Browse the evidence

Bariatric surgery (specifically sleeve gastrectomy and Roux-en-Y gastric bypass) achieves sustained weight loss and high rates of type 2 diabetes remission, while also significantly improving or resolving obstructive sleep apnea and metabolic dysfunction-associated steatotic liver disease (MASLD).

If you have severe obesity with diabetes or sleep apnea, bariatric surgery (sleeve or bypass) is the most effective current treatment for reversing these conditions. It offers the best chance for diabetes remission and resolving sleep apnea, though you must be monitored for potential liver issues if you lose weight too quickly.

GLP-1 and GIP/GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) and emerging triple agonists (e.g., retatrutide) significantly reduce body weight, improve glycemic control, and reverse hepatic steatosis in patients with obesity and type 2 diabetes.

GLP-1 and GIP/GLP-1 agonists (like semaglutide and tirzepatide) are highly effective for weight loss and reversing liver fat in people with obesity and diabetes. They work by mimicking gut hormones to reduce appetite and improve insulin sensitivity. Triple agonists (like retatrutide) are showing even greater promise for liver fat normalization.

Tirzepatide 15 mg once weekly produces statistically significant greater reductions in body weight, BMI, and HbA1c compared to semaglutide 2.4 mg once weekly in patients with type 2 diabetes and obesity/overweight.

For patients with type 2 diabetes and obesity, tirzepatide 15mg once weekly is a more effective option for weight loss and blood sugar control than semaglutide 2.4mg. This treatment must be combined with a reduced-calorie diet and regular physical activity. Patients should be aware that while tirzepatide 15mg is more effective, it may have a slightly higher risk of gastrointestinal side effects compared to semaglutide 10mg, though both are generally well-tolerated.

Tirzepatide 15 mg provides statistically significant improvements in cardiometabolic risk factors, including waist circumference, fasting plasma glucose, and triglycerides, compared to semaglutide 2.4 mg.

Beyond weight loss, tirzepatide 15mg offers superior benefits for heart health markers like waist size, blood sugar (fasting), and triglycerides compared to semaglutide 2.4mg. This makes it a strong option for patients concerned about cardiovascular risk factors associated with obesity and diabetes.

Maintaining a body weight loss of ≥7% of baseline (high Time in Target Range, TTR) is independently associated with a significantly lower risk of major adverse cardiovascular events in adults with overweight/obesity and type 2 diabetes, independent of mean body weight and weight variability.

For adults with type 2 diabetes and obesity, the key to reducing cardiovascular risk is not just losing weight, but keeping it off. Aim to maintain a 7% weight loss from your starting weight. Track your 'Time in Target Range' (TTR)—the percentage of time you stay within this 7% loss zone. Higher TTR is strongly linked to lower heart disease risk, independent of your average weight or how much it fluctuates. Focus on consistency and maintenance over the long term (years, not weeks).

Modest weight loss of 5–10% significantly improves cardiovascular and metabolic risk factors, whereas weight loss of ≥10% is required to reduce major cardiovascular events.

Focus on achieving a 5-10% weight reduction as a primary clinical goal for improving metabolic health markers like blood pressure and lipids. If the patient has established cardiovascular disease, aim for at least 10% weight loss to significantly lower the risk of major cardiovascular events. This can be achieved through lifestyle modifications, and if insufficient, anti-obesity medications or bariatric surgery should be considered.

GLP-1 analogues (e.g., semaglutide) and dual agonists (e.g., tirzepatide) produce robust weight loss (15-21%) that approaches or exceeds bariatric surgery efficacy, with potential independent cardiovascular benefits beyond weight loss.

For patients with obesity who have not achieved sufficient weight loss with lifestyle changes alone, consider GLP-1 analogues like semaglutide (2.4 mg weekly) or dual agonists like tirzepatide. These medications can produce 15-21% weight loss, approaching the efficacy of bariatric surgery, and may offer independent cardiovascular benefits.

Heavy-load resistance training preserves lean body mass in prostate cancer patients undergoing androgen deprivation therapy (ADT), effectively counteracting the muscle loss typically caused by the therapy, while simultaneously increasing muscle strength to a degree comparable to healthy elderly men.

