Obesity Care

Many People with Severe Obesity Face Medical Discrimination, Study Finds

Key Takeaways:

• A new study reveals that over 40% of clinics in the United States refused to schedule an appointment for a hypothetical patient with severe obesity.
  
• More than half of practices surveyed lacked the basic facilities or equipment required to provide appropriate care to patients with a body mass index (BMI) of 60 or greater.
  
• Researchers warn that discrimination and inadequate resources may contribute to poorer health outcomes, including delayed cancer detection, among people living with severe obesity.
  
  

Widespread discrimination in clinical settings

People living with severe obesity frequently encounter discrimination and barriers when seeking medical care, according to a new study published in the Annals of Internal Medicine. Researchers reported that about 2 in 5 (41%) clinics refused to schedule an appointment for a hypothetical patient weighing 465 pounds.

One receptionist at an orthopaedic surgeon’s office stated: “We’ve reached our limit for bariatric patients at this site,” without offering further explanation.

The study highlights a critical issue in access to care: beyond outright refusals, more than half of clinics (52%) did not have the equipment or facilities necessary to provide basic medical care for patients with very high body weights. Severe obesity is defined as a BMI of 40 or higher, with extremely severe obesity considered a BMI of 60 or greater.

Lack of facilities and equipment

Many clinics lacked essential infrastructure, including examination tables or chairs that could safely support higher weights, wide enough doorways and hallways for patient mobility, and appropriately sized medical gowns.

Dr Tara Lagu, senior author of the study and adjunct lecturer of medicine and medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, emphasised the harmful impact of such deficiencies:

“Patients living with severe obesity are likely already struggling with shame and difficulty navigating the world. To tell a patient that they can’t be examined on a table, or can’t wear a gown, or need to stand during an appointment makes what should be a safe place and the experience of seeing a doctor humiliating and degrading. We need to acknowledge, as a profession, that all people deserve better than this.”

Affected population and health risks

According to the researchers, approximately 1 in every 270 Americans – close to 1 million adults – lives with extremely severe obesity (BMI ≥ 60). These individuals are two to three times more likely to experience significant health problems compared with the general population.

Despite this increased risk, previous studies have shown that people with obesity are less likely to receive preventive health services such as cancer screenings. Dr Lagu explained:

“Obesity affects cancer screenings, and failure to screen can result in later cancer detection. We’re always attributing worse outcomes in higher-weight patients to weight itself, but more and more studies are now pointing to worse care, lack of care or being care avoidant as possible reasons for these delays.”

Study design and findings

To investigate barriers to care, researchers used a “secret shopper” approach, in which callers attempted to schedule an appointment for a hypothetical patient weighing 465 pounds. They contacted 300 clinics across four metropolitan areas – Boston, Cleveland, Houston, and Portland, Oregon. The study covered five specialties: dermatology, endocrinology, obstetrics and gynaecology, orthopaedic surgery, and ear, nose, and throat (ENT).

Lead researcher Dr Molly Hales, a physician at University of Chicago Medicine, noted that the caller questions were intentionally designed to suggest possible urgent medical needs:

“We designed some of the questions our callers asked to be red flags for a receptionist to think, ‘I should really schedule this person,’ because the questions suggested the patient might have cancer and need an urgent workup.”

Despite this, only 59% of clinics overall were willing to schedule the appointment. ENT specialists were least likely to agree, with only 48% offering an appointment, while endocrinologists were most likely to accept and to have suitable facilities.

Humiliating workarounds

Even among clinics that agreed to see the hypothetical patient, around 1 in 6 (16%) suggested workarounds that could be humiliating, such as requiring the patient to stand during the exam or to use a sheet instead of a gown.

Dr Hales observed:

“Our numbers likely underestimate the magnitude of the problem. Likely, very few high-weight patients who are scheduling appointments know to even ask if they can be accommodated based on their weight, and they might be hesitant to ask these questions or advocate for themselves because of the social stigma.”

Potential solutions

The researchers highlighted that a Clinical Environment Checklist has been developed to guide outpatient clinics in ensuring they can provide appropriate care for patients with obesity. However, it has not been widely adopted.

Dr Hales noted:

“They designed the checklist to be used by general outpatient clinics and tested it in both primary care and subspecialty settings, so it’s a good resource for clinics in determining where there are opportunities for improvement.”

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Green Tea Shows Significant Benefits for Glucose Metabolism and Muscle Health in Mice with Obesity

Key Takeaways: 

• Green tea extract significantly improved insulin sensitivity, glucose tolerance, and muscle preservation in mice with obesity, even when they continued consuming a high-calorie diet.
• The study controlled for temperature effects, providing clearer evidence that green tea’s metabolic benefits are independent of cold-induced energy expenditure.
• Findings suggest a potential role for green tea as a safe, accessible adjunct to obesity treatment in humans, though exact dosing for people remains to be established.
  

Ancient beverage, modern research

Green tea, long valued for its medicinal and antioxidant properties, continues to attract scientific interest for its impact on metabolic diseases such as obesity and type 2 diabetes. A recent study led by Professor Rosemari Otton from the Interdisciplinary Graduate Programme in Health Sciences at Cruzeiro do Sul University in São Paulo, Brazil, offers new insights into how green tea affects metabolism.

Otton, who has dedicated over 15 years to the study of green tea, explained that her initial curiosity stemmed from the popular belief that green tea promotes weight loss. The findings of her latest research, published in Cell Biochemistry & Function, reinforce the potential of green tea as a therapeutic adjunct in managing obesity.

Study design and green tea administration

The research team first fed mice a high-calorie diet for four weeks, including both a fat-rich diet and a “cafeteria diet” to replicate a Western-style eating pattern. “We give them chocolate, filled cookies, dulce de leche, condensed milk… In other words, the same type of food that many people consume on a daily basis,” said Otton.

After this induction phase, the mice continued on the high-calorie diet for 12 weeks, with some receiving a standardised green tea extract at 500mg per kilogram of body weight via intragastric gavage. This method ensured precise dosing. “If we put it in water, for example, we’d have no way of knowing how much the animal actually ingested,” Otton explained.

For humans, this dose would equate to approximately 3 grams of green tea daily — roughly three cups. However, Otton cautioned that not all commercial products meet required standards:

“Ready-made tea bags do not always guarantee the quantity or quality of the compounds. The ideal for consumption would be to use standardised green tea extract, like those found in compounding pharmacies. This is a concentrated way of using the plant, with a guarantee of the presence of flavonoids, which are the health-beneficial compounds present in the green tea plant.”

