In the trial, 39 adults with prior GLP-1-induced weight loss were randomized to usual care, a digital wellness application, or medically tailored meals at the time of GLP-1 cessation, continuing for 4 months.

Surveys showed that diet quality, perceived health, adherence, and satisfaction did not differ significantly by group, though some estimates suggested possible trends favoring the wellness application. Relative to the control group, the other groups experienced less weight gain. Over 4 months, participants in the control group gained an estimated 10.75% body weight, compared with 3.60% in the wellness application group and 3.58% in the medically tailored meals group.

“People invest significant time and effort in improving their health and achieving weight loss,” said corresponding author Kelseanna Hollis-Hansen, PhD, MPH, of Tufts University Food is Medicine Institute. “We need evidence-based strategies to support them if and when they discontinue GLP-1 medication, so they can maintain those gains and continue building long-term health, vitality, and well-being.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/osp4.70194

About the Journal
Obesity Science & Practice is an open access journal which offers prompt publication of high-quality original research related to all aspects of obesity and its comorbidities. The journal publishes papers of interest to researchers in academic, clinical, government and industry roles working to develop, test, and refine new medical, behavioral, dietary, pharmacologic and surgical approaches to treat obesity. The journal also publishes papers of interest to professionals engaged in the clinical management of obesity and its related comorbidities as well as individuals actively involved in the prevention of obesity at the local, regional, national and international level.

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The changes should benefit kids’ health, but may be challenging for schools to implement, according to a Stanford Medicine study.

“It’s easy to say, ‘Let’s remove ultra-processed foods from school meals,’ but school districts will likely face many challenges in implementing this policy,” said the study’s senior author, Anisha Patel, MD, professor of pediatrics at Stanford Medicine.

The research team’s work, to be published Sept. 28 in Public Health Nutrition, identified the top challenges that school food service directors expect to face. Budget constraints, limited staff, difficulty with food procurement and inadequate kitchen infrastructure were their biggest concerns, the study reports.

Lawmakers will likely need to direct more funding to school food budgets to help put the new legislation into practice, said lead study author Andrea Pedroza-Tobias, PhD. She was an instructor in pediatrics at Stanford Medicine when the study was conducted and is now an assistant professor in residence at the University of California, Irvine. “It’s an investment in the future of these kids. For many California children, two of the three meals they eat per day come from their schools.”

Evaluating barriers

The new California statute, AB 1264, aka the Real Food, Healthy Kids Act, requires elimination of certain ultra-processed foods considered harmful to children’s health from school menus by July 1, 2035. Several other states are considering similar legislation to reduce kids’ risk for obesity and related health problems, and the latest version of the Dietary Guidelines for Americans encourages people to consume fewer ultra-processed foods. The U.S. Department of Health and Human Services also recently announced a $32.5 million initiative to help school districts test how to deliver healthier food to students.

Ultra-processed foods can be defined in several ways. Researchers typically use the Nova classification: industrially created food with additives that enhance the item’s taste or convenience. The new California law uses a more specific definition, with more details about which food additives are prohibited and the balance of nutrients required. Heat-and-serve foods, flavored yogurt, frozen pizza and breakfast cereals are common examples of ultra-processed foods that currently appear on school menus.

The Stanford Medicine team, along with their colleagues, interviewed food service directors from 20 school districts in California’s San Joaquin Valley, an agricultural region with many low-income families whose students depend on school meals. In the interviews, the researchers asked participants to rate how much of a barrier they anticipated certain factors would be in eliminating ultra-processed menu items. The research team also asked open-ended questions to allow detailed responses about various challenges.

Fiscal and logistical challenges

One major category of challenge was fiscal. Eliminating ultra-processed foods — which are cheap and easy to heat and serve with minimal kitchen equipment — will strain budgets, food service directors said.

In 2021, California began providing meals to all K-12 public school students for free, regardless of families’ incomes. Federal and state funding reimburse districts around $4.60 per lunch served, and with more kids eating the meals, schools can now offer more and better menu choices.

“That has been something positive for school districts: Universal school meals increased participation, which brought more money to districts’ food service programs,” Pedroza-Tobias said.

But less-processed items will increase costs, likely outpacing existing budgets, and will make some foods harder to procure.

Amanda Harvey, director of nutrition services for the Fresno Unified School District, who was a member of the community advisory board for study, encountered these problems when her team eliminated products containing food dye from their menus.

For instance, it was difficult for her school district to purchase pickles made without green dye No. 5. “They’re pricey for pickles, and it can be quite challenging for our vendor to get them,” Harvey said. “So sometimes we have a shortage of pickles because of this food dye.”

Measures that reduce food costs may become harder for schools to use, the researchers noted. For instance, districts can purchase inexpensive commodity foods through the U.S. Department of Agriculture — such as raw chicken — which they may send to a food processor in exchange for easier-to-serve items such as chicken nuggets. “While this practice helps schools that don’t have the kitchen infrastructure for anything but ready-to-eat foods,” Pedroza-Tobias said, “it can inadvertently increase the amount of ultra-processed food on the menu.”

