Browse the evidence

Very low-carbohydrate diets (ketogenic) pose long-term sustainability, health, and environmental risks, including potential nutrient deficiencies and increased LDL cholesterol.

Be cautious with very low-carb diets. They can lead to nutrient deficiencies, increased LDL cholesterol, and are difficult to sustain long-term. Focus on balanced, high-quality diets instead.

Bariatric surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) provides long-term weight loss and high diabetes remission rates (51% at 12 years) by altering gut microbiota diversity and increasing specific beneficial bacteria like Bacteroides uniformis.

For severe obesity with type 2 diabetes, bariatric surgery (Roux-en-Y or Sleeve Gastrectomy) is the most effective long-term treatment, offering sustained weight loss (~35kg) and a 51% chance of diabetes remission after 12 years. This is achieved partly by reshaping the gut microbiome to favor beneficial bacteria.

The observed 'obesity paradox' in diabetes is likely non-causal and explained by biases such as reverse causation, confounding by fitness, and body composition differences (muscle mass).

Do not interpret the 'obesity paradox' as a reason to gain weight. The survival advantage seen in obese diabetics is likely due to them having more muscle, being fitter, or having less severe disease at diagnosis, not the fat itself. Weight loss interventions are safe and recommended.

Implementation of front-of-package warning labels on high-sugar foods drives food industry reformulation by replacing added sugars with non-nutritive sweeteners (NNS), particularly sucralose and stevia, rather than simply reducing total sugar content.

Regulations forcing sugar reduction often lead manufacturers to add artificial sweeteners instead of just cutting sugar. If you are trying to reduce sugar intake, check the ingredients list for sweeteners like sucralose or stevia; their presence indicates the product was reformulated to meet sugar limits, not necessarily to be healthier overall.

Products that reformulate to avoid 'high in sugar' warning labels are significantly more likely to introduce non-nutritive sweeteners (NNS) than products that do not change their sugar status.

If a product used to have a 'High in Sugar' warning but no longer does, it likely added artificial sweeteners to maintain taste. Look for ingredients like sucralose, aspartame, or stevia on the label to confirm this substitution.

South Asian patients with Type 2 Diabetes Mellitus (T2DM) face a disproportionately higher risk of Major Cardiovascular Events (MACE) and Chronic Kidney Disease (CKD) compared to White Europeans, even when South Asian patients are of normal weight or overweight status.

If you are South Asian and have Type 2 Diabetes, your risk for heart disease and kidney problems is significantly higher than that of White European patients, even if you are not overweight. Do not rely on BMI alone to gauge your health. You likely need more aggressive monitoring and management of blood pressure, lipids, and blood sugar than standard guidelines might suggest for your weight class.

In patients with incident stroke, higher BMI (overweight and obesity classes I-III) is associated with a lower risk of major adverse cardiovascular events (MACE), peripheral vascular disease, cardiovascular mortality, and all-cause mortality compared to normal BMI.

If you have had a stroke, being overweight or obese might actually be associated with a lower risk of future heart problems and death compared to being normal weight. This does not mean you should gain weight, but it suggests that aggressive weight loss immediately after stroke might not be the priority. Discuss weight management with your doctor, keeping in mind that your current weight might be protective.

Long-term intentional weight loss via intensive lifestyle intervention in obese adults with type 2 diabetes is associated with small relative deficits in global cognitive function and steeper rates of cognitive decline compared to a control group.

If you have type 2 diabetes and are obese, be aware that long-term, intensive weight loss programs might be associated with slightly faster cognitive decline compared to maintaining your current weight with standard diabetes education. This does not mean weight loss is bad for your heart or mobility, but it suggests that cognitive monitoring is important. The benefits for cardiovascular health are clear, but the cognitive trade-off in this specific group warrants caution and discussion with your doctor.

