Browse the evidence

Obesity lacks standardized diagnostic criteria and treatment targets compared to T2DM, leading to inconsistent care, underdiagnosis, and undertreatment.

If your doctor only uses BMI to diagnose obesity, ask for a more comprehensive assessment. This should include metabolic markers (blood pressure, lipids, glucose) and possibly the Edmonton Obesity Staging System to determine the severity of your condition and the appropriate treatment.

Initiation of GLP-1 receptor agonists (GLP-1RA) in older adults with type 2 diabetes on stable levothyroxine therapy significantly increases the risk of new-onset atrial fibrillation or flutter (AF/Aflutter) compared to SGLT2 inhibitors.

If you take levothyroxine and start a GLP-1RA (like Ozempic or Wegovy), your thyroid hormone levels may become too high because you lose weight or absorb the medication differently. This increases your risk of irregular heartbeats (AF). You need closer monitoring of your TSH levels and likely a reduction in your levothyroxine dose shortly after starting the GLP-1RA to prevent this.

GLP-1 receptor agonists (exenatide, liraglutide, dulaglutide, semaglutide, tirzepatide) reduce hepatic lipid accumulation in MASLD patients, primarily through indirect mechanisms involving weight loss and reduced fatty acid deposition, and directly by improving insulin sensitivity and suppressing de novo lipogenesis.

GLP-1 agonists like semaglutide and tirzepatide are effective treatments for reducing liver fat in people with MASLD, especially if they also have type 2 diabetes or obesity. They work by improving insulin sensitivity and directly reducing fat production in the liver, in addition to helping with weight loss. While they significantly reduce liver fat, they may not reverse advanced scarring (fibrosis). Consistency is key, as side effects and cost can lead to stopping treatment.

GLP-1 receptor agonists have limited efficacy in reversing advanced hepatic fibrosis compared to their ability to reduce hepatic steatosis.

If you have advanced liver scarring (fibrosis), GLP-1 medications may not reverse it, even though they will likely reduce liver fat. Newer multi-agonists (like resmetirom or dual agonists) might be needed for fibrosis.

Retatrutide increases the incidence of adverse events, particularly nausea, vomiting, and decreased appetite, in a dose-dependent manner compared to placebo.

While effective, retatrutide causes more side effects than placebo, including nausea, vomiting, and constipation. These side effects increase with higher doses (8mg and 12mg). Patients should be prepared for these potential issues, which may affect adherence.

Obesity pharmacotherapy is recommended against for compounded medications or unapproved medications due to safety and efficacy concerns.

Avoid compounded weight loss medications. They are not approved, may be unsafe, and are not proven to work. Stick to FDA/Health Canada-approved medications prescribed by your doctor.

For individuals with obesity and prediabetes who fail to achieve early weight loss (<2.5% at 4 weeks), adding exercise counseling or time-restricted eating (TRE) counseling does not significantly improve weight loss or glycemic outcomes compared to continuing the initial diet alone.

If you are not losing weight in the first month of a diet, simply adding more exercise counseling or trying a new eating window might not be enough. You may need more intensive support, such as provided meals or supervised exercise, rather than just advice.

GLP-1 RAs can cause clinically significant drug-drug interactions (DDIs) by delaying gastric emptying, particularly affecting the absorption of oral contraceptives and levothyroxine.

If you take oral contraceptives or levothyroxine, be aware that GLP-1 drugs can change how well these work by slowing stomach emptying. Your doctor may need to monitor your levels or adjust doses. Use backup contraception if advised.

GLP-1 receptor agonists directly modulate immune cell function, specifically suppressing T-cell activity and pro-inflammatory cytokine release, independent of metabolic changes.

GLP-1 medicines interact directly with your immune system. They can dampen the activity of T cells, which are key drivers of inflammation. This direct interaction helps reduce the production of inflammatory markers like TNF-α and IL-2, contributing to overall health benefits beyond blood sugar control.

GLP-1 receptor agonists reduce cardiovascular events and atherosclerosis progression through weight-loss-independent anti-inflammatory mechanisms involving endothelial and immune cell modulation.

GLP-1 medications like semaglutide and liraglutide are proven to reduce the risk of heart attacks, strokes, and cardiovascular death in people with type 2 diabetes and obesity. This protection is partly due to direct anti-inflammatory effects on blood vessels, independent of weight loss. These benefits are significant enough to be a primary reason for prescribing these drugs in high-risk patients.

Compared with animal protein, plant protein results in lower muscle mass, with a stronger negative effect observed in younger adults (<60 years) than in older adults (≥60 years).

If your goal is maximizing muscle mass, animal protein may offer a slight advantage over plant protein, particularly in younger adults. However, the difference is small, and plant protein is still effective. Focus on getting enough total protein and combining plant sources if possible.

There is no significant difference between plant and animal protein for muscle strength or physical performance.

You do not need animal protein to build strength or improve physical performance. Plant protein is equally effective for these outcomes. Focus on consistent training and adequate protein intake.

GLP-1RAs exhibit neuroprotective effects and may improve symptoms in patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and cognitive dysfunction associated with type 2 diabetes.

For patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes, GLP-1 receptor agonists like semaglutide can significantly reduce heart failure symptoms and improve physical limitations. Additionally, there is emerging evidence that these medications may offer neuroprotective benefits, potentially slowing cognitive decline in patients with T2DM.

GLP-1 receptor agonists are associated with a modestly increased risk of gallbladder and biliary disorders, particularly at higher doses and longer treatment durations.

Be aware that GLP-1 medications can slightly increase your risk of gallbladder issues, such as gallstones or inflammation. This risk is higher if you take higher doses or use the medication for a long time. While the absolute risk is low, report any severe abdominal pain to your doctor promptly.

Obesity induces chronic low-grade inflammation (LGCI) via adipose tissue hypertrophy, immune cell infiltration (M1 macrophages), and cytokine release (TNF-α, IL-6, IL-1β), which disrupts insulin signaling through JNK and NF-κB pathways, leading to systemic insulin resistance and metabolic dysfunction.

If you have obesity, your body is likely in a state of chronic, low-grade inflammation that actively works against your metabolic health. This isn't just 'being fat'; it's a biological state that disrupts how your body handles insulin and energy. Addressing this inflammation through lifestyle changes (diet, exercise) or medical interventions is crucial for breaking the cycle of metabolic dysfunction.

Obesity is a chronic, relapsing disease driven by a syndemic interaction of macro-systems (climate, globalization, policy) and micro-systems (behavior, environment), rather than solely individual choice.

Stop blaming yourself or others for obesity. Recognize it as a chronic disease shaped by your environment, food systems, and socioeconomic status. Seek medical help and policy changes rather than relying solely on willpower.

Body Mass Index (BMI) is an insufficient and potentially misleading sole diagnostic measure for obesity due to its inability to capture phenotypic heterogeneity and visceral adiposity.

Do not rely on BMI alone to assess your health. Ask your doctor for additional metrics like waist circumference, blood pressure, and blood sugar levels to get a complete picture of your metabolic health.

High-temperature cooking and prolonged storage can decrease protein quality by reducing the bioavailability of essential amino acids, particularly lysine, through the Maillard reaction and protein aggregation.

Avoid charring or overcooking meats and grains. High-temperature methods like grilling or prolonged roasting can chemically alter amino acids (especially lysine), reducing the protein's quality. Moderate cooking is generally better for preserving bioavailability.

GLP-1RAs exert their therapeutic effects through complex intracellular signaling pathways, specifically activating ERK1/2, AMPK, cAMP, MAPK, and PKC, which regulate insulin secretion, cell proliferation, and inflammation.

The effectiveness of GLP-1 medications is driven by their ability to activate specific cellular pathways (ERK1/2, AMPK, cAMP, MAPK, PKC). These pathways control insulin release, cell growth, and inflammation, which is why these drugs work for both diabetes and potentially other conditions like cancer or cardiovascular disease.

High cost or insurance-related barriers are the primary drivers of discontinuation for obesity pharmacotherapy with semaglutide or tirzepatide in clinical practice, accounting for nearly half of all early and late discontinuations.

If you are stopping semaglutide or tirzepatide, the most likely reason is cost or insurance issues, not that the drug didn't work. Check your insurance coverage, look for manufacturer coupons, and talk to your doctor about financial assistance programs before assuming the treatment is unsuitable for you.

Long-term use of GLP-1 receptor agonists (≥78 weeks) significantly increases the risk of deep vein thrombosis (DVT) compared to placebo or other anti-diabetic drugs.

If you are taking a GLP-1 medication (like Ozempic, Wegovy, or Victoza) for more than a year, be aware that your risk of deep vein thrombosis (DVT) is higher than if you were not taking it. This risk is most notable in people with existing cardiovascular disease. However, the absolute increase in risk is small. Discuss any history of blood clots with your doctor before starting or continuing long-term therapy.

Overall Venous Thromboembolism (VTE) risk is not significantly increased by GLP-1RA use, as the increase in DVT is offset by no change in Pulmonary Embolism (PE) risk.

Taking GLP-1 medications does not significantly increase your overall risk of blood clots (VTE) when looking at the big picture. While there is a small, non-significant upward trend, it is not statistically proven to be dangerous for the general population. The specific risk of DVT is only significant with very long-term use.

SGLT2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors provide cardiovascular organ protection in type 2 diabetes through direct antioxidant and anti-inflammatory mechanisms, independent of glucose lowering.

If you have Type 2 Diabetes, ask your doctor about SGLT2 inhibitors or GLP-1 agonists. These drugs do more than just lower blood sugar; they actively protect your heart and kidneys by reducing inflammation and oxidative stress, which are major drivers of heart disease in diabetic patients.

GLP-1 receptor agonists reduce platelet aggregation and thrombus formation, thereby mitigating the risk of thrombotic cardiovascular events in diabetic patients.

GLP-1 agonists may help prevent blood clots by making platelets less sticky, which adds to their heart-protective benefits beyond just sugar control.