Food service directors also identified challenges related to school staffing and infrastructure. Many schools employ part-time staff to heat and serve foods; these individuals may not be trained to cook similar foods from scratch. Scratch cooking also takes more time, and moving staff from part-time to full-time jobs would require larger budgets for staff salaries and benefits.

Many schools lack fully equipped kitchens, and retrofits are difficult. Harvey’s team explored whether they could make sandwiches from scratch in some of the elementary schools in her district that have kitchens designed only for heat-and-serve meals. The local health department denied the request because the kitchens did not meet permitting standards for scratch cooking, she said.

“They said, ‘In order to get these 50 schools permitted, you would need to add new sinks, drains and hoods,’” Harvey said. This would have cost millions of dollars, which would have had to come from district infrastructure funds, not the cafeteria budget, she added. The Fresno school district has a central kitchen facility equipped for scratch cooking, so Harvey’s team opted to make sandwiches there instead, but smaller school districts may lack that option.

Student preferences may also be a challenge, although some food service directors reported that students like certain fresh menu items. Harvey’s district works with chefs in developing scratch-made items they can add to their menus. Students also appreciate having more options on the menu, she said, adding that when her district began offering menu choices at elementary schools, “We definitely saw a huge decrease in parent and student complaints.”

Strategies for change

The research team also heard about how some districts have addressed these concerns. Some have bridged fiscal gaps with grant funding, although participants said that “if they get this funding for one year, and are not sure they’ll have the same money next year, they don’t feel like they can make sustainable changes,” Pedroza-Tobias said. Applying for grants also requires staff time, putting smaller districts with fewer support staff members at a disadvantage.

One district succeeded in making most of its food from scratch, in part because the food service director was a chef who also had a background in nutrition. “They also did a lot of engagement with families and students to increase the acceptance of scratch-cooked meals,” Pedroza-Tobias said. “For instance, they had a junior chef competition where students submitted a recipe, and they selected some of these recipes to cook in the school kitchen.”

The researchers hope their findings will help legislators and school districts navigate the challenges of serving healthier school meals, she said. Patel added, “Moving from ultra-processed food to scratch cooking requires an upfront investment, but healthier school meals can pay off in the long term by preventing health care costs associated with diseases such as obesity, Type 2 diabetes and cardiovascular disease.”

Researchers from the Dolores Huerta Foundation, Cultiva la Salud, and the Nutrition Policy Institute of the University of California Agriculture and Natural Resources contributed to the study.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (grant P30DK092924); the National Heart, Lung, and Blood Institute (grant K24HL169841); Stanford’s Maternal and Child Health Research Institute; the William and Nancy Thompson Family Foundation; and Stanford Impact Labs.

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Drawing from a large retrospective dataset collected between 2016 and 2025 and leveraging extensive support from the South Carolina Clinical & Translational Research (SCTR) Institute, including biostatistical and regulatory guidance, clinical research infrastructure, laboratory services and Nexus data resources, Wagner and Borsum identified a strong association between profound vitamin D deficiency and earlier gestational age at delivery. Wagner credited SCTR’s comprehensive support as instrumental to the study’s success.

Without SCTR, we as a team would never have been able to accomplish what we did. It’s a phenomenal infrastructure and an incredible gift to any researcher.”

While the team has not yet established a definitive causal relationship, the findings add to a growing body of evidence suggesting that optimizing a patient’s vitamin D status before and during pregnancy may improve both maternal and fetal health outcomes.

Why vitamin D might matter in pregnancy

Vitamin D is a vital nutrient that is known primarily for helping the body to absorb calcium and maintain normal bone, muscle, nerve and immune health. But as Wagner and fellow MUSC basic and translational scientist Bruce W. Hollis, Ph.D., discovered in earlier randomized controlled trials, vitamin D acts as a building block for hormones that play an important role in pregnancy.

“Vitamin D impacts literally thousands of genes in the body,” said Wagner. Research suggests that vitamin D helps the development of the placenta, the temporary organ that grows in a pregnant woman to nourish the fetus. It also appears to help support healthy immune function and may reduce the risk of serious complications like preeclampsia and gestational diabetes.

One crucial function vitamin D seems to serve is helping the mother’s immune system to adapt to pregnancy. Because a baby in utero contains genetic material from both parents, the mother’s body must learn to tolerate something that is partially foreign. Vitamin D may help to regulate that process, supporting a healthy pregnancy and fetal development.

Beyond pregnancy: Vitamin D’s broader health role

According to Wagner and Borsum, vitamin D may shape long-term health more than immediate outcomes. Some of the effects of deficiency may begin early in development, altering how genes function and potentially influencing the baby’s health for years, or even decades, to come.

Even outside of pregnancy, vitamin D deficiency is far more common than many people realize. Modern lifestyles often limit time spent outdoors, reducing the body’s ability to produce vitamin D from sunlight. At the same time, food sources provide only a small portion of the vitamin D most people need. As a result, many individuals do not reach healthy vitamin D levels.

