Browse the evidence

In patients with new-onset type 2 diabetes, a weight gain of 10% or more within the first two years is associated with an increased risk of stroke.

If you have recently been diagnosed with type 2 diabetes, try to avoid gaining more than 10% of your body weight in the first two years. Significant weight gain is linked to a higher risk of stroke. Maintaining a stable weight is associated with the lowest risk of cardiovascular events and mortality.

In patients with new-onset type 2 diabetes, weight change (gain or loss) of more than 10% is associated with higher all-cause mortality compared to stable weight.

If you have recently been diagnosed with type 2 diabetes, aim to maintain your weight. Both losing more than 10% and gaining more than 10% of your body weight in the first two years are associated with higher mortality. Stable weight is linked to the lowest risk of death.

A high-fat, low-carbohydrate diet (high dietary fat intake) increases whole-body fat oxidation and reduces skeletal muscle mitochondrial respiration in trained humans, whereas low carbohydrate availability alone does not drive these adaptations.

If you are a trained endurance athlete, consuming a diet with >65% of calories from fat (while keeping carbs low at <20%) for about 5 days will significantly increase your body's ability to burn fat during exercise and reduce mitochondrial respiration rates. This adaptation is driven by the high fat intake itself, not just by restricting carbohydrates. Performance in time trials remains unchanged despite these metabolic shifts.

Low-carbohydrate diets offer superior short-term glycaemic control (HbA1c reduction) compared to high-carbohydrate diets, but this benefit is not maintained at 12 months.

If you have type 2 diabetes, a low-carbohydrate diet can help lower your HbA1c significantly in the first 6 months. However, this advantage tends to disappear after a year, likely because it is hard to stick to. Focus on a sustainable dietary pattern that you can maintain long-term.

GIP has pleiotropic effects beyond glucose metabolism, including potential benefits for obesity, bone health, and neurodegenerative disorders, making it a candidate for pharmacotherapies.

GIP is not just a blood sugar hormone. It also influences fat storage, bone density, and brain health. This is why new drugs that mimic or modify GIP are being studied for obesity and even neurodegenerative diseases.

Targeting specific inflammatory pathways (IL-1beta, NLRP3) reduces cardiovascular disease events in patients with obesity and elevated inflammation, independent of lipid-lowering effects.

If you have obesity and high inflammation markers (like CRP), your risk of heart disease is significantly driven by inflammation, not just cholesterol. While lifestyle changes are primary, emerging treatments targeting inflammation (like IL-1beta blockers) can reduce heart events by ~15% in high-risk groups, though they carry infection risks and do not fix blood sugar issues.

Substantial weight loss (via bariatric surgery or intensive lifestyle) reduces systemic inflammation and cardiovascular risk, whereas modest weight loss may not translate to CVD benefits.

To protect your heart, you need to lose at least 10% of your body weight. Modest weight loss (5-10%) improves blood sugar and cholesterol but may not prevent heart attacks. Bariatric surgery is the most effective way to achieve this and reduce inflammation, but intensive lifestyle changes can also work if sustained.

Combining waist circumference (WC) and relative handgrip strength (HGS/BW) provides a significantly more accurate prediction of metabolic syndrome (MetS) risk than using either metric alone.

To better assess your risk for metabolic syndrome, do not rely on waist size or muscle strength alone. Measure your waist circumference and test your handgrip strength (normalized to your body weight). Combining these two simple, low-cost measurements provides a significantly more accurate risk profile than using either metric by itself.

In high-risk type 2 diabetes patients, higher BMI and waist circumference are significantly associated with worse cardiometabolic control (higher triglycerides, lower HDL-C, higher blood pressure) and higher medication intensity, despite these patients receiving more aggressive lipid and blood pressure therapy.

For patients with T2DM and high heart risk, carrying excess weight (high BMI or waist circumference) is strongly linked to harder-to-control blood pressure, cholesterol, and blood sugar, even when doctors prescribe more medication. Addressing adiposity is critical because it correlates with better control of these major risk factors.

Resistance training performed to momentary muscular failure does not produce superior muscle hypertrophy compared to non-failure training.

You do not need to train to momentary muscular failure to maximize muscle growth. Training with 1-3 reps in reserve (RIR) is likely sufficient for hypertrophy. This allows you to recover faster and perform more total work over time, which may be more beneficial than chasing failure on every set.

Higher velocity loss thresholds (>25%) do not produce superior muscle hypertrophy compared to moderate velocity loss (20-25%).

For resistance-trained individuals, stopping sets at moderate velocity loss (20-25%) is just as effective for muscle growth as stopping at high velocity loss (>25%). You can simplify your training by not obsessing over precise velocity loss metrics.

Resistance training performed to 'set failure' (defined as anything other than momentary muscular failure) provides a trivial advantage over non-failure training for muscle hypertrophy.

Training to 'set failure' (broadly defined) offers a trivial advantage over non-failure training. The practical benefit is minimal, so you can choose your failure definition based on comfort and recovery rather than expecting significant hypertrophy gains.

Pregnant women with obesity should not increase energy intake during the second and third trimesters; maintaining early-pregnancy energy intake levels achieves recommended gestational weight gain by mobilizing maternal fat mass.

If you have obesity and are pregnant, do not try to increase your daily calories in the second and third trimesters. Instead, aim to eat roughly the same amount you ate in early pregnancy. Your body will use your stored fat to support the baby's growth, which helps you stay within healthy weight gain limits without risking excess fat accumulation.

