Browse the evidence

Whey protein supplementation (total 1.2 g/kg/d) during diet-induced weight loss does not produce clinically important improvements in muscle mass or strength in middle-aged postmenopausal women with obesity.

If you are a postmenopausal woman losing weight, eating more protein (up to 1.2g/kg) than the standard recommendation will not save your muscle mass or strength. You will still lose muscle, and your strength will not improve, regardless of whether you take whey protein supplements. Do not rely on protein alone to preserve muscle during a diet.

Long-acting GLP-1 receptor agonists (GLP-1RAs) significantly reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes, particularly those with established cardiovascular disease or high cardiovascular risk.

If you have type 2 diabetes and are at high risk for heart disease or have existing heart conditions, GLP-1 receptor agonists (like semaglutide or liraglutide) are strongly recommended. These medications not only help control blood sugar but also significantly reduce the risk of heart attacks, strokes, and cardiovascular death. They are considered a standard of care for cardiovascular risk mitigation in this population.

GLP-1RAs reduce the risk of hospitalization for heart failure (HF) and prevent new-onset HF, although they may not reduce readmissions in patients with existing HF.

For patients with type 2 diabetes who are at risk for heart failure, GLP-1RAs can help prevent the initial development of heart failure and reduce the likelihood of being hospitalized for it. However, if you already have heart failure, these medications may not prevent future hospital readmissions, though they still offer other cardiovascular benefits.

Tirzepatide use can cause drug-induced liver injury (DILI) characterized by elevated transaminases, potentially linked to rapid hepatic fat mobilization.

If you are taking tirzepatide and experience unexplained fatigue or abdominal discomfort, ask your doctor to check liver enzymes (ALT/AST). This liver injury is rare and reversible, but monitoring ensures safety. Do not stop the medication without consulting your provider, as the metabolic benefits are significant.

Coadministration of SGLT2 inhibitors and tirzepatide creates a synergistic risk for euglycemic ketoacidosis (EKA), a life-threatening condition characterized by ketone production and acidosis despite normal blood glucose levels.

If you are taking both an SGLT2 inhibitor (like empagliflozin) and tirzepatide, be aware that you are at risk for a rare but serious condition called euglycemic ketoacidosis (EKA). Unlike typical diabetic ketoacidosis, your blood sugar may remain normal, so do not rely on glucose readings alone. If you experience persistent nausea, vomiting, or extreme fatigue, seek medical attention immediately and ask for ketone testing, even if your blood sugar is not high.

Observational studies claiming GLP-1 receptor agonists reduce cancer risk are currently methodologically flawed and cannot support clinical policy due to high risk of bias.

Do not rely on current observational studies to claim that GLP-1 drugs prevent cancer. The existing data is methodologically flawed and cannot yet inform clinical practice or public health policy.

The presence of the rare BDNF p.Thr2Ile variant is associated with a suboptimal response to high-dose tirzepatide treatment, resulting in significantly less weight loss compared to clinical trial averages.

If you have the rare BDNF p.Thr2Ile variant, you might experience less weight loss from tirzepatide than the average patient. Discuss your genetic profile with your doctor to manage expectations and explore alternative treatments.

Continuous Positive Airway Pressure (CPAP) is the recommended first-line treatment for stable ambulatory patients with OHS who also have severe Obstructive Sleep Apnea (OSA).

If you have OHS and severe sleep apnea, CPAP is the standard first treatment. You need to use it every night. While it can be uncomfortable at first, it is necessary to keep your airways open and manage your breathing until weight loss interventions can potentially resolve the underlying syndrome.

Serum bicarbonate levels below 27 mmol/L can effectively rule out Obesity Hypoventilation Syndrome (OHS) in obese patients with sleep-disordered breathing who have a low to moderate pretest probability (<20%) of having the condition.

If you are obese and have sleep apnea, your doctor can check your blood bicarbonate level. If it is below 27, it is very unlikely you have the serious breathing condition called OHS, and you might not need more invasive blood tests. If it is higher, you likely need further testing.

A 10-year intensive lifestyle intervention targeting weight loss and increased physical activity does not reduce the overall prevalence of cognitive impairment or probable dementia in overweight or obese adults with type 2 diabetes.

For adults with type 2 diabetes, a 10-year intensive lifestyle program focusing on weight loss and exercise did not reduce the overall risk of developing mild cognitive impairment or dementia compared to standard diabetes education. While the intervention successfully produced sustained weight loss and increased physical activity, these changes did not translate to a lower prevalence of cognitive impairment in this specific population. However, the intervention did improve other health metrics, suggesting that lifestyle changes remain important for general health even if they do not prevent cognitive decline in this context.

GLP-1R agonists improve cardiovascular risk factors by reducing systolic and diastolic blood pressure and total cholesterol concentrations.

Beyond weight loss, these medications also help lower blood pressure and cholesterol, which are key risk factors for heart disease. This makes them particularly useful for patients with metabolic syndrome.

GLP-1R agonists improve glycaemic control in patients with type 2 diabetes by reducing HbA1c and increasing the proportion of patients achieving target HbA1c levels, without causing significant hypoglycemia.