Some groups are at higher risk for deficiency, including people with darker skin, those who work indoors, individuals who regularly use sunscreen and people with limited mobility or chronic health conditions that keep them inside.

The team stresses that sunscreen remains essential for protecting against skin cancer. However, people with limited sun exposure may benefit from discussing their vitamin D levels and potential supplementation with their health care provider.

“We have to balance the importance of sunshine and vitamin D with the risk of skin cancer,” said Borsum. “But this further emphasizes the vast role vitamin D plays.”

Emerging research suggests that vitamin D helps to regulate thousands of genes throughout the body, particularly those involved in immune function. Low levels have been associated with autoimmune diseases such as lupus and multiple sclerosis as well as certain cancers.

Challenges of turning research into practice and future directions

Despite growing evidence supporting the importance of vitamin D, Wagner said changing clinical practice can be difficult. Unlike prescription medications, vitamin D is inexpensive, widely available and cannot be patented, which means there is less commercial impetus to promote its use. “No one’s going to make billions off of this,” Wagner explained. “So, it then becomes a public health issue.”

As researchers continue to build evidence about the role of vitamin D in pregnancy and overall health, Wagner and Borsum see the next steps as educating health care providers, continuing to investigate vitamin D’s long-term effects and increasing public awareness.

“We learn about vitamin D’s role in bone health, but no one teaches us about the various roles in pregnancy, especially this relationship with preterm birth we are uncovering,” Borsum explained. “I always tell my friends and family who are thinking about becoming pregnant to make sure they are sufficient!”

As researchers continue to uncover vitamin D’s far-reaching effects, Wagner and Borsum hope the growing body of evidence will encourage more conversations about a nutrient that may shape health across generations.

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The National Institutes of Health and American Heart Association-supported study, described July 27 in the journal Obesity, represents the latest findings from ongoing research led by Daisy Duan, M.D., an assistant professor of medicine and the study’s primary author, on how time-restricted eating without caloric restriction may change the body’s weight and other functions.

Other studies on time-restricted eating, Duan says, examined it with respect to either intentional or unintentional calorie restriction. The new study, she said, focused on whether restricted meal timing while ensuring consistent calorie intake would change other obesity-related factors, such as eating behavior, inflammation, and appetite hormones.

More than 100 million adults with obesity and 115 million adults with prediabetes in the United States are at an increased risk of cardiometabolic complications, such as high blood pressure, heart attack and stroke, and these numbers are expected to rise. Intermittent fasting — an umbrella term for structured patterns of fasting and eating that focus on changing when a person eats instead of reducing calories or avoiding certain foods — has broadly been linked to weight loss and may benefit individuals with either or both conditions.

Broadening clinical understanding of time-based dietary interventions, Duan’s team investigated whether health benefits linked to intermittent fasting and other time-based dietary plans are caused by weight loss alone or if other biological mechanisms are also involved.

In the 12-week study, a predominantly female (92%) and Black (92%) cohort of adults (ages 18–69 years) with obesity and prediabetes or diet-controlled type 2 diabetes were randomly assigned to a 10-hour time-restricted eating (TRE) schedule (19 adults) or a 16-hour usual eating pattern (UEP) schedule (20 adults).

All study participants received the same adapted Dietary Approaches to Stop Hypertension (DASH) diet — a heart-healthy diet that emphasizes limiting red meats, high-fat foods, sugar and salt intake — and the caloric intake of each person was personalized to maintain their starting weights.

All meals were prepared and provided by the Johns Hopkins ProHealth Clinical Research Unit in Baltimore, Maryland, under the supervision of research dieticians.

Before and after the study, participants provided fasting blood samples that were used to measure inflammation markers and appetite hormone levels and completed a Three-Factor Eating Questionnaire — a tool that captures how a person interacts with and thinks about food. The researchers used both to track and compare physical and psychological changes over time.

Notably, at the study’s conclusion, the researchers observed similar and modest weight loss in both the group that followed the time-restricted eating (median 2.7%) and the usual eating pattern (median 2.5%) meal schedules.

At the end of the study, participants from both groups reported greater restraint around food, a reduced tendency to eat when stressed, and a lower susceptibility to hunger overall after the study’s conclusion. However, the appetite hormones (ghrelin and leptin) and the inflammation markers (C reactive protein, cortisol and sRAGE) were comparable between TRE and UEP participants.

“We saw that people who followed a 10-hour time-restricted eating schedule lost weight and positively changed their eating habits without calorie restriction,” says Duan. “But we did not identify any unique, body-wide health benefits linked to the dietary strategy beyond that.”

Future directions for the research include exploring how time-restricted eating shapes weight loss maintenance in people who have successfully lost weight through other interventions, such as via GLP-1 receptor agonists.

In addition to Daisy Duan, researchers who authored the study are Susan Carnell, Scott J. Pilla, Stephanie T. Chung, Jeanne M. Clark and Nisa M. Maruthur.