GLP-1 receptor agonists (specifically liraglutide) reduce cardiovascular events by preventing the progression of atherosclerosis, whereas SGLT2 inhibitors (empagliflozin) reduce mortality linked to cardiovascular events likely through hemodynamic and volume depletion effects rather than atherosclerosis modulation.

Understand that while both empagliflozin and liraglutide protect the heart, they may do so differently. Empagliflozin works quickly to reduce fluid load and heart stress (beneficial for heart failure), while liraglutide may work more slowly to protect blood vessels from plaque buildup. This distinction helps doctors choose the right drug for your specific heart condition.

Non-exercise activity thermogenesis (NEAT) is the most variable component of total daily energy expenditure, ranging from 15% to over 50% of TDEE, and serves as a primary regulator of body weight and obesity risk.

To manage weight, prioritize increasing your daily non-exercise movement (NEAT) such as walking, standing, and fidgeting, rather than relying solely on structured exercise. NEAT is the most variable part of your energy expenditure and can range from 15% to over 50% of your total daily energy needs. Small changes in daily activity levels have a substantial cumulative impact on energy balance.

NEAT is regulated by biological factors (weight, gender, body composition) and environmental factors (occupation, urbanization), and changes in NEAT subtly accompany experimentally-induced changes in energy balance.

Understand that your daily movement (NEAT) is influenced by your job, environment, and genetics. While you cannot change your genetics, you can modify your environment to encourage more movement (e.g., walking to work, standing desks). NEAT changes subtly in response to energy balance, so increasing daily movement can help counteract weight gain.

Sustained caloric restriction (approx. 12-25% reduction) in healthy non-obese adults for two years is safe and well-tolerated, with no deaths and only minor adverse events, despite causing modest bone mineral density loss and hematocrit drops.

If you are healthy and not obese, restricting calories by about 12-25% for two years is generally safe and well-tolerated. You should take calcium and multivitamins, and get regular check-ups to monitor bone density and blood counts, as these may drop slightly.

Men experience significantly greater weight loss, fat mass loss, and lean mass loss on a healthy low-carbohydrate (HLC) diet compared to a healthy low-fat (HLF) diet, whereas women achieve similar weight loss outcomes on both diets.

If you are a man, a healthy low-carbohydrate diet is likely to produce greater weight loss than a healthy low-fat diet. If you are a woman, both diets are equally effective for weight loss, so you should choose the one you can adhere to best. Men lose more weight and fat on HLC, while women lose similar amounts on either diet.

Tirzepatide, a dual GIP/GLP-1 receptor agonist, significantly reduces systolic and diastolic blood pressure in patients with type 2 diabetes and obesity.

If you have type 2 diabetes or obesity, tirzepatide (a once-weekly injection) can help lower your blood pressure, which reduces your overall cardiovascular risk. The blood pressure reduction is dose-dependent, meaning higher doses tend to lower BP more.

Tirzepatide reduces inflammatory markers associated with cardiovascular risk, including YKL-40, ICAM-1, leptin, and GDF-15.

Tirzepatide reduces inflammatory markers associated with cardiovascular risk, such as YKL-40, ICAM-1, leptin, and GDF-15. This reduction in inflammation may contribute to the overall cardiovascular benefits of the drug.

SGLT2 inhibitors produce modest weight loss (2-5 kg) in Type 2 Diabetes, which is significantly less than the ~10 kg/year predicted by caloric loss from glycosuria due to compensatory metabolic adaptations.

If you are taking an SGLT2 inhibitor for diabetes, expect a modest weight loss of 2-5 kg, not the dramatic loss you might calculate from urine sugar loss. This modest loss is still beneficial for your heart and kidneys. Use this weight change as a motivational anchor to support other healthy lifestyle changes, rather than relying on the drug alone for significant fat loss.

Caloric restriction (25% deficit) improves metabolic flexibility, evidenced by amplified fasting-to-postprandial differences in acylcarnitines and free fatty acids, which correlates with improved insulin sensitivity.

To improve metabolic flexibility, consider a sustained caloric restriction of about 25% below your maintenance needs. This approach helps your body better switch between burning fat and glucose, which is linked to better insulin sensitivity. This is most effective if you are currently sedentary and have a normal-to-overweight BMI.

In Chinese patients with type 2 diabetes, obesity (BMI ≥28 kg/m²) and central obesity are significantly associated with a lower likelihood of achieving integrated cardiometabolic therapeutic goals (HbA1c <7%, BP <140/90 mmHg, LDL-C <2.6 mmol/L) compared to normal-weight patients, even when receiving more intensive pharmacotherapy.

If you have type 2 diabetes, achieving blood sugar, blood pressure, and cholesterol targets is significantly harder if you are obese, even if you are taking more medication than thinner patients. The study suggests that weight loss is a critical component of treatment that medication alone cannot replace. Focus on weight management strategies alongside your prescribed medications to improve your chances of reaching health goals.

Higher cardiorespiratory fitness (CRF) causally reduces the risk of type 2 diabetes, independent of adiposity (BMI), with a 1-SD increase in genetically predicted fitness associated with an 11% lower risk.

Improving your cardiorespiratory fitness (VO2max) directly lowers your risk of type 2 diabetes, regardless of your weight. Focus on exercises that challenge your heart and lungs (like cycling or running) to improve your body's ability to use oxygen, as this has independent metabolic benefits beyond just burning calories.