Browse the evidence

GLP-1 receptor agonists and GIP analogs show potential for achieving Type 2 diabetes remission through significant weight loss, but current trial data is limited.

For those with overweight or obesity, GLP-1 and GIP-based medications can facilitate significant weight loss, which is a key driver for Type 2 diabetes remission. While trials are still mapping their long-term efficacy for remission, they represent a promising tool for achieving weight loss goals necessary for reversing the disease.

Combining pharmacotherapy with lifestyle interventions (diet/exercise) or bariatric surgery yields superior weight loss and maintenance compared to either intervention alone.

For the best long-term results, do not rely on medication or diet/exercise alone. Use medication to help manage hunger while you establish sustainable diet and exercise habits. This combination is proven to help you keep the weight off after you stop the medication.

Primary Obesity Surgery Endoluminal (POSE) 2.0 and Endomina Gastric Plication are effective endoscopic gastric remodeling techniques that produce significant weight loss and metabolic improvements, though with varying efficacy profiles compared to ESG.

POSE 2.0 and Endomina are endoscopic options that use full-thickness plications to reduce stomach size. They are effective for weight loss and metabolic improvement, though ESG may offer higher weight loss percentages in some studies. They are suitable for patients seeking minimally invasive alternatives to surgery.

Once-weekly subcutaneous retatrutide significantly reduces body weight, BMI, and waist circumference in patients with overweight, obesity, and/or type 2 diabetes compared to placebo.

If you have obesity or type 2 diabetes, once-weekly retatrutide injections can lead to significant weight loss (averaging over 10 kg in these studies) and improved blood sugar control compared to no treatment. Be prepared for potential nausea or vomiting, which are common but usually not severe. The benefits are substantial, but the treatment requires adherence to a weekly injection schedule and dose escalation.

Retatrutide significantly improves glycemic control, including reductions in HbA1c, fasting glucose, and daily mean blood glucose, in patients with obesity and/or type 2 diabetes.

For those with type 2 diabetes or obesity, retatrutide helps lower blood sugar levels (HbA1c, fasting glucose) effectively. This is achieved through weekly injections that mimic natural hormones to regulate glucose. The benefit is particularly pronounced for those who already have diabetes.

Liraglutide is the only other anti-obesity medication that does not significantly differ in efficacy from phentermine for achieving ≥5% weight loss over 6 months.

Liraglutide (up to 3mg daily) is a viable alternative to phentermine for weight loss, showing similar efficacy in achieving 5% weight loss over 6 months when combined with lifestyle changes.

Naltrexone/bupropion, lorcaserin, and orlistat are significantly less effective than phentermine for achieving ≥5% weight loss over 6 months.

Naltrexone/bupropion, lorcaserin, and orlistat are less likely to produce significant weight loss (≥5%) compared to phentermine over 6 months when combined with lifestyle changes.

In individuals with pre-diabetes or metabolic syndrome, incorporating meal replacements into a weight loss intervention yields small, clinically important reductions in body weight, BMI, LDL-c, non-HDL-c, and systolic blood pressure compared to conventional food-based diets.

If you have pre-diabetes or metabolic syndrome, using meal replacements for 1-2 meals a day as part of a calorie-restricted diet will help you lose more weight and improve your cholesterol and blood pressure than just eating a standard healthy diet. Aim for replacements to make up about 28% of your daily calories. This is a short-term tool to jumpstart your health before transitioning to regular food.

Completion of a 24-week milk-based low-energy liquid diet (LELD) in adults with severe obesity significantly reduces the leptin-to-adiponectin ratio (LAR), indicating decreased insulin resistance, with the magnitude of LAR reduction being proportional to the percentage of weight lost.

If you have severe obesity, a structured, low-calorie milk-based diet for 24 weeks can significantly improve your metabolic health markers, specifically by lowering the ratio of leptin to adiponectin, which indicates better insulin sensitivity. This improvement is directly tied to how much weight you lose. However, be aware that adherence is difficult, with high dropout rates, and long-term weight maintenance is not guaranteed, so this intervention should be viewed as a powerful metabolic reset rather than a permanent lifestyle solution.

Long-term dietary interventions (≥12 months) involving moderate macronutrients, low-fat/high-carbohydrate, or high-fat/low-carbohydrate diets all produce significant and comparable weight loss, BMI reduction, and waist circumference reduction compared to a usual diet, with no clinically significant difference between the specific diet types.

If you are overweight or obese, any structured diet that involves active counseling and reduces calories will help you lose weight over the long term (12+ months). Whether you choose high-fat, low-fat, or moderate macronutrients, the amount of weight lost is roughly the same (around 5 kg). Do not waste energy trying to find the 'magic' macronutrient ratio; instead, choose the dietary pattern that fits your lifestyle and preferences so you can stick with it.

High-fat/low-carbohydrate (HFLC) diets may result in a statistically significant but clinically minimal additional weight loss (approx. 0.8 kg) and BMI reduction (approx. 0.4 kg/m2) compared to moderate macronutrient (MM) diets over the long term.

If you prefer a high-fat, low-carb diet, you might lose slightly more weight (less than 1 kg) than someone on a moderate diet, but the difference is negligible for health goals. Do not switch diets expecting a dramatic result; consistency and caloric deficit are the main drivers.

The same 12-week program significantly improves metabolic health markers, including insulin resistance (HOMA index), lipid profiles (triglycerides, VLDL), and inflammatory markers (CRP, PINI), independent of the magnitude of weight loss.

Obesity management should target metabolic health, not just weight. This program improves insulin sensitivity, lowers bad fats (triglycerides/VLDL), and reduces inflammation, which are key risk factors for cardiovascular disease and diabetes.

