Browse the evidence

Lorcaserin IR and XR promote weight loss and improve glycemic control in overweight or obese patients with type 2 diabetes when used as an adjunct to lifestyle modifications.

If you have type 2 diabetes and are overweight, lorcaserin (10 mg once or twice daily) can help you lose weight and lower your HbA1c. It works best when combined with diet and exercise. Common side effects like headaches are usually mild.

In healthy young humans, changes in skeletal muscle mass in response to resistance exercise, disuse, and aging are primarily driven by alterations in muscle protein synthesis (MPS), while muscle protein breakdown (MPB) remains largely unchanged or plays a negligible role.

To maintain or build muscle, prioritize resistance exercise and protein intake to stimulate muscle protein synthesis. You do not need to worry about 'blocking' muscle breakdown as a primary strategy, as your body naturally regulates this, and forcing suppression may be counterproductive. Consistent loading is the key lever.

Deuterated water (D2O) ingestion is a valid and increasingly used method for measuring long-term muscle protein synthesis in humans, providing insights that complement acute tracer infusion methods.

For researchers, D2O is a reliable tool for measuring long-term muscle protein synthesis. For practitioners, this validates that consistent, long-term training and nutrition strategies are what drive muscle changes, rather than just acute post-workout spikes.

In aging skeletal muscle, the progressive loss of mass (sarcopenia) is largely driven by anabolic resistance—a desensitized muscle protein synthesis response to stimuli like loading and protein ingestion—rather than increased protein breakdown.

Older adults should prioritize resistance training and adequate protein intake to overcome anabolic resistance. While muscle loss is slower with age, maintaining activity levels can prevent many age-related muscle deficits.

Patients with specific comorbidities, specifically dyslipidaemia and obstructive sleep apnoea (OSA), have significantly higher odds of receiving both anti-obesity medication (AOM) prescriptions and metabolic and bariatric surgery (MBS).

Having comorbidities like high cholesterol or sleep apnea can increase your chances of being prescribed obesity treatments. If you don't have these, you may face more hurdles. Discuss your overall metabolic health with your provider, as obesity itself is a valid reason for treatment.

GLP-1 receptor agonists significantly reduce binge eating behaviors and alcohol consumption, offering therapeutic potential for substance use disorders and eating disorders independent of weight loss.

If you struggle with binge eating or alcohol use, GLP-1 medications might help reduce these cravings directly, not just by making you lose weight. Clinical trials show significant improvements in binge eating scores and reduced alcohol intake. This suggests the drug affects the brain's reward system, offering a new tool for managing these specific behaviors.

In drug-naive patients with prediabetes, initiating GLP-1 RA as first-line therapy significantly reduces the 1-year risk of requiring additional glucose-lowering medication compared to metformin, but is associated with a significantly higher risk of treatment nonadherence.

For patients with prediabetes, GLP-1 RA is more effective than metformin at preventing the need for extra diabetes medications over one year. However, patients are more likely to stop taking GLP-1 RA than metformin. Clinicians should proactively manage expectations regarding side effects and adherence to maximize the benefit.

In drug-naive patients with diabetes, initiating GLP-1 RA as first-line therapy reduces the 1-year risk of requiring additional glucose-lowering medication compared to metformin, with no significant difference in adherence rates.

For patients with diabetes, GLP-1 RA is more effective than metformin at preventing the need for extra diabetes medications over one year, with similar adherence rates. This makes GLP-1 RA a strong first-line option for diabetes management.

Self-reported dietary intake methods (Remote Food Photography Method) significantly underestimate energy intake compared to doubly labelled water (DLW) derived estimates, leading to an overestimation of the prevalence of Low Energy Availability (LEA) in female soccer players.

If you are a female soccer player or coach using food photography or logs to track energy availability, be aware that you are likely under-reporting intake by about 22%. This means you might think you have Low Energy Availability (a risk factor for injury and hormonal issues) when you actually don't. Do not make drastic dietary changes based solely on self-reported data without considering this potential under-reporting bias.

Supplementing with 20g of native whey protein twice daily during a 12-week strength training program yields equivalent gains in muscle mass and strength compared to supplementing with an equivalent dose of spray-dried milk.

If you are starting a strength training program, you do not need to buy expensive native whey protein. Drinking milk or consuming standard milk powder provides the same muscle-building benefits as native whey, provided you are consuming enough total protein (around 1.6-2.0 g/kg/day) and training consistently.

Increasing cardiorespiratory fitness and losing body mass index (BMI) independently and synergistically slow the progression of deficit accumulation frailty (a marker of biological aging) in adults with type 2 diabetes and overweight/obesity.

If you have type 2 diabetes and are overweight, focusing on improving your aerobic fitness (like brisk walking for >175 minutes a week) and losing weight (targeting >7% loss) can significantly slow biological aging. These two actions work independently: improving fitness helps even if you don't lose much weight, and losing weight helps even if your fitness doesn't change much. Doing both provides the greatest benefit. This applies even if you are over 65.

Participants in a structured, lifestyle-based weight loss program demonstrate a high willingness to pay (median $45/month) for continued intervention, with Black participants showing significantly higher willingness to pay ($65/month) than Non-Black participants ($45/month).

If you are considering a paid weight loss program, know that many participants in the Hopkins POWER trial were willing to pay around $45 per month for continued support, with Black participants willing to pay even more ($65/month). This suggests that structured lifestyle programs offer perceived value comparable to commercial options, regardless of whether you achieved your specific weight loss goal.

