Earn Your Abs

In detail

Three or four sessions a week, every big muscle trained at least twice: squat, hinge, push, pull and carry. Keep the loads you used before the cut. The lifting is what tells the body to keep the muscle while the fat comes off, so the abs show on a body that still looks strong.

Found

Nearly half the muscle loss prevented. 34 trials of eating less: adding exercise prevented nearly half the lean mass that dieting alone would have lost. 119 studies on size: heavy, multi-set, twice-weekly training ranked first for building muscle.

Why

Eating less tells the body to spend tissue. Lifting tells it which tissue to keep. Heavy load switches on protein building for a day or two, even in a deficit.

Watch

Injury when you chase weight faster than tendons and joints adapt.

The deep dive on this

In detail

Count the hard sets each muscle gets in a week and keep it at about ten or more through the cut. Do not trim the volume to save energy. Recovering well? Add a set or two over the weeks.

Found

10 hard sets or more. 15 studies of lifting on fewer calories: programs that raised the volume over time lost little or no lean mass, unlike programs that cut it. A second set of pooled studies: more weekly sets, more muscle.

Why

Each hard set is a dose of the signal to keep muscle. Cutting sets during a diet takes away the reason to keep it.

Watch

Aching joints and lifts going backwards mean the volume has outrun recovery.

The deep dive on this

In detail

Train your abs like any other muscle: two or three loaded moves, twice a week, about 6 to 12 hard reps a set. Cable or weighted crunches, hanging leg raises, the ab wheel, and a heavy carry. Stronger, thicker abs show sooner. The fat over them comes off everywhere at once, as the deficit runs.

Found

Stronger abs; fat off everywhere. Six weeks of ab training built muscular endurance: 47 curl-ups against 32 without it. Twelve weeks of training one leg took fat off the arms and trunk, 10.2% and 6.9%: the body pulls fat from everywhere.

Why

Training grows the muscle; the deficit strips the fat. A thicker six-pack pushes against the layer of fat, so stronger abs can show through a little more of it. The fat itself comes off the whole body at once, the belly included.

Watch

Low back pain on sit-ups or leg raises: swap to the ab wheel from the knees or cable crunches, and keep the lower back still.

In detail

Eat a little under what holds your weight steady, enough to lose 0.5 to 1% of body weight a week. The leaner you get, the slower you go: about 0.7% or less once the abs start to show. Never more than about 500 calories a day under maintenance if you want to keep the muscle.

Found

Two reviews of fat-loss phases: 0.5 to 1% of body weight a week keeps the most muscle. A trial of two paces: losing 0.7% a week while lifting 4 times a week added 2.1% lean mass. A review of the trials: keep the deficit within 500 calories a day.

Why

A big deficit takes muscle along with the fat, and the leaner you are, the harder the body fights to hold its last fat. A steady, smaller deficit leaves the energy to train hard.

Watch

Hungry all the time, lifts falling or sleep breaking up: the deficit is too big. Eat a little more.

The deep dive on this

In detail

Eat 1 to 1.4 g of protein per pound of body weight (2.2 to 3.0 g per kilo) a day through the cut, nearer the top as you get leaner. For a 176 lb (80 kg) man, that is about 176 to 240 g. Meat, fish, eggs, dairy, soy, beans and lentils all count.

Found

1 to 1.4 g per pound (2.2 to 3.0 g per kilo) a day. Four weeks of lifting and intervals on 40% less food: 1.1 g of protein per pound (2.4 g per kilo) added 2.5 lb (1.2 kg) of lean mass while fat came off. It beat 1.2 g on both. The fat-loss review: 1 to 1.4 g per pound (2.2 to 3.0 g per kilo) a day.

Why

Eating less makes the body break down more protein. More protein coming in covers the loss, and it fills you up more than carbs or fat for the same calories, which makes a cut easier to hold.

In detail

Split the protein over 3 to 6 meals, about 0.18 to 0.25 g per pound (0.4 to 0.55 g per kilo) each. For a 176 lb (80 kg) man, about 32 to 44 g a meal. Put one meal in the 2 to 3 hours before training and one in the 2 to 3 hours after.

Found

0.18 to 0.25 g per pound (0.4 to 0.55 g per kilo) a meal. The fat-loss review: 3 to 6 meals, 0.18 to 0.25 g per pound (0.40 to 0.55 g per kilo) a meal, with a meal within 2 to 3 hours before and after training. The per-meal review: 0.18 g per pound (0.4 g per kilo) over at least four meals.

Why

Each protein meal switches muscle building on for a few hours. More meals keep it on for more of the day, which matters most when food is short.

In detail

Once protein is set, fill the rest. Fat at about 10 to 25% of calories, never zero. Carbs fill the remainder, matched to training: more on lifting days, and around the session. Cut carbs as far as a low-carb diet only if it suits you, and keep the lifting strong.

