Browse the evidence

SGLT2 inhibitors and GLP-1 receptor agonists provide significant cardiovascular risk reduction and should be considered first-line therapy for patients with type 2 diabetes and established cardiovascular disease.

If you have Type 2 Diabetes and existing heart disease, ask your doctor about SGLT2 inhibitors (like empagliflozin) or GLP-1 receptor agonists (like semaglutide). These drugs are now considered first-line because they protect your heart and reduce the risk of heart attack and stroke, in addition to controlling blood sugar. This is more important than just lowering your A1C number.

Lifestyle intervention (diet, physical activity, behavioral changes) is the cornerstone of obesity treatment and should be initiated in all patients, regardless of whether pharmacotherapy or surgery is added.

Start with lifestyle changes: diet, exercise, and behavior. This is the base for everyone. If you need medication or surgery, it only works well if you keep doing these lifestyle changes.

Resistance exercise is the only intervention capable of consistently restoring muscle function and strength in sarcopenia, partially overcoming age-related anabolic resistance.

You must lift weights to regain strength and function. Aim for 2-3 sessions per week at a moderate-to-vigorous intensity (70-85% of your max). This mechanical load is the key signal your body needs to rebuild muscle function, which nutrition alone cannot provide.

Lifestyle interventions (diet, exercise, weight loss, smoking cessation) significantly reduce the risk of developing Type 2 Diabetes, cardiovascular disease, and chronic kidney disease progression.

Adopting a healthy lifestyle is the most powerful tool for preventing heart, kidney, and metabolic disease. Focus on a balanced diet, regular physical activity (aiming for 150 minutes per week), maintaining a healthy weight, and quitting smoking. These changes can reduce your risk of developing diabetes by up to 72% and significantly lower your cardiovascular risk.

Semaglutide (2.4 mg once weekly) and Tirzepatide (up to 15 mg once weekly) produce significant weight loss (up to 14.9-20.9%) and improved glycemic control (HbA1c reduction >2%) in adults with obesity or type 2 diabetes, outperforming placebo and existing pharmacotherapies.

Semaglutide and Tirzepatide are highly effective, once-weekly injectable treatments for obesity and type 2 diabetes. They work by mimicking hormones that regulate appetite and blood sugar, leading to significant weight loss (up to 20%) and better glucose control than most other drugs. Because weight regain is common after stopping, these medications are intended for long-term management of these chronic conditions, not short-term fixes.

Adults should engage in at least 150 minutes per week of accumulated moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity to reduce atherosclerotic cardiovascular disease (ASCVD) risk.

Aim for 150 minutes of moderate activity (like brisk walking) or 75 minutes of vigorous activity (like running) each week. You do not need to do this all at once; breaking it into smaller chunks throughout the week works. Even if you can't hit these targets, any amount of movement is better than none for your heart health.

Lifestyle modifications, including moderate weight loss (approx 7% body weight) and regular exercise (150 min/week moderate intensity), are cost-effective in preventing or delaying the onset of diabetes and improving glycemic control.

Losing about 7% of your body weight and exercising 150 minutes a week (like brisk walking) can reduce your risk of developing diabetes by 58%. This is the most cost-effective way to manage or prevent diabetes. Combine this with a healthy diet and smoking cessation for best results.

Resistance training protocols for older adults should include 2-3 sets of 1-2 multijoint exercises per major muscle group, performed 2-3 times per week at 70-85% of 1RM, including power exercises at 40-60% 1RM.

Lift weights 2-3 times a week. Do 2-3 sets of 6-12 reps for major muscle groups. Use a weight that is 70-85% of your max for strength, or 40-60% of your max moved quickly for power. Progress gradually.

Multicomponent exercise interventions (aerobic, resistance, balance, and mobility training) are the most effective strategy for attenuating age-related declines in physical function, preventing frailty, and reducing mortality in older adults, whereas single-modality aerobic exercise is insufficient for musculoskeletal health.