Controlled conditions for reliable results

A distinctive feature of the study was the use of a thermoneutral environment at 28°C, eliminating confounding effects caused by chronic cold exposure. Mice are typically kept at around 22°C in animal facilities, a temperature that triggers energy expenditure to maintain body heat.

“Excessive cold activates compensatory regulatory mechanisms in the animals’ bodies, causing them to expend more energy to stay warm. This can mask the real effects of any substance,” Otton explained. “By maintaining thermoneutrality, we were able to see the effects of green tea in a ‘clean’ way, without environmental interference.”

A previous study published in European Journal of Nutrition (August 2022) found that obese mice treated with green tea lost up to 30% of their body weight — a reduction Otton described as highly significant:

“If a person loses 5% to 10% of their body weight, that’s already a lot. So this result in animals is very significant.”

Preservation of muscle health

One of the most striking findings of the latest study was the preservation of muscle fibre morphology. Obesity often leads to a reduction in muscle fibre diameter, but green tea helped maintain muscle structure.

“One way to assess muscle function is to look at fibre diameter. If it increases, we have more active muscle components. Green tea managed to maintain this diameter, showing that it protects muscle against the harmful effects of obesity,” Otton said.

Genetic and metabolic insights

The study also explored gene expression related to glucose metabolism. Green tea treatment enhanced the expression of genes such as Insr, Irs1, Glut4, Hk1, and Pi3k, all of which play a role in glucose uptake and utilisation in muscle tissue. Additionally, the activity of lactate dehydrogenase (LDH), an enzyme vital for glucose metabolism, was restored.

Otton noted that green tea appeared to have a selective effect:

“It makes obese animals lose weight but keeps lean animals at a balanced weight. This shows that the tea seems to need an environment with excess nutrients to act, which supports the hypothesis that it acts directly on fat cells.”

Synergy of bioactive compounds

Green tea contains dozens of bioactive compounds, and attempts to isolate them have proven less effective than using the whole extract.

“We’ve tried to separate these compounds and study their effects individually, but the whole extract is always more effective. There’s a synergy between the compounds that we can’t reproduce when they’re isolated,” Otton explained.

One mechanism under investigation involves adiponectin, a protein secreted by fat cells that regulates inflammation and metabolism. In mice genetically modified to lack adiponectin, green tea showed no effect — pointing to adiponectin as a key mediator of its benefits.

Translating findings to human health

Despite these promising findings, Otton cautioned that safe and effective doses for humans have yet to be established, owing to variability in extracts and individual responses. She stressed the importance of long-term, habitual consumption rather than expecting rapid results:

“The ideal is chronic consumption, as we see in Asian countries. In Japan, for example, people consume green tea every day, throughout their lives, and obesity rates are low. But this is different from drinking tea for five months and expecting a miraculous weight loss effect.”

Otton also emphasised the importance of accessible and safe treatment options:

“The idea is to have safe, natural, effective, and high-quality compounds. The Camellia sinensis plant offers this. We’re still studying all the compounds involved, but there’s no doubt that green tea, as a plant matrix rich in flavonoids, has important therapeutic potential.”

The road ahead

Finally, Otton underscored the need for caution when translating animal research to clinical practice:

“What we see in animals doesn’t always reproduce in humans. But if we want to make this translation to real life, we need to think about all the details, such as ambient temperature. It’s these precautions that increase the validity of our data. We’re far from having all the answers, but we’re getting closer and closer.”

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Fasting may influence metabolism and immunity differently depending on body type, study finds

Key Takeaways:

• New research shows that people living with obesity respond differently to fasting compared to lean individuals, particularly in how their immune systems react.
• A 48-hour fasting study found that lean participants’ immune cells adapted by burning more fat, while those with obesity maintained higher levels of pro-inflammatory signals.
• Researchers say the findings highlight the complex interaction between nutrition, metabolism and immune function, and stress the need for further investigation.
  

Growing interest in fasting and ketogenic diets

Fasting has become a popular dietary trend, especially among those seeking to manage weight. Increasingly, fasting is paired with ketogenic or very low-carbohydrate diets, which aim to shift the body’s energy use from carbohydrates to stored fat, producing ketones as an alternative fuel source.

Dr Hashim Islam, Assistant Professor in the School of Health and Exercise Sciences at the University of British Columbia Okanagan (UBCO) and a member of the Centre for Chronic Disease Prevention and Management, explains that while fasting and low-carbohydrate diets can be beneficial, their effects are not uniform across all body types.

“These diet trends continue to grow in popularity. But our study found that people with obesity may respond to fasting differently than leaner individuals, especially in how their immune systems react,” says Dr Islam.

Fasting and immune health

Fasting has attracted significant attention in recent years, partly because of its coverage in mainstream media. Beyond public interest, scientists value fasting for its potential to alter metabolic processes in beneficial ways.

Lead author Dr Helena Neudorf notes that fasting forces the body to switch from burning glucose to burning fat, a process that produces ketones. “Fasting may improve health by changing metabolism to strengthen the immune system and reduce chronic inflammation, which is linked to many diseases,” she says.

However, the team was particularly interested in whether fasting has distinct effects on people living with obesity compared with lean individuals.

Study design and methods

To investigate, the researchers recruited participants with obesity and lean counterparts. Each group underwent a 48-hour fasting period, during which blood samples were collected before, during and after the fast.

The samples were analysed for hormones, metabolites, metabolic rate, inflammation markers and the activity of T cells – white blood cells that are crucial for fighting infections but can also drive chronic inflammation.

The study was a collaborative effort between Dr Islam’s group and Professor Jonathan Little’s research group at UBCO’s Centre for Chronic Disease Prevention and Management. The findings were published in iScience. 

Key findings

The results indicated that fasting did not affect all participants equally.

• In people living with obesity: T cells remained more pro-inflammatory, continuing to produce inflammatory signals even after fasting. These participants also showed a smaller increase in ketones and lower levels of important chemical reactions associated with immune regulation, such as ketones binding to amino acids or proteins.
  
• In lean participants: Immune cells adapted more readily to fasting by shifting to fat metabolism. This led to a stronger movement towards a balanced, anti-inflammatory state compared with their counterparts living with obesity.
  

“We also found the immune cells in lean participants adapted to fasting by burning more fat. This didn’t happen in those living with obesity,” explains Dr Neudorf. “Overall, their shift toward a more balanced, anti-inflammatory state was weaker in this particular group.”

Implications and future research

The findings suggest that while fasting may carry health benefits, these benefits may be blunted in people living with obesity. Dr Islam stresses that the implications of this are not yet fully understood.