Found

Fat 10 to 25%; carbs for training. The review of lean-physique nutrition: low-end fat of 10 to 25% of calories leaves room for carbs to protect training on a diet. A scoping review of expert guidance: carbs periodized on training demands, 1.4 to 5.4 g per pound (3 to 12 g per kilo) depending on the load.

Why

Carbs fuel hard sets, so cutting them to nothing hurts training and the muscle it protects. Some fat keeps hormones and meals livable.

In detail

Pick the way of eating you can keep for months: more carbs or fewer, three meals or five, any mix of foods. The protein and the pace are what must hold. Swap drinks with calories for water or diet drinks, and build meals around protein and vegetables. Beer counts: see Drinking less.

Found

Any style, same result. The position stand on diets and body composition: diets from low-fat to low-carb and keto, and all points between, can improve body composition about equally. A diet's long-term success depends on sticking to it.

Why

Fat loss runs on the deficit, not on a food list. The best cut is the one you are still following in month three.

In detail

Count your steps for a week, then build toward about 8,500 a day, and hold it for the whole cut. Walk after meals, take the stairs, pace on calls.

Found

About 8,500 steps a day. The review of weight-loss plateaus: of all the energy the body spends, everyday movement falls the most as weight comes off. An overfeeding study: everyday movement explained 10-fold differences in fat gained. The steps review of the trials target: about 8,500 a day.

Why

Eating less quietly makes you move less: less fidgeting, standing and pacing. That drop can swallow the deficit and stall the cut. Counting steps keeps the everyday burn from sliding.

In detail

Keep the cardio you enjoy, on top of the lifting, never instead of it. Lift first if both land in one session. It adds to the burn without cutting food further.

Found

2 lb (0.87 kg) more lean mass kept. 34 trials of eating less: adding exercise kept 2 lb (0.87 kg) more lean mass than dieting alone. The verdict: exercise is very effective at cutting the lean mass lost on a diet.

Why

Muscle is kept by the lifting. Cardio adds to the deficit, so you can eat a little more and still lose, and a fitter heart recovers faster between sets.

Watch

Cardio burns calories: count it, so the deficit stays within the pace.

In detail

Seven to nine hours asleep, at the same times, seven days a week. On a cut, sleep decides how much of the loss is fat. Short sleeper? Add time in bed: 30 to 60 minutes more is a start. See Night cravings if the evenings are where the diet breaks.

Found

55% less fat lost on short sleep. Two weeks on the same diet: 5.5 hours in bed instead of 8.5 cut the fat lost by 55%. Four weeks of sleeping longer: less sugar eaten, 9.6 g a day less.

Why

Short sleep raises hunger, cuts the fat burned, and raises the hormones that break muscle down. The same diet then takes more muscle and less fat.

Watch

Nine hours or more a night that does not refresh is a reason to see a doctor, not a target.

The deep dive on this

In detail

3 to 5 g of creatine monohydrate a day, every day, with any meal. To fill the muscle faster, take 20 g a day for 6 days first, split through the day.

Found

63 studies, 1,489 people. 63 studies, 1,489 people: lifting with creatine built more upper- and lower-body strength and more lean mass than lifting alone, and body fat percentage fell slightly. A second review: with lifting, creatine adds strength during weight loss.

Why

A muscle runs its hardest few seconds on phosphocreatine. Creatine tops that store up, so hard sets last a little longer, which matters most when food is short.

Watch

Some water weight in the first weeks: that is the muscle filling up, not fat. Read the scale with the tape. Safety: studied up to 30 g a day for 5 years and well tolerated.

The deep dive on this

In detail

Short of 1 g per pound (2.2 g per kilo)? A shake of whey closes the gap: 20 to 40 g of protein, in water to keep the calories down. It is food in a tub.

Found

20 to 40 g a shake. A review of supplements during weight loss: with lifting, whey helps keep lean mass. The protein position stand: 20 to 40 g of good protein a serving.

Why

Whey is milk protein that digests fast and is rich in leucine, so it switches muscle building on quickly, for few calories.

Watch

Stomach upset for some. A milk allergy rules it out.

The deep dive on this

In detail

Optional: 3 to 6 mg per kilo (1.4 to 2.7 mg per lb) about an hour before training, and never over 400 mg in a day from all sources. For a 176 lb (80 kg) man, 240 mg is the low end. Keep it well away from bedtime.

Found

3 to 6 mg per kilo (1.4 to 2.7 mg per lb). The caffeine position stand: 3 to 6 mg per kilo (1.4 to 2.7 mg per lb) consistently improves exercise performance, and the lowest dose that works may be 2 mg per kilo (0.9 mg per lb). The safety ceiling from a separate review: 400 mg a day.

Why

Caffeine blocks the tiredness signal, adenosine, so a hard set feels lighter on less food. It helps the session, and the session keeps the muscle.

