Browse the evidence

In normal weight individuals, both weight loss and weight gain are associated with an increased risk of cardiovascular disease (CVD) compared to weight maintenance.

If you are normal weight, try to maintain your current weight. Both losing and gaining weight were associated with a higher risk of cardiovascular disease compared to staying stable. This may be because weight loss in normal weight individuals can be a sign of underlying illness.

In individuals with obesity, weight gain is associated with a higher risk of cardiovascular disease (CVD) compared to weight maintenance.

If you have obesity, avoiding weight gain is important for cardiovascular health. Gaining weight was associated with a higher risk of CVD compared to maintaining your current weight. Focus on strategies to maintain your current weight.

In older patients with diabetes mellitus, energy intake between 25 and 35 kcal/kg of body weight per day is associated with the lowest all-cause mortality, forming a U-shaped relationship where both lower and higher intakes increase mortality risk.

Older adults with diabetes should aim for an energy intake of 25 to 35 kcal per kilogram of body weight per day. This range is associated with the lowest risk of death. Both eating significantly less than this (leading to potential malnutrition/sarcopenia) and significantly more (excessive nutrition) increases mortality risk. This optimal range may be higher than what is traditionally calculated using standard body weight formulas.

Consuming 25g of protein immediately before resistance training yields similar muscular adaptations (strength and hypertrophy) as consuming the same dose immediately after training, refuting the necessity of a narrow post-workout anabolic window.

If you eat protein right before your workout, you do not need to rush to drink a shake immediately after. The benefits for strength and muscle growth are the same whether you take your protein before or after, as long as you get your total daily protein. Don't stress about the exact timing of your post-workout meal.

GLP-1 receptor agonists (semaglutide, tirzepatide) and bariatric surgery (RYGB) extend the duration of weight loss prior to plateau by weakening the physiological appetite feedback control circuit, whereas diet restriction fails to weaken this circuit and thus plateaus within ~12 months.

If you are using GLP-1s or had surgery, your prolonged weight loss is due to a physiological change in how your body regulates appetite, not just willpower. Dieting alone triggers a strong appetite feedback loop that causes early plateaus; these interventions bypass that loop.

Cultural norms prioritizing commensality, pleasure, and 'natural' food sourcing can act as protective factors against obesity by promoting mindful, socially-integrated eating behaviors, whereas rigid dieting and external pressure to overeat are identified as major obstacles to weight management.

If you are in a culture that values social eating and 'natural' foods, leverage this by focusing on the quality and social aspect of meals rather than strict calorie counting. Avoid rigid 'diets' which are culturally viewed as harmful; instead, prioritize seasonal, local foods and shared meals. Be aware that stress and social pressure can disrupt hunger cues, so practice mindful eating in social settings.

Automated dietary assessment using natural spoken language (COCO app) yields energy and macronutrient intake estimates that are statistically equivalent to the gold-standard multiple-pass 24-hour recall method, while significantly reducing user burden.

If you want to track your diet accurately without spending hours typing into an app, try a voice-logging tool. This study shows that speaking your meals into a smart app produces results just as accurate as a professional dietitian's interview, making it a sustainable way to monitor intake for weight management.

Exogenous ketone sources, specifically medium-chain triglycerides (MCTs) and ketone esters, increase energy expenditure and reduce energy intake when consumed in the context of high carbohydrate availability.

If you are eating a high-carbohydrate diet, adding MCT oil or ketone esters may slightly boost your energy expenditure and reduce your hunger. However, the effect is small ('slightly enhanced weight loss') and not a substitute for a balanced diet. It is not a magic bullet.

Dual (GLP-1/GIP) and Triple (GLP-1/GIP/Glucagon) receptor agonists offer superior weight loss and metabolic benefits compared to GLP-1 mono-agonism by leveraging complementary mechanisms.

Newer multi-agonists (dual/triple) like retatrutide show much higher weight loss (up to 24%) than older GLP-1 drugs. They work by hitting multiple metabolic targets at once, which may be necessary for patients who don't respond sufficiently to GLP-1 alone.

Supplemental mung bean protein (18 g/day) increases muscular strength in healthy, underactive vegetarians without concurrent exercise or lean body mass gains.

If you are a vegetarian and do not exercise heavily, adding 18 grams of mung bean protein daily may help you maintain or slightly improve your strength over 8 weeks, even without changing your diet or activity level.

Supplementing resistance training with defatted peanut protein powder increases vastus lateralis muscle thickness in older adults, though it does not significantly alter myofibrillar protein synthesis rates immediately post-exercise or change total lean soft tissue mass compared to no supplementation.

If you are over 50 and new to resistance training, adding a defatted peanut protein supplement (approx. 30g protein daily) to your routine may help increase the thickness of your thigh muscles (vastus lateralis) more than training alone. However, do not expect this to significantly change your total body weight or lean mass on a scale over a short period (6-10 weeks). It is a viable plant-based option for supporting local muscle growth.

Short-term time-restricted eating (8-hour window) leads to greater loss of trunk lean mass compared to an extended 12-hour eating window, although total body mass loss is similar.

While your muscle building capacity (MPS) stays the same, you might see a small drop in 'lean mass' on body scans during the first 10 days of an 8-hour eating window. This is likely due to fluid or organ mass changes, not actual muscle loss, especially since your muscle synthesis rates are unchanged. Don't panic if your strength doesn't drop.

