Browse the evidence

Among Japanese patients with type 2 diabetes, low intake of vegetables (specifically green-yellow and other vegetables) and high intake of sweets are the strongest dietary predictors of obesity, with these associations holding true across both men and women.

For Japanese patients with Type 2 Diabetes, managing obesity relies less on counting total calories and more on food quality. Prioritize increasing intake of green-yellow and other vegetables, as low vegetable intake is a strong predictor of obesity. Simultaneously, reduce sweets. If you consume sweets, ensure you are also eating a median amount of fruit, which may mitigate the obesity risk, but do not exceed median sweets intake even with high fruit consumption.

Combining low intake of total vegetables with low intake of fruits creates a synergistic effect that significantly increases the odds of obesity, with the highest risk observed when both are in the lowest quartiles.

Do not skip fruits. The highest risk for obesity occurs when you eat very few vegetables AND very few fruits. Eating both in adequate amounts (top quartiles) offers the strongest protection against obesity.

N-of-1 study designs provide a higher level of evidence for determining individualized treatment efficacy in medical nutrition therapy compared to traditional Randomized Controlled Trials (RCTs), which often mask individual variance through mean effect sizes.

If you are a dietitian, standard RCT-based guidelines may not work for every patient because individual responses vary widely. To practice true precision nutrition, consider using N-of-1 trial designs (testing one patient against themselves with multiple diet phases) to identify the specific dietary pattern that works for that individual's biology and lifestyle, rather than relying solely on population averages.

Low-load resistance training (50% 1RM) produces greater acute muscle swelling (cellular hydration) than high-load resistance training (85% 1RM) when volume load is equated, primarily due to increased time under tension and training density.

If your goal is to maximize the 'pump' (acute muscle swelling) in a single workout, use lighter weights (around 50% of your max) and perform more reps until you can't do another one. This creates more time under tension and metabolic stress than heavy lifting, which may support muscle growth mechanisms, even though the total weight moved is the same.

A 14-day continuous adaptive infusion of the GLP-1/GCGR co-agonist G3215 produces significant weight loss (mean -2.39 kg) and reduced food intake in adults with overweight or obesity, with adverse effects mitigated by real-time dose adjustment.

This study shows that a 14-day continuous infusion of a specific hormone drug (G3215) can lead to about 2.4 kg of weight loss in adults with overweight or obesity. The drug works by reducing food intake and increasing energy expenditure. Side effects like nausea were common but manageable by adjusting the infusion rate. This approach might offer faster weight loss with better tolerability than current weekly injection options, though it requires wearing a pump for two weeks.

GLP-1 receptor agonists (e.g., semaglutide/Ozempic) suppress appetite and hunger signals by mimicking the hormone GLP-1, leading to significant weight loss but also causing a loss of the sensory and relational pleasure of eating.

GLP-1 drugs like semaglutide work by mimicking a hormone to reduce hunger and increase fullness, leading to weight loss. However, this comes with side effects like nausea and a reduced ability to enjoy food. The paper highlights that while these drugs can help with weight loss, they do not guarantee mental health improvements or self-acceptance, and weight regain is common if treatment stops. They are expensive and often used off-label.

GLP-1 receptor agonists (semaglutide, tirzepatide) produce modest weight loss (2.3–5%) in breast cancer patients, which is significantly attenuated compared to non-cancer populations, likely due to concurrent endocrine therapy.

If you have breast cancer and are taking hormone-blocking therapy, GLP-1 drugs like semaglutide will likely help you lose some weight, but not as much as they do for people without cancer. Expect a modest loss (around 2-5%) rather than dramatic results. This is likely because your cancer treatment changes your metabolism. It appears safe regarding cancer recurrence, but discuss timing with your oncologist.

GLP-1 receptor agonist use in breast cancer patients does not increase the risk of cancer recurrence and may reduce cardiovascular morbidity.

For breast cancer patients, GLP-1 drugs appear safe regarding cancer recurrence. They may also offer significant cardiovascular protection, which is valuable since some cancer treatments can stress the heart. This benefit exists independently of weight loss.

Sympathomimetic agents (phentermine, phentermine/topiramate, naltrexone/bupropion) cause mild gastrointestinal side effects (constipation, dry mouth, nausea) with lower discontinuation rates compared to GLP-1 agonists.

If you take a sympathomimetic medication like phentermine or naltrexone/bupropion, you may experience mild side effects like constipation or dry mouth. These are generally less severe than the GI side effects associated with GLP-1 agonists. Stay hydrated and monitor your symptoms.

Health and well-being coaching (HWC) serves as an effective adjuvant intervention to GLP-1 receptor agonists by improving medication adherence and promoting sustainable lifestyle changes, thereby mitigating the high rates of weight regain and discontinuation associated with GLP-1 monotherapy.

If you are using a GLP-1 medication like Ozempic or Wegovy, do not rely on it alone. Engage a health coach to help you build sustainable habits around diet and exercise. This support is crucial for sticking with the medication, managing side effects, and ensuring you keep the weight off long-term, especially if you plan to stop the drug eventually.

Weight loss, particularly through GLP-1 based pharmacotherapy (e.g., Tirzepatide), significantly reduces OSA severity and improves cardiometabolic markers like blood pressure, offering a promising alternative or adjunct to CPAP.