Watch

It can wreck sleep, and short sleep on a cut takes muscle. Jitters, a racing heart and anxiety at higher doses. Count coffee, energy drinks and pre-workouts in the total.

The deep dive on this

In detail

About 11 g of psyllium husk a day, stirred into a full glass of water just before meals. Build up over a week or two, and keep it well apart from your pills.

Found

Six trials, 354 people: psyllium just before meals took 4.5 lb (2.1 kg) off body weight and 0.9 in (2.2 cm) off the waist. The average dose was 10.8 g a day, for 4.8 months.

Why

In the gut, psyllium forms a thick gel that slows how fast a meal is broken down and absorbed. That makes the deficit easier to hold.

Watch

Bloating and gas at first: build the dose up slowly. Always with a full glass of water: taken dry it can swell and block the throat or the gut, so not with trouble swallowing or a narrowed gut. It slows the absorption of pills taken at the same time: keep them apart. With diabetes drugs, blood sugar can drop further. Rarely an allergy. Some products carry lead: choose a tested one.

The deep dive on this

In detail

For fat to lose alongside the deficit, from a pharmacy. One capsule with each main meal that contains fat, up to three a day, during or within an hour of the meal. No fat in the meal, skip the capsule. The 60 mg capsule is sold in pharmacies in the UK and over the counter in the US; the 120 mg is prescription. Under 5% lost at 12 weeks: stop. The full plan: Weight loss injections and surgery.

Found

13 lb (5.8 kg) against 3.0 over 4 years. Over 4 years, orlistat with lifestyle took off 13 lb (5.8 kg) against 6.5 lb (3.0 kg) on a dummy pill with lifestyle. New diabetes fell from 9.0% to 6.2%, a 37.3% drop in risk.

Why

It blocks the gut enzyme that breaks down fat, so about a third of the fat you eat passes straight through. It works in the gut and barely enters the blood.

Watch

Never with chronic malabsorption or cholestasis, or with cyclosporine after an organ transplant. Oily spotting, gas with discharge, and urgent or leaky stools, worse after a fatty meal: keep fat to about 30% of calories, spread over three meals. A multivitamin with A, D, E and K once a day, at least 2 hours from the capsule, such as at bedtime. Rare severe liver injury: itching, yellow eyes or skin, dark pee, pale stools or loss of appetite, stop it and get seen. Kidney stones and kidney injury from oxalate. Gallstones with fast loss. It changes warfarin, levothyroxine (take them 4 hours apart), cyclosporine, amiodarone, seizure medicines and HIV medicines. Severe belly pain that will not go: get seen.

In detail

Beer belly or dad bod, a long way from abs? The same plan, with more room: the fast end of the pace, 1% a week, while the lifting and protein hold the muscle. Aim for the first 5 to 10% of body weight, then judge the waist. New to lifting? See First muscle. Soft at a normal weight? See Body recomposition.

Found

The first 5 to 10%. 58 studies, lifting against no exercise: body fat percentage fell 1.46 points and visceral fat came down too. 34 trials of eating less: exercise prevented nearly half the lean mass loss.

Why

With more fat to lose, the body gives it up more easily and spares muscle better, so a faster pace keeps the muscle well. The belly fat that goes first is the kind that raises blood sugar and blood fats.

In detail

Abs showing? Stop cutting. Add food back gradually over a few weeks, mostly carbs, until the weekly average holds steady, and keep the protein and the lifting. Settle a little above your leanest, at a level you can live at. A few pounds of water and glycogen come back in week one; that is not fat.

Found

Testosterone back after the cut. The review of lean-physique nutrition: gradual returns to off-season intakes and body compositions you can hold, with support close by. One cut tracked for a year: at the leanest point testosterone had fallen from 9.22 to 2.27 ng/mL, and it returned to 9.91 as he ate back up.

Why

At the end of a cut, hunger is high and the burn is low, so a sudden return to old eating overshoots. A gradual climb lets the burn and the hormones recover while the waist holds.

Watch

Bingeing once the cut ends is common. If it happens more than once, see the body-image check.

In detail

Early research: diet five days a week, then two days in a row at about maintenance, with the extra food coming from carbs. The weekly average still falls. Lift on or right after the refeed days.

Found

Lean mass kept better. A 7-week trial with 4 lifting days a week: two carb refeed days a week lost fat like the continuous diet, and kept fat-free mass and resting burn better. Continuous dieters lost 3 lb (1.3 kg) of fat-free mass; refeeders, 0.9 lb (0.4 kg).

Why

Two days of carbs refill the muscle's glycogen and ease the drop in resting burn and in the hormones that follow a long deficit.

Watch

The scale jumps after refeed days with water and carbs. Read the weekly average and the tape.

In detail

Early research: after a long block of dieting, eat at maintenance for one week, mostly by adding carbs. Then go back to the cut. Time it for when hunger is at its worst.