“People living with obesity may respond differently to an isolated two-day fast compared to those who are leaner, but we don’t yet know if this is good or bad,” he says. “Our study shows the complex relationship between nutrition, metabolism and immune function, and that more research is needed to see how fasting can be used as a therapeutic tool for people with different body types.”

CCH Insight

This study is a good reminder that there is no one diet that suits everyone. We are all biochemically unique, due to a range of personal factors such as genetics, the makeup of our gut microbiome and our state of health, so it is always a good idea to be skeptical about ‘shiny new diets’ that appear to be the answer for weight loss or longevity. In this study, fasting appears to benefit people of a healthy weight, but not those living with obesity. Considering that one of the keys to good health and maintaining a stable, healthy body weight is to adopt healthy dietary habits that works for you and you can sustain, it is arguable that regular fasting could be unhelpful for people with obesity, who may be prone to binges or irregular eating patterns.

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Global study reveals obesity has overtaken being underweight among the world’s young

Key Takeaways:

• For the first time in recorded data, there are more children and adolescents living with obesity than those who are underweight, according to UNICEF.
• Nearly one in ten young people aged 5–19 years – around 188 million globally – are now affected by obesity, driven largely by the rise in consumption of ultra-processed foods.
• UNICEF is calling for urgent government action to protect children’s diets, restrict the influence of the ultra-processed food industry on policymaking, and make nutritious foods affordable and accessible.
  

A historic shift in global child health

For the first time, the number of children and adolescents worldwide living with obesity has surpassed the number who are underweight. This milestone, highlighted in a major study by UNICEF, underscores a profound transformation in global nutrition and public health.

The study found that approximately one in ten young people aged between 5 and 19 years – an estimated 188 million individuals – are now living with obesity. This represents a sharp increase compared with the early 2000s. Researchers attribute this shift primarily to the replacement of traditional diets with ultra-processed foods that are inexpensive, calorie-dense, and nutritionally poor.

Redefining malnutrition

Historically, malnutrition in children was almost synonymous with underweight and hunger. Today, the definition is broader, encompassing not only wasting and stunting but also the growing prevalence of overweight and obesity.

Children are classified as overweight when their weight significantly exceeds the healthy range for their age, sex, and height. Obesity is recognised as the more severe form of overweight and is associated with an elevated risk of type 2 diabetes, cardiovascular disease, and some cancers in later life.

Good nutrition throughout childhood – including adequate intake of fruit, vegetables, and protein – is vital for healthy growth, cognitive development, and mental wellbeing. Yet many of these traditional sources of nourishment are being replaced by foods laden with sugar, starch, salt, unhealthy fats, and artificial additives.

UNICEF’s Executive Director, Catherine Russell, warned that the dangers posed by this trend must not be underestimated. She described obesity as “a growing concern” that has significant implications for the health and development of children.

Rising obesity, declining underweight

The UNICEF-backed study, which analysed data from over 190 countries, highlights two diverging global trends. Between 2000 and 2022, the proportion of children aged 5–19 years who were underweight declined from nearly 13 per cent to 9.2 per cent. At the same time, obesity rates rose steeply from 3 per cent to 9.4 per cent.

This means that almost one in ten children worldwide is now living with obesity. When combining overweight and obesity, the figures are even more striking: one in five school-aged children and adolescents – around 391 million globally – is above a healthy weight.

Although underweight remains a pressing concern in children under the age of five, particularly in low and middle-income countries, obesity is increasingly the dominant nutritional challenge for those aged 5–19. The only regions where underweight still exceeds obesity are sub-Saharan Africa and South Asia.

Geographic hotspots and global distribution

The prevalence of childhood obesity is particularly acute in certain regions. Pacific Island nations have some of the highest rates, including Niue (38 per cent), the Cook Islands (37 per cent), and Nauru (33 per cent).

High-income countries are not exempt. In Chile, 27 per cent of 5–19-year-olds live with obesity, while in the United States and the United Arab Emirates the figure stands at 21 per cent.

“This double burden of malnutrition – the existence of both stunting and obesity in the same populations – requires targeted interventions,” Catherine Russell explained. “Nutritious and affordable food must be available to every child to support their growth and development. We urgently need policies that support parents and caretakers to access nutritious and healthy foods for their children.”

The call to action

The UNICEF report highlights the potentially devastating health and economic consequences of inaction. By 2035, the global economic burden of overweight and obesity is projected to exceed US$4 trillion (£2.95 trillion) per year.

To mitigate these risks, UNICEF has called upon governments to implement robust policies. These include:

• Restricting unhealthy foods – such as removing ultra-processed products from school canteens and regulating food labelling and marketing to children.
  
• Introducing fiscal measures – for example, taxing sugar-sweetened beverages and other unhealthy products, while incentivising healthier options.
  
• Encouraging reformulation – compelling food manufacturers to reduce unhealthy ingredients such as excess salt, sugar, and harmful fats.
  
• Safeguarding policy from industry influence – ensuring that ultra-processed food and drink producers are excluded from developing or implementing public health policy. Any lobbying efforts would need to be transparently reported.
  

A global imperative

The findings mark a pivotal moment in global health, emphasising the urgent need for a coordinated response. The steady replacement of traditional diets with ultra-processed foods has triggered a nutrition crisis that spans continents and income levels.

Without decisive policy action, the health outcomes for millions of children and the economic burden for societies will only worsen. UNICEF’s call is clear: protecting children’s diets from the pervasive influence of ultra-processed food industries and ensuring access to affordable, nutritious foods must become a global priority.

CCH Insight:

These statistics highlight an interesting phenomenon occurring in some developing countries, such as India, China and Nigeria. As these countries develop economically, they are grappling with the dual challenge of undernourished, underweight children in poor, mostly rural areas, and childhood obesity amongst the more affluent, who have adopted a western, processed food diet, mostly in urban areas. Due to the populous nature of these countries, global childhood obesity rates are likely to continue to rise for many years to come, unless a concerted effort is made to regulate food processing, as suggested by the authors. Unfortunately, the food industry is a very powerful lobby, that makes these kind of policies very difficult to adopt.

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Large-scale study finds children with obesity face markedly higher risk of limb fractures

Key Takeaways: 

• Children with obesity at the age of starting school have nearly a five-fold higher risk of bone fractures during childhood compared with children of a healthy weight.
• Analysis of almost 467,000 children in Catalonia showed obesity at age four was associated with a 70% higher risk of lower limb fractures and a 20% higher risk of upper limb fractures.
• Findings highlight the long-term health implications of obesity in the preschool years, reinforcing the need for early intervention and further research.
  

