Browse the evidence

Achieving optimal levels of waist circumference, glomerular filtration rate, and urine albumin-to-creatinine ratio (each weighted 2 points) and glycated hemoglobin/blood pressure (each weighted 1 point) is significantly associated with a lower risk of heart failure in type 2 diabetes.

For individuals with Type 2 Diabetes, managing heart failure risk requires a multi-faceted approach. Prioritize achieving target levels for waist circumference, kidney function (GFR and urine albumin), blood pressure, and blood sugar. The study suggests that controlling waist circumference and kidney markers may offer greater protection against heart failure than controlling blood pressure or blood sugar alone.

Longitudinal improvement in the cardiometabolic health score is significantly associated with a lower risk of heart failure.

If you have Type 2 Diabetes, working to improve your cardiometabolic health over time—such as reducing waist circumference, improving kidney markers, or better controlling blood pressure and blood sugar—can significantly lower your risk of developing heart failure, even if you started with a lower health score.

Obesity increases the risk and severity of acute pancreatitis (AP) through mechanisms including gallstone formation, hypertriglyceridemia-induced lipotoxicity, and intrapancreatic fat infiltration.

If you have obesity, your risk of acute pancreatitis is significantly higher due to factors like gallstones and fat breakdown products. Losing weight, particularly visceral fat, can reduce this risk.

Steep, excessive weight loss (>17% average) during the post-intervention follow-up phase in older adults with type 2 diabetes is strongly associated with increased mortality risk, particularly when the loss is unintentional.

If you are an older adult with type 2 diabetes, do not pursue aggressive weight loss strategies without medical supervision. Monitor your weight closely; if you lose more than 5% of your body weight unintentionally or rapidly, consult your doctor immediately, as this may indicate underlying health issues like frailty or depression rather than improved health.

Implementing 2020–2025 DGA-aligned school meal standards (limiting added sugars and sodium, increasing whole grains) reduces childhood BMI and systolic blood pressure, leading to significant long-term reductions in cardiovascular disease, diabetes, and cancer mortality in adulthood.

For policymakers and school administrators, updating school meal standards to limit added sugars and sodium while increasing whole grains is a high-impact intervention. It modestly improves children's immediate health (BMI, BP) and yields massive long-term societal benefits, including thousands of prevented deaths and billions in healthcare savings in adulthood.

Inorganic nitrate supplementation (316-860 mg/day) improves vascular function and lowers blood pressure in older adults, which may indirectly support skeletal muscle health by enhancing nutrient delivery.

Older adults can improve blood pressure and vascular health by consuming inorganic nitrate (e.g., from beetroot juice) at doses of 316-860 mg per day. This may help deliver more nutrients to muscles, though direct muscle-building effects are not yet fully proven.

Higher consumption of ultra-processed foods (UPFs) is associated with an increased risk of developing type 2 diabetes mellitus (T2DM), with hazard ratios typically ranging from 1.12 to 1.53 for incremental increases in UPF intake.

Limit your intake of ultra-processed foods, particularly those high in added sugars, saturated fats, and specific additives like emulsifiers (e.g., carrageenan) or containing endocrine disruptors from packaging (e.g., BPA). Focus on reducing sugary beverages and processed meats, as these show the strongest link to T2DM risk, while noting that some processed items like whole grain breads may not carry the same risk.

Skeletal muscle hypertrophy following resistance training is associated with distinct, cell-type-specific non-coding RNA (ncRNA) expression patterns, including MYREM (myonuclear), MEG3 (satellite cells), and CARMN (linear association with lean mass gain), which mediate growth via discrete functional pathways rather than uniform bulk tissue changes.

Resistance training works for most people (61% in this large multi-study analysis). If you are not seeing expected gains, it may not be that you 'can't grow,' but that your body uses different molecular switches (ncRNAs) than the average responder. Focus on consistent, supervised resistance training; individual molecular responses vary, but the mechanical stimulus is the primary driver. Do not use 'non-response' as an excuse to stop training, as measurement error often masks small gains.

A one-week complete cessation from resistance training (deload) at the midpoint of a 9-week program does not enhance hypertrophy, power, or local muscular endurance compared to continuous training, and results in inferior strength gains.

If your goal is maximizing strength, do not take a full week off from resistance training. Continuous training yields better strength gains than a one-week complete break. If you take a break for hypertrophy, expect no loss in muscle size, but do not expect any extra growth. Use deloads to manage fatigue, not to force adaptation.

Back squat training elicits greater improvements in lower limb dynamic strength on a nonspecific strength test (45° leg press) compared to front squat training in recreationally trained females, while both variations produce similar hypertrophic adaptations in the lateral thigh.

If your goal is maximum strength, prioritize the back squat. It allows you to lift heavier loads, which translates to better strength gains on other exercises like the leg press. If your goal is just muscle growth in the quads, either squat works equally well, so choose the one you can perform with better technique and less joint pain. You do not need to force yourself to do front squats if they cause shoulder discomfort; the back squat will get you the same muscle growth.

Sarcopenic obesity is a distinct clinical phenotype characterized by high fat mass and low skeletal muscle mass/function, associated with increased risks of frailty, mortality, and metabolic complications, requiring specific diagnostic algorithms (e.g., ESPEN-EASO) for identification.

If you have obesity and are experiencing weakness, fatigue, or functional decline, especially as you age, ask your doctor about sarcopenic obesity. It is not just 'being overweight'; it involves muscle loss which increases health risks. Diagnosis requires specific tests for muscle mass and strength, not just BMI.

The same 25g whey + 5g collagen blend increases myofibrillar protein synthesis during exercise recovery, but does NOT significantly increase muscle connective protein synthesis in the exercised leg compared to placebo.