The study authors have the following conflict-of-interest disclosures to share: Duan serves as a consultant for Rhythm Pharmaceuticals and receives honoraria from the American Diabetes Association. Carnell receives grant funding from Eli Lilly and Company. Clark participates on a Data Safety Monitoring Board for Eli Lilly and Company and serves on the advisory board of Novo Nordisk. Maruthur receives royalties from UpToDate. The other authors declare no conflicts of interest.

The study was supported by the National Institutes of Health (R03DK144349, R01DK126825, R01DK139324 and K23DK133690) and the American Heart Association (17SFRN33590069).

DOI: 10.1002/oby.70270

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Six of the 19 members of the Scientific Advisory Committee on Nutrition (SACN) have conflicts of interest that its own rules deem ‘significant’ and should preclude them from being appointed, reports freelance journalist Sophie Borland.

SACN is a powerful group of experts that provides nutritional advice to the government on issues including artificial sweeteners, ultra-processed foods, and dietary guidelines for babies, young children and the over 65s. Their reports are used to inform national policy as well as NHS healthy eating recommendations.

One SACN adviser was until recently a long-serving senior member of the British Nutrition Foundation – a charity funded by firms including Coca Cola, Nestlé, and Mondelez, parent company of Cadbury’s.

Four other advisors have received research funding from the meat, dairy and nut industries, including one who has also taken a grant from Danone, the world’s largest yoghurt maker.

Today’s figures come two years after an initial investigation by The BMJ revealed that more than half of SACN’s advisors at the time had ties to the food industry.

The BMJ’s findings were highlighted in a major House of Lords report into diet and obesity and, last September, SACN updated its code of practice to state that “individuals are only eligible to be SACN members if they do not hold significant interests in relation to the food, drink, diet or supplement industry.”

A spokesperson for the Department of Health and Social Care (DHSC) explained that current SACN advisors must not take on any new interests that are “at odds” with the updated policy, and can only be reappointed if they meet the updated policy.

“All SACN members are due to meet the new interests policy within the next two years,” they added. “In the meantime, existing members with any significant interests are excluded from relevant discussions.”

But experts argue that scientists with financial ties to the food industry should not be involved in influencing policy and have called for the conflicts to be removed “immediately”. Some said that at least some previous financial relationships should also rule out involvement even once lapsed.

The BMJ analysed SACN’s latest register of interests, published in June 2026, and found that six of the members declared “significant” conflicts of interest that the committee itself highlights with a note next to the declaration.

A further three were recorded by SACN as having “relevant” interests to the food industry, which are considered less serious. This includes receiving research funding from or undertaking consultancy work with smaller food firms.

The BMJ also identified other potentially serious conflicts of interests not flagged by SACN. This includes one advisor who is a “distinguished fellow” of the American Society for Nutrition, an organisation funded by organisations including Mondelez, Nestle and Pepsico. Five other members are on the UK’s Nutrition Society, which receives sponsorship from Pepsico for conferences.

Chris van Tulleken, a professor of infection and global health at University College London and author of the book Ultra-Processed People, says: “This is not an allegation that individual members are acting improperly or deliberately influencing SACN’s conclusions. However, research shows that conflicts of interest do affect beliefs and behaviour, as well as eroding trust in decision-making and advice.”

He adds: “The problem is structural. SACN’s authority depends on its independence, and these interests weaken public confidence and confer credibility on commercial actors that harm human health and scientific integrity.”

Rob Percival, head of policy at food and farming charity the Soil Association, welcomed the tightening of SACN’s policy but said it needs to be applied robustly. “I would suggest that the conflicted members of SACN need to leave the committee immediately and there needs to be open recruitment for non-conflicted members to stand in their place through an appropriate process.”

SACN’s updated rules allow members to stay on if they drop their significant conflict of interest, regardless of how long they had been working with the food industry beforehand or how much money they received.

But Percival argues that “once a scientist has received funding in relation to a product or is in a financial relationship with a manufacturer they should not be involved in policy making or regulatory decisions that pertain to that product.”

The BMJ’s findings come as SACN is working on recommendations on nutrition and maternal health, vitamin D requirements, and infant feeding. At its June meeting it considered whether to make new recommendations on topics including ultra-processed foods, artificial sweeteners, protein intake, and wholegrain foods, and agreed to keep these on its “watching brief.”

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Funded by the Medical Research Council, the research is the first of its kind in the UK, and the findings reveal families are falling into unmanageable debt, reluctantly adopting feeding practices they know could harm their babies, and even taking formula from shops without paying as a last resort.

Exploring the experiences of 281 struggling parents through surveys and interviews, the study found that financial strain has triggered a severe crisis of anxiety, guilt, and isolation among parents.

Nearly every parent surveyed reported damage to their mental health. For some, the distress is so severe it has led to feelings of regret over having a baby. One participant shared: “Sometimes I regret having this baby and I feel awful about having those thoughts because I love her so much but I’m not a good mum to her.”

