Browse the evidence

Incretin-based therapies improve cardiovascular risk factors (lipids, blood pressure) and reduce the risk of major cardiovascular events and heart failure in individuals with obesity.

For those with obesity, incretin therapies like semaglutide offer cardiovascular protection, lowering risks of heart events and heart failure, independent of just weight loss.

Subcutaneous semaglutide increases the risk of gastrointestinal adverse events (nausea, diarrhea, vomiting) compared to placebo and other antidiabetic agents, but does not increase the risk of serious adverse events, hypoglycemia, acute pancreatitis, or diabetic retinopathy.

While semaglutide is effective, be aware that it commonly causes nausea, diarrhea, or vomiting, especially when starting or increasing the dose. These side effects are usually mild and temporary. Importantly, it does not appear to increase the risk of serious conditions like pancreatitis, hypoglycemia, or eye problems compared to other treatments.

Antihyperglycemic therapies reduce the risk of Major Adverse Cardiovascular Events (MACE) in a glycemic-dependent manner, where every 1% reduction in HbA1c is associated with a 14% relative reduction in MACE risk.

If you have type 2 diabetes, achieving a 1% reduction in your HbA1c through medication or lifestyle is associated with a 14% lower risk of major cardiovascular events like heart attack or stroke. This benefit is consistent across various drug classes, suggesting that effective glycemic control is a primary strategy for cardiovascular protection.

Visceral Adipose Tissue (VAT) and Epicardial Adipose Tissue (EAT) are stronger predictors of incident HFpEF and mortality than Body Mass Index (BMI) alone.

Don't just look at your weight. For heart failure risk, where you store fat matters more. High belly fat (VAT) and heart-adjacent fat (EAT) are major risks, even if your overall weight seems okay. Imaging can help assess this risk.

GLP-1 receptor agonists provide cardiovascular protection by reducing major adverse cardiac events (MACE), independent of substantial glucose lowering, through mechanisms including improved endothelial function and reduced inflammation.

GLP-1 medications offer significant cardiovascular protection, reducing the risk of heart attack, stroke, and cardiovascular death. This benefit exists even in non-diabetic obese patients, likely due to improved blood vessel function and reduced inflammation, not just weight loss or blood sugar control.

Physical activity reduces the risk of chronic diseases including cardiovascular disease, cancer, and dementia independent of weight loss.

Aim for 10,000 steps a day to lower your risk of heart disease, cancer, and early death. You get these benefits even if you don't lose weight on the scale.

Obesity (BMI ≥ 30 kg/m²) is associated with the highest risk of incident atrial fibrillation and ischemic stroke in young adults (20-39 years), with risk attenuating significantly in those over 60.

Maintain a healthy weight starting in your 20s. The cardiovascular damage from obesity (atrial fibrillation and stroke risk) is most potent when you are young. Waiting until middle age to manage weight misses the window where obesity causes the most severe relative risk increase.

Waist circumference (WC) is a more consistent predictor of atrial fibrillation and stroke risk across all age groups than BMI, which shows a J-shaped or attenuated relationship in the elderly.

Track your waist circumference, not just your weight. For predicting heart rhythm issues and stroke, visceral fat (waist size) is a more reliable indicator across all ages than total body mass (BMI).

Being underweight (BMI < 18.5 kg/m²) is associated with an increased risk of atrial fibrillation, particularly in adults over 60 years.

If you are over 60, do not aim for extreme thinness. Being underweight increases your risk of atrial fibrillation, likely due to loss of muscle mass and malnutrition. Focus on maintaining a healthy, robust weight.

Network meta-analyses (NMA) provide superior clinical utility for diabetes management compared to standard pairwise meta-analyses by simultaneously comparing multiple treatments using both direct and indirect evidence.

When choosing between multiple diabetes medications (like SGLT-2 inhibitors, GLP-1 RAs, or finerenone), rely on Network Meta-Analyses (NMA) rather than single-trial results. NMAs allow you to compare all options simultaneously against standard care, revealing which drugs best reduce specific risks like heart failure or kidney disease for your patient's specific profile.

SGLT-2 inhibitors and GLP-1 receptor agonists significantly reduce major adverse cardiovascular events (MACE) and end-stage kidney disease (ESKD) in Type 2 Diabetes patients, with SGLT-2i showing specific superiority for kidney outcomes.

For Type 2 Diabetes patients with heart or kidney risks, prioritize SGLT-2 inhibitors or GLP-1 RAs. These drugs do more than lower blood sugar; they significantly reduce the risk of heart attacks, heart failure hospitalizations, and kidney failure. SGLT-2 inhibitors are particularly strong for protecting the kidneys.

Semaglutide improves cardiovascular outcomes, including reducing the risk of major adverse cardiovascular events (MACE), in patients with type 2 diabetes.

If you have type 2 diabetes and heart disease, kidney disease, or heart failure, ask your doctor about adding a GLP-1 RA like semaglutide. It can significantly lower your risk of heart attack, stroke, and heart failure, even if your blood sugar is already well-controlled.

Genetically modeled GLP-1 and GIP receptor agonism reduces fatty food liking and increases vegetarian food liking.