For people with type 2 diabetes, GLP-1R agonists are effective at lowering blood sugar (HbA1c) and helping more people reach their target levels, without the risk of dangerous low blood sugar (hypoglycemia) associated with other diabetes medications.

Lowering total fat intake does not have negative effects on other cardiovascular risk factors, specifically lipid levels or blood pressure.

You can reduce your fat intake for weight management without worrying about harming your cholesterol or blood pressure, based on this large body of evidence.

Vitamin D deficiency is defined as serum 25(OH)D below 20 ng/ml, and insufficiency as 21-29 ng/ml, with sufficiency targeted above 30 ng/ml for optimal bone health.

Your Vitamin D status is categorized as deficient if your blood level is below 20 ng/ml, insufficient between 21-29 ng/ml, and sufficient above 30 ng/ml. These levels determine whether you need supplementation.

In high-risk type 2 diabetes patients, GLP-1 receptor agonists and SGLT2 inhibitors reduce major adverse cardiovascular events (MACE), heart failure hospitalization, and chronic kidney disease progression independently of baseline HbA1c levels.

If you have type 2 diabetes and are at high risk for heart or kidney problems, ask your doctor about GLP-1 receptor agonists or SGLT2 inhibitors. These drugs protect your heart and kidneys regardless of your blood sugar levels. This is a key shift in treatment guidelines for high-risk patients.

SGLT2 inhibitors are recommended for type 2 diabetes patients with heart failure with reduced ejection fraction (HFrEF) to reduce hospitalization for heart failure, MACE, and cardiovascular death.

If you have type 2 diabetes and heart failure, especially with reduced ejection fraction, ask your doctor about SGLT2 inhibitors. These drugs are proven to reduce hospitalizations for heart failure and cardiovascular death, offering protection beyond blood sugar control.

SGLT2 inhibitors are recommended for type 2 diabetes patients with chronic kidney disease (CKD) to prevent CKD progression, heart failure hospitalization, MACE, and cardiovascular death.

If you have type 2 diabetes and chronic kidney disease, ask your doctor about SGLT2 inhibitors. These drugs are proven to slow the progression of kidney disease and reduce the risk of heart failure and cardiovascular death, offering protection beyond blood sugar control.

GLP-1 receptor agonists are recommended for type 2 diabetes patients with established atherosclerotic cardiovascular disease (ASCVD) to reduce MACE, with the strongest evidence for dulaglutide.

If you have type 2 diabetes and established cardiovascular disease, ask your doctor about GLP-1 receptor agonists. These drugs are proven to reduce major adverse cardiovascular events, offering protection beyond blood sugar control.

The association between low BMI and increased mortality is likely caused by preclinical disease (weight loss preceding diagnosis) rather than low body weight itself.

If you are underweight, do not panic about mortality risk based on BMI alone. This risk is often driven by underlying undiagnosed health issues causing weight loss. Focus on medical check-ups rather than just trying to gain weight.

Cardiac rehabilitation, whether exercise-only or comprehensive, does not significantly reduce the rate of non-fatal myocardial infarction recurrence.

While cardiac rehabilitation saves lives, it does not appear to prevent heart attacks from happening again. It is crucial for survival, but not for preventing non-fatal cardiac events.

Hypertension is the most common modifiable risk factor for stroke in women, with a higher lifetime risk and prevalence in postmenopausal women compared to men, necessitating early and sustained treatment.

Monitor your blood pressure regularly, especially after menopause. Since women are more likely to develop hypertension and have a higher lifetime risk of stroke, keeping your blood pressure in a healthy range is the most effective step you can take to prevent stroke.

Increased body mass index (BMI) is strongly associated with a higher risk of developing oesophageal adenocarcinoma, colon and rectal cancer in men, biliary tract system cancer, pancreatic cancer, endometrial cancer (premenopausal), kidney cancer, and multiple myeloma.

Maintaining a healthy body weight is a critical, evidence-based strategy for reducing the risk of several major cancers, including colorectal, pancreatic, kidney, and endometrial cancers. This is not just about aesthetics; it is a direct modifiable risk factor. For men, colorectal risk is particularly sensitive to BMI increases. For women, maintaining a healthy weight, especially before menopause, is crucial for endometrial health. Public health guidelines should target these populations for personalized prevention strategies.

Weight gain in adulthood is strongly associated with an increased risk of postmenopausal breast cancer in women who have never used hormone replacement therapy (HRT).

For postmenopausal women, especially those not using hormone replacement therapy, avoiding weight gain in adulthood is a key strategy for reducing breast cancer risk. Each 5 kg of weight gain is linked to an 11% higher risk. This highlights the importance of long-term weight management, not just immediate weight loss.

Waist-to-hip ratio (WHR) is strongly associated with an increased risk of endometrial cancer.

For endometrial cancer risk, where you carry weight is as important as how much you weigh. A higher waist-to-hip ratio is strongly linked to a 21% increased risk for each 0.1 increase. Focus on reducing central adiposity through diet and exercise, not just overall weight loss.