Browse the evidence

In patients with diabesity who have comorbidities, HIIT may significantly increase HDL cholesterol and further reduce HOMA-IR compared to MICT.

If you have type 2 diabetes, obesity, and other health conditions, HIIT might offer extra benefits for your 'good' cholesterol (HDL) and insulin resistance compared to moderate exercise. However, the evidence for this is very low certainty.

Among GLP-1 receptor agonists, Tirzepatide demonstrates superior weight loss efficacy compared to Semaglutide and Liraglutide in post-bariatric surgery patients, with the lowest rate of non-responders.

If you are using a GLP-1 agonist after bariatric surgery and not seeing enough results, ask your doctor about switching to or starting Tirzepatide. It is a newer dual-agonist that has shown greater weight loss and fewer non-responders compared to older options like Liraglutide or Semaglutide in recent studies. Note that data is currently limited to shorter-term studies.

Interval walking (alternating fast and slow speeds) improves glucose effectiveness and insulin sensitivity more effectively than continuous walking of matched energy expenditure in T2DM patients.

If you want to maximize the metabolic benefits of walking, try interval walking. Alternate 1 minute of brisk walking with 1 minute of normal walking for 60 minutes, 5 times a week. This method may improve your insulin sensitivity more than walking at a constant speed.

High-intensity interval training (HIIT) significantly improves cardiometabolic health markers—including glycemic control, insulin resistance, and lipid profiles—in patients with diabesity (Type 2 Diabetes and Obesity), even when body composition changes are minimal.

If you have Type 2 Diabetes and are overweight, High-Intensity Interval Training (HIIT) is a highly effective way to improve your blood sugar and cholesterol levels, even if the scale doesn't move much. Aim for short, intense bursts of exercise (like cycling or walking) 3 times a week for about 20-30 minutes, interspersed with rest. This approach targets your metabolic health directly and is considered safe for this population when prescribed correctly.

HIIT significantly improves lipid profiles (LDL, Triglycerides, Total Cholesterol) and insulin resistance (HOMA-IR) in patients with diabesity.

Focus on improving your insulin sensitivity and cholesterol through HIIT. This type of training has been shown to significantly lower your HOMA-IR score and improve LDL and Triglyceride levels compared to doing nothing, offering a powerful metabolic boost for those with diabesity.

Once-daily oral orforglipron significantly reduces body weight, BMI, and waist circumference compared to placebo in adult patients with obesity or overweight.

Take once-daily oral orforglipron as prescribed. Expect an average weight loss of about 6 kg compared to placebo, along with improvements in waist circumference and metabolic markers. Be prepared for common, non-severe gastrointestinal side effects like nausea, but note that serious adverse events are not increased. This is a viable alternative to injectable GLP-1s for those who prefer oral medication.

Postoperative use of GLP-1 receptor agonists (specifically liraglutide and semaglutide) effectively treats suboptimal clinical response (SoCR) and recurrent weight gain (RWG) after metabolic bariatric surgery, achieving weight loss comparable to or exceeding non-surgical populations.

If you regain weight after bariatric surgery, do not assume you must have another operation. GLP-1 medications (like semaglutide or liraglutide) are highly effective at reversing weight regain and improving metabolic health, often working better than in non-surgical patients.

Repeated dosing of smaller caffeine amounts (e.g., 2 mg/kg) is superior to a single large dose (e.g., 6-10 mg/kg) for maintaining performance during long-duration competitions with rest periods.

For long competitions with long breaks between lifts, don't take your whole caffeine dose at once. Split it into smaller doses (e.g., 2mg/kg) taken before each lift to keep the performance boost steady.

Eight weeks of moderate-intensity aerobic exercise training significantly reduces fasting plasma glucose in diabetic patients compared to conventional care alone.

If you have diabetes, adding moderate walking to your routine three times a week for 30-45 minutes can significantly lower your fasting blood sugar. Start with a 10-minute warm-up, walk at a pace that keeps your heart rate at 50-60% of its maximum, and finish with a 10-minute cool-down. This should be done in addition to your regular medical care.

Semaglutide oral is effective for weight loss compared to placebo, but is less effective than subcutaneous semaglutide formulations.

If you prefer oral medication, oral semaglutide is effective for weight loss compared to placebo. However, it is significantly less effective than the injectable form of semaglutide. If maximum weight loss is your primary goal, the injectable form is superior.

Extending the dosing interval of GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) from once-weekly to once-every-two-weeks reduces medication costs by approximately 50% while maintaining 70-75% of the weight loss efficacy.

If you are on a GLP-1 medication like semaglutide or tirzepatide and cost is a major barrier, discuss with your doctor the possibility of extending your dosing interval (e.g., from once a week to once every two weeks). While you might not lose as much weight as the maximum possible, you will likely retain most of the benefit (around 75%) while cutting your medication costs in half. This is particularly useful for ensuring long-term access to the medication.

Adhering to a low carbohydrate diet (approx. 30g/day) allows type 2 diabetes patients on insulin therapy to significantly reduce or completely stop insulin usage, while improving HbA1c and reducing body weight.

If you have Type 2 Diabetes and take insulin, discuss with your doctor a plan to drastically reduce carbohydrates to about 30 grams per day. This approach may allow you to lower or stop your insulin injections, lose weight, and improve your blood sugar control, provided you are monitored closely during the transition.

Semaglutide administration (0.5-1 mg weekly) enables obese end-stage renal disease (ESRD) patients on hemodialysis to achieve target BMI and become eligible for renal transplantation with substantial weight loss (11.7-14.8%) and minimal side effects.