If you are doing resistance training, your body already significantly boosts connective tissue synthesis. Adding a whey-collagen blend won't necessarily boost connective tissue synthesis further in the working muscles compared to just placebo, though it does help muscle protein synthesis. Focus on the blend for muscle growth, but don't expect it to be a magic bullet for tendon repair in exercised muscles.

Time since Type 2 Diabetes diagnosis is a significant moderator of absolute peak oxygen uptake, with longer duration associated with greater reductions in fitness.

The longer you have Type 2 Diabetes, the more your maximum oxygen uptake tends to drop. However, this decline is gradual. Prioritize exercise early in your diagnosis to preserve fitness, as the most significant drops may occur within the first 5 years.

Metabolic surgery can reverse or significantly improve existing diabetic microvascular complications, including nephropathy, neuropathy, and retinopathy, independent of the degree of weight loss or glycemic control.

If you have Type 2 Diabetes and are developing kidney or nerve damage, metabolic surgery may offer benefits that standard blood sugar management cannot, potentially reversing or halting this organ damage.

Metabolic surgery is an effective treatment for Non-Alcoholic Steatohepatitis (NASH), significantly reducing liver steatosis, inflammation, and fibrosis, and reducing progression to hepatocellular carcinoma (HCC).

If you have NASH, metabolic surgery is currently the most effective treatment to reverse liver damage and reduce the risk of liver cancer, as current medications and lifestyle changes are largely ineffective.

Metabolic surgery reduces overall and cardiovascular mortality in patients with Type 2 Diabetes and obesity, independent of preoperative BMI.

Metabolic surgery significantly lowers the risk of death from heart disease and other causes in people with Type 2 Diabetes and obesity, offering a survival benefit that intensive medical management does not provide.

Alternative forms of creatine (e.g., creatine HCl, creatine ethyl ester, creatine malate) are not superior to creatine monohydrate (CM) in increasing muscle creatine content or improving exercise performance, despite marketing claims suggesting otherwise.

If you are buying creatine, stick to creatine monohydrate (CM). Alternative forms like creatine HCl, ethyl ester, or malate are marketed as superior, but scientific evidence shows they are not better at increasing muscle creatine or improving performance than standard CM. You are likely paying significantly more (up to 116% higher per gram) for no additional benefit.

Adherence to a Mediterranean diet (MedDiet) mitigates the increased risk of type 2 diabetes and metabolic dysfunction associated with the TCF7L2 rs7903146 T-allele, effectively neutralizing the genetic predisposition when adherence is high.

If you carry the TCF7L2 rs7903146 T-allele (a common genetic variant linked to higher diabetes risk), strict adherence to a Mediterranean-style diet is your most powerful tool. It doesn't just help; it specifically neutralizes the genetic disadvantage, keeping your weight, waist circumference, and diabetes risk in check. Focus on high adherence to this pattern rather than just isolated nutrients.

Multidisciplinary team (MDT) interventions are more effective for weight loss and management of complex obesity than single-component interventions.

If you have complex obesity (high BMI with diabetes or other conditions), do not rely on a single strategy like diet or exercise alone. Seek a specialized Tier 3 weight management service that uses a multidisciplinary team (doctors, dietitians, psychologists, nurses). This team approach is proven to help you lose more weight (average 6%) and manage your diabetes better than single-focus interventions.

GLP-1 RA treatment is associated with significant lean tissue (muscle) loss, with studies showing 14-40% of total weight loss being lean mass, necessitating interventions to preserve muscle.

While GLP-1 RAs are effective for weight loss, they also cause muscle loss (14-40% of total weight loss). To protect your strength and metabolism, it is crucial to consume adequate protein and engage in resistance exercise during treatment. This is especially important for older adults or those already at risk of muscle loss.

Reduced gut microbial diversity (alpha-diversity) and specific taxonomic shifts (e.g., depletion of Akkermansia muciniphila and Faecalibacterium prausnitzii) are consistently associated with obesity and metabolic syndrome, serving as a marker of a less resilient microbiome.

Focus on dietary patterns that support microbial diversity (e.g., fiber-rich diets) rather than seeking simple diagnostic ratios. A diverse diet supports a resilient microbiome, which is associated with better metabolic health.

Continuous Positive Airway Pressure (CPAP) therapy effectively improves daytime sleepiness and quality of life in Obstructive Sleep Apnoea (OSA) patients, but its impact on cardiometabolic outcomes is uncertain and secondary prevention trials have failed to demonstrate significant modification of cardiovascular events.

CPAP is the most effective treatment for stopping snoring and fixing daytime sleepiness in OSA patients. However, do not expect it to automatically fix your heart health or blood sugar levels, as evidence for those benefits is weak. If you struggle with the mask, talk to your doctor about alternatives like oral appliances or nerve stimulation, as adherence is a major hurdle.

Using gender-specific portion sizes (GS-PS) in food frequency questionnaires improves the accuracy of absolute nutrient intake estimates compared to using common portion sizes, but does not improve the accuracy of nutrient density estimates.

If you are tracking your absolute nutrient intake (e.g., total grams of protein or calories) using a food diary or app, using gender-specific portion estimates can improve accuracy. However, if you are tracking nutrient density (e.g., percentage of calories from fat or protein), using standard portion sizes is likely sufficient as gender-specific adjustments do not significantly change these ratios.

Physical activity and exercise provide significant health benefits for adults with overweight or obesity independent of weight loss, including improvements in body composition quality, cardiorespiratory fitness, and metabolic health.

Prioritize regular physical activity regardless of your current weight. Focus on building cardiorespiratory fitness and muscle strength, as these provide health benefits even if you do not lose weight. Do not let the absence of scale movement discourage you from exercising.