Successful weight loss and reversal of insulin resistance via combined nutritional and exercise interventions do not restore mitochondrial homeostasis in visceral adipose tissue (VAT), which remains characterized by irreversible mitochondrial dysfunction and metabolic plasticity breakdown.

For individuals who have successfully lost weight and improved insulin sensitivity, it is crucial to understand that visceral fat may retain permanent structural and functional damage (mitochondrial failure) from previous obesity. This means that while systemic health markers improve, the tissue itself may remain metabolically rigid. Continued lifestyle maintenance is essential not just for weight control, but to manage this residual tissue vulnerability.

A 6-week static stretching program, regardless of frequency (1x or 3x per week) or volume-equated duration, does not increase muscle strength or muscle architecture (thickness/pennation angle) of the medial gastrocnemius in healthy, non-athletic males.

If you are doing static stretching to build muscle or get stronger, this 6-week protocol will not work. Whether you stretch once a week for 6 minutes or three times a week for 2 minutes, you will not see changes in muscle size or strength. Stretching is useful for range of motion, but do not expect it to replace resistance training for hypertrophy or strength gains.

Epigenetic modifications (DNA methylation) associated with obesity and diet are largely consequences of the phenotype or acute events rather than causal factors.

Do not pay for 'biological age' tests based on DNA methylation. These changes are often just markers of your current health status, not something you can easily 'fix' with a specific supplement or diet. Focus on proven healthy habits.

The Core Obesity Model (COM) accurately predicts obesity-related event rates for type 2 diabetes, cardiovascular disease, and obstructive sleep apnea when validated against studies used for its development.

For decision-makers using the Core Obesity Model, the dependent validation results provide high confidence that the model accurately predicts the rates of T2D, CVD, and OSA for populations similar to those used in its development. This supports the use of the model for cost-effectiveness analyses in these specific contexts.

The Core Obesity Model tends to underestimate the incidence of cardiovascular disease, mortality, and type 2 diabetes when validated against independent studies not used in its development.

When using the Core Obesity Model for independent validation, be aware that it tends to underestimate the rates of CVD, mortality, and T2D. This underestimation is particularly pronounced for mortality and stroke. However, the model still shows good linear correlation, and the underestimation may not significantly impact incremental cost-effectiveness ratios if it affects both intervention and comparator arms similarly.

Longer leukocyte telomere length (LTL) is associated with a significantly lower risk of all-cause mortality and coronary heart disease (CHD) mortality in elderly adults.

Leukocyte telomere length is a biomarker of biological aging and cardiovascular health. This study shows that longer telomeres are associated with lower mortality risk. While you cannot directly 'take' telomere length, maintaining a healthy lifestyle (not smoking, moderate alcohol, healthy diet) is associated with longer telomeres and lower mortality risk. Focus on these modifiable factors rather than trying to directly manipulate telomere length.

Five days of bed rest does not significantly alter skeletal muscle mitochondrial protein content, enzyme activity, or dynamics (fission/fusion/biogenesis/mitophagy markers) in healthy older adults.

For older adults facing short hospital stays (around 5 days), do not panic about losing metabolic health or mitochondrial density. While muscle mass may decrease, the cellular machinery for energy production remains largely intact during this specific timeframe, suggesting that immediate post-discharge recovery of metabolic function is feasible without needing to rebuild mitochondrial content from scratch.

Nutrient-based front-of-pack labeling systems (like Health Star Rating) can assign high health scores to ultra-processed foods, creating a 'health halo' that misleads consumers about the nutritional quality of convenience foods, sports/diet foods, and meat alternatives.

When evaluating packaged foods, do not rely solely on front-of-pack labels like the Health Star Rating. These systems focus on nutrients (sugar, sodium, fiber) but ignore how processed the food is. Look for the ingredient list: if it contains industrial additives, emulsifiers, or protein isolates, it is likely ultra-processed, even if it has a high health score. Prioritize whole, minimally processed foods over highly processed ones with 'good' nutrient profiles.

