Nutrition Tag

Whole Milk and Childhood Obesity – New Study Challenges Long-Standing Dietary Advice

Key Takeaways:

• Children who consumed whole-fat milk in early childhood showed lower odds of living with obesity in later childhood compared with those consuming reduced-fat options
  
• The study found no evidence that whole milk increases adiposity, challenging decades of low-fat dietary guidance
  
• Researchers suggest milk fat may influence satiety and overall dietary patterns, although mechanisms remain unclear
  
  
  

Rethinking milk fat and childhood health

New research from the University of Toronto suggests that children who consume whole-fat milk during early childhood may have a lower likelihood of living with obesity in middle childhood than those who drink reduced-fat milk.

These findings contribute to a growing body of evidence indicating that lower-fat milk may not provide the protective effect against childhood obesity that has long been assumed. For several decades, dietary guidelines in many countries have promoted low-fat dairy products. For example, Canada’s Dietary Guidelines in 2019 continued to recommend reduced-fat options, reflecting a broader historical focus on reducing dietary fat intake.

Study overview and design

The study, published in the American Journal of Clinical Nutrition, is described as one of the most comprehensive analyses to date examining the relationship between milk consumption and childhood obesity over time.

Researchers, including former postdoctoral fellow Tara Zeitoun and doctoral student Zheng Hao Chen, analysed data from the CHILD Cohort Study. This large, prospective study tracks health data from thousands of children from before birth through to adolescence.

Caregivers reported the type of milk consumed by children, including skim, one per cent, two per cent, and whole-fat milk. Researchers then assessed a range of outcomes at ages five and eight, including:

• Body mass index (BMI)
• Waist-to-height ratio
• Fat mass
• Preclinical and clinical obesity status
  
  
  

Key findings

Milk consumption was common among participants, with over 90 per cent of children consuming milk before the age of five. Among these:

• 24 per cent consumed whole-fat milk
• Approximately half consumed less than one cup per day
  

Despite relatively modest intake, notable differences emerged. Children who consumed whole milk at age five had significantly lower BMI at age eight. They also had 69 per cent lower odds of living with obesity compared with children who consumed skim milk.

In addition, researchers identified a broader pattern in which higher milk fat content was associated with more favourable adiposity profiles.

Expert insight

Kozeta Miliku, a professor of nutritional sciences at the University of Toronto’s Temerty Faculty of Medicine and a researcher at the Joannah and Brian Lawson Centre for Child Nutrition, emphasised the implications of these findings:

“The most important learning from this study is that whole milk was not associated with higher adiposity or obesity risks risk in children, and may even be linked to healthier growth patterns,”

She also highlighted the limitations of focusing narrowly on fat reduction:

“Switching to lower-fat milk has been about cutting fat in the diet, but that may miss the bigger picture,” says Miliku. “When we think about healthy growth, it’s important to consider the overall nutritional context. Removing fat does not automatically make skim milk a healthier choice for children.”

Implications for public health guidance

The findings raise important questions about long-standing public health recommendations. Prior to 2019, Health Canada advised that children transition from whole milk to reduced-fat milk from the age of two. Similarly, the Dietary Guidelines for Americans 2020–2025 supported reduced-fat dairy intake.

However, recent policy developments suggest a shift in thinking. In the United States, the Whole Milk for Healthy Kids Act has allowed full-fat milk to be reintroduced into school lunches, aligning with updated national guidance that is more permissive of full-fat dairy.

Possible biological mechanisms

While the study did not directly investigate underlying mechanisms, the researchers proposed several hypotheses:

• Milk fat may enhance satiety, potentially reducing the consumption of energy-dense, nutrient-poor foods
• It may influence overall energy balance
• It could play a role in metabolic pathways linked to growth and nutritional status
  

These potential explanations highlight the complexity of dietary patterns and suggest that focusing on single nutrients may overlook broader physiological effects.

The need for further research

Miliku noted that additional research is needed to better understand how milk fat may influence obesity risk and whether any protective effects persist into adolescence and adulthood.

With Canada’s 2019 dietary recommendations offering limited specific guidance on milk consumption for children, the study’s findings may help inform future discussions among parents, clinicians, and policymakers.

A broader view of healthy diets

Miliku concluded by reinforcing the importance of overall dietary quality:

“Whole fat milk can be part of a healthy diet and does not on its own increase obesity risk,” she adds. “And it’s important to think about the overall quality of the diet – the fruits and vegetables, whole grains and protein-rich foods they consume.”

Funding and support

The research was funded by the Canadian Institutes of Health Research and the Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto, supported through a donation by President’s Choice Children’s Charity.

CCH insights:

This interesting new research will hopefully be the trigger for governments and public health bodies to review and amend their outdated advice to choose low-fat dairy options instead of full-fat. The reductionist approach to nutrition, which considers food just in terms of calories and individual nutrients, is an oversimplification which does not help our understanding of the relationship between food and health. If the best food for children early in life is whole milk, why would it be beneficial for them to suddenly switch to low-fat milk at the age of 2?

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Visual Signals, Healthier Choices – Study Shows Colour-Coded Labels Influence Consumer Decisions

Key Takeaways:

• Colour-coded nutrition labels are more effective than traditional tables in guiding healthier food choices
  
• Red warning signals have a stronger behavioural impact than green positive cues, reflecting a “negative bias” in decision-making
  
• Simple visual labelling systems may support public health efforts to address obesity and poor dietary habits
  
  
  

The growing use of colour-coded nutrition labels

Colour coding on food packaging is becoming increasingly common, particularly as policymakers and manufacturers seek ways to guide consumers towards healthier dietary choices. A recent study conducted by researchers from SWPS University, the University of Wisconsin, and the University of Massachusetts suggests that these visual systems are significantly more effective than traditional nutritional tables.

The findings, published in Current Psychology, indicate that the effectiveness of colour-coded labels lies in how the brain processes signals of benefit and risk. Rather than requiring effortful interpretation, colour cues allow for rapid, intuitive judgements about a product’s healthfulness.

Obesity and the need for clearer nutritional guidance

According to the World Health Organization, overweight and obesity are major contributors to the development of chronic diseases. Over the past three decades, the proportion of children and adolescents in the United States who are overweight or at risk has more than tripled, reaching 37% and 34% respectively.

This trend has been driven largely by reduced physical activity and the increased consumption of foods high in fat and sugar. In response, clearer and more accessible nutritional labelling systems are being explored as tools to help people make more informed food choices.

How traffic light labelling works

One widely adopted approach is the traffic light labelling (TLL) system, originally developed in the United Kingdom. This system uses colours to indicate the levels of key nutrients such as calories, fat, saturated fat, sugar, and salt relative to recommended intake levels.

• Green indicates low levels, typically below 15% of the reference intake
  
• Red signals high levels, typically exceeding 25% of the reference intake

By translating numerical data into easily recognisable visual cues, the system allows consumers to assess a product’s nutritional profile at a glance.

“A picture is worth a thousand words”

The study aimed to explore the psychological mechanisms behind how people interpret these colour-coded labels.

“We decided to investigate the psychological mechanisms behind the reading of color-coded product labels. We drew on theories about verbal and visual information processing, as well as the perception of information in positive and negative contexts. We wanted to bridge a gap. Previous studies focused exclusively on consumer purchasing behavior and analyzed the extent to which color-coded labels influenced the choice of healthy food products,” says Professor Andrzej Falkowski, a business psychologist from the Institute of Psychology at SWPS University and the author of the study.

To examine this, researchers recruited 79 participants in the United States via Amazon Mechanical Turk. Participants were asked to evaluate products such as chicken noodle soup, ranch dressing, and peanut butter. These products were presented either with colour-coded nutrient indicators or with traditional text-based information.

Participants rated each product on a scale from 0 to 10, where 0 indicated “harmful” and 10 indicated “healthy”.

Faster processing, more intuitive decisions

The findings confirmed that visual information is easier for people to process than text. Colour cues are interpreted almost instantly by the brain, requiring minimal cognitive effort.

This enables individuals to make quick, instinctive judgements about whether a product is beneficial, even in time-pressured situations such as shopping. In contrast, traditional nutritional tables require more deliberate analysis, which may reduce their practical usefulness in real-world settings.

The power of red and the role of negative bias

One of the most striking findings was the disproportionately strong influence of the colour red. While green highlights positive attributes, red signals high levels of fat or sugar and prompts caution.

“This result also aligns with existing theories suggesting that negative events exert a stronger influence on behavior than positive ones. It is this ‘negative bias’ that makes color systems so effective. Red causes us to pause and reconsider a purchase,” Professor Falkowski emphasizes.