For older adults, simply walking is not enough to maintain muscle and prevent falls. You need a mix of activities: strength training (at least 2 days a week), balance exercises, and aerobic activity (150 minutes moderate or 75 minutes vigorous per week). If you are new to exercise or frail, start with just strength training to build a foundation, then add balance and aerobic work. This combination is proven to keep you independent and reduce the risk of falls and chronic disease.

Regular physical activity and higher cardiorespiratory fitness (CRF) significantly reduce the prevalence and incidence of metabolic syndrome and its components (insulin resistance, dyslipidemia, hypertension, obesity).

To reduce your risk of metabolic syndrome, aim for at least 150 minutes of moderate-intensity activity per week (like brisk walking) or 75 minutes of vigorous activity. Add resistance training twice a week. You don't need to be an elite athlete; even short bouts of activity help. Ask your doctor for a physical activity prescription, as this counseling is often underutilized in clinical settings.

Oral semaglutide significantly improves glycemic control (HbA1c reduction) and promotes weight loss in patients with type 2 diabetes compared to placebo, with efficacy scaling with dosage up to 40mg.

If you have Type 2 Diabetes and struggle with blood sugar or weight, oral semaglutide is a proven, once-daily pill option that works significantly better than a placebo for lowering HbA1c and reducing weight. It is titrated up slowly to minimize stomach upset, which is a common but usually manageable side effect. It is not a substitute for diet and exercise but works alongside them.

Creatine monohydrate supplementation (loading phase of ~20g/day for 5-7 days followed by maintenance of 3-5g/day) increases intramuscular creatine stores by ~30% and enhances performance in high-intensity exercise lasting less than 150 seconds.

Load with 20g of creatine monohydrate daily (split into 4 doses) for 5-7 days, then switch to 3-5g daily. Take it with a meal containing protein and carbs for better absorption. Expect a 1-2kg weight gain from water retention, which is normal. This will improve your performance in short, high-intensity efforts like sprinting or weightlifting.

Adults should perform at least 150–300 minutes per week of moderate-intensity aerobic activity (or 75–150 minutes of vigorous-intensity) to achieve substantial health benefits.

Aim for 150 minutes of moderate aerobic activity (like brisk walking) per week. You can split this into 30 minutes, 5 days a week. If you prefer higher intensity, 75 minutes is sufficient. Add muscle-strengthening exercises on 2 or more days a week for extra benefits.

Long-term exercise training (≥1 year) significantly reduces the risk of falls and injurious falls in older adults, with multicomponent training performed 2-3 times per week being the optimal regimen.

For older adults, engaging in moderate-intensity multicomponent exercise (aerobic, strength, and balance) 2-3 times per week for at least a year significantly reduces the risk of falls and injurious falls. This is a safe and effective intervention.

Once-weekly subcutaneous semaglutide 2.4 mg, used as an adjunct to behavioral intervention, produces substantial and sustained weight loss (mean -15.2%) and improves cardiometabolic risk factors in adults with obesity or overweight with comorbidities over 104 weeks.

If you have obesity or overweight with a related health issue, adding once-weekly semaglutide 2.4 mg to your diet and exercise plan can help you lose about 15% of your body weight over two years. This is significantly more than diet and exercise alone. Expect some stomach issues like nausea at first, but they usually get better. You need to keep taking the medication to keep the weight off.

Tirzepatide, a dual GIP/GLP-1 receptor agonist, produces significantly greater reductions in BMI, waist circumference, and body weight compared to GLP-1 receptor agonists (semaglutide, dulaglutide), insulin, and placebo in patients with obesity or type 2 diabetes.

Tirzepatide is a once-weekly injectable medication that activates two gut hormones (GIP and GLP-1) to significantly reduce body weight and waist circumference. Clinical data shows it is more effective than existing GLP-1 drugs (like semaglutide), insulin, and placebo. It is prescribed for adults with obesity or type 2 diabetes, often starting at a low dose (2.5 mg) and increasing to 5, 10, or 15 mg to minimize side effects. Common side effects include nausea and diarrhea, which are usually mild and temporary. It should be used alongside diet and exercise.

Tirzepatide produces substantial, dose-dependent weight loss in non-diabetic adults with obesity, with maximum tolerated doses achieving mean body weight reductions of approximately 20.9% compared to placebo.