Found

1.5 lb (0.7 kg) more fat-free mass. After 12 weeks of dieting: a week at maintenance added 1.5 lb (0.7 kg) of fat-free mass, improved leg endurance and alertness, and cut hunger and irritability.

Why

A long deficit turns up hunger and turns down the resting burn. A week of full food eases both, and makes the next block easier to hold.

Watch

The scale jumps a little with the carbs and water. Read the tape.

In detail

Early research, for a long cut: diet for 2 weeks, then eat at maintenance for 2 weeks, and repeat. It takes longer on the calendar, and in the trial more fat came off.

Found

27 lb (12.3 kg) against 18 lb (8.0 kg) of fat. A 30-week trial: 2-week diet blocks with 2-week breaks at maintenance lost more fat, 27 lb (12.3 kg) against 18 lb (8.0 kg) dieting straight through, with a matched loss of fat-free mass. The resting burn fell less.

Why

Breaks at maintenance may reduce the body's push-back, the drop in resting burn that makes a long diet stall.

Watch

It doubles the time the cut takes. Only worth it if you have a lot to lose and the time to do it.

In detail

Early research: about 3 g of HMB a day while you eat less, as an extra beside the protein, never in place of it.

Found

A 12-week dieting trial: a daily drink with 3 g of HMB and 24 g of protein kept skeletal muscle and took more fat off, visceral fat included. The HMB position stand: 38 mg per kilo (17 mg per lb) a day with training may improve body composition.

Why

HMB is made in the body from leucine and works mainly by holding back muscle breakdown, which is the risk when food is short.

Watch

Mild stomach upset. The trial drink carried protein too, so part of the effect may be the protein.

The deep dive on this

In detail

Early research for this goal: 4 to 6 g of beta-alanine a day, in doses of about 1.6 g spread through the day, for at least 4 weeks. It helps hard efforts of 1 to 4 minutes, so sessions stay strong on less food.

Found

Efforts of 1 to 4 minutes. A review of 15 papers: beta-alanine improved efforts lasting 60 to 240 seconds, and longer ones too. A larger one of 40 studies found a clear overall effect on exercise.

Why

Beta-alanine builds carnosine in muscle, which buffers the acid that burns in a long hard set. Better sessions keep the signal to hold the muscle.

Watch

Tingling skin is the one reported side effect; smaller split doses of about 1.6 g cut it.

The deep dive on this

In detail

Early research: if it suits you, eat all your food inside 8 hours a day, still hitting the protein and lifting as normal. It helps some men hold the deficit.

Found

An 8-week trial with lifting, calories matched: eating in an 8-hour window lost more fat mass. Fat-free mass, arm and thigh muscle and maximum strength held.

Why

A shorter eating day makes eating less easier for some. The fat loss rests on the calories, and the muscle on the lifting and the protein.

Watch

In the trial, testosterone fell on the eating window. Fitting 1 g per pound (2.2 g per kilo) of protein into fewer meals is harder.

In detail

Early research, and a small effect: chili or capsaicin with meals. It adds a little to the daily burn and shifts it toward fat. Food first: chili in the cooking, not a cayenne pill.

Found

About 58 calories a day more. A review of 9 trials: after capsaicin or its mild cousins, energy spent rose by about 58 calories a day and the body burned a larger share of fat. Twenty trials, 563 people: regular chili cut belly fat, appetite and the food eaten.

Why

Capsaicin opens the heat receptor TRPV1, which nudges the nervous system to burn a little more energy and more of it as fat.

Watch

Heartburn and a burning gut for some. Stop if it upsets your stomach.

The deep dive on this

In detail

Early research: 2,000 mg of L-carnitine a day with food, the dose where the pooled effect peaked. An extra beside the deficit, never instead of it.

Found

4.5 lb (2.08 kg) of fat off, 37 trials. 37 trials, 2,292 people: carnitine took 2.5 lb (1.21 kg) off body weight and 4.5 lb (2.08 kg) off fat mass against control. The effect peaked at about 2,000 mg a day.

Why

Carnitine carries fatty acids into the mitochondria, the part of the cell that burns them for energy.

Watch

Stomach upset, nausea and a fishy body or breath smell, more at higher doses. It raises TMAO, a gut-made compound linked to artery disease: with heart disease, ask a doctor first. It can raise seizure frequency: with epilepsy, ask first. It may blunt thyroid hormone and add to the effect of warfarin: on thyroid medicine or a blood thinner, ask first. With kidney disease, ask first.

The deep dive on this

In detail

Early research: 3 or 4 cups of brewed green tea a day, the last one before mid-afternoon. The drink, never a concentrated extract pill.

Found

3 lb (1.31 kg), 11 trials. Eleven studies pooled: green tea catechins took weight off, and helped keep it off after a diet, by 3 lb (1.31 kg). The authors call it a small positive effect on losing weight and keeping it off.