If you have end-stage kidney disease and are on dialysis, obesity might currently block you from getting a transplant. This case series suggests that using semaglutide (a weekly injection) can help you lose enough weight (around 12-15% of body weight) to meet transplant criteria. It was well-tolerated in these patients, but requires close monitoring by your nephrologist to adjust dialysis settings as you lose weight. It serves as a bridge to surgery when lifestyle changes or bariatric surgery are not options.

GLP-1 analogues (liraglutide and semaglutide) enable significant weight loss (approx. 14%) in obese patients with end-stage lung disease, thereby bridging the gap to lung transplantation eligibility when dietary and exercise interventions fail.

If you have severe lung disease and a BMI that bars you from transplant, ask your care team about GLP-1 medications (like semaglutide or liraglutide). This case shows they can help you lose enough weight to qualify for surgery when diet and exercise aren't enough, even while taking steroids.

Extending the dosing interval of GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) from once-weekly to once-every-two-weeks maintains approximately 70-75% of the weight loss efficacy while reducing total drug cost by 50%.

If you are taking a GLP-1 drug like semaglutide or tirzepatide, ask your doctor about extending your dosing interval to every two weeks. Mathematical models suggest this could cut your medication costs by 50% while keeping about 75% of the weight loss benefits. This is not a substitute for medical advice, but it is a potential strategy to improve affordability and adherence.

For patients on lower doses of tirzepatide (e.g., 5 mg), switching to a less frequent dosing schedule (e.g., every two weeks) while simultaneously increasing the dose size (e.g., to 10 mg or 15 mg) can maintain or even exceed the weight loss efficacy of the standard once-weekly regimen.

If you are on a lower dose of tirzepatide (5 mg) and find it expensive, ask your doctor if switching to a higher dose (10 mg or 15 mg) taken every two weeks is an option. This strategy might keep your weight loss results the same or even better while cutting your costs in half. However, be aware that higher doses may increase side effects, so this requires careful medical supervision.

GLP-1 receptor agonists have assumed the primary role in treating obesity with significant weight loss.

Practitioners should consider GLP-1 receptor agonists as a treatment for obesity.

Weekly subcutaneous administration of GLP-1 receptor agonist (dulaglutide) significantly reduces HbA1c and body weight in patients with Type 2 Diabetes Mellitus who fail to adhere to low carbohydrate diet (LCD) or calorie restriction diet (CRD).

If you have Type 2 Diabetes and struggle to maintain a low-carb or calorie-restricted diet due to lifestyle, cognitive issues, or lack of support, ask your doctor about once-weekly GLP-1 receptor agonists like dulaglutide. This medication can significantly lower blood sugar (HbA1c) and help with weight loss even when dietary adherence is inconsistent. It is particularly useful for elderly patients or those with comorbidities who find daily management difficult.

Intermittent Energy Restriction (IER) involving alternating periods of energy restriction with refeeds may preserve resting energy expenditure (REE) and fat-free mass (FFM) better than Continuous Energy Restriction (CER) during weight loss, though evidence in athletes is currently limited.

If you are an athlete struggling with plateaus or extreme hunger on a standard diet, try adding 'refeed' days where you eat at maintenance or slightly above. This might help preserve your muscle and keep your metabolism from slowing down as much as it would on a constant low-calorie diet. However, be aware that direct proof in athletes is still scarce, so monitor your progress closely.

Combination anti-obesity medication regimens including GLP-1 receptor agonists can achieve total body weight loss (approx. 32.5%) comparable to metabolic/bariatric surgery in patients with severe obesity.

If you have severe obesity and have not lost significant weight with standard medications or lifestyle changes alone, ask your doctor about combination therapy. Adding a GLP-1 agonist (like semaglutide) to other approved weight-loss drugs may produce results similar to bariatric surgery. This approach targets multiple biological pathways (hunger, satiety, metabolism) simultaneously, which may be necessary for severe cases.

The effect of lifestyle intervention on cognitive impairment varies by baseline BMI, with potential benefit for overweight individuals (BMI 25-29) and potential harm for obese individuals (BMI ≥40).

For overweight individuals (BMI 25-29) with type 2 diabetes, lifestyle intervention may offer some cognitive protection. However, for those with severe obesity (BMI ≥40), the same intervention might be associated with a higher risk of cognitive impairment compared to controls. This suggests that the cognitive impact of weight loss may depend on starting weight, with potential benefits for the overweight and potential risks for the severely obese, possibly due to the loss of neuroprotective factors associated with higher body fat.

Alternate-day fasting (ADF) may lead to more favorable body composition changes (fat loss vs. lean mass gain) during weight regain compared to daily caloric restriction, potentially due to preserved resting metabolic rate.

If you are concerned about losing muscle while dieting, ADF might be a better option than daily restriction. This study suggests that after weight loss, ADF participants regained less fat and more muscle than those on daily restriction, possibly due to better preservation of metabolic rate.

Testosterone replacement therapy in older men with confirmed late-onset hypogonadism improves body composition by decreasing fat mass and increasing lean body mass.

If you are an older man with symptoms of low testosterone (like low libido, fatigue, or loss of muscle mass) and your blood tests confirm low levels, testosterone therapy can help you lose fat and gain muscle. It is not a magic bullet, and you must be monitored for prostate health and blood counts. If you don't feel better after a few months, the treatment likely isn't working for you.

Testosterone therapy improves erectile function and libido in men with documented testosterone deficiency, and may have synergistic effects when combined with phosphodiesterase-5 inhibitors in those who do not respond to either treatment alone.

If you are struggling with low sex drive or erectile dysfunction, ask your doctor to check your testosterone levels. If they are low, testosterone therapy can help. If you are already taking medication for ED (like Viagra) and it isn't working well, adding testosterone might improve the effect. Always discuss all your symptoms with your doctor.