Genetic evidence suggests that activating GLP-1 and GIP receptors shifts food preferences away from fatty foods and towards vegetarian options. This change in food preference may contribute to the observed reduction in binge drinking.

Tirzepatide treatment (10 mg or 15 mg once weekly for 72 weeks) significantly improves self-reported health-related quality of life (HRQoL) in adults with obesity or overweight and type 2 diabetes, specifically in physical functioning, bodily pain, general health, vitality, and social functioning.

If you have type 2 diabetes and are overweight or obese, treatment with tirzepatide (Mounjaro/Zepbound) can significantly improve your daily quality of life. This includes feeling less pain, having more energy, and being more socially active. The improvements are seen in both physical and mental well-being, and they are greater for those who lose more weight. Talk to your doctor about whether this once-weekly injection is right for you, especially if you are struggling with physical limitations due to your weight.

Glucagon regulates glucose and amino acid homeostasis and counters hypoglycemia.

Glucagon is a natural hormone that helps keep your blood sugar and amino acid levels stable. It acts as a counter-regulatory mechanism to prevent hypoglycemia, making it essential for metabolic balance.

Lifestyle interventions (caloric restriction and exercise) are the foundation of MASLD treatment but often fail to achieve sufficient or sustained weight loss, necessitating pharmaceutical intervention.

Start with lifestyle changes: eat less and move more. This is the foundation of treating fatty liver. However, be realistic: it is very hard to maintain these changes long-term, and many people struggle to lose enough weight. If lifestyle changes are not enough, talk to your doctor about adding medications like GLP-1RAs or SGLT2-is, which can help you achieve the weight loss needed to improve your liver health.

GLP-1 receptor agonists (GLP-1RAs) such as liraglutide and semaglutide significantly reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes at high cardiovascular risk.

If you have Type 2 Diabetes and are at high risk for heart problems, ask your doctor about GLP-1 RAs like liraglutide or semaglutide. These drugs not only help control blood sugar but have been proven in major studies to significantly lower your risk of heart attack, stroke, and cardiovascular death. The benefits extend beyond glucose control to direct heart protection.

Obesity is a chronic disease driven by dysfunctional adipose tissue and dysregulated energy homeostasis, requiring medical treatment rather than solely lifestyle changes.

Obesity is a medical condition, not a moral failing. If you have obesity, you need medical treatment, not just willpower. Seek a doctor who understands this and offers evidence-based therapies.

Naltrexone/bupropion combination therapy produces moderate weight loss (up to 6.1% vs placebo) and improves metabolic markers, but carries risks of seizures and psychiatric side effects.

This medication can help you lose weight by affecting brain chemicals that control hunger. It is taken twice daily and must be started at a low dose to avoid side effects like nausea, constipation, or headaches. It is not suitable for people with a history of seizures, eating disorders, or heart problems. You must stop the medication if you do not lose at least 5% of your body weight after 12 weeks.

Current clinical guidelines recommend continuing GLP-1 receptor agonists for most patients undergoing elective surgery, shifting away from routine preoperative cessation.

Do not stop your GLP-1 medication before surgery unless your surgeon or anesthesiologist explicitly tells you to. Most modern guidelines now say you should keep taking it, and you should discuss your specific risk factors with them.

Metformin is the first-line pharmacological treatment for T2DM and prediabetes, offering significant reduction in microvascular complications and diabetes-related deaths through mechanisms including inhibition of hepatic gluconeogenesis and increased insulin sensitivity.

Metformin is the standard first-line drug for T2DM and prediabetes. It reduces complications and deaths. If you experience stomach upset, ask your doctor about slow-release versions or slow titration to manage side effects.

SGLT2 receptor inhibitors (SGLT2R-i) provide significant cardiovascular and renal benefits, including reduced cardiovascular mortality and heart failure hospitalization, in addition to glycaemic control, by preventing glucose reabsorption in the kidneys.

SGLT2 inhibitors (like empagliflozin or dapagliflozin) are powerful drugs for T2DM patients with heart or kidney risks. They significantly reduce heart failure hospitalizations and mortality. Maintain good hygiene to minimize the risk of genital infections.

Obesity acts as an independent risk factor and driver for cardiovascular diseases through mechanisms including insulin resistance, endothelial dysfunction, systemic inflammation, and neurohormonal activation, leading to hypertension, heart failure, coronary artery disease, and stroke.

High body weight is a major biological driver of heart disease, not just a cosmetic issue. Addressing it requires medical and public health strategies, not just willpower, because it triggers harmful biological changes like inflammation and high blood pressure.

GLP-1 receptor agonists (e.g., semaglutide) and dual agonists (e.g., tirzepatide) are effective pharmacotherapies for obesity, achieving 10-20% mean body weight reduction, but their use is limited by stigma, regulatory barriers, and lack of insurance coverage.

If you have obesity, ask your doctor about GLP-1 receptor agonists (like semaglutide) or dual agonists (like tirzepatide). These are proven to help with significant weight loss. If insurance doesn't cover them, advocate for policy changes or look for patient assistance programs.