If you are undergoing hormone therapy for prostate cancer, do not skip resistance training. Heavy lifting (using weights that feel hard for 6-12 reps, 2-3 times a week) will help you keep the muscle you have and make you stronger. You might not see your muscles get bigger like a healthy person would, but you will stop them from shrinking, which is a major win for your health and survival.

A 12-week combined resistance exercise and protein supplementation intervention significantly increases lean body mass in community-dwelling older adults aged 75 and younger, but not in those older than 75.

If you are 75 or younger, this combined exercise and protein strategy is effective for adding muscle mass. If you are over 75, you may not gain significant muscle mass, but you will still gain significant strength and functional ability, so the intervention remains valuable for mobility.

Older adults with mobility-impairing disorders (frailty, sarcopenia, or osteoarthritis) benefit equally from combined resistance exercise and protein supplementation as those without these disorders in terms of absolute effects.

If you have frailty, sarcopenia, or osteoarthritis, this combined exercise and protein program is still effective for you. You can expect similar absolute improvements in strength and function as older adults without these conditions.

An online multidisciplinary collaborative weight loss management program significantly improves glycemic control (HbA1c, fasting, and postprandial blood glucose) and self-management abilities in obese or overweight patients with type 2 diabetes compared to conventional outpatient management.

If you have type 2 diabetes and are overweight, an online program with a dedicated team (doctor, dietitian, exercise coach, psychologist) can help you manage your blood sugar and weight better than standard clinic visits. You will need to use a smartphone app to log your food, exercise, and body measurements daily, and participate in online courses. The program provides regular feedback and support from experts to help you stay on track. This approach has been shown to significantly lower HbA1c and improve your ability to manage your health.

Personalized nutrition interventions yield significantly greater reductions in body weight, BMI, waist circumference, and LDL cholesterol in individuals carrying the FTO risk genotype (TT/TC) compared to those with the non-risk genotype (CC).

If you carry the FTO risk genotype (TT or TC), a personalized nutrition plan is likely to be significantly more effective for weight and lipid management than a standard one-size-fits-all approach. You should prioritize interventions that are tailored to your specific metabolic profile, as your body appears to respond more robustly to dietary changes in this genetic context.

Individualized Repetitions-in-Reserve (RIR) to velocity relationships provide acceptable prediction accuracy (mean error <2 repetitions) for resistance training monitoring and prescription, whereas general population models do not.

Stop using generic velocity charts for everyone. To prescribe training accurately, you must establish your own personal relationship between how fast the bar moves and how many reps you have left in reserve. Test this by performing sets to failure at different loads (e.g., 70%, 80%, 90% of 1RM) and recording the velocity for each Repetition-in-Reserve (RIR) level. Use this personal data to guide your daily training, adjusting loads to hit your specific velocity targets for desired RIRs, rather than guessing based on population averages.

Tirzepatide 15 mg once weekly is preferred for individuals with obesity and heart failure with preserved ejection fraction (HFpEF) to improve symptoms and functional capacity, irrespective of glycemic status or weight loss magnitude.

If you have obesity and heart failure with preserved ejection fraction (HFpEF), tirzepatide 15 mg once weekly is a preferred treatment to significantly reduce hospitalizations and improve your ability to walk and feel better, even if your blood sugar is normal or you don't lose a lot of weight.

Multireceptor incretin agonists (targeting GLP-1, GIP, and/or Glucagon receptors) produce clinically meaningful weight loss by simultaneously suppressing appetite via central nervous system pathways and increasing energy expenditure via peripheral metabolic activation.

If you have obesity, relying on willpower and diet alone often fails because your body fights back by slowing your metabolism and increasing hunger. Modern incretin-based medications work by targeting specific hormone receptors to simultaneously turn off the drive to eat and turn up your energy expenditure. This dual approach addresses the physiological root of obesity, offering significantly higher weight loss potential than lifestyle changes alone, with newer formulations designed to minimize side effects like nausea.

High protein intake is the most satiating macronutrient per calorie and promotes weight loss and fat loss when combined with calorie restriction, primarily by preserving lean mass and increasing energy expenditure.