Driven by the high cost of formula, parents reported a range of drastic coping strategies:

• Compromised infant safety: Almost 40% of parents resorted to unsafe feeding practices, including reusing leftover formula, watering down formula, and reducing sterilisation.
• Extreme personal sacrifices: More than a third of parents (37%) left their homes unheated, 43% fell behind on bills, and nearly half (47%) took on debts that are difficult to repay. For 21% of mothers, it meant cutting maternity leave short to return to work early.
• Cheaper alternatives: Nearly half of the families (48%) introduced solid foods before their baby was ready, or switched to cheaper milk intended for older babies (45%).
• Acts of last resort: Facing absolute desperation, 10% of parents reported taking formula from a shop without paying.

Amy Brown, a Professor of Public Health at Swansea University, who led the study, said: “Infant formula prices were high before the cost-of-living crisis, and rose up to 45% between 2021 and 2023. A recent report by the Competition and Markets Authority identified excessive price rises for infant formula and exceptionally high profit margins of between 50-75%.

“This is a significant issue because infant formula is not a discretionary product. When infants are not breastfed or not fully breastfed, infant formula is needed to support growth and development. The worrying and rapid changes in the formula market coincide with the broader cost-of-living crisis, with many families already struggling to get by.”

More than half of babies in the UK receive formula during their first week, with 88% receiving some formula milk by six months of age. Low-income households are far more likely to use formula to feed their babies. Globally, fewer than half of infants are exclusively breastfed for the first six months of life.

Many mothers featured in the study had wanted to breastfeed their baby but had been unable to get the support to do so. This left them feeling particularly guilty, anxious and let down twice when they then struggled to afford the formula their baby needed.

Professor Brown added: “We expected our research to reflect some of the experiences we had been seeing in the media but were shocked at how many families it was affecting and how deeply.

“Mothers described how the lack of support and action on the issue had left them feeling heartbroken and feeling like they had failed. Some attributed it to causing postnatal depression, especially when they really wanted to breastfeed and felt as if they had let their baby down twice.

“Our research shows that we urgently need more holistic support across infant feeding that both ensures more women who want to breastfeed can do so, and those who are using formula have reliable access to affordable products that put babies and parents first. This would help to ensure greater infant food security, protecting both infant health and nutrition but wider development and family wellbeing.”

Published in Maternal and Child Nutrition, the study ‘Infant formula affordability negatively impacts parental wellbeing, financial security and safe feeding practices in the UK’v was carried out in collaboration with Cardiff Metropolitan University, University of Hertfordshire, First Steps Nutrition Trust, Leicester Mammas, the Independent Food Aid Network, and the Newcastle upon Tyne Hospitals NHS Foundation Trust.

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More weight loss is also generally accompanied by greater harms including stomach and bowel symptoms, fatigue, and loss of lean (muscle) mass – and improvements are not sustained after stopping treatment.

Several drugs for adults with overweight or obesity produce substantial weight loss, but most have not been compared directly in head-to-head trials, leaving uncertainty about the broader balance of benefits and harms.

To address this, researchers searched scientific databases for randomised controlled trials comparing one or more drugs with lifestyle changes, placebo, or another drug.

They found 262 eligible trials involving 99,791 participants (average age 49; 63% female; average BMI 35) that evaluated 19 currently available and emerging obesity drugs with follow-up from 12 to 172 weeks.

Benefits included changes in body weight, fat mass, and quality of life, while potential harms included changes in lean mass, gastrointestinal adverse events, gallbladder related disorders and fatigue.

The trials were of varying quality, but the researchers were able to assess the certainty of evidence using the recognised GRADE system.

Compared with lifestyle changes alone, the largest weight loss after one year was with tirzepatide (14.9%) and CagriSema (14.8%), followed by oral semaglutide (10.9%), orforglipron (9.9%), subcutaneous semaglutide (9.8%), and phentermine-topiramate (8.1%).

Emerging drugs – including retatrutide, ecnoglutide, and mazdutide – showed large effects on weight loss but are supported by low or very low certainty evidence.

Greater weight loss was consistently accompanied by higher rates of side effects and treatment discontinuation, which the authors say indicates a clear benefit-harm trade-off.

Tirzepatide reduced fat mass the most (by 25.7%) but also lean mass the most (8.3%). Subcutaneous semaglutide was the only drug associated with a reduced risk of death from any cause (19%), heart attack (28%), and heart failure (57%). Tirzepatide also reduced heart failure risk by 51%.

No drug convincingly reduced kidney failure or showed clinically important improvements in quality of life.

The authors acknowledge that most trials had relatively short follow-up, limiting conclusions about long term safety, quality of life, and effects on heart and kidney health. In addition, evidence for several newer drugs was sparse and of low certainty, and trial populations may not fully represent real world patients.

However, they say this review provides a comprehensive and up-to-date comparison of currently available and emerging obesity drugs across a broad set of outcomes important to patients, clinicians, and policymakers.

They conclude: “Treatment decisions for obesity should be individualised, balancing expected benefits, harms, treatment burden, costs, availability, and patient preferences.”