If you have obesity and do not have diabetes, tirzepatide is a highly effective pharmacological intervention for weight loss. The medication works by mimicking hormones that regulate appetite and metabolism. Higher doses (up to the maximum tolerated dose) yield greater weight loss, with some patients losing over 20% of their body weight. While gastrointestinal side effects like nausea are common, they do not appear to increase the risk of serious health events compared to a placebo, making it a viable option for chronic weight management.

GLP-1 receptor agonists (liraglutide, semaglutide, tirzepatide) produce significant, clinically meaningful weight loss (7–21%) and improve cardiometabolic markers in adults and adolescents with obesity.

If you have obesity, GLP-1 medications like semaglutide or tirzepatide are currently the most effective pharmacological tools available, producing weight loss comparable to bariatric surgery. They work by mimicking hormones that regulate appetite and digestion. While they require weekly (or daily) injections and can cause temporary gastrointestinal side effects, they also improve blood pressure, blood sugar, and cholesterol. Because obesity is a chronic disease, these medications are intended for long-term use to maintain weight loss, not just short-term fixes.

Discontinuation of GLP-1 receptor agonist therapy leads to substantial weight regain, indicating that obesity requires long-term, possibly lifelong, pharmacological management.

If you stop taking GLP-1 medications like semaglutide, you will likely regain most of the weight you lost. This is because obesity is a chronic condition, and the medication helps manage the underlying hormonal drivers. To keep the weight off, you likely need to stay on the medication long-term, similar to how blood pressure medication is used for hypertension.

Tirzepatide, a dual GIP/GLP-1 receptor co-agonist, produces significantly greater reductions in HbA1c and body weight compared to selective GLP-1 receptor agonists (semaglutide) and basal insulin in patients with type 2 diabetes.

If you have Type 2 Diabetes, Tirzepatide offers the highest level of blood sugar and weight loss control currently available in injectable medications, surpassing other popular GLP-1 drugs. It works by mimicking two natural gut hormones. The key to success is starting with a very low dose and increasing it slowly every few weeks to minimize stomach upset, which is the main reason people stop taking these drugs.

Adhering to national dietary guidelines using minimally processed foods (MPF) results in significantly greater weight loss and fat mass reduction compared to adhering to the same guidelines using ultraprocessed foods (UPF), primarily driven by lower energy intake.

If you want to lose weight, follow your country's official healthy eating guidelines. Doing so with minimally processed foods (like whole grains, fresh fruits, and vegetables) will help you lose more weight than doing so with ultraprocessed foods (like reformulated cereals and ready meals). However, even if you eat ultraprocessed foods, as long as they meet national nutritional standards (low sugar, salt, and fat, high fiber), you can still lose weight. The key is that minimally processed foods help you eat fewer calories naturally, likely because they are less energy-dense and take longer to eat.

Tirzepatide and semaglutide are the only obesity management medications (OMMs) achieving greater than 10% total body weight loss (TBWL) at study endpoints, with tirzepatide uniquely associated with a significantly higher proportion of patients achieving ≥25% TBWL.

If you are seeking significant, clinically meaningful weight loss (over 10% of body weight), current evidence strongly supports using tirzepatide or semaglutide over older oral medications. Tirzepatide shows the highest efficacy, with a unique ability to help a larger proportion of patients lose 25% or more of their body weight. Be aware that these are long-term treatments; stopping them typically leads to regaining most of the lost weight, so they should be viewed as ongoing management for obesity, not a short-term fix.

Once-weekly subcutaneous 2.4 mg semaglutide induces clinically meaningful, sustained double-digit weight loss (average ~15-16%) in adults with obesity or overweight, significantly outperforming previous pharmacotherapies and approaching results of metabolic surgery.

For adults with obesity or overweight plus a comorbidity, once-weekly 2.4 mg semaglutide is a highly effective treatment that produces an average 15-16% weight loss, which is significantly better than previous drugs and lifestyle changes alone. It requires a weekly injection, titrated up over 4 months to minimize side effects, alongside a modest calorie deficit and exercise. While GI side effects are common, they are usually manageable.

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.