Growing concern over childhood obesity

The rising prevalence of childhood obesity is a major global public health challenge. It has already been linked to a wide range of conditions in later life, including cardiorespiratory disease, type 2 diabetes, and mental health disorders. Much of the research in this field has focused on obesity in older children and its consequences for adult health. Less is known about how excess weight in the preschool years influences immediate health outcomes during childhood and adolescence.

A new study, published in the Journal of Bone & Mineral Research and supported by the NIHR Oxford Biomedical Research Centre, sought to address this gap by examining whether obesity at the age of school entry is associated with an increased risk of fractures in later childhood.

Study aims and design

“The primary aim of the study was to determine if elevated body mass index (BMI) just before starting school at age 4 years was associated with an increased incidence of fracture in childhood,” explained Jennifer Lane, Versus Arthritis Clinical Research Fellow in Orthopaedic Surgery at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and lead author of the paper. “We found that elevated body weight at the age of starting school increased the risk of breaking a bone later in childhood.”

To investigate this, the research team – consisting of scientists and doctors from the United Kingdom and Spain – analysed the anonymised health records of 466,997 children living in Catalonia. As part of routine healthcare check-ups before starting school, each child was weighed and measured, and their BMI calculated. The researchers then followed the health of these children until they reached 15 years of age, or until data were no longer available due to other reasons such as moving away.

Key findings

At baseline, 5.7% of the children were classified as overweight and 2.0% as having obesity according to their BMI. The results showed a clear link between higher BMI at preschool age and later fracture risk:

• Children with obesity at age four faced a 70% higher risk of lower limb fractures and a 20% higher risk of upper limb fractures compared with peers of a healthy weight.
• Children with overweight had a 40% higher risk of lower limb fractures and a 10% higher risk of upper limb fractures.
  

These findings underscore that excess body weight at the point of starting school is not only a predictor of long-term health risks but also increases vulnerability to fractures during the remainder of childhood.

Next steps and research implications

Jennifer Lane highlighted the importance of building on this work to understand the underlying biological and mechanical mechanisms: “More research is needed to further understand the mechanisms underlying this correlation. Our study adds to a body of work that supports further research into the role that pre-school obesity has in health problems in childhood and beyond.”

While the precise pathways are not yet fully understood, potential factors may include greater force exerted on bones during falls, differences in bone structure or density, or changes in physical activity patterns among children with overweight or obesity.

Broader significance

The study is one of the largest of its kind to investigate fracture risk in relation to BMI measured at preschool age. Its findings highlight the importance of early monitoring of weight and growth, as well as timely interventions that support healthy development before children enter formal education.

The evidence reinforces that obesity in the early years is not only a future risk factor for adult disease but also has immediate and tangible consequences for musculoskeletal health during childhood.

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Obesity drives high rates of chronic disease in US adolescents and young adults

 Key Takeaways: 

• A new JAMA Pediatrics study found obesity is linked to a substantial proportion of chronic health conditions in US adolescents and young adults, with the highest impact seen in liver steatosis and type 2 diabetes.
• Among young adults with obesity, nearly 79% of type 2 diabetes cases were attributable to excess weight, while almost half of adolescent liver steatosis cases were linked to obesity.
• Researchers emphasise the need for early prevention and treatment strategies, including behavioural, surgical, and pharmacological interventions, to mitigate long-term health and economic consequences.
  

Rising prevalence of obesity and chronic disease

The prevalence of obesity among adolescents and young adults in the United States continues to rise and is closely linked with a growing burden of obesity-related conditions (ORCs). A study recently published in JAMA Pediatrics has provided one of the most comprehensive analyses to date, showing that obesity accounts for a substantial share of several chronic health conditions in this population.

Researchers conducted a cross-sectional analysis using pooled data from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2023. The study population included 4199 adolescents aged 12–17 years and 3200 young adults aged 18–25 years. These participants represented approximately 56 million people nationwide. Individuals who were pregnant or underweight were excluded.

How the study was conducted

Body mass index (BMI) was classified into three categories: normal weight, overweight, and obesity, according to standard clinical definitions. Investigators identified obesity-related conditions using consensus definitions and the data available from NHANES. Conditions examined included:

• Prediabetes and type 2 diabetes
• Hypertension
• Dyslipidaemia
• Asthma
• Stress urinary incontinence
• Liver steatosis
• Kidney hyperfiltration
• Probable obstructive sleep apnoea
  

Relative risks for each condition were calculated by comparing individuals with obesity or overweight to those with normal BMI, while adjusting for factors such as age, sex, insurance status, access to health care, and survey cycle. The researchers then estimated population attributable fractions (PAFs), which indicate the proportion of each condition that could be attributed to overweight or obesity.

Study findings

Among adolescents, 18.7% had overweight and 22.3% had obesity. Among young adults, 25.8% had overweight and 29.7% had obesity. Prevalence of obesity-related conditions varied widely — from 0.3% for type 2 diabetes in adolescents to 36.4% for liver steatosis in young adults.

The analysis showed that obesity made a striking contribution to the overall disease burden:

• Adolescents – Six of seven measured conditions showed significant PAFs due to obesity, ranging from 10.2% for asthma to 49.6% for liver steatosis.
• Young adults – Eight of nine conditions showed significant obesity-attributable fractions, ranging from 10.4% for asthma to 78.9% for type 2 diabetes.
  

Overweight status also contributed to disease burden, though to a lesser extent. For adolescents, PAFs due to overweight ranged from 6.2% for asthma to 13.1% for liver steatosis. In young adults, overweight contributed to 10.0% of hypertension cases and 21.0% of liver steatosis cases.

The study authors concluded: “Large portions of ORCs in US adolescents and young adults may be attributable to obesity and, to a lesser extent, overweight.”

Implications for prevention and treatment

The findings underscore the critical role of obesity in the early development of chronic disease. The researchers highlighted that obesity-related conditions arising in adolescence or young adulthood increase the risk of more severe disease later in life.

They noted: “These PAFs can inform estimates of the potential impact of expanding access to behavioural, surgical, and pharmacotherapeutic interventions, including glucagon-like peptide-1 receptor agonists, on reducing ORCs in US youth.”

Limitations

The study acknowledged several limitations. Its cross-sectional design assumed causality between obesity and obesity-related conditions, which cannot be proven definitively. Reliance on self-reported data introduced the risk of recall bias, and there was a possibility of misclassifying diabetes subtypes. The researchers also noted the potential for confounding factors, such as independent precursors that may contribute to both obesity and associated conditions.

Conclusion

Obesity remains a major driver of chronic disease among adolescents and young adults in the United States. While overweight status contributes to some extent, obesity accounts for much larger proportions of conditions such as liver steatosis, hypertension, and type 2 diabetes.