Why

The catechins and the caffeine together raise heat production and fat burning for a few hours. The effect is small and adds up daily.

Watch

The drink only: concentrated green tea extract pills have injured livers. Caffeine late in the day takes from sleep. The tannins cut iron absorption from food: drink it between meals. Very hot tea is linked to cancer of the food pipe: let it cool a little. It can change how some medicines work: on regular medicines, ask a pharmacist.

The deep dive on this

In detail

Early research: swap some of your cooking fat for MCT oil, 18 to 24 g a day as in the trial. Swap it, never add it on top. Start small and build up.

Found

Thirteen trials, 749 people: in place of ordinary fats, MCT took 1 lb (0.51 kg) off body weight and 0.6 in (1.46 cm) off the waist. Total and visceral fat fell too. A 16-week weight-loss trial: 18 to 24 g a day of MCT oil ended 3.5 lb (1.67 kg) lighter than olive oil.

Why

Medium-chain fats go straight to the liver and are burned fast, so less is stored and a little more energy is spent.

Watch

Gut upset, cramps and diarrhea if you start high: build up slowly. It can raise cholesterol in some: recheck your lipids. It is still fat, full of calories: it only helps as a swap. With poorly controlled diabetes or liver disease, ask a doctor first.

The deep dive on this

In detail

Early research: 15 mL of vinegar a day, about a tablespoon, diluted in a large glass of water with a meal. The trial also tested 30 mL. Drink it through a straw and rinse after.

Found

Weight and waist down in 12 weeks. A 12-week trial: 15 or 30 mL of vinegar a day, in a 17 fl oz (500 mL) drink, lowered body weight, BMI, visceral fat, waist and triglycerides against placebo. Ten trials pooled: a daily vinegar drink took weight and waist down.

Why

Acetic acid, the acid in vinegar, curbed fat build-up in animal studies. It also slows how fast a meal leaves the stomach.

Watch

Never neat: it erodes tooth enamel and can burn the throat. Dilute it, use a straw and rinse your mouth after. It slows stomach emptying, which matters if your stomach already empties slowly. With insulin or other diabetes drugs, blood sugar can drop. Large amounts over time can lower potassium: on water pills, ask a doctor first. With advanced kidney disease, ask first.

The deep dive on this

In detail

Early research: 125 to 250 mg of OEA a day, before meals, the doses the trials used, for 8 weeks. Beside the deficit and the protein, never in place of them.

Found

Waist about 0.8 in (2 cm) smaller. Ten trials pooled: weight, waist, fat mass and body fat percentage all fell on OEA. Thirteen studies: the waist came in by about 0.8 in (2 cm).

Why

OEA is a fat the gut makes after a meal. It signals fullness to the brain, so the deficit is easier to hold.

Watch

Mild gut upset in some.

The deep dive on this

In detail

Early research: 5 g of a spinach thylakoid extract a day, stirred into water 30 minutes before the main meal, the trials' dose. Beside the deficit, never in place of it.

Found

Less hunger, more fullness. Pooled trials: hunger fell and fullness rose when thylakoids came with the meal, most clearly in the first two months.

Why

Thylakoids are the green membranes in leaves. They slow how fast fat is digested, so the gut's fullness signals run longer.

Watch

Mild gut upset in some.

The deep dive on this

In detail

For a lot of fat to lose, not the last few kilos: it is prescribed for obesity, or overweight with a weight-related condition. A weekly injection, on a prescription only, from a registered pharmacy: fake weight-loss pens are sold online. It starts at 2.5 mg a week for 4 weeks, rising by 2.5 mg no sooner than every 4 weeks, to 5, 10 or 15 mg. Keep lifting and keep the protein high the whole time. Prescription. The full plan is on Weight loss injections and surgery; keeping the muscle is Muscle loss on GLP-1.

Found

20.9% of body weight off. At 72 weeks, weight fell 20.9% on 15 mg, 19.5% on 10 mg and 15.0% on 5 mg, against 3.1% on a dummy shot. Head to head, it took off 20.2% against 13.7% on semaglutide.

Why

Two gut hormones in one molecule, GLP-1 and GIP: appetite down, fullness up, the stomach slower. The fat comes off the whole body, belly included. The loss runs as long as the drug does.

Watch

The label's boxed warning: thyroid C-cell tumors in rats, so never with a personal or family history of medullary thyroid cancer or MEN 2. A lump in the neck, trouble swallowing, breathlessness or a hoarse voice that lasts: tell the doctor. Never after a serious allergic reaction to it. The dose steps up no faster than every 4 weeks: sickness, vomiting and diarrhea peak during the steps and can be severe. Not with severe gastroparesis. Kidney injury when sickness or diarrhea dries you out, so kidney function is checked. Gallstones and gallbladder inflammation. Pancreatitis: severe belly pain that will not go, sometimes into the back, means stop it and get seen. Anaphylaxis and swelling of the face or throat. Low blood sugar, most with insulin or a sulfonylurea. Diabetic eye disease can get worse. Food can stay in the stomach under anesthesia or deep sedation: tell the team before any procedure. Tablets you swallow can absorb differently, so drugs such as warfarin are monitored. Never share a pen. Never with another GLP-1 drug. Muscle goes with the fat unless you keep lifting and keep the protein high: hold both the whole time.