This study represents an important step in providing comparative information to inform patient-clinician discussions about obesity drugs in this rapidly evolving landscape of treatment options, say researchers in a linked editorial.

And they suggest future studies that incorporate individual characteristics, as well as long term outcomes, such as mortality, should provide additional data to inform individualised decision making.

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A modelling study found that using vegetables, beans and eggs instead of processed and unprocessed meat and dairy could deliver environmental and health benefits without increasing the overall cost of diets.

Experts say making healthier, more sustainable food options more accessible and convenient could help accelerate progress towards climate and public health goals.

Scientists from the University of Edinburgh assessed 33 different ways of meeting the UK Climate Change Committee’s recommendations for sustainable diets.

The research examined the impact of dietary changes on greenhouse gas emissions, land and water use, nutrient intake, diet costs and health conditions including type 2 diabetes and cardiovascular disease.

Across all scenarios modelled, reductions in meat and dairy consumption were associated with improvements in health outcomes and environmental indicators, the study found.

Researchers found that even small, gram-for-gram substitutions in everyday meals such as sandwiches and pasta dishes could produce meaningful long-term benefits for both people and the planet.

Replacing some meat with a variety of alternative foods did not adversely affect nutrient intake. While lower dairy consumption could considerably reduce iodine intake among some groups, this could be addressed through iodine fortification of plant-based dairy alternatives, experts say.

The findings challenge perceptions that more sustainable diets are necessarily more expensive, with most dietary changes having little impact on overall food costs.

The study suggests that targeting people who consume the largest amounts of processed and unprocessed red meat could deliver the greatest benefits. Rather than reducing consumption evenly across the population, helping high consumers move towards lower intakes was predicted to prevent almost 60,000 cases of type 2 diabetes over a 10-year period while also achieving greater environmental gains.

All modelled dietary pathways resulted in lower greenhouse gas emissions as well as reductions in land and water use.

The research also found that emissions associated with food consumption by adults in Scotland, including the carbon footprint of imported food, exceed emissions from agricultural production in Scotland. The findings highlight the importance of dietary change alongside efforts to reduce emissions from agriculture.

Dr Joe Kennedy, from the University of Edinburgh’s Division of Global Agriculture and Food Systems, said: “The findings show that modest, realistic dietary changes, when scaled across a population, can deliver substantial benefits to people and the planet. Making healthier, sustainable options more available and convenient will be key to enabling such change.”

The study was carried out in collaboration with colleagues from the University of Oxford and Food Standards Scotland.

The study is published in the journal Nature Food: https://www.nature.com/articles/s43016-026-01384-3 [URL will become active after embargo lifts]. It was funded by the Wellcome Trust and Food Standards Scotland.

For further information, please contact: Guy Atkinson, Press and PR Office, 07816 392904, guy.atkinson@ed.ac.uk

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The research findings have been published in the renowned journal Nature Communications: Dual human milk oligosaccharide-fibre utilisation is a selection cue for the weaning gut microbiome.

“We have long known that breastfeeding is important for infants’ health. What is new is that we can now explain how the sugars in breast milk, HMOs, also help to select the bacterial communities associated with a healthy gut microbiota later in life. This underlines the importance of combining breastfeeding with solid baby food at this stage of child’s development,” says Maher Abou Hachem, professor at DTU Bioengineering and senior author of the study.

The study reveals a previously unknown mechanism that gives specific gut bacteria an advantage in the competition to inhabit the infant’s gut during weaning, because they are endowed to metabolise both HMOs from breast milk and fibres from plant-based foods.

The results suggest that the weaning period is a crucial developmental window, during which the combination of breast milk and solid food, promotes the maturation of the gut microbiota to the adult-like community that is maintained during adulthood. On the long term, this new knowledge may contribute to the development of better nutritional solutions for infants and strengthen our understanding of how early nutrition affects health later in life.

“The findings are important in daily clinical practice as an additional justification to the already strong emphasis on promoting the mother’s own milk production and breastfeeding when infants and young children are admitted to a neonatal intensive care unit due to preterm birth or critical illness,” says Consultant Lise Aunsholt from the Department of Intensive Care for Newborns and Young Children at Rigshospitalet.

“It is encouraging to know that when we advise a mother to continue breastfeeding after discharge – and for as long as possible during the transition to solid foods – this will potentially have a positive impact on the child for the rest of their life,” she says.

According to the researchers, the study shows that breast milk not only supports the infant’s nutrition during infancy but also helps to select the bacteria that become a permanent part of the gut microbiota later in life.

Close collaboration between DTU and TUH

The study was carried out in close collaboration between researchers from DTU and clinical research environments at the Technical University Hospital (TUH – see fact box)

The researchers analysed the changes in bacteria and their genes over the weaning phase. This gave them insight into which bacteria were present and what the bacteria were doing. At the same time, the researcherscultured the bacteria in the laboratory under conditions resembling the environment in the human gut. In this way, they were able to identify the bacteria capable of metabolising both HMOs from breast milk and dietary fibres from solid food.

