Browse the evidence

Dapagliflozin, an SGLT2 inhibitor, significantly reduces cardiovascular risk and mortality in type 2 diabetes patients by correcting major risk factors like obesity and hypertension, unlike older therapies which may increase risk.

If you have Type 2 Diabetes and are at high risk for heart problems, ask your doctor about Dapagliflozin. It is a daily pill that not only helps control blood sugar but has been proven to significantly reduce the risk of heart attacks, strokes, and heart failure hospitalizations compared to older treatments. It also helps with weight loss and blood pressure.

GLP-1 receptor agonists (Liraglutide, Semaglutide, Dulaglutide, Albiglutide, Efpeglenatide) significantly reduce MACE-3 and cardiovascular death in patients with Type 2 Diabetes and high cardiovascular risk.

If you have Type 2 Diabetes and high heart disease risk, GLP-1 agonists (injectable or oral) are recommended to reduce the risk of heart attack, stroke, and cardiovascular death. Discuss these options with your provider.

Hedonic feedback (reward learning) and cognitive feedback (self-regulation, social norms) interact with homeostatic signals to regulate food intake, often overriding homeostatic satiety.

Understand that food intake is regulated by homeostatic, hedonic, and cognitive systems. Changing the environment and managing hedonic cues is as important as willpower.

Metabolic adaptations to weight loss (e.g., decreased energy expenditure) act to resist weight change and contribute to weight regain.

Expect metabolic adaptations when losing weight. These adaptations resist weight change and contribute to regain, making sustained weight loss challenging.

Using nutrient densities (mg per 1,000 kcal) improves the measurement accuracy of both potassium and sodium compared to absolute intake, and the Sodium:Potassium Ratio (SPR) is measured significantly better than sodium alone.

When tracking sodium, do not just look at the total milligrams. Calculate the Sodium:Potassium Ratio (SPR) or look at sodium density (mg per 1,000 kcal). These metrics are measured much more accurately by self-report instruments than absolute sodium values, reducing the error inherent in memory-based food logging.

Prolonged calorie restriction (25% deficit) in nonobese overweight adults induces metabolic adaptation, reducing 24-hour energy expenditure by ~6% more than expected from the loss of fat-free mass alone.

If you restrict calories for 6 months, your body will burn fewer calories than expected for your new size. This is a normal survival mechanism, not a failure. To manage this, you may need to adjust your calorie targets or increase activity as you lose weight, rather than assuming your old maintenance calories will still apply.

Prolonged calorie restriction reduces fasting insulin levels and core body temperature in nonobese overweight adults, aligning with biomarkers associated with longevity in rodents and primates.

Calorie restriction lowers fasting insulin and body temperature, which are markers linked to longer life in animals and observational human studies. This suggests that maintaining lower insulin and slightly lower body temperature through moderate calorie restriction may support longevity.

Prolonged calorie restriction reduces DNA damage (measured by comet assay) in nonobese overweight adults, while protein carbonyl levels remain unchanged.

Calorie restriction reduces DNA damage, a key factor in aging. This benefit was seen across different types of calorie restriction (moderate, with exercise, and very low-calorie), suggesting that reducing energy intake protects DNA integrity.

Sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB) produce clinically equivalent long-term excess BMI loss, though RYGB yields significantly higher total weight loss and superior resolution of dyslipidemia.

If you are considering bariatric surgery, understand that both sleeve gastrectomy and Roux-en-Y gastric bypass provide similar long-term excess weight loss results. However, RYGB offers better improvement in cholesterol levels (dyslipidemia) and a lower risk of developing new acid reflux (GERD). Sleeve gastrectomy has a lower rate of minor complications. Your choice should be based on your existing health conditions, particularly whether you suffer from reflux, rather than the assumption that one surgery is strictly 'better' for weight loss.

GLP-1 receptor agonists are associated with a higher frequency of gastrointestinal adverse events (nausea, vomiting, diarrhea) compared to placebo, although the risk of serious adverse events like pancreatitis remains comparable.

Expect gastrointestinal side effects like nausea and diarrhea when starting GLP-1 medications. These are common but usually mild to moderate. Serious side effects like pancreatitis are rare and occur at similar rates to placebo. Discuss management strategies with your provider to maintain treatment.

Among healthy, never-smoking white adults, a BMI of 20.0 to 24.9 is associated with the lowest all-cause mortality, while both overweight (BMI 25.0-29.9) and obesity (BMI ≥30.0) are associated with significantly increased mortality risk.

For non-smoking adults without major chronic diseases, maintaining a BMI between 20.0 and 24.9 is associated with the lowest risk of death. Being overweight or obese increases this risk, with the risk rising significantly as BMI increases beyond 30.

Among middle-aged women who have never smoked and maintained stable weight, higher body-mass index (BMI) is directly associated with increased all-cause mortality, with the lowest mortality observed in lean women (BMI < 19.0).

For middle-aged women who have never smoked, maintaining a stable, lean body weight (BMI < 19.0) is associated with the lowest risk of death from all causes, particularly cardiovascular disease and cancer. Avoiding significant weight gain since young adulthood (age 18) is also critical, as gaining 10kg or more increases mortality risk. The perceived safety of being 'overweight' is largely an artifact of smoking and pre-existing illness in other studies.