Eating more protein helps you feel full and lose weight, especially if you are also eating fewer calories or exercising. It helps keep your muscles while you lose fat. However, just eating protein without exercise won't necessarily make you a better athlete or significantly stronger.

Combining high-intensity resistance training with chronic chicken meat intake significantly increases muscle strength and lean body mass in elderly women more effectively than either intervention alone.

For elderly women looking to build muscle and strength, combining resistance training (3 times a week) with regular chicken meat consumption (approx. 110g, 3 times a week) is more effective than doing either one alone. Ensure the training intensity is challenging (around 70% of your max lift) and adjust weights as you get stronger.

BCAA supplementation (500mg Leucine/250mg Isoleucine/250mg Valine daily) significantly reduces Delayed Onset Muscle Soreness (DOMS) and perceived fatigue in women undergoing resistance training, with effects exceeding those in men.

If you are a female recreational weightlifter, taking a BCAA supplement containing 2.5g Leucine, 1.25g Isoleucine, and 1.25g Valine daily may significantly reduce your muscle soreness and perceived fatigue after workouts compared to not taking them. This allows for better recovery between sessions. Men in this study saw greater strength gains but less specific recovery benefit from BCAAs compared to women.

Spreading total training volume across more sessions (higher frequency) reduces the Rate of Perceived Exertion (RPE) for high-fatigue exercises like the barbell back squat, particularly in the middle stages of a training block.

If you find squats extremely exhausting or difficult to recover from when training them only twice a week, try splitting your squat volume across more sessions (e.g., 3-4 times a week). This will lower your perceived exertion per session without reducing your strength gains, making your training more sustainable.

Weight loss of 2.5% to 20% in individuals with obesity (with or without type 2 diabetes) is associated with statistically significant improvements in health state utilities, with the magnitude of utility gain increasing non-linearly with the percentage of weight lost.

For individuals with obesity, losing even small amounts of weight (2.5%) improves quality of life, with greater benefits as weight loss increases up to 20%. This improvement is not linear; the utility gains are significant across the board. Patients should be encouraged that weight loss positively impacts their perceived health state, though those concerned about looking 'too skinny' or losing strength should be reassured that health-focused weight management prioritizes function.

First-line GLP-1 RA initiation is associated with greater HbA1c reduction compared to metformin in both patients with prediabetes and diabetes.

GLP-1 RA is more effective than metformin at lowering HbA1c levels in both prediabetes and diabetes. This makes it a potent option for achieving glycemic targets, though adherence should be monitored.

Tirzepatide produces significantly greater weight loss than semaglutide in patients with type 2 diabetes, with a mean difference of -4.84 kg favoring tirzepatide.

If you have Type 2 Diabetes and are choosing between Tirzepatide and Semaglutide for weight loss, Tirzepatide is likely to produce greater weight loss (approx. 4.8 kg more on average). Both drugs share similar gastrointestinal side effect profiles, which are generally manageable. The choice may depend on individual response, tolerability, and cost/insurance coverage, but Tirzepatide shows superior efficacy in head-to-head comparisons.

Combining high adherence to a macronutrient-restricted diet (low-carb or low-fat) with high dietary quality yields significantly greater weight loss than either factor alone or low adherence/quality.

If you are following a low-carb or low-fat diet, your weight loss success depends heavily on two things: how closely you stick to the diet (adherence) and how nutritious the food is (quality). Simply cutting carbs or fat without focusing on whole foods and dietary quality may not lead to significant weight loss. To maximize results, aim for both high adherence to your chosen macronutrient limits and high dietary quality (e.g., high Healthy Eating Index score).

Sugar-sweetened beverage (SSB) consumption is a major global driver of incident Type 2 Diabetes and Cardiovascular Disease, with the highest proportional burdens found in Latin America/Caribbean and Sub-Saharan Africa.

Reduce or eliminate sugar-sweetened beverages to significantly lower your risk of Type 2 Diabetes and heart disease. This is especially critical if you live in or originate from regions with high SSB consumption like Latin America or Sub-Saharan Africa, where the population-level risk is highest.