The authors emphasised that intervening early in life — through prevention and treatment strategies — may reduce both the long-term health impact and the associated economic burden of these conditions.

CCH Insight:

The findings of this study are, in a way, quite shocking – the fact that large numbers of young people have liver disease, prediabetes and hypertension, conditions that were once associated with the later stages of life. However, the rising prevalence of child and adolescent obesity over recent decades means this has been sadly predictable, and it is a ticking time-bomb in terms of chronic diseases, disability, premature mortality and health and social care costs. As the authors stated, it is vital that obesity is addressed from the earliest opportunity, including access to GLP-1 medications.

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Childhood obesity associated with structural changes in foot shape

Key Takeaways:

• A large international study published in BMC Pediatrics has identified a significant link between childhood obesity and changes in foot morphology.
• Using advanced photogrammetry techniques, researchers found that children with higher BMI were more likely to present wider and flatter feet, with potential consequences for mobility and musculoskeletal health.
• The findings highlight the importance of considering foot structure in obesity management and suggest the need for tailored footwear, early interventions, and holistic public health strategies.
  

Rising childhood obesity and its overlooked consequences

Childhood obesity continues to rise at concerning rates worldwide, prompting extensive research into its impact on health and development. While much of the scientific focus has traditionally been on metabolic or cardiovascular complications, a new international study has turned attention towards a less-examined area – foot morphology. The research provides new insights into how excess body weight may affect the structure of children’s feet and the implications this has for mobility and long-term musculoskeletal health.

Understanding foot morphology

Foot morphology refers to the anatomical shape and structure of the foot, including features such as arch height, width, and length. In children, whose bones and musculoskeletal systems are still developing, these structures are particularly sensitive to external pressures such as excess weight. While previous studies have linked obesity to chronic conditions such as diabetes or hypertension, few have explored how it alters the structural integrity of the body during growth.

The team of researchers – Hakan Büyükçelebi, Mahmut Açak, Özgür Eken, Adem Doğaner, Gökmen Özen, and Luca Paolo Ardigò – set out to address this gap by analysing how obesity correlates with variations in foot structure.

Advanced use of photogrammetry

To capture precise data, the researchers used state-of-the-art photogrammetry. This imaging technique builds detailed three-dimensional models from photographs, allowing highly accurate measurement of anatomical features. Unlike traditional measuring methods, photogrammetry is non-invasive and child-friendly, reducing discomfort during assessment.

Each participant’s foot was digitally scanned, producing accurate records of structural features such as arch height, foot length, and width. These digital models enabled the team to identify subtle but consistent differences in foot shape across groups of children categorised by Body Mass Index (BMI).

Large and diverse study sample

The cross-sectional study engaged children from a wide range of backgrounds and geographical locations, improving the reliability and generalisability of the results. Participants were grouped according to BMI, and their foot morphology was carefully compared.

The data revealed clear patterns. Children with higher BMI tended to have feet that were wider and flatter than those of children in a healthy weight range. Conversely, children with BMI within standard limits displayed foot shapes more typically associated with healthy biomechanics.

Findings and implications for children’s health

The study suggests that children living with obesity may be more susceptible to structural changes in the foot that affect overall mobility. “Wider and flatter foot shapes were prevalent among obese children,” the researchers noted, raising concerns about increased risk of pain, discomfort, and potential musculoskeletal injuries.

These structural changes can alter gait and movement patterns, potentially leading to joint strain or other biomechanical problems as children grow. The implications extend beyond immediate discomfort. Altered foot morphology may increase vulnerability to long-term mobility limitations, impacting physical activity and overall health.

The role of footwear and early interventions

One practical consideration arising from the study is footwear. Children with altered foot morphology may require specially designed shoes that provide adequate support and prevent further complications. Standard footwear may not meet the needs of children with wider, flatter feet, potentially exacerbating problems.

The researchers highlight the importance of recognising these needs early and encouraging parents, educators, and healthcare professionals to consider foot health as part of obesity management. Promoting healthy weight, encouraging physical activity, and ensuring supportive footwear could together help safeguard mobility and comfort in growing children.

Broader public health significance

The findings also reinforce the urgent need for comprehensive strategies to address childhood obesity. As the researchers note, excess weight has “multifaceted consequences,” with foot morphology being one aspect of a much wider issue. The study underscores that obesity does not only affect internal systems but also the very structures that underpin daily movement.

Public health initiatives that encourage balanced nutrition, regular activity, and healthy environments for children may reduce not only metabolic risks but also structural complications such as those observed in foot shape.

Future directions for research

The study paves the way for future investigations into related areas. Longitudinal studies could help determine how these morphological changes evolve over time and whether early interventions can reverse or mitigate their effects. Researchers may also examine whether obesity influences other structural aspects of the musculoskeletal system, such as the spine or lower limb joints.

Additionally, there is scope for exploring the effectiveness of footwear specifically designed for children with altered foot structures, assessing whether targeted design can improve mobility outcomes and reduce injury risk.

Conclusion

This large-scale study provides compelling evidence of a link between childhood obesity and changes in foot morphology. The use of advanced photogrammetry offered detailed insights into how excess weight may alter the developing foot, with potential implications for gait, mobility, and injury risk.

By drawing attention to foot structure, the research underscores the importance of addressing childhood obesity in a holistic manner. As Hakan Büyükçelebi and colleagues highlight, the medical community should consider foot health as an integral part of assessment and management.

In doing so, society can take one step closer to ensuring that children receive comprehensive support for healthier, more active futures.

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Study highlights ways to improve primary care visits for people living with obesity

Key Takeaways:

• A new study led by Drexel University shows that people living with obesity strongly prefer primary care visits that emphasise empathy, respect, and freedom from stigma.
• Surveyed participants rated an “ideal” visit scenario at 9.4 out of 10, citing the importance of attentive listening, respectful communication, and not attributing all health concerns solely to weight.
• Researchers recommend that clinician training, office practices, and referral systems should explicitly address weight stigma, with a greater focus on patient-centred, respectful care.
  

Understanding barriers in primary care

Accessing health care can be difficult under any circumstances, but systemic barriers make the experience particularly challenging for some groups. For people living with obesity, weight-related stigma and inequities in health care often negatively influence their experiences when visiting primary care physicians. Such encounters can lead to frustration, mistrust, and in some cases, avoidance of care altogether.

Redesigning the “ideal” primary care visit

To address these challenges, researchers at Drexel University’s College of Nursing and Health Professions worked with people living with obesity to explore what an “ideal” primary care visit might look like. Their findings, recently published in Patient Education and Counseling, provide an evidence-based model for improving everyday interactions between clinicians and patients.