“The collaboration between DTU’s technological and biological expertise and the clinical environments at TUH has been crucial in enabling us to link knowledge about the bacteria’s functions to the development of the gut microbiota in children. This provides unique insight into how early dietary choices affect health later in life,” says Maher Abou Hachem.

Could pave the way for new nutritional solutions

The researchers believe that this new knowledge sets the stage for the development of future nutritional solutions for infants and targeted interventions that support the establishment of healthy gut bacterial community.

The results also suggest that the weaning period may be a crucial time for preventive measures against diseases that are later in life associated with disturbances in the gut microbiota.

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Robert Fletcher of the University of Cambridge, Health Data Research UK and The George Institute, and study co-lead says:

“Levels of obesity in England have worsened since the pandemic, with nearly one in three people now affected.

“We’re also seeing large disparities across the country: the percentage of adults affected by obesity in northeast England is six times higher than in central London. Differences on this scale are rarely seen in other areas of public health. The rise in new cases among young adults of childbearing age is especially concerning. Beyond the implications for their own long-term health, obesity is associated with infertility, adverse pregnancy outcomes, and child obesity, which may perpetuate intergenerational cycles of health inequality.”

Key findings:

Obesity is rising: Rates of new obesity cases increased overall by 4% in 2025 compared with before the COVID-19 pandemic.

Young adults hit hardest: The largest increases over time were seen in younger adults. Rates of new obesity cases rose by almost 20% in those aged 30-39, and by 16% in those aged 20-29, while rates fell among adults aged 60-79.

Risk rises with deprivation: Over the study period, rates of new obesity cases were 35% higher for people with the highest socioeconomic deprivation (those with the lowest incomes, highest unemployment, and poorest housing) compared with people with the lowest socioeconomic deprivation. The gap was wider still for women, where new cases were 54% higher among the most deprived, and widest for Asian women, at 94% higher.

Ethnicity and deprivation compound: The percentage of people living with obesity ranged from 4% among the most affluent White men aged 18–19 to 66% among the most socioeconomically deprived Black women aged 60–69 – nearly double the figure for the least-deprived White women of the same age.

Large geographical differences: The percentage of people affected by obesity in some areas of northeast England (48%) was nearly six times higher than that seen in the most affluent parts of central London (8.5%). The steepest increases over time were seen in areas with the lowest GDP per capita.

The person-level data analysed in this study has all direct identifiers such as names and NHS numbers removed before researchers access the data, which is then only accessible within NHS England’s Secure Data Environment. The data is only accessible by approved researchers working on approved, COVID-19 related research projects.

The researchers’ definition for obesity was a recorded body-mass index (BMI) of 30 or above, or a clinician’s diagnosis of obesity in a person’s health records. Their findings from this electronic health record study correspond well with the NHS Health Study for England, which samples households across the country, giving confidence in the extra depth of the insights this study is able to provide.

They looked at rates of new cases of obesity (incidence) and the percentage of people with obesity (prevalence) in the general population, as well as differences across sociodemographic groups and geographical regions.

Obesity is now more common than hypertension (high blood pressure) in the UK, and nearly three times as common as smoking. It is a chronic, complex disease linked with a whole host of conditions, including heart disease, stroke, cancer, diabetes, and kidney failure. As well as affecting individuals’ mental wellbeing, and placing growing pressure on both the healthcare system and the economy. These findings highlight the scale and urgency of the obesity crisis, and how it has worsened since the COVID-19 pandemic.

GLP-1 receptor agonist drugs, like Ozempic/Wegovy and Mounjaro, are known to be effective in managing obesity and are being more widely prescribed and used. The study did not set out to examine their impact.

“We don’t see any obvious reduction in obesity in our data following the introduction of GLP-1 receptor agonists, at least not within the current study period,” says Robert Fletcher. “However, the drugs on their own are unlikely to be the answer. At present, the majority are privately prescribed and the jabs are expensive, which poses a barrier for people from disadvantaged backgrounds. We need deep-seated change to the many social and economic factors that drive obesity in the first place.”

Naveed Sattar, one of the co-authors, Professor of Cardiometabolic Medicine at the University of Glasgow and Chair of the Obesity Health Care Goals Programme, agrees:

“Obesity is not primarily about will power. These new, powerful data indicate that those most at risk frequently reside in the most obesogenic environments and likely have the least agency to withstand such environments. To achieve lasting change, the UK must expand access to new treatments faster but also fundamentally reshape food and activity environments so that healthier choices occur with minimal conscious effort. Failure to act will drive further rises in multimorbidity and human suffering, with profound consequences for the NHS and the wider economy.”

Study co-lead Angela Wood, Professor at the University of Cambridge and Associate Director at the British Heart Foundation Data Science Centre, says:

“The COVID-19 pandemic has had a lasting impact on health and lifestyle behaviours. By analysing electronic health records from the entire adult population of England before, during, and after the pandemic, we have generated the most comprehensive evidence to date on how obesity risk and burden are increasingly diverging across multiple dimensions of inequality. These findings underscore the critical importance of secure access to whole-population health data to enable research, surveillance, and timely action to address widening health inequalities.”