Time-restricted eating (TRE) improves metabolic markers (insulin sensitivity, blood pressure) and aids weight loss, but its long-term efficacy is not yet fully established.

Try eating within an 8-hour window each day (e.g., 12 PM to 8 PM). This may improve your blood pressure and insulin sensitivity. Be cautious if you have diabetes or are pregnant. Adjust the window to fit your social life.

An 8-week stress management program comprising diaphragmatic breathing, progressive muscle relaxation, and guided visualization significantly enhances weight loss (BMI reduction) and improves mental health outcomes in adults with obesity compared to standard lifestyle instructions alone.

If you are struggling with obesity, adding a structured stress management routine to your standard diet and exercise plan may yield better weight loss results than diet and exercise alone. The study used an 8-week program involving breathing exercises, muscle relaxation, and visualization, practiced weekly with home reinforcement. This approach targets the hormonal and behavioral links between stress and weight gain, such as cortisol-driven abdominal fat storage and emotional eating.

Patients taking GLP-1 receptor agonists or dual GIP/GLP-1 agonists should continue these medications through the peri-operative period rather than withholding them, as evidence suggests withholding is insufficient to reduce aspiration risk.

If you take a GLP-1 or GIP/GLP-1 drug (like Ozempic, Wegovy, Mounjaro, Trulicity) for your upcoming elective surgery, do NOT stop taking it. Stopping it for a week or even three weeks does not guarantee your stomach is empty and may not reduce aspiration risk. Instead, tell your anesthesia team you are taking it so they can use specific techniques (like ultrasound or specific intubation methods) to keep you safe.

Patients taking SGLT2 inhibitors should omit these medications the day before and the day of surgery to prevent euglycemic diabetic ketoacidosis (DKA).

If you take an SGLT2 inhibitor (like Jardiance, Farxiga, or Invokana) for your upcoming elective surgery, stop taking it the day before your surgery and do not take it on the day of surgery. This is critical to prevent a rare but serious condition called euglycemic DKA. Your medical team will monitor your blood sugar closely during your stay and manage it with insulin if necessary, which is the safest approach.

Combined adherence to healthy lifestyle factors (Mediterranean diet, physical activity, non-smoking, moderate alcohol, ideal weight) significantly reduces the risk of developing periodontitis and tooth loss.

Your gum health depends on more than just brushing. Combining a healthy diet (like Mediterranean), regular exercise, not smoking, and maintaining a healthy weight significantly lowers your risk of gum disease and tooth loss, even if your brushing habits are average.

A reduction in the FibroScan-aspartate aminotransferase (FAST) score of at least 0.22 points after 72 weeks of semaglutide treatment is associated with achieving the primary histological endpoint of NASH resolution without worsening of fibrosis.

If you are being treated for NASH with semaglutide, a reduction in your FAST score of 0.22 points or more after 72 weeks is a strong indicator that your liver is improving histologically (NASH resolution without worsening fibrosis). This non-invasive metric may help doctors monitor your progress without requiring repeated liver biopsies, although further validation is needed.

Preoperative administration of GLP-1 receptor agonists (OMMs) serves as an effective bridging therapy for super-obese patients, facilitating technical operability and reducing perioperative complications compared to non-pharmacological methods.

If you are waiting for bariatric surgery and have a very high BMI, ask your doctor about using GLP-1 medications (like liraglutide) beforehand. This can help you lose weight faster and reduce surgical risks, potentially making you eligible for surgery sooner than if you waited without medication.

Exercise stimulates the release of 'exerkines' (signaling molecules like IL-6, 12,13-diHOME, and musclin) that mediate systemic health benefits, including improved cardiac function and metabolic flexibility.

Engaging in regular exercise triggers the release of beneficial signaling molecules (exerkines) from your muscles, fat, and liver that protect your heart and metabolism. You don't need to manage these molecules directly; consistent physical activity is the key to activating them.

Among dietary factors, vitamin or mineral supplement use is associated with decreased cardiovascular disease risk, whereas caffeine intake is associated with increased risk, and alcohol consumption exhibits a U-shaped association with risk.

This study suggests that among Canadian adults, those who take vitamin or mineral supplements tend to have a lower predicted risk of cardiovascular disease, while high caffeine intake is linked to higher risk. Alcohol consumption shows a complex U-shaped pattern, with moderate frequency (1-3 times per week) associated with lower risk than both heavy drinking and abstinence. These are observational associations, not proof of causation, and should not replace standard medical advice.

Integrating passive stretch into the inter-set rest period of resistance training enhances muscle hypertrophy compared to standard passive rest, particularly in type I muscle fibers, without compromising strength gains.

To potentially maximize muscle growth without extending your workout time, hold a passive stretch for 20-30 seconds immediately after your last rep of each set, during your rest period. Aim for a discomfort level of 8 out of 10. This strategy appears most beneficial for slower-twitch (Type I) muscle fibers and does not appear to negatively impact long-term strength gains.

Social interactions between sedentary individuals and moderately active individuals are the primary driver for transitioning sedentary populations to physically active habits.

To build a lasting exercise habit, do not rely on willpower alone. Actively seek out social environments where moderate physical activity is the standard. Join groups or classes where you interact with moderately active peers, as their influence is the strongest predictor of your own persistence.

Social interactions that draw moderately active individuals into sedentary behaviors are the primary cause of exercise persistence failure (recidivism).

Protect your exercise gains by managing your social environment. If your social circle is predominantly sedentary, you are at high risk of dropping out. Limit social activities that reinforce sedentary behavior and seek interactions that support active lifestyles.