This asymmetry – where negative signals carry more weight than positive ones – was not observed with traditional labelling formats. Without clear visual cues, participants found it more difficult to distinguish between beneficial and harmful aspects of a product.

Improved consistency in consumer judgements

The study also found that colour-coded labels led to more consistent evaluations across participants. Because the visual system clearly differentiates between risks and benefits, individuals were better able to assess products in a uniform way.

By contrast, traditional descriptors such as “low fat” can be ambiguous and open to interpretation, particularly for those with limited nutritional knowledge. Colour coding, based on universally recognised traffic signals, offers a more accessible and intuitive alternative.

Implications for public health and obesity prevention

The researchers suggest that these findings have important implications for public health policy.

“Given the ongoing global challenges of obesity and poor dietary habits, color-coded labeling represents a simple yet impactful strategy for guiding healthier consumer choices,” Falkowski says.

By enhancing the visibility and clarity of nutritional information, colour-coded systems may encourage people to select healthier options. Over time, such behavioural shifts could contribute to improvements in population health.

The authors conclude that leveraging visual attention mechanisms and simplifying complex nutritional data may be a practical and scalable approach to addressing poor dietary habits and the global rise in obesity.

CCH insights:

The results of this study supports the use colour-coded labelling system as it enables quick health-based decision-making, with minimal time or effort required. And it also revealed that we use the system more to avoid unhealthy ‘red’ foods than to actively choose healthy ‘green’ foods. These outcomes emphasise the complex range of factors that contribute to shopping behaviours and decisions about what people eat. And if we want to encourage people to eat healthily, we need to understand these factors better and consider how best to influence them.

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AI Diet Recommendations for Adolescents Show Significant Nutritional Gaps, Study Finds

Key Takeaways:

• AI-generated diet plans consistently underestimated energy and key macronutrients required by adolescents
  
• Macronutrient balance was frequently misaligned with clinical guidelines, with lower carbohydrates and higher fat and protein levels
  
• Researchers caution that AI tools should not replace dietitians for adolescent nutrition without professional oversight
  
  
  

Growing demand for accessible nutrition support

Artificial intelligence is increasingly being used to support dietary planning, particularly in areas where access to qualified professionals is limited. However, a new study published in Frontiers in Nutrition raises important concerns about the reliability of these tools when applied to adolescents living with overweight or obesity.

Globally, adolescent overweight and obesity are rising at pace, affecting an estimated 390 million young people in 2022. In many regions, this now represents the most common form of malnutrition. Excess body weight in adolescence is associated with a range of adverse health outcomes, including type 2 diabetes, dyslipidaemia, hypertension, and sleep apnoea. It also increases the likelihood of obesity in adulthood and is linked to reduced quality of life.

Alongside physical health risks, adolescents may experience body image concerns and engage in harmful weight control behaviours such as self-induced vomiting or misuse of laxatives.

Dietary modification remains central to improving outcomes. Dietitians play a key role in delivering tailored, evidence-based nutrition plans aligned with established guidelines. However, limited access and workforce pressures can restrict the availability of personalised support.

AI tools, including chatbots and large language models, are increasingly being explored as a way to bridge this gap. While they can provide general dietary guidance, concerns remain about their accuracy, safety, and ability to replicate the individualised care provided by trained professionals.

Study design – comparing AI models with dietitian plans

To better understand the role of AI in adolescent nutrition, researchers conducted a direct comparison between AI-generated diet plans and those created by a dietitian.

Five AI systems were evaluated: ChatGPT-4o, Gemini 2.5 Pro, Claude 4.1, Bing Chat-5GPT, and Perplexity. Across two sessions, these models generated a total of 60 diet plans. Each plan covered three days and was based on four standardised adolescent profiles, including boys and girls living with overweight or obesity.

These AI-generated plans were compared with dietitian-designed one-day plans developed in line with established nutritional recommendations. The reference plans followed a macronutrient distribution of:

• 45–50 % carbohydrates
• 30–35 % fat
• 15–20 % protein

The researchers then analysed energy intake, macronutrient composition, micronutrient content, safety, and feasibility.

Consistent underestimation of energy and macronutrients

The findings revealed a clear and consistent pattern across all AI models. Diet plans generated by AI underestimated both total energy intake and key macronutrients when compared with dietitian-designed plans.

On average:

• Energy intake was lower by 695 kcal
• Protein intake was reduced by 20 g
• Fat intake was reduced by 16 g
• Carbohydrate intake was reduced by 115 g

Given the high energy demands of adolescence, such deficits could have meaningful clinical implications, particularly for growth, development, and overall health.

Macronutrient imbalance – a shift away from guidelines

Beyond total intake, the balance of macronutrients was also significantly altered in AI-generated plans.

Some AI models recommended:

• Protein intake up to 23.7 %
• Fat intake up to 44.5 %

Both values exceeded recommended levels. In contrast, carbohydrate intake accounted for no more than 36.3 %, falling below guideline recommendations.

Dietitian-designed plans, by comparison, remained closely aligned with clinical standards:

• Carbohydrates: 44 %–46 %
• Protein: 18 %–20 %
• Fat: 36 %–37 %

The authors noted:

“This pattern illustrates a systematic shift across all AI models to lower CHO, higher protein, and higher lipid meal structures, indicating that the macronutrient balance, not just the amount of gram-based nutrients, is significantly disrupted in AI-generated plans.”

Researchers suggest that AI models may be influenced by popular dietary trends, such as low-carbohydrate or ketogenic approaches, rather than evidence-based adolescent nutrition guidelines. This shift may pose risks during a critical period of physical and cognitive development.

Micronutrient variability raises additional concerns

In addition to macronutrient discrepancies, the study identified significant variability in micronutrient composition across AI-generated plans.

No model consistently matched the dietitian-designed reference diet across all nutrients. This inconsistency raises concerns about potential micronutrient deficiencies, which could further compromise adolescent health.

The findings suggest that AI tools currently lack the technical precision required to accurately estimate both macro- and micronutrient needs in personalised dietary plans for adolescents.

Strengths and limitations of the study

The study offers several notable strengths. It evaluated multiple AI models, allowing for robust comparison across systems. The use of three-day diet plans enabled identification of consistent patterns rather than isolated outputs. Dietitian-designed plans provided a credible clinical benchmark, and the inclusion of both macro- and micronutrient analysis allowed for a comprehensive assessment of dietary quality.

However, there are limitations to consider. The findings are specific to the models tested, which are rapidly evolving. Standardised adolescent profiles may not fully capture real-world complexity, limiting personalisation. The use of simulated scenarios rather than real-life behaviours may reduce ecological validity. Additionally, prompts were standardised and delivered in a single language, which may limit generalisability across populations.

Implications for clinical practice and AI use

The study highlights important risks associated with the unsupervised use of AI for adolescent dietary planning.

As the authors conclude:
“AI models have exhibited clinically significant deviations in diet plans for adolescents at both macro and micro levels.”

These deviations include consistently lower energy and carbohydrate recommendations compared with dietitian-designed plans.

Until these limitations are addressed, AI-generated diet plans should be used with caution. They may serve as a supplementary tool under professional supervision, but they are not currently a safe or reliable substitute for qualified dietary guidance in adolescents.

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Virtual Care Could Reduce Hospital Admissions in Severe Eating Disorders, Study Finds

Key Takeaways:

• A fully virtual, multidisciplinary treatment programme demonstrated strong engagement and positive clinical outcomes for adults living with severe eating disorders
  
• Structured online support during high-risk transition periods may help reduce hospital admissions and sustain recovery following discharge
  
• The model highlights the potential for digitally delivered, evidence-based care to bridge gaps between inpatient and community services
  
  
  

Evaluating a new approach to severe eating disorder care

An evaluation conducted by Oxford Health NHS Foundation Trust has examined whether intensive, fully virtual treatment can effectively support people living with severe eating disorders. The study, published in the Journal of Eating Disorders, focused on a service known as Step Care, developed through the HOPE Provider Collaborative.

Researchers describe this as the first prospective study to investigate a completely virtual, intensive treatment model using multidisciplinary enhanced cognitive behavioural therapy (CBT-E). The programme is designed to support individuals as they transition between inpatient treatment and community-based care.

This period of transition is widely recognised as a critical phase in recovery. People living with severe eating disorders face a particularly high risk of relapse shortly after discharge from hospital, especially within the first two months. The study therefore explored whether structured virtual support during this vulnerable period could help maintain recovery and reduce the likelihood of readmission.

Addressing gaps in existing services

Step Care was developed in response to well-documented challenges within eating disorder services. These include fragmented transitions between inpatient and community care, repeated hospital admissions, and limited access to intensive day treatment.