The deep dive on this

In detail

For a lot of fat to lose: it is prescribed for obesity, or overweight with a weight-related condition. A weekly injection or a daily tablet, on a prescription only, from a registered pharmacy. The shot starts at 0.25 mg a week and steps up every 4 weeks to 2.4 mg, or 1.7 mg if needed. It can go to 7.2 mg. The tablet starts at 1.5 mg a day, then 4 mg, then 9 mg, then 25 mg to keep, each step after 30 days. Keep lifting and keep the protein high the whole time. The shot and the tablet on prescription. The full plan is on Weight loss injections and surgery; keeping the muscle is Muscle loss on GLP-1.

Found

14.9% of body weight off. Over 68 weeks, semaglutide 2.4 mg took off 14.9% of body weight, 34 lb (15.3 kg) on average, against 2.4% on a dummy shot.

Why

It copies GLP-1, the meal-is-done hormone, made to last a week. Hunger drops and food thoughts go quiet, so the deficit is easier to hold.

Watch

The label's boxed warning: thyroid C-cell tumors in rodents. So never with a personal or family history of medullary thyroid cancer or MEN 2. A lump in the neck, trouble swallowing, breathlessness or a hoarse voice that lasts: tell the doctor. Never after a serious allergic reaction to it. The dose steps up every 4 weeks. If a step is not tolerated, the next is delayed 4 weeks. Severe gut side effects, and not with severe gastroparesis. Pancreatitis: severe belly pain that will not go, sometimes into the back, means stop it and get seen. Gallstones and gallbladder inflammation. Low blood sugar with insulin or a sulfonylurea. Kidney injury when sickness or diarrhea dries you out. Anaphylaxis and swelling of the face or throat. Diabetic eye disease can get worse. The resting heart rate rises, so it is checked at regular intervals. A racing heart at rest: tell the doctor. Food can stay in the stomach under anesthesia or deep sedation: tell the team before any procedure. The tablet form raised levothyroxine levels 33%. Never share a pen. A sudden loss of vision, usually in one eye: get urgent help. Muscle goes with the fat unless you keep lifting and keep the protein high. Hold both the whole time.

The deep dive on this

In detail

For a lot of fat to lose, if you would rather take a pill: it is prescribed for obesity, or overweight with a weight-related condition. A daily tablet, on a prescription only, from a registered pharmacy. It starts at 0.8 mg a day, then 2.5 mg, then 5.5 mg, each step after at least 30 days. It can go on to 9, 14.5 or 17.2 mg, the maximum. Swallow it whole, with or without food. Keep lifting and keep the protein high. Prescription. The full plan is on Weight loss injections and surgery; keeping the muscle is Muscle loss on GLP-1.

Found

11.2% of body weight off. At 72 weeks, weight fell 11.2% on the top dose, 8.4% on the middle dose and 7.5% on the lowest, against 2.1% on a dummy pill. Waist, blood pressure and blood fats improved too.

Why

A small molecule, not a protein, that switches on the GLP-1 receptor like the shots do. So it works as a pill, with no fasting routine and no fridge.

Watch

The label's boxed warning: drugs of this class caused thyroid C-cell tumors in rodents. Orforglipron did not cause them in rodents. Even so, never with a personal or family history of medullary thyroid cancer or MEN 2. A lump in the neck, trouble swallowing, breathlessness or a hoarse voice that lasts: tell the doctor. Never after a serious allergic reaction to it. The dose steps up no sooner than every 30 days. Sickness, vomiting and diarrhea can be severe, and it is not for severe gastroparesis. Pancreatitis: severe belly pain that will not go, sometimes into the back, means stop it and get seen. Kidney injury when sickness dries you out. Gallstones and gallbladder inflammation. Low blood sugar with insulin or a sulfonylurea. Anaphylaxis and swelling of the face or throat. Diabetic eye disease can get worse. Food can stay in the stomach under anesthesia or deep sedation: tell the team before any procedure. Strong CYP3A4 blockers cap it at 9 mg. These include some antibiotics, antifungals and HIV drugs. Strong inducers such as rifampin are avoided. Simvastatin no higher than 20 mg. It slows how other pills absorb. Never with another GLP-1 drug. Missed 7 or more days: restart lower. Muscle goes with the fat unless you keep lifting and keep the protein high. Hold both the whole time.