In women with suspected ischemia, a history of intentional weight cycling (defined as losing ≥10 lbs at least three times) is associated with a significantly lower rate of adverse cardiovascular outcomes compared to non-cyclers, despite having lower HDL-cholesterol levels.

For women with suspected heart issues, attempting to lose weight—even if they regain it and cycle multiple times—does not appear to increase their risk of heart attacks, stroke, or heart failure. In fact, these women had better outcomes than those who never tried to lose weight. This suggests that the intention and effort to manage weight may be beneficial, countering the fear that 'yo-yo' dieting is harmful.

Handgrip strength reference values for European adults aged 50+ vary significantly by age, sex, and geographic region, with Northern and Western Europe showing higher absolute strength than Southern and Central/Eastern Europe, and standing position yielding higher values than sitting.

If you are over 50, do not compare your handgrip strength to a generic global average. Use the specific reference values for your age group, sex, and European region (Northern, Western, Southern, or Central/Eastern) to accurately assess your muscle health. Standing grip is typically higher than sitting; ensure you are comparing like with like.

Current precision nutrition products and nutrigenomics concepts promoted on social media frequently contain misleading or untrue information, particularly regarding the readiness of personalized diets and the ability of specific foods to alter DNA.

Be skeptical of social media posts claiming that specific diets or supplements can change your DNA or that personalized nutrition products are ready for general use. The scientific consensus is that these technologies are not yet ready for broad application, and many products contain misleading or untrue information. Focus on evidence-based dietary patterns rather than unproven genetic tailoring products.

In Chronic Kidney Disease, Heart Failure, Liver Disease, Psoriasis, Rheumatoid Arthritis, and COPD, elevated CRP is NOT explained by adiposity alone, indicating independent inflammatory pathology driven by end-organ damage or tissue-specific inflammation.

If you have CKD, Heart Failure, Liver Disease, Psoriasis, RA, or COPD, your high CRP is likely due to the disease process itself, not just your weight. While weight management is still beneficial, you likely need specific treatments targeting the organ damage or autoimmune response, as weight loss alone may not resolve the inflammation.

In individuals with ideal cardiovascular health (high CVHS), elevated BMI (≥35.0 kg/m²) does not significantly increase the risk of incident atherosclerotic cardiovascular disease (ASCVD) compared to normal BMI, whereas low cardiovascular health strongly predicts ASCVD regardless of BMI.

If you have ideal cardiovascular health (normal blood pressure, lipids, glucose, no smoking, active, healthy diet, good sleep), your risk of heart disease is low even if your BMI is high (≥35). Focus on maintaining these healthy habits rather than trying to lose weight. If your cardiovascular health score is low, your risk is high regardless of your BMI, so prioritize improving lifestyle and metabolic markers.

Markov models are the dominant methodological framework for economic evaluations of obesity interventions, with 85% of reviewed studies utilizing state-transition models.

When evaluating the long-term cost-effectiveness of obesity treatments, decision-makers should expect and look for Markov modeling. This is the standard approach for comparing interventions like bariatric surgery, pharmacotherapy, and lifestyle changes over a patient's lifetime.

Current Markov models for obesity interventions exhibit significant methodological heterogeneity, particularly in how they model the progression of obesity and its impact on costs and utilities.

When comparing economic evaluations of obesity treatments, be aware that different studies use different structures (direct BMI-to-cost vs. BMI-to-complications). This makes direct comparison difficult. Look for studies that use standardized validation and include a broad spectrum of complications.

Diabetes mellitus (DM) and cardiovascular disease (CVD) are the most frequently modeled obesity-related complications in Markov models, with DM appearing in 15/15 models focusing on complications and CVD in 14/15.

If you are looking at an economic evaluation of an obesity treatment, expect it to focus heavily on preventing diabetes and cardiovascular events. These are the main drivers of long-term cost savings and quality-of-life improvements in these models.