The service is delivered entirely online and brings together a multidisciplinary team, including professionals from psychology, nursing, dietetics, and art therapy. This integrated approach aims to provide consistent and coordinated care across different stages of recovery.

Step Care operates through three distinct pathways:

• Starting Well – for individuals at risk of requiring hospital admission, with a focus on prevention
  
• Staying Well – for those recently discharged from inpatient care, supporting early recovery
  
• Working towards Recovery – for individuals who have begun restoring weight and are focusing on longer-term recovery
  

Lucy Gardner, professional lead dietitian within the Step Care service, highlighted the importance of integrating nutritional support within a broader therapeutic framework:

“Nutrition plays a crucial role in mental health, yet access to the right level of dietetic support is often inconsistent,” she said. “Our model offers a clear, evidence-informed way to tailor dietetic input to individual need, delivering CBT-E virtually as part of a multidisciplinary team.”

Positive outcomes across key measures

The evaluation reported high levels of engagement and programme completion, including among individuals who had been living with eating disorders for an extended period.

Participants within the Starting Well pathway experienced significant improvements across several clinical and psychological measures, including:

• Body mass index (BMI)
  
• Eating disorder symptoms
  
• Psychosocial impairment
  
• Mood
  

Importantly, most individuals in this group were able to avoid hospital admission during the course of the programme.

For those in the Staying Well pathway, outcomes were also encouraging. Participants maintained their weight and experienced a reduction in the overall impact of their illness during a period typically associated with high relapse risk. Unplanned hospital admissions were reported to be rare, and many individuals were successfully supported in transitioning to community-based care.

Sharon Ryan, nurse lead within the Step Care service, emphasised the importance of this post-discharge phase:

“The weeks after leaving hospital are often the most fragile,” she said. “Step Care provides consistent multi-disciplinary support at that point, helping people maintain their recovery with support to feel safe and confident out of hospital.”

Implications for future care models

The findings suggest that intensive, evidence-based treatment for severe eating disorders can be delivered effectively in a virtual format. This approach may offer a valuable additional option for supporting individuals at home, particularly during critical transition periods.

Agnes Ayton, clinical lead for the HOPE Provider Collaborative, explained the underlying aim of the service:

“Step Care was designed to bridge the gap between inpatient and community services,” she said. “The findings show that intensive, evidence-based treatment can be delivered safely online, providing continuity of care at a time when people are most vulnerable.”

She also noted that both engagement and clinical outcomes were encouraging, including among individuals who had experienced long-term illness.

A complement to existing services

The authors conclude that virtual programmes such as Step Care may serve as an important complement to traditional inpatient and community services. By providing structured, multidisciplinary support during high-risk periods, these models have the potential to enhance continuity of care and support sustained recovery for people living with severe eating disorders.

As healthcare systems continue to explore digital and hybrid models of care, this study adds to a growing body of evidence suggesting that virtual interventions can play a meaningful role in complex, long-term conditions.

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Ultra-Processed Food Intake Linked to Higher Risk of Binge Eating in Adults Living with Obesity

Key Takeaways: 

• Higher consumption of ultra-processed foods was associated with increased symptoms of binge eating, bulimia-related behaviours, and emotional or uncontrolled eating in adults living with obesity.
  
• Individuals consuming the greatest proportion of ultra-processed foods had poorer overall diet quality and significantly lower protein intake.
  
• The findings suggest that addressing eating behaviour patterns alongside dietary composition may be important when supporting people living with obesity.
  
  
  

Rising consumption of ultra-processed foods during nutritional transition

A cross-sectional study published in Archives of Endocrinology and Metabolism has explored the relationship between ultra-processed food (UPF) intake and eating behaviour among adults living with obesity in São Paulo, Brazil.

The research was conducted against the backdrop of a broader nutritional transition that has been occurring in many developing countries. Economic development, demographic changes, cultural shifts, and evolving food systems have led to major transformations in dietary patterns.

While these changes have contributed to reductions in malnutrition and infectious diseases, they have also been accompanied by a marked increase in noncommunicable diseases such as obesity. A key driver of this shift has been the growing consumption of highly processed foods that are rich in fat, sugar, and refined ingredients.

Previous research has linked high consumption of ultra-processed foods to a range of adverse health outcomes, including obesity, overweight, type 2 diabetes, metabolic syndrome, cardiovascular and cerebrovascular disease, anxiety, depression, and increased all-cause mortality.

There is also emerging evidence that ultra-processed foods may influence eating behaviour itself. Some studies suggest that these foods may affect neurobiological and endocrine pathways that regulate appetite, potentially encouraging compulsive overeating.

Disordered eating patterns are also known to occur among individuals living with obesity. These patterns can complicate treatment and may reduce the effectiveness of weight management interventions. Understanding how ultra-processed food consumption interacts with eating behaviour is therefore clinically important.

Study design and participant characteristics

To explore this relationship, researchers recruited adults aged 18 to 59 years living with obesity, defined as a body mass index (BMI) of 30 kg/m² or higher. Participants were recruited both through a clinical obesity treatment service and via social media in São Paulo.

Several exclusion criteria were applied to minimise confounding factors. Individuals were excluded if they were pregnant or had diagnosed eating disorders, cardiac disease, renal disease, obesity caused by genetic disorders, or if they were taking antiepileptic medications or corticosteroids. People who smoked, misused alcohol, or were currently receiving pharmacological treatment for weight loss were also excluded.

Dietary intake was assessed using three non-consecutive 24-hour dietary recalls, including one weekend day. Researchers used the multiple-pass method, a structured interview approach designed to improve the accuracy of dietary reporting.

Foods reported in the recalls were categorised using the NOVA classification system, which groups foods according to the degree of industrial processing. Diet quality was assessed using the Diet Quality Index associated with the Digital Food Guide.

Eating behaviour was evaluated using validated self-administered online questionnaires:

• BITE (Bulimic Investigatory Test Edinburgh) – measuring symptoms and severity of bulimia and binge eating
  
• TFEQ-21 (Three-Factor Eating Questionnaire) – assessing cognitive restraint, emotional eating, and uncontrolled eating
  
• DEBQ (Dutch Eating Behaviour Questionnaire) – evaluating external eating, emotional eating, and restrained eating
  

Associations between ultra-processed food intake and eating behaviours were analysed using generalised linear models.

Prevalence of unusual eating behaviours

A total of 77 adults took part in the study. Of these participants, 78 percent were female.

The mean age of the group was 36 years, and the average BMI was 39.14 kg/m², corresponding to class II obesity.

Participants were divided into three groups based on the proportion of calories derived from ultra-processed foods:

• First tertile – less than 24.1 percent of calories from UPFs
  
• Second tertile – 24.1 percent to 35.4 percent
  
• Third tertile – more than 35.4 percent
  

Only around one quarter of participants displayed what researchers classified as normal eating behaviour.

In contrast:

• Approximately 52 percent exhibited unusual eating behaviour
  
• 23.4 percent reported binge eating
  

Symptoms consistent with unusual eating behaviours were observed across all tertiles of ultra-processed food consumption. However, participants in the highest UPF tertile showed significantly higher symptom scores on the BITE questionnaire compared with those in the lowest tertile.

Despite this difference in symptom scores, severity scores did not significantly differ between groups.

Overall, 40.3 percent of participants had clinically significant symptoms, while 13 percent were classified as having severe symptoms.

Eating style patterns associated with UPF intake

The study also examined several different eating style patterns.

Using the DEBQ questionnaire, researchers found that:

• 37.8 percent of participants had elevated external eating scores
  
• 36.5 percent had elevated emotional eating scores
  
• 25.7 percent had elevated restrained eating scores
  

Results from the TFEQ-21 questionnaire revealed:

• 52 percent had higher emotional eating
  
• 29.3 percent demonstrated increased cognitive restraint
  
• 18.7 percent showed higher uncontrolled eating
  

Higher intake of ultra-processed foods was positively associated with several problematic eating behaviours.

These included:

• Binge eating and bulimia-related symptoms measured by BITE
  
• Emotional eating
  
• External eating
  
• Uncontrolled eating
  

Together, these results suggest that people consuming larger amounts of ultra-processed foods were more likely to display eating behaviours characterised by reduced self-regulation and greater responsiveness to emotional or environmental triggers.

Diet quality and macronutrient intake

Across the overall study population, diet quality was classified as intermediate.

Participants in the highest ultra-processed food tertile had significantly lower diet quality scores than those in the lower tertiles.

Clear dietary differences were also observed between groups.

Participants in the lowest tertile consumed a higher proportion of unprocessed or minimally processed foods, whereas those in the highest tertile consumed more ultra-processed foods.

Interestingly, individuals in the first and second tertiles reported greater intake of processed culinary ingredients, such as oils or sugars used in cooking, compared with those in the third tertile.