In detail

For a lot of fat to lose, not the last few kilos: it is prescribed for obesity, or overweight with a weight-related condition. A daily injection, on a prescription. It starts at 0.6 mg a day and rises weekly to 3 mg. Judge at 16 weeks: under 4% lost, stop. Prescription. The full plan: Weight loss injections and surgery.

Found

Over 56 weeks, liraglutide 3 mg with diet and exercise went with lower weight and better metabolic control. After a diet, a year on it kept 15 lb (6.8 kg) more off than a dummy shot.

Why

The first GLP-1 shot licensed for weight. It lasts a day rather than a week, so it is a daily shot. A fallback when the weekly shots do not suit you.

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The label's boxed warning: thyroid C-cell tumors in rats and mice, so never with a personal or family history of medullary thyroid cancer or MEN 2. A lump in the neck, trouble swallowing, breathlessness or a hoarse voice that lasts: tell the doctor. Pancreatitis: severe belly pain that will not go, sometimes into the back, means stop it and get seen. Gallstones and gallbladder inflammation. Low blood sugar with insulin or a sulfonylurea. The resting heart rate rises and is checked: a racing heart at rest, tell the doctor. Kidney injury when sickness dries you out. Severe gut side effects: the dose climbs weekly, and a step can wait a week. Anaphylaxis and swelling of the face or throat. Food can stay in the stomach under anesthesia or deep sedation: tell the team. Never with another GLP-1 drug. More than 3 days missed: restart at 0.6 mg. Muscle goes with the fat unless you keep lifting and keep the protein high: hold both the whole time.

The deep dive on this

In detail

For a lot of fat to lose, not the last few kilos: it is prescribed for obesity, or overweight with a weight-related condition. It suits a cut lost to cravings. A tablet on a prescription. Week 1: one in the morning. Week 2: one morning, one evening. Week 3: two morning, one evening. Week 4 on: two and two, 32 mg naltrexone and 360 mg bupropion a day. Never with a high-fat meal. Under 5% lost at 12 weeks on the full dose: stop. Prescription. The full plan: Weight loss injections and surgery.

Found

6.1% off, against 1.3%. Over 56 weeks, weight fell 6.1% on the full dose against 1.3% on a dummy pill. 48% lost 5% or more, against 16%.

Why

Bupropion lifts the brain’s fullness signal; naltrexone stops that signal switching itself off. The pair targets cravings and food reward more than stomach fullness.

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The label's boxed warning: suicidal thoughts and behavior, a risk raised up to age 24. Never with seizures in your past, uncontrolled high blood pressure, bulimia or anorexia, or another bupropion product. Never with regular opioids, opioid withdrawal, or within 14 days of an MAOI. Never while stopping alcohol, benzodiazepines, barbiturates or seizure medicines suddenly. Seizures: never more than two tablets at once, and never with a high-fat meal. Blood pressure and pulse can rise, most in the first three months, so both are checked. It blocks opioid painkillers, and taking large amounts to override the block can kill. Liver injury: yellow skin, dark pee or belly pain, stop and get seen. Mania, angle-closure glaucoma, rashes and allergic reactions. Low blood sugar with diabetes medicines. Keep alcohol to a minimum, or none.

In detail

For a lot of fat to lose, not the last few kilos: it is prescribed for obesity, or overweight with a weight-related condition. A capsule each morning, US only: not licensed in the UK. It starts at 3.75/23 mg for 14 days, then 7.5/46 mg. Under 3% lost at 12 weeks: step to 11.25/69, then 15/92. Under 5% lost at 12 weeks on the top dose: stop, tapering it. The full plan: Weight loss injections and surgery.

Found

At 28 weeks, it took off 8.5% on 7.5/46 mg and 9.2% on 15/92 mg, against 1.7% on a dummy pill. It beat either drug alone.

Why

Phentermine is a stimulant that blunts appetite; topiramate adds fullness and cuts food reward. Low doses of both together beat a higher dose of either.

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It harms an unborn baby, so never in pregnancy. Never with glaucoma, an overactive thyroid, or within 14 days of an MAOI. Sudden blurred vision or eye pain: stop it and get seen now, it can be acute glaucoma. Mood swings, anxiety and poor sleep. Slower thinking, poor memory and word-finding trouble: take care driving at the start. Acid build-up in the blood and a fall in kidney function: salts, creatinine and potassium are checked before and during. Kidney stones: drink plenty. Less sweating and overheating, most in hot weather while active. Rare severe rashes and whole-body allergic reactions: stop at the first rash. The top dose is stopped slowly, every other day for at least a week, or a seizure can follow. Alcohol adds dizziness and drowsiness. The resting heart rate rises. A controlled drug in the US.

In detail

For a lot of fat to lose, not the last few kilos: it is prescribed for obesity, or overweight with a weight-related condition. A short-term appetite tablet, US only, for a few weeks alongside diet and exercise. Two label strengths: one 37.5 mg tablet each morning, or one 8 mg tablet up to three times a day, half an hour before meals. Never late in the evening. A controlled drug; not licensed in the UK. The full plan: Weight loss injections and surgery.