The project was conducted in two phases.

In the first phase, the Obesity Action Coalition (OAC) partnered with Thoughtform, an experience design studio, to work directly with people who have obesity. Participants shared their personal experiences, highlighting both barriers and possible solutions within primary care. Concerns included a limited sense of rapport with clinicians and the lack of appropriate physical resources such as larger blood pressure cuffs or gowns that fit comfortably.

From these discussions, OAC and Thoughtform developed a story-based narrative that illustrated a more positive primary care experience. The scenario depicted a setting where patients were listened to, treated kindly, and not judged for their weight. Illustrations were included to help visualise these improvements.

Validating the “ideal” model with patient input

In the second phase, the research team surveyed 250 American adults living with obesity, asking them to compare the “ideal” scenario with their most recent real-life doctor’s visit. The results were clear: participants overwhelmingly preferred the redesigned model, giving it an average rating of 9.4 out of 10.

Respondents highlighted several aspects that made the “ideal” scenario preferable. These included clinicians who:

• listened attentively,
• showed respect,
• avoided attributing every health issue to weight, and
• referred patients to specialists who treated them with empathy and professionalism.
  

“The survey results showed that people living with obesity want empathetic, respectful health care,” explained Kristal Lyn Brown, PhD, assistant professor in the College and lead author of the study. “We hope these results encourage providers and their staff to make their spaces more inclusive and free of weight bias and stigma.”

The value of empathy and common sense in care

Brown emphasised that the findings underscore the importance of recognising patients’ humanity.

“People with obesity are asking for basic, every day, human interactions — not resource-intensive changes but literally common-sense practices, of which our primary care offices often fall short,” she said.

The study suggests that simple changes in tone, communication, and approach can make a significant difference. By fostering empathy and respect, health care teams may help patients feel more comfortable attending primary care appointments, reducing the risk of avoidance. Over time, these practices could also build greater trust between providers and patients.

Recommendations for practice and training

Based on the findings, the research team outlined several key recommendations:

• Clinician training should explicitly address weight stigma and promote patient-centred, respectful communication.
• Front office staff should be trained to recognise and address bias, as the patient experience often begins at reception.
• Referral practices should prioritise specialists known for respectful and empathetic care.
• Patient-centred dialogue should allow individuals to tell their story without assumptions that every concern is weight-related.
  

Including patient voices in systemic change

Brown stressed that beyond individual practice, the study highlights the value of including patient voices in the design of health systems and research projects. Actively partnering with people living with obesity ensures that proposed solutions address real-world needs, and helps create care environments that are inclusive, respectful, and free from stigma.

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Responsive parenting may help reduce behaviours tied to childhood obesity

Key Takeaways: 

• Infants whose mothers received responsive parenting guidance showed fewer behaviours associated with later childhood obesity risk.
• The intervention was especially effective in reducing risk behaviours during the first two months of infancy.
• Coordinated care between paediatricians and nutritionists supported mothers in better recognising and responding to their babies’ cues.
  

Early weight gain and obesity risk

One in five children in the United States is living with obesity, a condition strongly associated with long-term health complications. Infants who gain excessive weight before their second birthday face an elevated risk of developing obesity later in childhood. This risk is particularly high among infants encouraged to continue eating after expressing signs of fullness, according to researchers from the Penn State Department of Nutritional Sciences and Geisinger College of Health Sciences.

A recent study demonstrated that mothers who were guided in responsive parenting were better able to identify and respond appropriately to their babies’ cues. These mothers also reported fewer behaviours in their infants that could contribute to obesity risk.

Details of the study

The study was led by Yining Ma, a doctoral student in nutritional sciences, together with Professor Jennifer Savage Williams, professor of nutritional sciences and director of the Centre for Childhood Obesity Research, and Professor Lisa Bailey-Davis, professor of population health sciences and director of the Centre for Women’s & Children’s Research at Geisinger College of Health Sciences. The findings were published in Pediatric Obesity.

“Responsive parenting helps mums and caregivers to be in tune with their baby and correctly identify their baby’s needs to respond in a supportive and nurturing way,” Ma explained. “For new parents, recognising signs of hunger or tiredness in their baby can be challenging. When these cues are missed or misread, it can sometimes lead to overfeeding, which may contribute to excessive weight gain.”

The WEE Baby Care intervention

The researchers analysed data from 288 mother–infant pairs from low-income households who participated in the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study. This clinical trial, led by Savage Williams and Bailey-Davis, tested whether coordinated care between paediatricians and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutritionists could improve maternal education in responsive parenting.

Over a six-month period, participating mothers were divided into two groups. One group received a responsive parenting intervention involving integrated care from paediatricians and WIC nutritionists. The other group received standard care during routine well-child visits.

The responsive parenting intervention offered guidance on infant feeding, soothing strategies, sleep, and interactive play. All mothers completed a lifestyle risk assessment during their babies’ two-month and six-month wellness visits. These assessments included questions on feeding practices, behaviours associated with obesity risk, infant sleep, appetite traits, interactive parent–child play, and caregiver relationships. The results were recorded in electronic health records to support tailored counselling.

Outcomes and findings

According to Bailey-Davis, “The Early Healthy Lifestyles (EHL) Screening tool used to assess lifestyle risk allowed us to target a combination of obesity risk behaviours at developmentally relevant times to better help mothers with their unique needs rather than focusing on a single behaviour.”

Key findings included:

• Mothers in the intervention group were less likely to pressure their infants to finish bottles.
• They were less likely to put their babies to bed after 8 p.m.
• They were less likely to use devices such as smartphones or televisions during feeding or play.
• They reported fewer nighttime feedings.
  

The researchers developed an overall obesity risk behaviour score. Infants whose mothers received the responsive parenting intervention had significantly lower scores at two months compared with the standard care group, though this difference was not evident at six months.

“Our main finding demonstrated the effectiveness of responsive parenting behaviours for reducing the obesity-promoting risk for children during the first two months of infancy,” Savage Williams stated. “The education that WEE Baby Care’s intervention provided helped mothers better understand their baby’s cues and needs and how to respond appropriately to them.”

Broader significance

The study also demonstrated the value of coordinated healthcare approaches for addressing obesity risk during infancy. The research team intends to further explore how the EHL screening tool may be used by practitioners to identify risk behaviours and track their relationship to infant weight patterns.

“For many families, especially those with limited access to educational resources, programmes like WEE Baby Care and WIC provide vital support in helping caregivers learn babies’ behaviour cues and building confidence in caring for a new baby,” Ma noted.