The average macronutrient distribution across the entire sample was:

• 20 percent protein
  
• 48 percent carbohydrates
  
• 32 percent lipids
  

Participants in the highest UPF tertile had significantly lower protein intake than those in the other groups. Carbohydrate and lipid intake did not differ significantly between tertiles.

Median total daily caloric intake across the sample was 1,661 kcal. However, participants in the highest UPF tertile reported higher caloric intake than those in the second tertile.

Researchers suggested that lower protein intake associated with higher UPF consumption may influence satiety and appetite regulation, potentially contributing to overeating.

Clinical implications and study limitations

Overall, the study found that more than half of adults living with obesity exhibited unusual eating behaviours.

Higher intake of ultra-processed foods was associated with:

• Binge eating
  
• Bulimia-related symptoms
  
• Emotional eating
  
• External eating
  
• Uncontrolled eating
  

In addition, greater consumption of ultra-processed foods was linked to poorer diet quality and reduced protein intake.

These findings suggest that obesity treatment strategies may benefit from incorporating both dietary assessment and evaluation of eating behaviour patterns. Addressing behavioural drivers alongside nutritional composition could potentially improve weight management outcomes.

However, the authors emphasised several important limitations.

Because the study used a cross-sectional design, it cannot establish cause-and-effect relationships. The research was also conducted within a single clinical population in one urban centre, which may limit the generalisability of the findings.

In addition, dietary recalls and questionnaires were self-reported, which may introduce recall bias or social desirability bias. The relatively small sample size and predominantly female participant group may also affect the applicability of the results to broader populations.

Nevertheless, the study highlights the importance of considering ultra-processed food consumption within a wider behavioural and nutritional context when addressing obesity and supporting individuals in weight management.

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Camera Glasses and Biomarkers Aim to Transform How Diets Are Measured in Real Life

Key Takeaways:

• A UK-wide study is testing camera glasses alongside blood and urine biomarkers to produce more accurate dietary data than self-reported food diaries.
  
• Researchers say existing methods often fail to capture snacking, portion sizes, and mindless eating, limiting confidence in nutrition research.
  
• While the technology could improve objectivity, experts caution it may not be suitable for everyone, particularly people vulnerable to food anxiety or disordered eating.
  
  
  

A new approach to measuring what people really eat

A new UK trial is exploring whether wearable camera glasses, combined with biological markers, can provide a more reliable picture of what people eat and drink in their everyday lives. The study is led by the University of Reading and aims to address long-standing challenges in nutrition research, particularly the limitations of self-reported dietary data.

Registered nutritionist Christine Bailey explained that camera glasses build on existing clinical tools, such as food photographs used to support dietary assessment, by capturing intake automatically and in real time. According to the research team, this approach could significantly reduce reliance on memory and self-reporting, which are known to be imperfect.

Professor Julie Lovegrove, who is leading the trial, said: “Humans are not very reliable, especially when asked to remember snacking or portion sizes.”

The study is taking place against a backdrop of rising rates of excess weight in the UK. Analysis from the Health Foundation in 2025 indicated that more than 60 percent of UK adults are now classified as living with overweight or obesity, including around 28 percent living with obesity.

How the SODIAT-2 study works

The study, known as SODIAT-2, will recruit 133 adults from across the UK to take part in a five-week programme conducted entirely from their own homes.

For up to 12 days, participants will wear camera glasses that automatically take photographs of everything they eat and drink. During this period, they will also collect small blood and urine samples using easy-to-use kits that are returned by post for laboratory analysis. In addition, participants will complete short online questionnaires to report what they have eaten over recent days.

All participants will then follow a standardised test diet, consuming identical foods and drinks for three days. By combining wearable imagery, biological data, and self-reported information, the research team aims to identify the most accurate and practical way to study diets in real-world settings.

Why current dietary assessment methods fall short

One of the central problems in nutrition research is obtaining an accurate account of people’s habitual eating patterns. Dr Manfred Beckmann, lead principal investigator from the Department of Life Sciences at the Aberystwyth University, said: “One of the problems facing nutrition researchers is getting a true picture of people’s eating habits.”

Professor Lovegrove noted that current approaches typically rely on food diaries, questionnaires, and 24-hour dietary recalls. She described these tools as “not very reliable or accurate”, largely because they depend on memory and honest reporting.

Christine Bailey added: “Research consistently shows that self-reported food diaries are prone to recall bias, with people often misremembering what they ate, when they ate it, and portion sizes.”

Dr Michelle Weech, research fellow at the University of Reading and trial manager, said: “By automatically photographing everything they eat and drink and measuring substances the body makes from food in their blood and urine – we will have dietary data we can really rely on.”

Potential benefits for nutrition and public health research

Researchers believe that combining camera glasses with biomarkers could mark a step change in how diets are measured. More accurate dietary data would allow scientists to explore links between diet, health, and disease with greater confidence, including conditions such as type 2 diabetes, cardiovascular disease, and some cancers.

Bailey said wearable camera technology may “improve objectivity and offer valuable insight into eating behaviours and patterns” that are not always captured through written food records alone.

Wearable devices and AI-driven analysis like this are part of a much wider digital transformation of healthcare – a shift that professional training such as the College of Contemporary Health’s digital health CPD courses aims to help practitioners keep pace with.

Registered nutritional therapist Gemma Westfold, based in Windsor, highlighted how the technology could also shed light on behavioural aspects of eating. She said: “Humans can eat mindlessly on occasion, whilst scrolling on social media or while watching TV. When we are absorbed in other activities whilst eating, we can risk overeating, but more importantly, we can also switch off our ability to adequately digest and absorb the nutrients.”

Westfold added that using camera glasses for a short period could help identify behavioural patterns and support mindful eating, which she described as “key for all health conditions”.

Ethical considerations and concerns about over-monitoring

Despite the potential benefits, experts emphasise that such tools will not be appropriate for everyone. Bailey cautioned that increased monitoring could be counterproductive for some people: “For a small proportion of individuals, particularly those vulnerable to food anxiety or disordered eating, increased focus on food monitoring or quantity can become counterproductive and heighten preoccupation around eating.”

Westfold also raised concerns about how constant monitoring might affect therapeutic relationships. She said: “My line of work is based on relationships and making someone feel comfortable. Camera glasses could imply that as a nutritionist I do not trust my client, or believe what they are telling me.”

“It could make us feel like a food nanny, policing our clients and damage that relationship because they are under constant surveillance,” she added.

A collaborative UK research effort

The SODIAT-2 project brings together expertise from several UK institutions. Alongside the University of Reading and Aberystwyth University, partners include the University of Cambridge, which is leading blood sample analysis, and Imperial College London, which developed the camera glasses and is using artificial intelligence to analyse the images captured by the wearable devices.

Funded by the UK Medical Research Council and the Biotechnology and Biological Sciences Research Council, the project aims to improve how dietary intake is measured, providing stronger evidence to inform future nutrition guidance and public health policy.

CCH insight

Camera glasses and AI-analysed dietary data are a vivid example of how digital health tools – wearables, connected devices and machine learning – are moving into the heart of research and care. As these technologies become part of everyday practice, being equipped to understand and use them well is increasingly imperative for healthcare professionals. CCH’s CPD-accredited digital health short courses are designed to help practitioners build the practical skills and judgement to keep pace, quickly and flexibly around a clinical schedule.

Explore CCH’s Digital Health courses →

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New Cochrane Review Finds Intermittent Fasting Offers No Clear Weight Loss Advantage

Key Takeaways:

• A major Cochrane review found intermittent fasting did not lead to clinically meaningful weight loss compared with standard dietary advice or no structured diet.
  
• Evidence on safety and long-term outcomes remains limited due to small trials, inconsistent reporting, and short follow-up periods.
  
• Experts caution against overinterpreting social media claims and emphasise the need for individualised, long-term approaches to weight management.
  
  
  

Intermittent fasting under scrutiny

Intermittent fasting has become one of the most widely promoted dietary strategies for weight loss, often presented as a superior alternative to conventional calorie reduction. However, a new Cochrane review suggests that these claims may not be supported by robust evidence.

According to the review, intermittent fasting does not appear to deliver greater weight loss than standard dietary advice or even no specific diet plan. The findings challenge the widespread perception that structured fasting schedules offer a unique or clinically meaningful advantage for people who are overweight or living with obesity.

Obesity remains a global public health challenge

Obesity continues to represent a major public health concern worldwide and is now among the leading causes of death in high-income countries. Data from the World Health Organization show that global adult obesity rates have more than tripled since 1975. By 2022, an estimated 2.5 billion adults were classified as overweight, including around 890 million adults living with obesity.

