiabetic adults, whereas in-person coaching and no coaching do not show significant within-group improvements.

Telemedicine coaching can help improve insulin sensitivity in obese, nondiabetic individuals, potentially reducing diabetes risk, even if other blood markers like glucose and HbA1c do not change significantly in the short term.

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.

High-glycemic load carbohydrates promote obesity by stimulating insulin secretion, which partitions calories into adipose tissue, thereby reducing circulating fuel availability, increasing hunger, and lowering energy expenditure.

To manage weight, prioritize the quality of carbohydrates over strict calorie counting. Reduce intake of high-glycemic foods like refined grains, potatoes, and added sugars. Instead, emphasize low-glycemic carbohydrates such as non-starchy vegetables, legumes, and whole fruits. This approach aims to lower insulin levels, reduce fat storage, and decrease hunger, making it easier to maintain a healthy weight without severe restriction.

Individuals with high insulin secretion in response to carbohydrates are more likely to gain weight on high-glycemic load diets and benefit more from low-glycemic or low-carbohydrate diets.

If you struggle with weight loss despite following a low-fat diet, you might have a high insulin response to carbohydrates. Trying a low-glycemic or low-carbohydrate diet may be more effective for you.

People with severe insulin resistance or diabetes may benefit from reducing total carbohydrate intake.

If you have diabetes or severe insulin resistance, talk to your doctor about reducing your total carbohydrate intake. This may help improve your metabolic health, but long-term data is still being gathered.

Administration of 4 g daily of omega-3 carboxylic acids (Epanova) to statin-treated high-risk patients with hypertriglyceridemia and low HDL-C reduces triglycerides by 26-31% and non-HDL-C, but its impact on reducing cardiovascular events is currently unknown and being tested in the STRENGTH trial.

If you are on a statin and still have high triglycerides and low HDL, your cardiovascular risk remains elevated. This trial investigates whether adding 4 grams of a specific prescription omega-3 (Epanova) daily, on top of your statin, can lower those lipids and prevent heart events. While it reliably lowers triglycerides, whether this translates to fewer heart attacks or strokes is still being determined by the STRENGTH trial results.

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.

Pre-operative administration of carbohydrate-rich fluids (12.5% solution, 400-800 mL) attenuates post-operative insulin resistance and endogenous glucose release, potentially reducing hospital stay and inflammatory markers in THR/TKR patients.

If you are having hip or knee replacement surgery, ask your surgical team about drinking a specific carbohydrate-rich solution (like a clear maltodextrin drink) the night before and/or 2 hours before your procedure. This is not regular food or water; it is a specific medical protocol designed to reduce surgical stress and speed up recovery. Do not do this unless your medical team approves it, as they will provide the specific type and timing.

GLP-1 receptor ligands improve bone health and reduce fracture risk in type 2 diabetes, with clinical outcomes varying by specific agent.

If you have type 2 diabetes, some GLP-1 drugs like liraglutide and lixisenatide may help protect your bones and reduce fracture risk. However, not all GLP-1 drugs have this effect (e.g., exenatide shows no impact). Discuss your bone health history with your doctor to choose the right medication.

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.

Very-low-calorie diets (VLCDs) can induce remission of type 2 diabetes and favorable metabolic profiles in the short term, but long-term sustainability and safety data are lacking.

VLCDs can help some people with type 2 diabetes achieve remission in the short term, but they are not a long-term solution. They require medical supervision and supplementation. Long-term success depends on transitioning to sustainable habits.

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.