Amy Moore, assistant professor of nutritional sciences, also contributed to the study.

Funding

This research was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services, the Maternal and Child Health Field-initiated Innovative Research Studies Programme, and the National Center for Advancing Translational Sciences of the National Institutes of Health.

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UK government launches £85m programme to expand obesity care through pharmacies and community services

Key Takeaways:

• The Government has announced an £85 million initiative to expand obesity support services, delivered through pharmacies, digital platforms, and community-based models.
• The pharmaceutical company Lilly will contribute £35 million in grant funding, though the firm insists its involvement is not linked to its obesity medicines.
• Pharmacy leaders welcome the programme but stress that funding must adequately cover the costs of providing wraparound care.
  

Government unveils new obesity programme

The Government has launched an £85 million programme designed to expand access to obesity care across the United Kingdom. The initiative will allow people living with obesity to seek support through community pharmacies as well as via digital platforms and local community-based services.

Labour has invited integrated care boards and technology providers to submit bids to pilot the programme, which it describes as offering “comprehensive holistic weight management support including a range of wraparound services.”

The Department of Health and Social Care (DHSC) confirmed that patient eligibility will be determined locally by clinicians, with all services required to follow national guidelines, NHS governance, and clinical standards. The department emphasised that this approach is intended to ensure care remains patient-centred and responsive to local needs.

Funding breakdown

The Government will contribute around £50 million to the programme, with an additional £35 million coming from pharmaceutical company Lilly in the form of grant funding. At least £10 million has been set aside to support bids in Scotland, Wales, and Northern Ireland.

While pharmacies already provide weight management services such as lifestyle advice, the details of their role under the new programme remain unclear. According to the DHSC, the initiative will focus on “innovative models of care for people living with obesity, outside of existing specialist weight management services,” with the aim of increasing capacity and reducing pressure on current services.

The DHSC also noted that treatments for obesity could “potentially” be included as part of the wraparound services offered, although specifics were not confirmed.

Questions over medicines provision

Independent Community Pharmacist (ICP) sought clarification from the DHSC on several points, including:

• Whether participating pharmacies will provide weight loss injections such as Mounjaro, Ozempic, and Wegovy once the programme launches in summer 2026, or only Mounjaro given Lilly’s financial involvement.
• Whether pharmacies will supply Lilly’s investigational daily obesity pill orforglipron, which is currently in trials and not yet licensed but may become available next year.
• How much funding each pharmacy will receive to deliver services under the programme.
  

When asked whether it was effectively paying the Government to promote its obesity medicines through pharmacies, Lilly stated the programme is “completely unrelated” to its pharmaceutical products and that its grants “will not fund purchasing or prescribing of specific medicines.”

A Lilly spokesperson explained:

“The aim of the programme is to facilitate the development of innovative models of care for obesity across the UK, to enhance the support available to individuals living with obesity.

The programme could make it easier for patients to access holistic obesity care, which could include access to medicines and other treatments for eligible patients, as deemed clinically appropriate by their healthcare professional. This is agnostic of which treatment and there is no link to Lilly’s medicines.”

Pharmacy leaders respond

Numark: Community pharmacies ‘uniquely placed’

Harry McQuillan, chair of Numark, said the programme is “ideally suited for community pharmacy involvement” and represents “an important step in expanding access to weight management support across our communities.”

He emphasised the value of pharmacists in this role:

“Pharmacists and their teams are uniquely placed to deliver this service. As highly accessible healthcare professionals, they already provide trusted advice, regular health interventions, and continuity of care to millions of people every year.

This service recognises their critical role in supporting healthier lifestyles and tackling one of the most pressing public health issues we face.”

NPA: Ensure funding covers costs

Henry Gregg, chief executive of the National Pharmacy Association (NPA), also welcomed the announcement but underlined the importance of adequate funding:

“Any funding made available is sufficient to cover the costs involved for pharmacies to provide wraparound care and support.

Obesity is the single biggest health challenge facing our country, and if we are serious about tackling it, pharmacies must be empowered to play a central role in the solution. With the right funding, pharmacies can scale up delivery quickly, ensuring more people get the help they need, when and where they need it.”

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Maternal obesity before pregnancy linked to autism-like behaviours in offspring, University of Hawai‘i mice study finds

Key Takeaways:

• University of Hawai‘i researchers have shown that maternal obesity prior to conception can cause epigenetic changes in eggs that affect offspring brain development.
• Male offspring of obese mothers displayed autism-like traits, including altered social behaviour and increased repetitive actions, linked to changes in the Homer1 gene.
• The findings, obtained using an in vitro fertilisation model, may inform early interventions aimed at reducing neurodevelopmental risk before pregnancy.
  

Maternal health before conception found to have long-term impact on brain development

A study conducted at the University of Hawai‘i at Mānoa’s John A. Burns School of Medicine (JABSOM) has revealed a direct link between a mother’s weight before pregnancy and autism-like behaviours in her offspring.

Published in the journal Cell, the research offers new insight into how maternal health in the period before conception can influence a child’s brain development. The team, led by Professors Alika K. Maunakea and Monika Ward from JABSOM’s Department of Anatomy, Biochemistry & Physiology and the Yanagimachi Institute for Biogenesis Research (YIBR), found that maternal obesity can trigger metabolic changes which cause lasting epigenetic modifications in eggs.

These modifications are transmitted to the developing embryo, altering the expression of genes involved in brain development, including Homer1, a protein that regulates synaptic signalling, learning, memory, and responses to neural activity.

Gene changes linked to autism-like behaviours in male offspring

The researchers discovered that male offspring of obese mothers exhibited increased levels of a specific Homer1 gene isoform. This variant is known to disrupt neural connections and has been associated with behaviours linked to autism spectrum disorder (ASD).

“This work highlights how a mother’s health prior to pregnancy, not just during gestation, can shape her child’s brain development in profound ways,” said Professor Maunakea. “We were surprised to find that even without direct maternal contact after conception, these epigenetic imprints from the egg carried enough weight to alter behaviour.”

IVF and embryo transfer model used to isolate effects

To separate the effects of obesity before pregnancy from those during gestation, the team used an in vitro fertilisation (IVF) and embryo transfer model. This allowed them to examine the influence of early epigenetic programming without confounding maternal factors during pregnancy.

When the adolescent male mice were tested, behavioural assessments showed reduced social interactions and increased repetitive behaviours — characteristics that parallel features of ASD. These changes were traced to altered regulation of brain-related genes.

“This discovery exemplifies the core mission of the YIBR,” said Professor Ward. “By leveraging our institute’s expertise in developmental biology, reproductive science and epigenetics, we are beginning to understand how early-life programming can ripple through generations.”