Total fat intake is not significantly related to the risk of coronary heart disease in women; the type of fat is the critical determinant.

Do not focus on reducing the total amount of fat you eat. Instead, focus on the type of fat. Replacing saturated and trans fats with unsaturated fats (like those in olive oil, nuts, and fish) is the key to heart health, not simply eating less fat.

Higher body weight and greater weight gain during adulthood are strongly associated with an increased risk of coronary heart disease in women, independent of other risk factors.

Maintain a healthy body weight and avoid significant weight gain as you age. This study indicates that carrying extra weight, especially gaining weight in adulthood, significantly raises your risk of heart disease. Focus on sustainable lifestyle habits that support a stable, healthy weight rather than quick fixes.

High consumption of meat and seafood increases the risk of gout in men, whereas high consumption of dairy products, particularly low-fat dairy, decreases the risk.

If you are a man at risk for or have gout, focus your dietary changes on reducing meat and seafood intake, as these are linked to higher risk. Conversely, increasing your intake of low-fat dairy products (like skim milk and low-fat yogurt) is associated with a lower risk of gout. You do not need to restrict purine-rich vegetables or total protein intake.

Obesity and diabetes mellitus independently and jointly increase the risk of cardiovascular disease (CVD) and stroke by approximately 2-fold, with obesity acting as an independent risk factor even after adjusting for hypertension, diabetes, and cholesterol.

Obesity and diabetes are major, independent drivers of heart disease and stroke, roughly doubling your risk. This risk persists even if you manage blood pressure and cholesterol. The most effective way to lower this risk is to maintain a healthy weight and blood sugar through sustainable lifestyle changes, as these conditions are largely preventable despite environmental challenges.

Lorcaserin produces modest but clinically meaningful weight loss (approx 3.2% more than placebo) with a favorable side effect profile compared to other agents, though long-term cardiovascular safety requires monitoring.

Lorcaserin (10mg, 2x daily) offers a moderate weight loss benefit (~3% more than placebo) with a generally well-tolerated side effect profile. It is a viable option for patients who cannot tolerate the side effects of other drugs or who need a modest boost to lifestyle changes. Long-term cardiovascular safety is still being monitored.

Excess weight (BMI ≥25) and physical inactivity (<3.5 hours/week) together account for a substantial proportion of premature deaths (31% of all deaths, 59% of CVD deaths) in nonsmoking women.

To prevent premature death, public health efforts should focus on both maintaining a healthy weight and staying physically active. These two factors combined are responsible for nearly one-third of all premature deaths and more than half of cardiovascular deaths in this population.

Chronic energy imbalance (caloric excess) drives adipocyte hypertrophy and hyperplasia, leading to endoplasmic reticulum (ER) and mitochondrial stress, which causes systemic insulin resistance and inflammation.

Focus on correcting the root cause: energy imbalance. Reducing caloric intake and increasing energy expenditure reverses the cellular stress (ER and mitochondrial) that drives obesity-related disease. Lifestyle modification is the most promising intervention.

Higher mid-life hand grip strength is independently associated with significantly lower long-term all-cause mortality in initially healthy men, regardless of body mass index (BMI).

For long-term survival, prioritize building and maintaining muscle strength over simply managing body weight. Grip strength serves as a robust indicator of overall health and physiological reserve. Incorporate resistance training into your routine to improve strength, as this metric predicts mortality risk independently of your BMI.

Postmenopausal weight gain of 10 kg or more increases the risk of invasive breast cancer, with a relative risk of 1.18 compared to weight maintenance.

If you are postmenopausal, avoiding significant weight gain (10 kg or more) can help lower your risk of breast cancer. This is likely due to the hormonal effects of increased body fat. Maintaining a stable weight is a key strategy for risk reduction.

Obesity (BMI ≥30 kg/m²) is a major risk factor for the development, recurrence, and mortality of several solid-organ and hematological malignancies, including post-menopausal breast, colorectal, endometrial, kidney, esophageal, pancreatic, liver, and gallbladder cancers.

Maintaining a healthy body weight (BMI <25) is a critical strategy for reducing the risk of developing several common cancers, particularly post-menopausal breast, colorectal, and endometrial cancers. For cancer survivors, weight management is essential to reduce the risk of recurrence and improve survival outcomes.

Global consumption of saturated fat and dietary cholesterol is generally within recommended limits, whereas intakes of polyunsaturated fats (omega-6, omega-3) and trans fats are suboptimal for public health.

Prioritize the quality of fats you eat over the total amount. Ensure your diet includes adequate sources of polyunsaturated fats (like fish, nuts, seeds, and vegetable oils) while keeping saturated fat and trans fat intakes low. Global averages show we are doing well on saturated fat/cholesterol but failing to get enough beneficial unsaturated fats.

Seafood omega-3 and plant omega-3 intakes are significantly below optimal levels for the majority of the global population.

Increase your intake of omega-3 fatty acids. Aim for at least 250 mg/day of seafood omega-3 and 1,100 mg/day of plant omega-3. This is a global public health priority as most people fall short.