Browse the evidence

Postoperative exercise training does not significantly affect lean body mass in adults undergoing bariatric surgery.

While exercise training may not significantly increase lean body mass after bariatric surgery, it can still improve muscle strength and function. Focus on building strength and endurance rather than just muscle mass.

Both bariatric surgery (RYGB/SG) and structured medical treatment (VLED) result in similar safety profiles regarding hospitalization, need for further surgery, and mortality at 2-year follow-up, despite differences in weight loss magnitude.

Safety outcomes, including hospitalization and mortality, are comparable between bariatric surgery and structured medical treatment at 2 years. This suggests that for many patients, the higher efficacy of surgery does not come with a proportionally higher immediate safety risk compared to medical management.

Omega-3 polyunsaturated fatty acid (EPA+DHA) supplementation does not reduce the risk of cardiovascular events or mortality in patients with diabetes mellitus or prediabetes.

If you have diabetes or prediabetes, taking fish oil supplements will not protect your heart or prevent heart attacks. Do not take them for this purpose. Focus on proven diabetes management strategies instead.

GLP-1 receptor agonists reduce hospitalizations for heart failure (HHF) by approximately 10-11%, although their effect on heart failure with reduced ejection fraction (HFrEF) is neutral or potentially harmful in small studies.

If you have Type 2 Diabetes and heart failure, GLP-1 RAs can help reduce the risk of being hospitalized for heart failure. However, if you have a specific type of heart failure where the heart muscle is weak (HFrEF), the data is less clear, and you should discuss the risks and benefits with your doctor.

Bariatric surgery is the most efficacious treatment for sustained weight loss and can induce long-term remission of type 2 diabetes in approximately 30% of patients, with Roux-en-Y gastric bypass being potentially more effective than sleeve gastrectomy for T2D remission.

For severe obesity, bariatric surgery is the most effective long-term treatment. It can lead to remission of type 2 diabetes in about 30% of patients and reduces the risk of heart disease and stroke. It is a serious medical intervention, not a cosmetic procedure.

High-fat diets, particularly those high in saturated fatty acids, increase oxidative stress and mitochondrial dysfunction, leading to systemic inflammation and insulin resistance.

Reduce excessive consumption of high-fat diets, particularly those high in saturated fats, to mitigate oxidative stress and mitochondrial dysfunction. Be aware that not all fats are equal, but excessive intake contributes to inflammation and insulin resistance.

Elevated baseline plasma ceramide concentrations are positively associated with an increased risk of incident cardiovascular disease (CVD), including myocardial infarction, stroke, and cardiovascular death.

High plasma ceramide levels are linked to a higher risk of heart attacks, strokes, and cardiovascular death. However, this risk is not fixed; adhering to a Mediterranean diet (enriched with olive oil or nuts) can neutralize the increased risk associated with high ceramide levels, bringing it down to the level of those with low ceramide levels.

Red meat consumption does not significantly differ from various comparison diets combined in its effect on total cholesterol, LDL cholesterol, HDL cholesterol, apolipoproteins, or blood pressure.

Eating red meat does not inherently worsen your cholesterol or blood pressure if you replace it with a variety of other foods. The key is not just removing meat, but understanding what you put in its place. If you swap meat for plants, you may see better cholesterol results.

Carbohydrate co-ingestion with protein does not enhance muscle protein synthesis or muscle hypertrophy beyond protein ingestion alone, although it may aid in glycogen restoration.

You do not need to eat carbohydrates with your post-workout protein to build muscle. Protein alone is sufficient for muscle growth. Only add carbohydrates if you need to restore energy levels (glycogen) for your next training session.

The obesity epidemic is primarily driven by changes in the caloric quantity and quality of the food supply, specifically the industrialization of cheap, highly processed foods with supernormal appetitive properties, rather than by specific macronutrients like protein, fat, or carbohydrates.

Focus on the overall food environment rather than isolating single nutrients. The rise in obesity is linked to the availability of cheap, highly processed, convenient foods that are engineered to be overconsumed. Reducing reliance on these foods and increasing home-prepared meals may help mitigate intake.

SGLT2 inhibitors produce significantly less weight loss than predicted by urinary glucose excretion because of compensatory hyperphagia (increased energy intake).

If you are taking an SGLT2 inhibitor (like Jardiance or Farxiga), expect about 2-3 kg of weight loss, not the 7 kg you might calculate based on urine sugar loss. Your body will likely increase your hunger to compensate for the calories lost in urine. To maximize weight loss, you must actively manage your appetite and food intake, as the drug alone will not overcome this biological compensation.

Increasing red meat consumption by at least half a serving per day over an eight-year period is associated with a 10% higher risk of all-cause mortality in the subsequent eight years, with processed meat showing a stronger association (13% higher risk) than unprocessed meat (9% higher risk).

If you are currently eating red meat, try to avoid increasing your intake by more than half a serving per day over time. If you do increase it, be aware that your risk of death increases, especially if it is processed meat. Simply reducing red meat without replacing it with healthier options may not lower your mortality risk; instead, focus on replacing red meat with healthier protein sources like nuts, fish, or legumes, or whole grains and vegetables.

Long-term metformin treatment (up to 2,000 mg/day) significantly alters gut microbiota composition by increasing Escherichia coli and Ruminococcus torques while decreasing Intestinibacter bartlettii and Roseburia species, effects that persist for at least 12 months.