Found

In a 28-week trial, 46.2% lost 5% or more on phentermine 15 mg alone, the trial's dose, not a label dose, against 15.5% on a dummy pill.

Why

A stimulant related to amphetamine that turns appetite down for a while. The effect fades, which is why it is labeled for weeks, not months.

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Short-term only: a few weeks. Never with heart disease, a stroke, an irregular heartbeat, heart failure or uncontrolled blood pressure. Never with an overactive thyroid, glaucoma, agitation, a history of drug misuse, or within 14 days of an MAOI. Rare, often fatal lung blood-pressure disease and heart valve damage were reported, mostly with fenfluramine: new breathlessness, chest pain or fainting, stop and get seen. It raises blood pressure. It is related to amphetamine, can be misused and can cause dependence: if the effect fades, stop rather than take more. It can impair driving. Alcohol can react with it. Never with other weight-loss drugs. A controlled drug.

In detail

For a lot of fat to lose, between the medicines and surgery. Two procedures done through the mouth with a camera, no cuts. A balloon is placed in the stomach and filled with salt water, then taken out later. An endoscopic sleeve stitches the stomach into folds, up to 80% smaller, and may be reversible. Ask a specialist weight service or an endoscopy team. The full plan: Weight loss injections and surgery.

Found

13.6% off at 52 weeks. At 52 weeks, the endoscopic sleeve took off 13.6% of body weight, against 0.8% with lifestyle alone. A review of 15 trials: the balloon beat standard care for weight loss at 6, 9 and 12 months.

Why

Both make the stomach hold less and empty slower, so you feel full sooner. They sit between the medicines and surgery: less loss than surgery, less recovery.

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Sickness, cramps and vomiting in the first days, most with the balloon. Rare serious harms: bleeding, a tear or a leak, and a balloon that deflates and moves. Severe belly pain, vomiting blood or black stools: 911.

In detail

For a lot of fat to lose, far past the belly: this is for a BMI of 40, or 35 with a condition. A referral, not a prescription. At a BMI of 40, or 35 with a condition such as diabetes or sleep apnea, ask your doctor for a referral to a specialist weight service. The usual operations are the sleeve, which removes about 80% of the stomach, and the gastric bypass. The full plan: Weight loss injections and surgery.

Found

57 lb (26 kg) more off than without surgery. In a review of 11 trials, surgery took off 57 lb (26 kg) more than treatment without surgery. In a long study, weight losses held at 25% after bypass at 10 years, and deaths were lower than in matched controls.

Why

Surgery shrinks the stomach and rewires the gut hormones, so hunger drops for years. It is the largest and longest-lasting loss available, and it comes with lifelong follow-up.

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Blood clots, a leak where the stomach is joined, infection, a narrowed gut, gallstones and loose skin. Lifelong vitamins and yearly checks. The details: the next card.

In detail

Before any operation, know this. Know the risks before you sign. After surgery: cut food small, chew well and do not drink with meals. Take the vitamins and minerals the team sets, for life. Go to every yearly review. Drink far less alcohol than before. The full plan: Weight loss injections and surgery.

Found

In a large safety study, 0.3% died within 30 days of a bypass or band, and 4.3% had a major complication. A bypass lost more excess weight than a sleeve at 5 years, 62.7% against 55.5%, with more complications.

Why

The operation changes how you absorb food for good. Iron, vitamin and protein shortfalls build quietly, so the checks and the supplements are part of the treatment.

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Trouble breathing or chest pain with a painful, swollen leg, severe belly pain, or vomiting blood: 911 now. A fast heartbeat, fever, belly pain or repeated vomiting after surgery: urgent care or your doctor today.

In detail

Only for testosterone confirmed low: the symptoms, plus low levels on repeat morning tests. A doctor prescribes it and sets the dose on your blood tests. Keep the lifting and the deficit going. If you want children, that talk comes first. The full detail: TRT. UK and US: prescription only.

Found

59 trials; fat down, lean mass up. 59 trials: testosterone therapy lowered fat and raised lean mass, and fasting sugar and insulin resistance fell with them.

Why

Low testosterone makes fat easier to gain and muscle harder to keep. Put back to normal, it shifts the body toward muscle and away from fat.

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The label: sperm production can be suppressed. Red cell count and blood pressure can rise, and blood clots in the legs and lungs have been reported. The prostate is checked before and during treatment, and breast or prostate cancer rules it out. It can worsen sleep apnea, cause fluid retention and grow breast tissue. Its safety and benefit in age-related low testosterone are not established. On the gel, children and women must not touch the skin where it went on. It has been abused at high doses, with serious heart and mental-health harms, and the label lists dependence.

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