Potential for early intervention before conception

Both obesity and ASD have been increasing worldwide, underscoring the public health importance of these findings. The researchers suggest that interventions — potentially nutritional or pharmacological — could be developed to reverse or reduce the impact of pre-pregnancy obesity on brain development.

The study highlights the importance of maternal health not only during pregnancy but also in the months and years before conception, signalling that preventive measures could have lasting benefits for the next generation.

CCH Insight:

We have to interpret this study with caution, because it was conducted with mice, so we cannot extrapolate directly to humans. However, it serves as a reminder that obesity reduces fertility, and obesity during pregnancy carries risks to mother and baby, so pre-conception should be a priority for pro-active obesity care interventions.

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Landmark UK study finds ultra-processed foods may undermine the benefits of healthy eating

Key Takeaways: 

• Ultra-processed foods (UPFs) significantly reduce weight loss effectiveness, even when nutritional content aligns with national healthy-eating guidelines.
• Participants lost more than twice as much weight on a minimally processed food (MPF) diet compared to a UPF-based diet, despite identical macronutrient targets.
• The findings underscore the urgent need for UK dietary policy reform, highlighting food processing as an independent factor influencing diet quality and public health.
  

Introduction: Ultra-Processed Foods Under Scrutiny

New research has revealed that diets high in ultra-processed foods (UPFs) may hinder weight loss efforts, even when they comply with national dietary recommendations. The study, published on 4 August in Nature Medicine, was conducted in the United Kingdom and led by Samuel Dicken, an obesity and behaviour researcher at University College London (UCL). According to the researchers, the study provides some of the clearest evidence to date that the way food is processed — not just its nutritional composition — plays a critical role in weight management and overall health.

Defining Ultra-Processed Foods

Ultra-processed foods are industrially manufactured products that combine food extracts with additives, preservatives, and other synthetic ingredients. These products are typically designed for cost efficiency, long shelf-life, and mass appeal, making them highly profitable and widely available. Examples include packaged snacks, soft drinks, instant meals, and many supermarket-ready items.

While their high salt, sugar, and fat content has long been known to contribute to poor health outcomes, this new study suggests that the processing itself — including textural changes, heating methods, and additives — may also play a significant role in how the body responds to these foods.

Study Design: Real-World Eating in a Controlled Trial

This eight-month randomised crossover trial involved 55 adult participants and was designed to reflect real-world conditions as closely as possible. Each participant completed two distinct 8-week diet phases: one based on minimally processed foods (MPFs) and the other on ultra-processed foods (UPFs). The two phases were separated by a 4-week washout period, during which participants returned to their usual diet.

Both diets were constructed in accordance with the UK government’s Eatwell Guide, which provides recommendations on the proportions of food groups and macronutrients (carbohydrates, fats, proteins). Participants received all meals, snacks, and beverages directly to their homes, allowing them full flexibility in terms of portion size and meal timing.

“The motivation behind this study was to address a gap in national dietary recommendations, and to do so in the participants’ everyday environment,” said lead author Samuel Dicken. “It will be the longest-ever trial of a UPF diet to date. It’s the first one to do it in the real world to try and apply all those behavioural influences.”

Findings: Same Nutrients, Very Different Results

The study found that while participants lost weight during both dietary phases, weight loss was significantly greater during the MPF phase. On average, participants lost 1.84 kilograms while consuming minimally processed foods — more than double the 0.88 kilograms lost on the UPF-based diet.

In addition to greater weight loss, the MPF phase led to measurable improvements in body composition, including:

• Reduction in total fat mass
• Decrease in body-fat percentage
• Lower visceral-fat rating
  

Such changes were not observed during the UPF phase.
Participants also reported fewer food cravings while on the MPF diet.

Why the Difference? The Role of Processing

Although the exact mechanism remains uncertain, several hypotheses were proposed by the researchers:

• Texture and structure: UPFs are often softer and easier to chew, which may lead to faster consumption and delayed feelings of fullness.
• Gut microbiome: Additives and heat treatments used in processing could negatively impact gut health and promote inflammation.
• Behavioural cues: Attractive packaging and misleading nutritional claims may encourage overconsumption.
  

“UPFs are engineered to be overconsumed,” noted Carlos Monteiro, an epidemiologist at the University of São Paulo, Brazil, who coined the term ultra-processed food. “These foods are more ‘addictive-like’, energy-dense and tasty, which can lead to higher intake when compared with MPFs.”

Public Health Implications: Beyond Nutrients

The findings challenge existing dietary policies that focus predominantly on macronutrients while paying little attention to how food is processed.

“This trial supports the importance of considering food processing as a distinct and policy-relevant dimension of diet quality,” said Tera Fazzino, a psychologist at the University of Kansas. “Policies that focus solely on reformulating UPFs to meet nutritional standards may overlook the behavioural and physiological effects of how those foods are engineered.”

Fazzino added, “This study strengthens the evidence base needed to inform policy and public-health messaging. By showing that processing matters even when nutritional quality is controlled, it challenges the current focus on nutrients alone and may help catalyse broader discussion and reform.”

A Socio-Economic Dimension

In the UK, over 50% of the average person’s daily energy intake comes from ultra-processed foods — a figure echoed across much of Europe and North America. Dicken warned that the ubiquity and affordability of UPFs pose a particular risk for individuals from low-income communities, where access to fresh, minimally processed foods is limited.

“Issues around diet and obesity related to these [UPFs] are very much related to socio-economic inequalities,” he said. “People might have unhealthy diets not because they aren’t trying to eat healthily, but because our food environment is just setting us up to fail.”

Conclusion: A Call to Re-Evaluate National Guidelines

This landmark trial provides compelling evidence that ultra-processed foods can substantially blunt the effects of otherwise healthy diets. It also highlights a pressing need to broaden the scope of national dietary guidelines to include food processing as a factor in health outcomes.

According to Dicken, “This isn’t just about calories or nutrients — it’s about the way our food is made, marketed, and made available to us. If we want meaningful change, we need policy that reflects that complexity.”

CCH Insight:

This is an excellent study and the results provide confirmation of what many of us have suspected for a long time; that these foods have health implications beyond just their nutrient content – the food has been altered in a way which has a wider impact on health. But the challenge is how to reverse the increasing levels of consumption of these foods, especially amongst deprived communities who are most vulnerable to obesity and associated chronic health issues. One option is taxation, in the hope this will not drive up prices, but will motivate the food industry to re-formulate foods (as they re-formulated sugary drinks) to reduce the degree of processing.

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