Against this backdrop, intermittent fasting has gained substantial attention. Eating patterns such as alternate-day fasting, periodic fasting, and time-restricted feeding are widely promoted across social media platforms, often accompanied by claims of rapid weight loss and metabolic benefits.

What the review examined

To assess whether intermittent fasting truly offers an advantage, researchers analysed 22 randomised clinical trials involving 1,995 adults across North America, Europe, China, Australia, and South America. The studies evaluated a range of fasting approaches, including alternate-day fasting, periodic fasting, and time-restricted feeding. Most trials followed participants for up to one year.

When outcomes were compared with those of traditional dietary advice or no dietary intervention, intermittent fasting did not result in a clinically meaningful difference in weight loss. In practical terms, fasting-based approaches did not outperform more conventional strategies.

Limited evidence on safety and long-term outcomes

The review also highlighted substantial limitations in the available evidence. Reporting of side effects varied widely between studies, and many trials were relatively small. Inconsistent data collection made it difficult to draw firm conclusions about safety or potential long-term effects.

As a result, the overall certainty of the evidence was judged to be limited.

“Intermittent fasting just doesn’t seem to work for overweight or obese adults trying to lose weight,” said Luis Garegnani, lead author of the review from the Universidad Hospital Italiano de Buenos Aires Cochrane Associate Centre.

Social media enthusiasm outpaces the evidence

Garegnani also warned against the level of enthusiasm surrounding intermittent fasting online. “Intermittent fasting may be a reasonable option for some people, but the current evidence doesn’t justify the enthusiasm we see on social media.”

A further concern is the lack of long-term research. Few studies have examined outcomes beyond relatively short trial periods. “Obesity is a chronic condition. Short-term trials make it difficult to guide long-term decision-making for patients and clinicians,” Garegnani added.

Generalisability remains uncertain

Most of the studies included in the review primarily involved white participants living in high-income countries. Given that obesity prevalence is rising rapidly in low and middle-income countries, the findings may not fully reflect outcomes in more diverse global populations.

The authors note that responses to intermittent fasting could vary depending on sex, age, ethnic background, underlying health conditions, or existing eating behaviours and eating disorders.

Implications for clinical practice

Given the current state of evidence, the review’s authors advise caution when recommending intermittent fasting as a weight loss strategy.

“With the current evidence available, it’s hard to make a general recommendation,” said Eva Madrid, senior author from the Cochrane Evidence Synthesis Unit Iberoamerica. “Doctors will need to take a case-by-case approach when advising an overweight adult on losing weight.”

Overall, the findings reinforce the need for personalised, sustainable approaches to weight management rather than reliance on highly promoted dietary trends.

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Big Breakfast Study Shows Protein Reduces Appetite While Fibre Supports Gut Microbiome Health

 Key Takeaways: 

• Within a calorie-restricted big-breakfast eating pattern, a higher-protein breakfast improved satiety, while a higher-fibre breakfast produced more favourable gut microbiota and short-chain fatty acid profiles.
  
• Both dietary approaches led to clinically meaningful short-term weight loss and improvements in metabolic markers, but with distinct physiological effects.
  
• Fibre-rich breakfasts were linked to greater abundance of beneficial butyrate-producing bacteria, whereas protein-rich breakfasts may better support appetite control and dietary adherence.
  
  
  

Background and rationale

A recent study published in the British Journal of Nutrition examined how breakfast composition influences appetite regulation, energy balance and markers of gut microbiota health when consumed as part of a calorie-restricted, big-breakfast weight-loss diet.

There is growing evidence that meal timing, in addition to dietary composition, plays an important role in healthy weight management. Previous research has shown that people who eat earlier in the day tend to lose more weight than those who eat later. Morning calorie intake has also been associated with improved blood glucose control and lower hunger levels compared with evening intake.

Larger breakfasts have been shown to improve appetite control, while late eating patterns have been linked to increased hunger and greater fat storage. Despite public health advice emphasising the importance of breakfast for weight management, relatively little is known about what people typically consume in the morning. Moreover, evidence explaining how meal timing, calorie distribution and macronutrient composition interact to influence appetite remains limited.

Study design and dietary interventions

The researchers used a randomised crossover design to compare two calorie-restricted weight-loss diets with identical big-breakfast calorie distribution but differing macronutrient profiles. The primary outcomes were appetite, energy balance and gut microbiota composition and metabolites, rather than clinical gastrointestinal outcomes.

Healthy adults with overweight or obesity, aged 18–75 years, were recruited. The protocol consisted of:

• a four-day ad libitum diet
  
• a four-day maintenance diet
  
• a 28-day high-fibre weight-loss diet or high-protein weight-loss diet
  

These phases were separated by a washout period, with participants acting as their own controls. Resting metabolic rate was measured by indirect calorimetry during screening.

The maintenance diet provided 15% of energy from protein, 55% from carbohydrate and 30% from fat, and was set at 1.5 times resting metabolic rate to maintain body weight. Both weight-loss diets were set at 100% of resting metabolic rate to induce a calorie deficit.

Participants consumed three meals per day, with 45% of daily calories at breakfast, 20% at lunch and 35% in the evening. Lunch intake was allowed ad libitum within the provided calorie allowance.

• High-fibre weight-loss diet – 50% carbohydrate, 15% protein and 35% fat, incorporating both soluble and insoluble fibre sources such as lentils, fava beans, buckwheat and wheat bran.
  
• High-protein weight-loss diet – 30% protein, 35% carbohydrate and 35% fat, using foods including fish, poultry, eggs, red meat and dairy.
  
  
  

Measurements and outcomes assessed

Body density, waist and hip circumference, resting metabolic rate, total body water and blood pressure were measured. The thermic effect of food was assessed every 30 minutes for four hours after breakfast. Subjective appetite was evaluated using visual analogue scales.

Blood samples collected after an overnight fast were used to assess glucose, lipid profile and insulin as metabolic biomarkers rather than clinical disease outcomes. Insulin and glucose values were used to calculate HOMA-IR, HOMA-β and the insulin-to-glucose ratio. Total body water was measured using deuterium dilution, and faecal samples were collected to analyse gut microbiota composition.

Weight loss, energy expenditure and metabolic markers

Nineteen participants completed the study, including two women. The mean age was 57.4 years and the mean body mass index was 33.3 kg/m², indicating a predominantly male cohort and limiting generalisability to broader populations.

Energy intake did not differ significantly between the two weight-loss diets. Average weight loss was 4.87 kg with the high-fibre diet and 3.87 kg with the high-protein diet. Both diets significantly reduced fat mass and fat-free mass compared with the maintenance diet, although loss of fat-free mass was greater with the high-fibre approach.

Total body water was reduced following the high-fibre diet but not after the high-protein diet. Waist and hip circumferences, as well as waist-to-hip ratio, were significantly reduced with both weight-loss diets compared with the maintenance diet.

The high-protein breakfast maintained postprandial satiety, whereas the high-fibre breakfast was associated with reduced satiety after meals. Resting metabolic rate declined significantly after both weight-loss diets. The thermic effect of food was lower following the high-fibre diet than after the high-protein or maintenance meals.

Both weight-loss diets improved lipid profiles relative to baseline, with no significant difference between the two approaches. Fasting and postprandial glucose levels were reduced by around 10% following the high-fibre diet and by 8–7% following the high-protein diet compared with the maintenance diet. Fasting insulin, HOMA-IR and the insulin-to-glucose ratio were significantly lower after both weight-loss diets.

HOMA-β decreased significantly more after the high-protein diet than after the maintenance diet, with no significant change observed after the high-fibre diet.

Gut microbiota composition and short-chain fatty acids

Total bacterial load in faecal samples did not differ significantly between the two weight-loss diets. However, microbial diversity was lower following the high-protein diet compared with the high-fibre diet.

Distinct differences in microbiota composition were observed between the dietary patterns, although individual variation remained a major determinant of microbiota profiles and diet explained only part of the observed variability.

The high-fibre diet was associated with a greater abundance of butyrate-producing bacteria, including Anaerostipes hadrus, Roseburia faecis and Faecalibacterium prausnitzii. At the genus level, Bifidobacterium, Faecalibacterium and Roseburia were linked to the high-fibre diet, while Streptococcus was associated with the high-protein diet.

Total short-chain fatty acids and key faecal short-chain fatty acids, including acetate, butyrate and propionate, were significantly lower with the high-protein diet compared with the high-fibre diet.

Interpretation and clinical implications

Overall, the findings suggest that within a calorie-restricted big-breakfast eating pattern, breakfast composition meaningfully influences short-term weight loss, metabolic health markers and gut microbiota characteristics.