The study, funded by the Wellcome Trust, Health Data Research UK, the British Heart Foundation, the National Institute for Health and Care Research Cambridge Biomedical Research Centre, the Cambridge British Heart Foundation Centre of Research Excellence, has been published in The Lancet Diabetes & Endocrinology.

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Overall, the plant-based products contained more additives, more ingredients and more E-numbers than their animal-based counterparts.

A team from the Institute for Optimum Nutrition in London (a provider of university-accredited courses in nutrition) led the research which is published today in the peer-reviewed journal, Food Additives & Contaminants: Part A.

Joseph Whittaker, Vivienne Alexa Robinson and Elouise Redmayne looked at 71 like-for-like pairs of animal-based and plant-based products from an unidentified UK supermarket, that were available on the shelves in late-October 2025.

The team matched the products with each other based on a variety of factors such as the ingredients, packaging, and size, to achieve the closest match possible. So, for instance, almond milk was paired with normal milk, vegan brownies with dairy-based brownies, and plant-based meat with regular meat. Other products included were lasagne, coleslaw, pesto, mayonnaise, yoghurt and cake.

The product range used was marketed as plant-based, but all the products were also vegan.

Overall, results showed:

• the total number of food additives in the plant-based products was 199 compared with 100 in their corresponding animal-based equivalents.
• the total ingredients in the plant-based range was 1,566. In the animal-based range, it was 1,110.
• there were 39 E-numbers in the plant-based range and 31 in the animal-based set. (In total, 50 E-numbers were identified, of which 20 appeared in both groups.)

Across additives, ingredients and E-numbers, the difference between plant-based and animal-based was most stark in dairy, meat and fish products and their plant-based replacement.

“We found roughly twice as many food additives in the total sample of plant-based products compared to animal-based ones: 199 versus 100,” states senior author Joseph Whittaker, a lecturer at ION.

“However, even though we found that plant-based products had more food additives this does not necessarily mean an increased health risk. First, we only analysed one product range so we can’t make generalisations to all plant-based products. Second, we didn’t assess the quantity or concentration of food additives used, nor how much or how often people eat these products, so, essentially, we don’t know the level of exposure of food additives from these products. And last, all food additives used in these products have passed UK food safety regulations.”

Plant-based eating is on the rise. UK survey data shows a trend of declining meat consumption – from 103.7 to 86.3 g per capita per day in the decade to 2018–2019*. US dietary survey data reveals that the proportion of adults consuming a plant-based diet increased from 14.4% to 17.2% between 1999–2000 and 2017–2020**. And a Flemish study found that the number of adult ‘flexitarians’ rose from 5.3% to 9.2% from 2011 to 2020***.

Joseph adds: “Our study comes at a particularly important time as plant-based diets are increasing in popularity and more people are turning to plant-based alternatives products, but people are also concerned about the number of food additives in their food. This is known as the ‘clean label trend’. They are also trying to avoid ultra-processed foods and their potential negative effects upon health, although our study wasn’t focused on this.”

The main limitation of the research carried out was the limited sample of products used – from just one supermarket range.

The author team suggest future research should aim to see if the findings are replicated in other product ranges, including different brands and products available in other countries. “If future findings are consistent with ours, we could start to generalise more about plant-based products and be more certain in our conclusions,” Joe adds.

“One really interesting area that our study did not assess is the level of processing of plant-based products” he concludes. “It may be the case that many of these products are highly processed, and people switching to a plant-based diet and using a lot of these products, may end up on a highly refined diet. I think further research should test this, particularly as these diets are so popular now.

“I would argue that plant-based dieters should focus on whole-foods that are naturally plant-based, rather than trying to replicate animal-based foods. By necessity many plant-based alternative foods use food additives and refined ingredients, as foods like plant-based meat do not exist in nature.”

Research cited: * Stewart et al. 2021. **Sullivan et al. 2024. *** Deliens et al. 2022.

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The analysis found that while healthy behaviour and lifestyle interventions remain an essential foundation of any effective weight management programme — delivering meaningful weight loss and improvements in body composition on their own — adding pharmacotherapy produced the strongest outcomes. Crucially, the study’s authors characterise medication not merely as a supplementary tool, but as a core component of treatment when combined with lifestyle change.

The review assessed short-term outcomes typically measured over six to twelve months, tracking improvements in body mass index (BMI) and BMI z score, a metric used to contextualise weight relative to age and sex in children and adolescents. Long-term sustainability and safety were also monitored across the included studies.

The findings come as obesity rates in children and adolescents continue to rise globally, placing growing pressure on clinicians and health systems to identify effective, evidence-based treatment approaches. The results suggest a shift in how pharmacotherapy should be framed in paediatric obesity care — not as a last resort or add-on, but as an integral element of a combined strategy.

The study was led by corresponding author Bjorn T. Tam, PhD, and is published in JAMA Pediatrics (doi:10.1001/jamapediatrics.2026.2248). The full text is freely accessible here.

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