Browse the evidence

For patients with Class III obesity (BMI >39.9 kg/m2), metabolic bariatric surgery (MBS) is significantly more effective than any currently approved medication, with BilioPancreatic Diversion (BPD) showing the highest estimated weight loss.

If you have Class III obesity (BMI >39.9), surgery is the most effective treatment available. Medications like semaglutide are significantly less effective than surgery for this group. If you are not a candidate for surgery or refuse it, medication is still an option, but you should expect less weight loss compared to surgical outcomes.

Supervised exercise training (SET) is the first-line treatment for chronic symptomatic peripheral artery disease (PAD) and intermittent claudication, significantly improving walking distance and functional status.

If you have PAD, supervised walking exercise is your best first treatment. Go to a clinic or program where professionals supervise you. Walk until your leg pain is severe (but not unbearable), rest until it passes, and repeat. Do this at least 3 times a week for 30-60 minutes. This will significantly increase how far you can walk.

Resistance training (RT) is the most effective intervention to prevent, mitigate, and recover from disuse-induced skeletal muscle atrophy in older adults, particularly when combined with adequate protein intake.

To protect your muscles as you age, especially if you have to be inactive for any reason (like surgery or illness), you must do resistance training. Aim for at least two days a week. You don't need heavy weights; resistance bands or bodyweight exercises work well. Focus on doing 1-3 sets of 6-12 repetitions with good effort, and make sure you eat enough protein. This is the best way to keep your strength and independence.

Comprehensive lifestyle intervention combining a daily caloric deficit of 500-1,000 kcal, aerobic exercise of ≥150 minutes per week, and resistance training 2-4 times per week is the foundational, evidence-based standard for obesity management.

Start by cutting 500-1,000 calories daily and aim for 150 minutes of moderate cardio (like brisk walking) spread over 3-5 days. Add 2-4 days of strength training using major muscle groups. Crucially, engage in behavioral counseling (tracking food, setting goals) for at least 6 months to ensure you stick with it.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are more effective than adjustable gastric banding (AGB) for weight loss and quality of life in severe obesity, with RYGB providing superior weight loss compared to SG.

If you have severe obesity and are considering surgery, Roux-en-Y gastric bypass offers the best chance for significant, lasting weight loss and improved quality of life. Sleeve gastrectomy is a good alternative if bypass is not possible, but expect less weight loss. Adjustable gastric banding is not recommended as it is significantly less effective. Discuss these options with a specialist bariatric team to determine the best fit for your health profile.

Suboptimal dietary intake is responsible for 70.3% of global incident type 2 diabetes cases, with the largest burdens driven by insufficient whole-grain intake, excess refined rice and wheat, and excess processed meat.

Focus on increasing whole grains, reducing refined grains (rice/wheat), and limiting processed meats. These three factors alone account for the majority of diet-attributable diabetes risk globally.

Excess intake of harmful dietary factors (refined grains, processed meats, SSBs, potatoes, fruit juice) contributes a larger proportion (60.8%) of diet-attributable T2D burden than insufficient intake of protective factors (whole grains, yogurt, fruits, vegetables, nuts/seeds) (39.2%).

Prioritize cutting back on refined grains, processed meats, and sugary drinks. While eating more fruits and vegetables is beneficial, the biggest reduction in diabetes risk comes from reducing these specific harmful categories.

An 18-week personalized dietary program (PDP) based on postprandial glucose, triglycerides, microbiome, and health history significantly reduces triglycerides, body weight, waist circumference, and HbA1c compared to standard USDA dietary guidelines.

Follow a personalized nutrition program that uses your body's specific response to food (glucose, triglycerides, microbiome) to guide your diet. This approach leads to greater improvements in triglycerides, weight loss, and blood sugar control compared to following standard government dietary guidelines alone. High adherence to the personalized advice is key to seeing these benefits.

When total volume load (sets x reps x weight) is equated, high-load resistance training (≥80% 1RM) produces superior dynamic strength gains compared to low-load training (<60% 1RM), while muscle hypertrophy remains similar across all load magnitudes.

To maximize strength, prioritize heavier weights (80%+ 1RM). To maximize muscle size, you have flexibility: you can use heavy weights or lighter weights (as low as 30% 1RM), as long as you match the total amount of work (sets x reps x weight). You do not need to train to failure with lighter weights to get the same muscle growth as heavy weights.

Consumption of sugar-sweetened beverages (SSBs) is causally associated with a significant global burden of incident type 2 diabetes (T2D) and cardiovascular disease (CVD), mediated by both direct metabolic effects and adiposity.

Reduce or eliminate sugar-sweetened beverages to significantly lower your risk of developing type 2 diabetes and cardiovascular disease. The risk is not just from weight gain but from how sugar is metabolized directly. This is especially critical if you are young, male, or live in urban areas in high-burden regions like Latin America or Sub-Saharan Africa.

Maximum strength improvements are maximized by heavy loads (high % 1RM), whereas vertical jump performance is maximized by lighter loads (~30% 1RM) and power by low-to-moderate loads (40–70% 1RM).

To maximize strength, use heavy loads. To maximize jumping ability, use lighter loads around 30% of your one-rep max. For general power, use loads between 40-70% of your one-rep max. Do not use the same heavy load for all exercises.

Bariatric surgery (specifically Sleeve Gastrectomy and Roux-en-Y Gastric Bypass) produces significant, sustained weight loss and metabolic improvements in adults with morbid obesity, with RYGB generally demonstrating superior long-term weight loss and diabetes remission rates compared to SG.