Both dietary approaches led to significant weight reduction and metabolic improvements. The high-protein breakfast produced greater satiation, which may support long-term adherence in some people. In contrast, the high-fibre breakfast promoted a more favourable gut microbiota profile and higher short-chain fatty acid production, which may be beneficial for long-term gut health, although this was inferred from microbial and metabolic markers rather than direct clinical outcomes.

The authors emphasised that longer-term studies are needed to determine whether these differences are sustained over time and how they translate into long-term health outcomes.

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Nutrition Gaps Raise Safety Concerns as Use of GLP-1 Weight Loss Drugs Accelerates

Key Takeaways:

• Many people prescribed GLP-1 weight loss medications receive little or no structured nutritional guidance, increasing the risk of preventable vitamin and mineral deficiencies and loss of muscle mass.
  
• New research highlights a lack of high-quality evidence on how diet quality, protein intake, and micronutrient intake are affected during treatment with drugs such as semaglutide and tirzepatide.
  
• Experts warn that without integrated nutritional care, the rapid expansion of GLP-1 drug use could undermine long-term health benefits despite effective weight loss.
  
  
  

Experts from University College London and the University of Cambridge are warning that many people prescribed newer weight loss medications may not be receiving sufficient nutritional guidance to support safe and sustainable weight loss. As a result, some individuals may face avoidable risks, including vitamin and mineral deficiencies and loss of lean body mass, particularly muscle.

The concerns arise from new research published in Obesity Reviews. Led by Dr Marie Spreckley of the University of Cambridge, the review identified limited high-quality evidence on how nutritional advice influences calorie intake, body composition, protein consumption, and patient experiences among people using these medications.

How GLP-1 weight loss drugs work

Drugs such as semaglutide and tirzepatide, sold under brand names including Ozempic, Wegovy, and Mounjaro, work by mimicking the action of glucagon-like peptide-1 (GLP-1). This hormone is released after eating and plays a role in regulating appetite and glucose metabolism. By enhancing feelings of fullness, reducing hunger, and dampening food cravings, these medications can substantially lower energy intake.

Studies suggest that calorie intake may fall by 16–39%, helping to explain why these drugs are highly effective for people living with obesity or overweight. However, the researchers note that there has been very little detailed study of how such reductions affect overall diet quality, protein intake, or micronutrient intake, including vitamins and minerals. Existing evidence indicates that lean body mass, including muscle tissue, can account for as much as 40% of total weight lost during treatment.

Experts warn of risks without nutrition support

Dr Adrian Brown, an NIHR Advanced Fellow at UCL’s Centre of Obesity Research and the study’s corresponding author, described how these medications alter eating behaviour.

“Obesity management medications work by suppressing appetite, increasing feelings of fullness, and altering eating behaviors, which often leads people to eat significantly less. This can be highly beneficial for individuals living with obesity, as it supports substantial weight loss and improves health outcomes.

“However, without appropriate nutritional guidance and support from healthcare professionals, there is a real risk that reduced food intake could compromise dietary quality, meaning people may not get enough protein, fiber, vitamins, and minerals essential for maintaining overall health.”

Without structured support, reduced intake may unintentionally lead to inadequate consumption of nutrients needed to preserve muscle mass, bone health, immune function, and overall physical resilience.

Public guidelines versus private use

Guidance from the National Institute for Health and Care Excellence recommends semaglutide for weight management only for people who meet strict eligibility criteria, such as a body mass index of at least 35.0 kg/m² alongside obesity-related comorbidities including type 2 diabetes or cardiovascular disease. When prescribed through the NHS, the medication is intended to be delivered as part of a comprehensive programme that includes dietary changes and increased physical activity.

In reality, most people currently using GLP-1 drugs in the UK obtain them outside the NHS. An estimated 1.5 million people are now using these medications, with around 95% accessing them through private providers. In these settings, ongoing nutritional advice and follow-up support are not always consistently offered.

Rising use outpaces nutrition guidance

Dr Spreckley, who works at the Medical Research Council Epidemiology Unit at the University of Cambridge, said nutritional care has not kept pace with the rapid uptake of these therapies.

“Use of GLP-1 receptor agonist therapies has increased rapidly in a very short period of time, but the nutritional support available to people using these medications has not kept pace. Many people receive little or no structured guidance on diet quality, protein intake, or micronutrient adequacy while experiencing marked appetite suppression.

“If nutritional care is not integrated alongside treatment, there’s a risk of replacing one set of health problems with another, through preventable nutritional deficiencies and largely avoidable loss of muscle mass. This represents a missed opportunity to support long-term health alongside weight loss.”

Low intakes of essential vitamins and minerals are associated with fatigue, impaired immune function, hair loss, and increased risk of osteoporosis. Loss of lean mass, most commonly muscle, can also raise the likelihood of weakness, injuries, and falls, particularly in older adults.

Limited research leaves major questions unanswered

The review identified only 12 studies that examined diet and nutritional outcomes alongside treatment with semaglutide or tirzepatide. These studies differed widely in how dietary advice was delivered and how nutritional outcomes were measured. Many lacked standardised methods and consistent reporting, making it difficult to draw firm conclusions about best practice.

Despite the rapid expansion of GLP-1 drug use, the researchers found little robust evidence to guide clinicians on how to support people nutritionally during treatment.

Lessons from bariatric nutrition care

Given the urgent need for practical guidance, the researchers suggest that interim lessons could be drawn from nutritional care used after bariatric surgery. Procedures such as gastric banding and gastric bypass lead to similar reductions in appetite and food intake.

Dr Cara Ruggiero, a co-author from the MRC Epidemiology Unit at the University of Cambridge, said established post-surgery principles could help address current gaps.

“While GLP-1 receptor agonists are increasingly used, there remains a clear gap in structured nutritional guidance. In the interim, we can draw on well-established post-bariatric nutrition principles. Our previous work highlights the importance of prioritizing nutrient-dense foods including high-quality protein intake, ideally distributed evenly across meals, to help preserve lean mass during periods of reduced appetite and rapid weight loss.”

Equipping healthcare professionals with the nutritional knowledge to guide patients safely through this kind of rapid weight loss is the focus of professional training such as the College of Contemporary Health’s Nutrition & Weight Management Essentials, a CPD-accredited online short course.

The available evidence did not support recommending strict low-fat diets alongside GLP-1 therapies. However, some observational studies reported that people using these medications consumed relatively high amounts of total and saturated fat, suggesting a potential need for personalised guidance that aligns with national dietary recommendations.

Meal timing was rarely examined in clinical trials. Nevertheless, the researchers note that eating smaller meals more frequently may help manage side effects such as nausea and improve tolerability, particularly during the early stages of treatment.

Studying real-world experiences

The research team also emphasised the importance of incorporating the perspectives of people using GLP-1 medications into future studies. Understanding what types of information and support individuals find most helpful could improve real-world care and long-term outcomes.

To address this, the team has launched AMPLIFY – Amplifying Meaningful Perspectives and Lived experiences of Incretin therapy use From diverse communitY voices. The project aims to explore how people experience next-generation weight loss medications in everyday life.

“These medications are transforming obesity care, but we know very little about how they shape people’s daily lives, including changes in appetite, eating patterns, well-being, and quality of life,” Dr Spreckley said. “That’s what we’ll explore, working in particular with people from communities historically under-represented in obesity research, to help shape the future of obesity treatment.”

The research was funded by the National Institute for Health and Care Research, with additional support from the Medical Research Council and the NIHR UCLH Biomedical Research Centre.

CCH insights:

GLP-1 medications are licensed for the treatment of diabetes and obesity and they should be used alongside diet and lifestyle advice to improve cardiometabolic health. However, they are now commonly known as ‘weight loss drugs’, implying their primary aim is for people to lose weight. But this is kind of missing the point – the weight loss outcome is one of the mediating effects of the drugs which leads to improved health. However, if weight loss is not accompanied by a move to a healthy diet, which provides adequate levels of essential nutrients, then health outcomes will be compromised, as highlighted by this study then health outcomes will be compromised, as highlighted by this study. Closing that gap starts with clinicians themselves being confident in the fundamentals: CCH’s Nutrition & Weight Management Essentials CPD short course (10 CPD hours, fully online, CPD-accredited) gives healthcare professionals a solid grounding in nutrition and weight management, including how to help patients meet their protein and micronutrient needs and preserve lean muscle during weight loss.

Explore Nutrition & Weight Management Essentials →

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Economic Survey Urges Tougher Action on Ultra-Processed Foods as Obesity and Heart Disease Risks Rise in India

Key Takeaways: 

• India’s Economic Survey links rising consumption of ultra-processed foods with increasing risks of obesity, heart disease, diabetes and mental health conditions.
  