Losing weight is one of the most effective ways to treat OSA. New medications like Tirzepatide are showing great promise in reducing breathing pauses and improving blood pressure in obese patients. However, access and cost remain significant barriers.

Combining tirzepatide with low-energy ketogenic therapy (LEKT) produces significantly greater reductions in hepatic steatosis and liver stiffness than combining tirzepatide with a low-calorie diet (LCD), independent of total body weight loss.

If you have MASLD and are using tirzepatide, adding a structured low-energy ketogenic diet (under 30g carbs, ~1200 kcal) for 12 weeks may reduce liver fat and stiffness more effectively than a standard low-calorie diet, even if your total weight loss is similar. This requires strict adherence and monitoring, ideally under medical supervision, to ensure safety and efficacy.

Allostatic load (AL) represents the cumulative physiological stress and cost of adaptation, and can be measured using an Allostatic Load Index (ALindex) to guide nutrition and exercise interventions.

For elite athletes, consider monitoring allostatic load using biomarkers (like CRP, resting heart rate, HDL, waist-to-height ratio, and HbA1c) to assess cumulative stress. This can help adjust training and nutrition to prevent overtraining and injury.

Higher intake of whole grains and fruits is associated with lower total cholesterol, LDL-C, and HDL-C levels in long-term plant-based eaters.

Prioritize whole grains and fruits daily. While the cholesterol-lowering effect is modest, it is a consistent benefit. Do not fear small amounts of less-healthy plant foods (like pasta) if they fit your overall healthy pattern, but be aware they may impact other markers like uric acid.

Higher intake of plant-based fast food and white flour pasta is associated with higher uric acid levels, even in a plant-based diet.

Limit plant-based fast food and white flour pasta. While they are plant-based, they can raise uric acid levels. Choose whole-food alternatives like whole-grain pasta and unprocessed foods to minimize this risk.

Higher intake of polyunsaturated fatty acids (PUFAs) is uniquely and negatively associated with LDL-C levels in a plant-based diet.

Include sources of PUFAs (nuts, seeds, flax) in your diet. They may help lower LDL-C levels, even if the effect is modest.

Multivitamin supplementation is recommended for individuals using GLP-1 receptor agonists to address micronutrient insufficiencies resulting from reduced caloric intake and gastrointestinal side effects.

Take a daily multivitamin while on GLP-1RA medication. Because you are eating less, you might not get enough vitamins from food alone. This helps protect your long-term health and prevents deficiencies.

Fiber and Probiotic supplementation can improve bowel regularity and mitigate gastrointestinal side effects (constipation, diarrhea) associated with GLP-1RA treatment.

If you experience constipation or diarrhea from GLP-1RA medication, try taking more than 10 grams of fiber daily and a probiotic supplement. This can help regulate your bowel movements.

The cardiometabolic benefits of exercise, particularly on glucose regulation and inflammation, may be attenuated or dependent on weight loss in individuals with obesity.

Be aware that while exercise is beneficial, achieving weight loss may be necessary to fully improve glucose regulation and inflammation in obesity. However, do not stop exercising if weight loss is difficult; other benefits remain.

Proactive, personalized lifestyle coaching significantly increases patient engagement (messaging frequency and app usage) in semaglutide-supported digital obesity programs, but does not significantly improve short-term (16-week) weight loss compared to reactive, standardized coaching.

If you are using semaglutide with a digital coaching program, expect that a proactive coaching style will make you feel more supported and engaged (more messages, more app opens). However, do not assume this increased engagement will automatically lead to more weight loss in the first 4 months. The medication and basic lifestyle changes drive the weight loss, while the coaching style drives the feeling of support. Stick to the program regardless of engagement levels, as the weight loss outcomes are similar between high and low engagement groups in the short term.

High-calorie, high-protein nutritional supplementation and specific supplements (L-alanyl-L-glutamine + PUFAs) can counteract lean mass loss and improve quality of life in heart failure patients, potentially mitigating GLP-1RA-induced sarcopenia.

If you are losing muscle on heart failure medication, ask your doctor about high-protein nutritional supplements. Specific combinations like glutamine and fish oil (PUFAs) have been shown to help increase lean body mass and improve how you feel.

Intentional weight loss, particularly through bariatric surgery, is associated with improvements in New York Heart Association (NYHA) classification, diastolic function, and reductions in left ventricular (LV) mass index and left atrial size.

Intentional weight loss improves heart function, including diastolic function and reducing left ventricular mass and left atrial size.

A salutogenic, peer-group-based healthy eating program for type 2 diabetes improves glycemic control and psychosocial well-being by fostering active learning, social belonging, and stress management rather than strict dietary prescription.

For someone with Type 2 Diabetes, try joining a supportive peer group focused on holistic health rather than just strict dieting. Focus on building social connections, managing stress, and experimenting with small, sustainable food changes (like swapping ingredients) instead of extreme restrictions. Use tools like glucose monitoring to get feedback on how these small changes affect your body, and involve your partner for support.

Very Low Calorie Diets (VLCD) produce substantial short-term weight loss (10-17 kg) but suffer from gradual attenuation and weight regain over time unless supported by behavioral interventions.

VLCDs are powerful for rapid short-term loss but require medical supervision and a structured reintroduction phase. Without behavioral support, the weight loss is likely to be partially regained over time.