Triple agonists targeting GLP-1, GIP, and Glucagon receptors (GCGR) offer additional metabolic benefits, including increased energy expenditure and weight loss, by combining the insulinotropic effects of incretins with the lipolytic and anorectic effects of glucagon.

For patients with Type 2 Diabetes and obesity who need more than standard treatment, triple-agonist medications (targeting GLP-1, GIP, and Glucagon) are in early development. These drugs aim to boost weight loss and energy expenditure by leveraging the body's natural hormonal responses to food. Because they are still in early trials, their long-term safety and optimal dosing are not yet fully established, but they represent a promising next step for complex metabolic cases.

Low-load blood flow restriction (LL-BFR) resistance training produces type I fiber hypertrophy that is at least equal to, and sometimes greater than, type II fiber hypertrophy, contrasting with high-load training which preferentially hypertrophies type II fibers.

To target slow-twitch (Type I) muscle fibers, use low loads (20-50% of your one-rep max) combined with blood flow restriction cuffs. Perform sets to near failure with short rest periods (30 seconds). This method can stimulate growth in these fibers as effectively as, or better than, heavy lifting, which typically favors fast-twitch fibers.

High-load resistance training (HL-RT) produces significantly greater muscle hypertrophy than low-load resistance training with blood flow restriction (LL-RT with BFR) in upper limb exercises.

When training upper body muscles (like biceps or shoulders) with blood flow restriction, you may not get as much muscle growth as you would with heavy weights. If your goal is maximum upper body size, high-load training might be more effective than BFR. However, BFR is still a viable option for rehabilitation or when heavy weights are not possible, just expect potentially smaller gains compared to heavy lifting.

Tirzepatide demonstrates potential for cardiovascular protection, including reduced risk of major adverse cardiovascular events (MACE-4) and improved lipid profiles, in patients with Type 2 Diabetes.

Beyond lowering blood sugar, Tirzepatide may improve heart health by lowering bad cholesterol and triglycerides and reducing the risk of heart attacks and strokes. This is particularly important for diabetic patients with existing heart risks.

Tirzepatide shows promise for treating Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) by reducing liver fat content and improving liver enzymes, likely through indirect weight loss and metabolic effects.

For diabetics with fatty liver, Tirzepatide may help reduce liver fat and improve liver enzymes, likely by aiding weight loss and metabolic health. However, more specific clinical trials are needed to confirm its efficacy as a primary treatment for NASH.

Bariatric surgery results in greater weight loss and higher rates of type 2 diabetes remission compared to sleeve gastrectomy, and is associated with reduced nephropathy and major adverse cardiovascular events.

For individuals with severe obesity and type 2 diabetes who have not achieved remission with lifestyle changes or medications, bariatric surgery (particularly Roux-en-Y gastric bypass) can be a highly effective option. It offers greater weight loss and diabetes remission rates than other surgical options like sleeve gastrectomy, along with reduced heart and kidney risks, though it carries higher surgical risks.

Fasted cardiovascular exercise is commonly recommended by bodybuilding coaches (67%), primarily to synergize with fat-burning supplements like yohimbine and clenbuterol, despite systematic reviews showing no superiority over fed cardio for fat loss in general populations.

Bodybuilding coaches frequently prescribe fasted cardio (67% of respondents) not because it burns more fat than fed cardio, but to allow the use of fat-burning supplements like yohimbine or clenbuterol. If you are not using these specific supplements, fasted cardio offers no fat-loss advantage over fed cardio. Focus on total weekly energy expenditure and recovery.

Diets high in rapidly digestible carbohydrates increase the insulin-to-glucagon ratio, shifting energy partitioning toward adipose storage and away from metabolically active tissues, which triggers compensatory hunger and reduced metabolic rate.

To manage weight, focus on reducing rapidly digestible carbohydrates (refined grains, added sugars) to lower insulin levels. This prevents the hormonal trapping of energy in fat cells and reduces the biological drive to overeat and slow metabolism.

High-glycemic load (GL) diets reduce total energy expenditure (TEE) compared to low-carbohydrate or low-GL diets, even when calories and weight are matched.

When maintaining weight loss, choose lower-carbohydrate or lower-glycemic load foods to support a higher metabolic rate compared to high-carbohydrate diets.

A 12-month Mediterranean diet intervention in firefighters leads to modest but significant improvements in specific cardiometabolic markers, specifically body fat percentage and LDL cholesterol, at 6 months, though these effects may not persist or reach significance after multiple comparison corrections.

While the diet improves adherence, expect modest changes in body fat and LDL cholesterol, particularly in the first 6 months. Do not expect dramatic shifts in these specific markers, and be aware that statistical significance may be lost when accounting for multiple health metrics.

Lifestyle interventions (diet and exercise) combined with GLP-1 receptor agonists (GLP-1RAs) may mitigate gastrointestinal side effects and enhance weight loss, though their efficacy requires confirmation via randomized controlled trials.

If you are taking a GLP-1RA, do not abandon lifestyle changes. Focus on dietary strategies like smaller, lower-fat meals to manage nausea and other side effects. This may help you stay on the medication longer and potentially achieve greater weight loss, although more research is needed to confirm these benefits.

Weight loss of 20% or higher with newer GLP-1RAs raises concerns for nutritional deficiency and sarcopenia, necessitating monitoring similar to post-bariatric surgery care.

If you are losing a lot of weight (20% or more) on a GLP-1RA, ask your doctor about monitoring for nutritional deficiencies and muscle loss. You may need a dietitian to help you ensure you are getting enough protein and nutrients, similar to post-bariatric surgery guidelines.