• The survey recommends stronger policy measures, including higher taxes, stricter labelling and limits on advertising, particularly to protect children and young people.
  
• Rapid growth in ultra-processed food sales has coincided with a marked rise in overweight and obesity rates across adults and children in India.
  
  
  

Growing concern over ultra-processed food consumption

India’s latest Economic Survey has flagged the rapid growth in the consumption of ultra-processed foods and its implications for public health, recommending that the government consider increasing taxes on products that exceed defined nutritional thresholds, alongside a broader package of regulatory measures.

Tabled in Parliament, the survey draws attention to mounting evidence linking ultra-processed foods with poorer diet quality and higher risks of obesity, diabetes, heart disease and mental health conditions.

“There is a growing body of evidence on the impact of UPFs on human health, indicating that there should be no delay in implementing public health policies while further research continues to unfold,” the survey said.

What are ultra-processed foods?

Ultra-processed foods are industrially manufactured products that undergo multiple stages of processing and typically contain additives not commonly used in home cooking. These include preservatives, flavour enhancers, emulsifiers, colours and sweeteners.

They are generally high in fat, sugar and salt, while being low in fibre and essential nutrients. Common examples include packaged snacks, instant noodles, sugary drinks, reconstituted meat products and ready-to-eat meals.

Rising obesity across adults and children

The survey highlights concerning trends in overweight and obesity across India’s population. According to the National Family Health Survey 2019–21, 24 percent of women and 23 percent of men are living with overweight or obesity. Among women aged 15–49 years, 6.4 percent are living with obesity, compared with 4 percent of men.

Excess weight among children under five has also increased, rising from 2.1 percent in 2015–16 to 3.4 percent in 2019–21.

Looking ahead, the survey warns that the scale of the problem is likely to grow substantially. It cites estimates that more than 33 million children in India were living with obesity in 2020, with this figure projected to rise to 83 million by 2035.

A rapidly expanding market

India has emerged as one of the fastest-growing markets for ultra-processed foods. The survey notes that sales increased by more than 150 percent between 2009 and 2023, while retail sales rose from around $0.9 billion in 2006 to nearly $38 billion in 2019, representing a forty-fold increase.

“It is during the same period that obesity nearly doubled in both men and women,” the survey said.

Health and economic costs

Drawing on evidence from the Lancet Series on Ultra-Processed Foods and Human Health, the survey reports that high intake of ultra-processed foods is associated with obesity, heart disease, diabetes, respiratory conditions and mental health disorders.

Beyond health impacts, it notes substantial economic consequences, including higher healthcare spending, productivity losses and long-term fiscal pressures on the health system.

Marketing practices under scrutiny

The survey raises concerns about marketing strategies that encourage overconsumption of ultra-processed foods. These include the use of celebrity endorsements and messaging that presents such products as healthy options.

It highlights evidence showing that children and adolescents exposed to this advertising report greater desire and intention to consume ultra-processed foods.

“Policies have so far focused on advocacy to reduce consumption of foods high in added fats, sugar, and sodium, many of which are UPFs. However, improving diets cannot depend solely on consumer behaviour change; it will require coordinated policies across food systems that regulate UPF production, promote healthier and more sustainable diets and marketing,” the survey said.

Existing policies and regulatory gaps

The Economic Survey refers to the National Multi-sectoral Action Plan for non-communicable diseases, which set a target to halt the rise in obesity by 2025. Proposed measures include front-of-pack labelling and restrictions on advertising foods high in fat, sugar and salt.

It also cites the 2024 dietary guidelines issued by the Indian Council of Medical Research-National Institute of Nutrition, which explicitly warn against the consumption of ultra-processed foods.

However, the survey points to gaps in enforcement. While current advertising rules prohibit misleading claims, they do not define such claims using nutrient-based criteria, allowing companies to continue making broad or vague health and energy claims.

“This regulatory ambiguity highlights a critical policy gap that needs reform,” it said.

Proposed measures, including advertising restrictions

Building on recommendations made in last year’s Economic Survey, the latest report outlines a more detailed set of policy options. These include exploring a time-based ban on advertising ultra-processed foods from 6am to 11pm across all media platforms, including digital channels, and restricting sponsorship of school and college events by manufacturers.

On food labelling, the survey refers to a multi-sector statement endorsed by 29 organisations that supports warning labels rather than rating systems such as health stars. “Studies have shown that warning labels are the most effective option for discouraging UPF consumption,” it said.

The survey also suggests a nutrient-based tax approach, including applying the highest GST slab and an additional surcharge on ultra-processed foods that exceed thresholds for sugar, salt or fat. It proposes that revenues from such taxes be earmarked for public health programmes.

Call for a multi-pronged response

In conclusion, the Economic Survey reiterates that “a multi-pronged approach is necessary” to address the growing burden of diet-related disease. It calls on the Food Safety and Standards Authority of India to clearly define ultra-processed foods, set enforceable standards, strengthen labelling requirements and increase public awareness, particularly among young people.

Taken together, the recommendations reflect a shift towards more assertive regulation of ultra-processed foods as part of India’s wider strategy to curb obesity and reduce the long-term burden of non-communicable diseases.

CCH insights:

India has undergone a typical ‘nutrition transition’ over the past 20 years. Rapid economic growth and development, accompanied by globalisation of food manufacturing and mass access to online advertising, have lead to the adoption of many aspects of the western diet and the associated non-communicable diseases. We applaud the government’s plans to introduce a multi-sectoral action plan to reduce UPF consumption, but we know from other countries that these tend to have limited effects, and UPFs are just one part of a very complex puzzle of rising obesity rates.

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Dietary Melatonin Intake Linked to Lower Rates of Obesity and Depression

Key Takeaways: 

• Higher intake of melatonin from foods was associated with lower prevalence of obesity and depression in a large cohort of Brazilian university graduates.
  
• No significant associations were found between dietary melatonin intake and most cardiometabolic outcomes, including hypertension, metabolic syndrome or type 2 diabetes.
  
• The strongest associations were observed at moderate rather than very high levels of dietary melatonin intake, highlighting the complexity of diet–health relationships.
  
  
  

Background and study context

In a study published in the Journal of Human Nutrition and Dietetics, researchers examined the melatonin content of commonly consumed foods and explored how dietary melatonin intake was associated with a range of health outcomes. The analysis used cross-sectional data from a large cohort of Brazilian university graduates.

Melatonin is a hormone best known for regulating circadian rhythms and sleep–wake cycles. Beyond its endogenous production, melatonin is also present in both animal-based and plant-based foods. Experimental, observational and supplementation studies have linked melatonin to sleep regulation, mood, and metabolic health. Although the concentration of melatonin in foods is considerably lower than in supplements, diets rich in melatonin-containing foods have been shown to increase circulating melatonin levels within physiological ranges.

Previous evidence suggests that increasing melatonin intake through food may deliver doses that align more closely with natural circadian rhythms than pharmacological supplementation, potentially avoiding suprapharmacological exposure. On this basis, dietary melatonin has attracted interest as a marker of broader dietary patterns rather than as a direct therapeutic intervention.

Rationale for examining dietary melatonin

Obesity, depression and sleep disorders represent a substantial and growing public health burden. Prior observational and experimental studies have suggested that melatonin may have protective effects against inflammatory, metabolic and neurobehavioural outcomes. In addition, observational research has reported inverse associations between melatonin exposure and outcomes such as liver cancer incidence and all-cause mortality.

Despite this, relatively few studies have investigated habitual dietary melatonin intake or its associations with chronic conditions in adult populations. The present study aimed to address this gap by estimating melatonin intake from the diet and examining its relationship with multiple health outcomes in a large cohort.

Study design and population

The analysis drew on data from the Cohort of Universities of Minas Gerais (CUME+) study. CUME+ is an open, prospective cohort designed to assess the impact of dietary patterns and nutrition transition on noncommunicable diseases.

At baseline, participants completed a questionnaire administered in two parts. The first part collected information on sociodemographic characteristics, clinical history, lifestyle factors, anthropometric measures and self-reported morbidity.

Dietary assessment and estimation of melatonin intake

The second part of the baseline assessment included a food frequency questionnaire (FFQ), alongside questions on dietary habits, supplement use and cooking practices. Nutrient intake was estimated using established food composition tables.

Dietary melatonin content was estimated based on values reported in the scientific literature for individual food items. These estimates were then adjusted for total energy intake to account for differences in overall food consumption between participants.

Health outcomes and definitions

The health outcomes assessed in the study included obesity, obstructive sleep apnoea (OSA), hypertension, metabolic syndrome (MetS), type 2 diabetes (T2D), sleep duration, dyslipidaemia and depression.