Long-term adherence to healthy low-carbohydrate or low-fat diets results in transient microbiota shifts that revert toward baseline composition, demonstrating microbiome resilience despite sustained weight loss.

If you are trying to lose weight and keep it off, know that your gut bacteria will likely bounce back to their original state after the first few months, even if you stick to your diet. This 'resilience' might make long-term weight maintenance harder. Focus on sustainable dietary habits rather than expecting your microbiome to permanently change to support weight loss.

Long-term pharmacotherapy for obesity requires medications with proven efficacy and safety, as lifestyle modification alone is often insufficient for sustained weight loss.

If lifestyle changes alone aren't enough, consult a doctor about long-term obesity medications. These drugs are designed for sustained use and can help manage weight effectively, but they come with side effects and costs that need to be managed.

Older anti-obesity medications (Orlistat, Naltrexone/Bupropion, Phentermine/Topiramate, Liraglutide) have limited efficacy compared to newer GLP-1/GIP agonists.

Older obesity medications provide moderate weight loss (8-10%). They are established options but are less effective than the newest injectable treatments.

Tirzepatide treatment (5-15 mg weekly for 72 weeks) significantly improves both insulin sensitivity and beta-cell function in adults with obesity or overweight (BMI ≥27 kg/m2) with prediabetes or normoglycemia, independent of type 2 diabetes.

If you have obesity or are overweight and have prediabetes or normal blood sugar, tirzepatide (a once-weekly injection) can significantly improve how your body handles insulin and how well your pancreas functions. This happens partly because you lose weight, but also directly from the medication itself, potentially lowering your risk of developing type 2 diabetes.

GIP secretion is robustly stimulated by dietary lipids (fats) via GPR40, GPR120, and GPR119 receptors, with fat inducing a threefold higher GIP response compared to an oral glucose tolerance test.

Fats are the most potent natural trigger for GIP secretion, causing levels to rise three times higher than glucose. This secretion depends on specific receptors (GPR40/120/119) and bile acids.

Weight loss interventions improve cardiovascular vascular function (endothelial health) only in obese individuals with baseline hyperinsulinemia (fasting insulin >12 mIU/ml), whereas those with lower insulin levels derive no vascular benefit.

If you are obese and undergoing weight loss, ask your doctor to check your fasting insulin levels. If your levels are high (>12 mIU/ml), weight loss is likely to significantly improve your blood vessel health and cardiovascular risk. If your levels are normal, you may not see vascular improvements from weight loss alone, suggesting you might need to focus on other metabolic markers or interventions.

Very Low-Calorie Diets (VLCDs) produce rapid weight loss (15-25% in 3-6 months) but are associated with high attrition and significant weight regain (>50%) at 1-2 year follow-ups.

VLCDs can help you lose weight quickly (15-25% in a few months), but they are hard to sustain. Most people regain more than half the weight within 1-2 years if they don't have a structured plan to transition to normal food and maintain lifestyle changes. Use VLCDs only under medical supervision and as part of a broader program.

A 1-week diet break (increasing carbohydrate intake to energy balance) following intermittent energy restriction improves leg muscle endurance in adult athletes without compromising fat loss goals.

If you are an athlete cutting weight, schedule a 1-week 'diet break' where you eat at maintenance calories (focusing on carbs) every 3-4 weeks. This will not add fat, but it will significantly improve your leg endurance and mental alertness, making your training sessions more effective. Time this break before a key training block or competition.

Time-restricted eating (TRE) improves glucose homeostasis, lipid metabolism, and blood pressure in individuals with metabolic conditions, independent of weight loss.

If you have metabolic risks like prediabetes or high blood pressure, try limiting your daily eating window to 8-10 hours, preferably starting earlier in the day (e.g., 8am-4pm). This timing aligns with your body's natural rhythms and can improve insulin sensitivity and blood pressure, even if your weight doesn't change. Ensure you are eating enough protein within that window to protect muscle mass, especially if you are older.

GLP-1 receptor agonists suppress appetite through a non-aversive neural pathway (NTS GLP1R neurons projecting to PVH) that is distinct from the nausea-inducing pathway (Area Postrema GLP1R neurons projecting to PBN/CeA), allowing for weight loss without nausea.

GLP-1 medications like semaglutide work through two separate brain pathways: one that makes you feel full without feeling sick, and another that causes nausea. You can achieve significant weight loss through the 'fullness' pathway even if you experience some nausea, but the nausea itself isn't required for the fat loss. If nausea is severe, it may indicate you are activating the nausea pathway more than the satiety pathway, and dose adjustments might help optimize the benefit-to-side-effect ratio.

Endoscopic sleeve gastroplasty (ESG) using full-thickness suturing produces significant, durable weight loss (approx. 13-15% total body weight loss at 12 months) and improves metabolic markers, serving as a safer, reversible alternative to bariatric surgery.

If you are looking for a weight loss solution that is less invasive than surgery but more effective than dieting alone, ESG is a viable option. It involves an endoscopic procedure to suture the stomach, creating a sleeve that slows digestion and increases fullness. Expect about 13-15% weight loss over a year, combined with lifestyle changes. It is safer than traditional surgery and reversible.

Older anti-obesity medications (orlistat, naltrexone/bupropion, phentermine/topiramate) produce modest weight loss (5-11%) and are less effective than newer GLP-1/GIP agonists.

Older weight-loss drugs like Orlistat produce modest weight loss (around 7%) and have significant gastrointestinal side effects. They are less effective than newer GLP-1 medications.