Browse the evidence

Higher genetically predicted lifelong BMI causally increases all-cause mortality, with the effect substantially mediated through diabetes.

In this population, higher lifelong BMI significantly increases the risk of premature death, largely by increasing the risk of diabetes. Managing weight and blood sugar are critical for longevity.

Higher genetically predicted BMI causally increases the risk of renal, acute diabetic crisis, and infective deaths.

Higher BMI is strongly linked to death from kidney disease, severe diabetic episodes, and infections. Preventing these outcomes requires addressing underlying metabolic health.

Energy expenditure can be increased through specific physiological mechanisms independent of physical activity, including UCP1-dependent thermogenesis in brown/beige fat, futile cycling of substrates (creatine, glucose, lipids), and ion pumping (Na+/K+-ATPase, SERCA).

Your body burns calories through several active processes beyond just moving around. These include generating heat in fat tissue (thermogenesis), running 'futile' metabolic cycles that burn energy as heat, and maintaining electrical gradients in cells. While you can't easily control these directly, understanding them helps explain why some medications work better than others. Future treatments may target these specific pathways to help you burn more calories passively.

Semaglutide provides robust cardiovascular risk reduction (MACE) in patients with Type 2 Diabetes and established cardiovascular disease, independent of glycemic control improvements.

If you have obesity and established heart disease, semaglutide (2.4mg weekly) significantly reduces your risk of major adverse cardiovascular events (MACE), even if you do not have diabetes. This benefit is driven by weight loss and cardiometabolic improvement, not just blood sugar control.

Sodium glucose cotransporter 2 inhibitors (SGLT2i) significantly reduce the composite risk of cardiovascular death or heart failure hospitalization in patients with heart failure with preserved ejection fraction (HFpEF), regardless of diabetes status.

If you have HFpEF, ask your doctor about SGLT2 inhibitors (like empagliflozin or dapagliflozin). These drugs are proven to reduce the risk of heart failure hospitalization and cardiovascular death, even if you do not have diabetes. They are a standard part of modern treatment.

GLP-2 analogs are effectively used in the management of short bowel syndrome, reducing the need for parenteral support and improving patient quality of life.

For patients with short bowel syndrome, GLP-2 analogs are an effective treatment that can reduce the need for intravenous nutrition (parenteral support) and improve quality of life.

Glucagon remains essential for emergency hypoglycemia treatment.

Glucagon is an essential emergency treatment for severe hypoglycemia. Patients at risk should have access to glucagon kits and be trained in their use to ensure rapid and effective treatment of low blood sugar episodes.

Current food environment policies in Vietnam are insufficient, with 74% of assessed indicators scoring low or very low, particularly in food composition standards, marketing, and labeling.

Policymakers must move beyond food safety regulations to address nutritional quality. This requires implementing mandatory food composition standards (e.g., sugar/salt/trans-fat limits), restricting marketing of unhealthy foods (especially to children), and enforcing front-of-package labeling.

Empagliflozin (10 mg/day) does not significantly reduce the primary composite endpoint of hospitalization for heart failure or death from any cause in patients hospitalized with acute myocardial infarction.

Empagliflozin (10 mg daily) did not significantly reduce the risk of heart failure hospitalization or death in patients recently hospitalized for a heart attack, according to the EMPACT-MI trial. However, secondary analyses suggested some benefits in reducing heart failure events.

Females exhibit higher GLP-1 receptor (GLP1R) expression in specific brain regions (PBN, AP/NTS) involved in processing aversive stimuli, which may explain their heightened sensitivity to GLP-1 agonist-induced nausea.

This finding suggests that women's brains may have more 'targets' for GLP-1 drugs in areas that control nausea, which is why side effects are more common. This is a biological fact, not a personal failing.

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) significantly slow the progression of diabetic kidney disease (DKD) and reduce cardiovascular events in patients with chronic kidney disease (CKD), regardless of baseline glycemic control or diabetes status.