Obesity was defined as a body mass index of 30 kg/m² or higher. Depression and OSA were identified based on self-reported medical diagnoses.

Dyslipidaemia was defined as the presence of at least one abnormal lipid parameter, including total cholesterol of 200 mg/dL or higher, triglycerides of 150 mg/dL or higher, high-density lipoprotein cholesterol below 40 mg/dL for males or below 50 mg/dL for females, or low-density lipoprotein cholesterol of 130 mg/dL or higher.

Cardiometabolic criteria

Metabolic syndrome was defined as central obesity plus any two of the following criteria: elevated triglycerides or treatment for hypertriglyceridaemia, reduced high-density lipoprotein cholesterol or treatment, elevated blood pressure or treatment for hypertension, and elevated fasting plasma glucose or a diagnosis of type 2 diabetes.

Hypertension was defined by the use of antihypertensive medication, a physician diagnosis, systolic blood pressure of 140 mmHg or higher, or diastolic blood pressure of 90 mmHg or higher. Type 2 diabetes was defined as a self-reported or physician diagnosis, use of antidiabetic medication, or fasting plasma glucose of 126 mg/dL or higher.

Sleep duration was categorised as short if participants reported sleeping less than seven hours per day, and normal if they reported seven hours or more per day.

Statistical analysis

Associations between dietary melatonin intake and health outcomes were estimated using logistic and Poisson regression models. Analyses were adjusted for a wide range of potential confounders, including age, sex, family income, binge drinking, smoking status, screen time, physical activity, medication use and sleep duration.

Participant characteristics

The final analysis included 8,320 participants with a mean age of 35.9 years. Most participants were female and reported that they did not smoke. Around one third of the cohort reported short sleep duration.

Dyslipidaemia, depression, obesity and hypertension were the most commonly reported health conditions within the study population.

Melatonin content of foods and dietary sources

Melatonin content was estimated for 119 of the 144 food items included in the FFQ. Reported concentrations ranged from 0 to 169.9 ng per gram of food. Mean daily melatonin intake was estimated at 25,554.7 ng and was significantly higher in males than in females.

The main dietary sources of melatonin in this population were coffee, lentils and beans, and rice. Higher melatonin intake was associated with lower intake of protein, cholesterol, and saturated and monounsaturated fats, alongside higher intake of fibre and carbohydrates. These patterns suggest that dietary melatonin intake may reflect broader differences in dietary composition.

Associations with health outcomes

After full adjustment, no significant associations were observed between dietary melatonin intake and obstructive sleep apnoea, hypertension, metabolic syndrome or type 2 diabetes. Initial associations with sleep duration and dyslipidaemia were attenuated after adjustment for age and sex and did not remain statistically significant.

In contrast, dietary melatonin intake showed an inverse association with both obesity and depression. Participants with daily melatonin intakes between approximately 14,900 and 34,400 ng were less likely to have obesity, while intakes between approximately 14,900 and 25,000 ng were associated with a lower likelihood of depression.

Notably, the strongest associations were observed in intermediate intake quintiles rather than among those with the highest melatonin intake, suggesting a non-linear relationship.

Conclusions and implications

In this cohort of Brazilian university graduates, higher dietary melatonin intake was associated with lower prevalence of obesity and depression, while no significant associations were identified for most other cardiometabolic outcomes or sleep duration.

The findings support existing hypotheses that dietary melatonin may play a role in metabolic and neurobehavioural regulation, potentially through anti-inflammatory pathways. However, the cross-sectional design of the study means that causal relationships cannot be established.

Further longitudinal and experimental research is needed to confirm these associations, determine whether dietary melatonin has an independent effect beyond overall dietary patterns, and clarify the biological mechanisms that may underlie the observed relationships.

CCH insights:

This is an interesting study, but it is difficult to see where this research leads to. If a person is suspected of having obesity, depression or some other condition due to a lack of melatonin, the solution is surely likely to be supplementation of melatonin, not an increase in melatonin-rich foods – because dietary changes are notoriously difficult to adhere to and when we are looking at just one nutrient, supplementation is a much easier option.

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Mice Study Connects Soybean Oil Intake to Liver Changes and Obesity

Key Takeaways: 

• New research in mice suggests that weight gain linked to soybean oil is driven by the metabolic products of linoleic acid rather than the oil itself.
  
• Genetically engineered mice resistant to obesity on a high-fat soybean oil diet produced fewer oxylipins and showed healthier liver function.
  
• Scientists believe differences in human genetics, enzyme levels, and metabolic stress may influence people’s susceptibility to soybean-oil-related metabolic effects.
  
  

A closer look at soybean oil and obesity

Soybean oil is the most widely consumed cooking oil in the United States and is a key ingredient in many processed foods. A growing body of research has associated high intake of soybean oil with weight gain in animals. A new study from the University of California, Riverside (UCR), published in the Journal of Lipid Research, provides fresh insight into why this may occur.

Researchers found that mice consuming a high-fat diet rich in soybean oil gained considerable weight. However, a separate group of genetically engineered mice did not, despite eating the same diet. These altered mice carried a slightly different version of a liver protein that affects the expression of hundreds of genes involved in fat metabolism.

The findings point toward a metabolic mechanism that may help explain differences in weight gain among individuals exposed to similar diets.

“This may be the first step toward understanding why some people gain weight more easily than others on a diet high in soybean oil,” said Sonia Deol, a UCR biomedical scientist and corresponding author of the study.

The role of HNF4α in fat metabolism

In humans, both forms of the liver protein known as HNF4α occur naturally. However, the alternative version typically appears only under certain conditions, such as chronic illness, prolonged fasting, metabolic stress, or alcoholic fatty liver disease. These variations, combined with factors such as age, sex, medication use, and underlying genetics, may influence how different people respond to high levels of soybean oil in their diet.

The UCR team believes that the altered form of HNF4α in genetically engineered mice changes how the body processes linoleic acid, a major fatty acid in soybean oil.

Building on earlier research

The study adds to previous findings from the same research group.

“We’ve known since our 2015 study that soybean oil is more obesogenic than coconut oil,” said Frances Sladek, a UCR professor of cell biology. “But now we have the clearest evidence yet that it’s not the oil itself, or even linoleic acid. It’s what the fat turns into inside the body.”

One of the major metabolic products of linoleic acid is a group of molecules called oxylipins. These compounds are associated with inflammation, fat accumulation, and other metabolic changes.

Oxylipins and their link to weight gain

Mice engineered to produce the alternative form of HNF4α showed markedly lower levels of oxylipins in their livers, despite consuming a high-fat soybean oil diet. They also had healthier liver profiles and enhanced mitochondrial function. Improved mitochondrial activity may help explain their resistance to weight gain.

Researchers pinpointed specific oxylipins derived from both linoleic acid and alpha-linolenic acid (another fatty acid found in soybean oil) that appeared necessary for weight gain in regular mice.

However, the picture is complex. Even though transgenic mice on a low-fat diet showed elevated oxylipin levels, they did not become obese. This suggests that while these molecules contribute to weight gain, they are unlikely to be the sole drivers. Other metabolic conditions must also play a role.

Genetic variation in enzyme levels

Further analysis revealed that the modified mice had far lower levels of two key enzyme families responsible for converting linoleic acid into oxylipins. These enzymes are highly conserved across all mammals, including humans, and can vary significantly from person to person based on factors such as genetics and diet.

The scientists also observed that oxylipin levels in the liver, rather than in the bloodstream, were correlated with body weight. This indicates that standard blood tests may not reliably detect early metabolic disturbances linked to diet.

Soybean oil’s rise in the American diet

Soybean oil consumption in the United States has risen dramatically over the past century. It has increased from around 2 percent of total daily calories to almost 10 percent. Although soybeans provide protein and the oil contains no cholesterol, modern diets deliver far greater quantities of linoleic acid than the body is likely evolved to manage.

In line with this, the UCR study found that soybean oil intake was associated with increased cholesterol levels in mice despite the oil containing no dietary cholesterol. This reflects the complex interplay between dietary fats and internal metabolic pathways.

Questions for future research

The team now aims to understand precisely how oxylipin formation leads to weight gain and whether oils with similarly high linoleic acid content – including corn, sunflower, and safflower oils – trigger comparable effects.

“Soybean oil isn’t inherently evil,” said Deol. “But the quantities in which we consume it is triggering pathways our bodies didn’t evolve to handle.”

Although the researchers have no plans for human trials, they hope the findings will inform future studies and guide public health policy.

“It took 100 years from the first observed link between chewing tobacco and cancer to get warning labels on cigarettes,” Sladek noted. “We hope it won’t take that long for society to recognise the link between excessive soybean oil consumption and negative health effects.”

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