If you take metformin, expect your gut bacteria to change in a specific way: more E. coli and Ruminococcus torques, less Intestinibacter bartlettii and Roseburia. These changes don't just happen briefly; they stick around for at least a year. Importantly, these changes happen regardless of how much weight you lose, meaning the drug itself is driving this shift. While this might sound concerning because E. coli can be harmful, in this context, it is linked to increased production of short-chain fatty acids like acetate, which may help improve insulin sensitivity. If you experience stomach upset, talk to your doctor about slow dose titration.

Poststratification of UK Biobank data to match general population demographics reveals that the protective association between heavy alcohol consumption and cardiovascular disease (CVD) mortality observed in unweighted analyses is spurious and disappears.

If you drink heavily (≥5 times/week), do not rely on alcohol for heart health. The perceived protective effect seen in older studies likely disappears when looking at the general population. Focus on proven lifestyle factors like physical activity and diet for cardiovascular protection.

Cohort unrepresentativeness in the UK Biobank leads to an underestimation of the mortality risk associated with the least healthy cumulative lifestyle profiles.

If you have an unhealthy lifestyle (poor diet, low activity, smoking), the risk to your life is likely higher than general statistics suggest. Correcting for population biases shows a 9% increase in mortality risk for the least healthy groups. Prioritize improving these factors to mitigate this hidden risk.

Obesity should be clinically classified as a chronic, progressive, and relapsing disease rather than a lifestyle choice or mere risk factor, which is necessary to combat stigma and promote effective long-term management.

Understand that obesity is a chronic medical condition, not a character flaw. This means it requires long-term management strategies similar to other chronic diseases like hypertension or diabetes, rather than short-term 'fixes' based on willpower. Seek care from providers who view it as a disease to manage, not a failure to overcome.

In healthy humans, disuse-induced muscle atrophy is primarily driven by a significant reduction in muscle protein synthesis (MPS), while muscle protein breakdown (MPB) remains largely unchanged.

If you are immobilized or inactive but healthy, your muscle loss is not because your body is actively destroying muscle tissue, but because it has stopped building it. The primary lever to prevent loss is to restore the stimulus for muscle protein synthesis (e.g., through resistance exercise or adequate protein intake) rather than focusing solely on preventing breakdown.

In disease states (e.g., sepsis, cancer, critical illness), muscle atrophy is driven by both elevated muscle protein breakdown (MPB) and reduced muscle protein synthesis (MPS), mediated by inflammatory cytokines.

If you have a disease involving inflammation (like cancer or sepsis), your muscle loss is driven by both increased breakdown and decreased synthesis due to inflammatory signals. Preventing loss requires addressing the underlying disease and inflammation, not just rest or exercise.

In overweight or obese individuals with type 2 diabetes, metabolic dyslipidemia (defined as high triglycerides and low HDL-C) is associated with a significantly higher risk of coronary artery disease and composite cardiovascular events, independent of LDL-C levels.

If you have Type 2 Diabetes and are overweight, your risk of heart disease is significantly higher if you have both high triglycerides and low HDL cholesterol, even if your LDL is normal. This risk exists independently of your LDL levels. You should discuss your triglyceride and HDL levels with your doctor as part of your cardiovascular risk assessment, not just your LDL.

Linoleic acid has a long half-life in the body (approximately two years), meaning that reducing intake takes years to significantly lower tissue levels.

Be patient when reducing seed oils. It can take up to six years to significantly replace body stores of linoleic acid with healthier fats.

Dietary diversity measures (count, evenness, dissimilarity) are not standardized and do not consistently correlate with diet quality scores like HEI or DASH.

Do not rely on 'dietary diversity scores' to judge your diet's health. These scores are not standardized and often do not reflect actual diet quality. Focus on specific food groups (vegetables, fruits, whole grains) rather than the number of different foods you eat.

Very low-carbohydrate/ketogenic, Paleolithic, and low-carbohydrate dietary patterns have low to moderate or poor alignment with 2021 AHA Dietary Guidance due to restrictions on whole grains, legumes, and oils, and high saturated fat content.

If you follow a low-carb, Paleo, or ketogenic diet, be aware that it may not align well with heart health guidelines. These diets often restrict whole grains, legumes, and healthy oils, and may be high in saturated fat. Consult a registered dietitian to ensure nutrient adequacy and minimize cardiovascular risk.

Ultraprocessed food (UPF) consumption does not have a unique mechanistic link to increased body mass index or obesity risk, as epidemiological associations are weak and mechanistic evidence is lacking or contradictory.

Do not avoid all processed foods based on the NOVA classification. Focus on nutrient density, portion control, and overall dietary patterns. Many processed foods are safe, nutritious, and affordable. Avoiding them entirely may lead to nutrient deficiencies and higher costs without proven health benefits.

Bariatric surgery significantly reduces the overall incidence of cancer, obesity-related cancers, and cancer-associated mortality in patients with morbid obesity compared to conventional treatment.

For individuals with morbid obesity, bariatric surgery is a highly effective intervention for reducing the risk of developing various cancers, particularly obesity-related types like breast, colorectal, and endometrial cancer, as well as reducing cancer mortality. This benefit is attributed to sustained weight loss and metabolic improvements that are difficult to achieve through lifestyle changes alone.