If you have diabetes and kidney disease (or high cardiovascular risk), ask your doctor about SGLT2 inhibitors (like Jardiance, Farxiga, or Trjendi). These drugs protect your kidneys and heart, even if your blood sugar is already well-controlled. They are taken once daily. Be aware of potential genital yeast infections or, rarely, ketoacidosis, but these risks are generally manageable and outweighed by the protection they offer to your kidneys.

Bariatric surgery remains the most effective long-term treatment for severe obesity, offering superior durability and comorbidity remission compared to pharmacotherapy.

For severe obesity, surgery is still the most durable and effective option for long-term health improvement. It offers better comorbidity remission than drugs alone. Consider it if your BMI is very high or you have serious health issues.

GLP-1 receptor agonists induce nausea and vomiting primarily by binding to GLP-1 receptors in the dorsal vagal complex (brainstem) and stimulating peripheral vagal nerve fibers, leading to delayed gastric emptying and increased gut-to-brain signaling.

Nausea from GLP-1 medications is not a sign of toxicity or damage. It is a predictable side effect caused by how the drug interacts with your brain and gut nerves. This is why starting with a low dose helps your body adapt. The feeling is temporary and manageable, and it does not mean the medication is harming you.

SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) significantly reduce the risk of hospitalization for heart failure in patients with type 2 diabetes, independent of glycemic control.

If you have Type 2 Diabetes and are at risk for heart failure, ask your doctor about SGLT2 inhibitors (like empagliflozin or dapagliflozin). These drugs have been proven in large studies to significantly lower the risk of hospitalization for heart failure, even independent of their blood sugar-lowering effects. This is a key preventive strategy for heart health in diabetes.

Historical obesity pharmacotherapies utilizing thyroid hormones, sympathomimetics, and serotonergic agents were withdrawn due to severe cardiovascular, psychiatric, or oncological toxicity, despite demonstrating weight loss efficacy.

Do not use historical weight loss drugs like thyroid hormones, amphetamines, or fenfluramine. They are dangerous and have been withdrawn from the market due to severe side effects like heart damage and death. Modern treatments focus on safer mechanisms like GLP-1 agonists.

Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are highly effective surgical interventions for severe obesity, with RYGB showing slightly greater long-term weight loss.

Surgical options like RYGB and SG are highly effective for severe obesity, leading to 47-55% excess weight loss over seven years. RYGB tends to result in slightly greater weight loss than SG, but both improve quality of life. These are major surgeries requiring careful patient selection and postoperative management.

There is no head-to-head evidence to determine which drug class (THR-β vs Incretins) is superior for histological outcomes in MASH.

Both resmetirom and incretins work for MASH, but we don't know which is better for the liver itself because no study has compared them directly.

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is projected to increase from 33.7% (86.3 million people) in 2020 to 41.4% (121.9 million people) by 2050.

Health systems should prepare for a significant increase in MASLD cases.

Cases of metabolic dysfunction-associated steatohepatitis (MASH) are expected to rise from 14.9 million (5.8% of US adults) in 2020 to 23.2 million (7.9% of US adults) by 2050.

Increased awareness and management strategies for MASH are needed.

Liver-related mortality is estimated to increase from 30,500 deaths (1.0% of all-cause deaths in adults) in 2020 to 95,300 deaths (2.4%) in 2050.

Strategies to reduce liver-related mortality must be prioritized.

GLP1-RA treatment is not associated with a significant difference in risk of serious psychiatric adverse events compared with placebo (log[RR] = -0.02; P = .87).

GLP1-RAs can be considered safe regarding serious psychiatric events in this population.

There is a strong correlation between online search trends and prescriptions for semaglutide (Wegovy) with a correlation coefficient of r = 0.97.

Monitoring online search trends can provide insights into public interest in obesity medications.

Tirzepatide and semaglutide are not cost-effective at current net prices, requiring significant discounts to meet cost-effectiveness thresholds.

Healthcare providers should consider the cost-effectiveness of these medications when making treatment decisions.

Reduced microbial diversity in the gut is implicated in several gastrointestinal diseases and cancers.

Maintaining gut microbiome diversity may be crucial for preventing gastrointestinal diseases.