For individuals with a BMI ≥35 (or ≥30 with comorbidities like diabetes), bariatric surgery is the most effective medical intervention for significant, sustained weight loss and metabolic health improvement. Roux-en-Y Gastric Bypass (RYGB) generally offers better long-term weight loss and diabetes remission than Sleeve Gastrectomy (SG), but requires strict lifelong supplementation and monitoring. Surgery is not a first-line option for mild obesity but is critical for morbid obesity where lifestyle changes fail.

Supervised exercise training (SET) is a first-line therapy for chronic symptomatic peripheral artery disease (PAD) that significantly improves walking distance and functional status.

If you have PAD, supervised walking exercise is your primary treatment. Go to a clinic or program where professionals supervise you. Walk until your leg pain is severe (3-4 out of 4), rest until it subsides, then walk again. Do this at least 3 times a week for 30+ minutes. This improves your walking distance and quality of life.

Sarcopenia is a potentially reversible disease defined by the concurrent combination of reduced muscle mass and muscle strength, with muscle-specific strength also included as a component.

Sarcopenia is not just 'getting old'; it is a reversible condition defined by low muscle mass and strength. To address it, focus on resistance training and adequate protein intake to build muscle and strength, as these are the core components of the disease definition.

Higher-load resistance training (≥80% 1RM) is the primary determinant for maximizing muscle strength gains, whereas multiple sets are the primary determinant for maximizing muscle hypertrophy.

If your main goal is to get stronger, prioritize lifting heavy weights (at least 80% of your one-rep max). If your main goal is to build muscle size, focus on doing multiple sets per exercise (e.g., 2-3 sets) rather than just one. You do not need to choose one goal over the other; high-load, multi-set training is the best of both worlds.

Diets high in ultra-processed foods cause excess ad libitum energy intake and weight gain compared to minimally processed diets, even when macronutrients and presented calories are matched.

Prioritize whole, minimally processed foods. Even if you match the calories and macros, ultra-processed foods make you eat more because of their physical structure and hyper-palatability. Focus on food quality and processing level, not just nutrient numbers.

Protein supplementation augments strength and hypertrophy.

If you are doing resistance training, protein supplementation can help you build more strength and muscle.

Creatine supplementation augments strength.

Creatine supplementation is an effective way to increase strength when combined with resistance training.

Adherence to the DASH dietary pattern reduces systolic blood pressure by 1–13 mm Hg and diastolic blood pressure by 1–10 mm Hg, with effects amplified when combined with weight loss or sodium restriction.

Adopt the DASH diet by prioritizing fruits, vegetables, low-fat dairy, and whole grains while limiting saturated fats and sugars. This approach is clinically proven to lower blood pressure significantly, often matching the effectiveness of standard blood pressure medications, especially if you also manage your weight and sodium intake.

Creatine supplementation combined with resistance training significantly increases fat-free mass (FFM) and body mass in both novice and experienced lifters, with experienced lifters gaining approximately 0.6 kg more FFM than novices, though this difference is not statistically significant.

If you are lifting weights, adding creatine will help you gain more muscle and body weight than training alone. This benefit applies whether you are just starting out or have been training for years. While experienced lifters might gain slightly more muscle than beginners, the difference isn't statistically significant, meaning creatine is a valuable tool for everyone.

High consumption of ultra-processed foods (UPFs) causes increased risk of obesity, diabetes, and cardiovascular disease, independent of nutrient content, due to hyper-palatability and additive effects.

Shift your diet away from ultra-processed foods (soft drinks, packaged snacks, ready meals) towards freshly prepared dishes using unprocessed or minimally processed ingredients. Focus on the nature of the food, not just its calories or macros, as UPFs are linked to higher risks of obesity and chronic disease regardless of nutrient content.

Increased consumption of ultra-processed foods is a major contributor to the global pandemics of obesity, type 2 diabetes, and related non-communicable diseases.

Prioritize fresh and minimally processed foods in your diet. Be aware that ultra-processed foods (UPFs) are a major driver of obesity and metabolic disease. UPFs are industrially formulated products high in sugars, unhealthy fats, and sodium, and low in fiber and protein. They are designed to be hyper-palatable and addictive. To improve health, reduce UPF consumption and replace them with whole or minimally processed alternatives. Policy changes are needed to make healthy foods more accessible and affordable.

Total Diet Replacement (TDR) using meal replacements in very-low-calorie diets (VLCDs) produces significantly greater weight loss (average >10 kg over 12 months) and superior diabetes remission rates compared to usual care or food-based diets.

If you have obesity or Type 2 Diabetes, using Total Diet Replacement (TDR) with meal replacements for 3-5 months, followed by maintenance with 1-2 meal replacements daily, is a clinically proven strategy. It leads to significantly more weight loss (average 10kg+) and higher diabetes remission rates than standard advice. Ensure you work with a healthcare provider for medical supervision, especially during the initial very-low-calorie phase.

Bariatric-metabolic surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) significantly increases the probability of histological NASH resolution without worsening fibrosis compared to lifestyle modification plus best medical care in patients with obesity and NASH.

For individuals with obesity and confirmed NASH, bariatric surgery (Roux-en-Y or sleeve gastrectomy) is a highly effective treatment for resolving liver inflammation and fibrosis, far outperforming lifestyle changes and medical therapy alone. This should be considered a primary treatment option for eligible patients.