This commentary highlights the critical role of research systems and framing in either perpetuating or challenging weight stigma. Despite growing recognition of weight stigma as a public health issue, research discourse can reinforce harmful narratives through weight-centric models, stigmatizing language, and narrow focus on weight. We call for inclusive, transdisciplinary, and co-designed research that centers lived experience and prioritizes health outcomes over weight loss. We advocate for systemic changes across research funding, ethics, publication, and dissemination practices to reduce stigma and promote equity.

Obesity ReviewsVolume 25, Issue 3 e13728 IN MEMORIAM W.P.T (Philip) James, born June 27, 1938 and died October 5, 2023 - Tributes from friends and colleagues Tim Gill, Corresponding Author Tim Gill [email protected] Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia Correspondence Tim Gill, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia. Email: [email protected]Search for more papers by this authorKaren McColl, Karen McColl Savoie, French Alps, FranceSearch for more papers by this authorTim Lobstein, Tim Lobstein World Obesity Federation, London, UKSearch for more papers by this authorNick Finer, Nick Finer National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UKSearch for more papers by this authorWalmir Coutinho, Walmir Coutinho Department of Medicine, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, BrazilSearch for more papers by this authorIan Caterson, Ian Caterson SoLES, Boden Initiative, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, AustraliaSearch for more papers by this author Tim Gill, Corresponding Author Tim Gill [email protected] Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia Correspondence Tim Gill, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia. Email: [email protected]Search for more papers by this authorKaren McColl, Karen McColl Savoie, French Alps, FranceSearch for more papers by this authorTim Lobstein, Tim Lobstein World Obesity Federation, London, UKSearch for more papers by this authorNick Finer, Nick Finer National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UKSearch for more papers by this authorWalmir Coutinho, Walmir Coutinho Department of Medicine, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, BrazilSearch for more papers by this authorIan Caterson, Ian Caterson SoLES, Boden Initiative, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, AustraliaSearch for more papers by this author First published: 26 February 2024 https://doi.org/10.1111/obr.13728Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Volume25, Issue3March 2024e13728 RelatedInformation

Dietary macronutrients significantly impact cardiometabolic health, yet research often focuses on individual macronutrient relationships. This study aimed to explore the associations between dietary macronutrient composition and cardiometabolic health. This study included 33,681 US adults (49.7 ± 18.3 years; 52.5

Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach. This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high). A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10

The role of dietary macronutrients and energy intake in the aging process has been well-established. However, previous research has mainly focused on the association between leukocyte telomere length (LTL) and individual macronutrients, while the effects of macronutrient composition on LTL remain unclear. This cross-sectional analysis involved 4130 US adults (44.8 ± 17.0 years; 51% female) from the National Health and Nutrition Examination Survey during 1999-2002. A single 24-h dietary recall is used to collect dietary data. The relationship between dietary macronutrient composition and LTL is examined using three-dimensional generalized additive models. After adjustment for age, sex, ethnicity, education, physical activity, BMI, and dietary quality, a three-dimensional association of macronutrient composition with LTL (P = 0.02) is revealed. Diets lower in protein (5-10%), higher in carbohydrates (75%), and lower in fat (15-20%) are associated with the longest LTL corresponding to 7.7 years of slower biological aging. Diets lowest in protein (5%) and carbohydrate (40%), while highest in dietary fat (55%) are associated with the shortest LTL, corresponding to accelerated biological aging of 4.4 years. The associations appeared magnified with higher energy intake. These findings support a complex relationship between dietary macronutrients and biological aging independent of diet quality.

Esta ponencia examina las evidencias para la actividad física en la pérdida de peso y de adiposidad, la prevención del aumento de peso y la adiposidad, así como la recuperación de peso en adultos, y provee orientación sobre las implicaciones para los profesionales del ejercicio. La evidencia de la investigación indica que se requieren > 150 minutos, pero preferiblemente 300 minutos por semana de actividad aeróbica de intensidad al menos moderada para prevenir el aumento de peso y adiposidad, y al menos el extremo superior de esta gama de actividad para prevenir la recuperación de peso después de la pérdida de peso. Para que la pérdida de peso y adiposidad total sea significativa, se requiere un mínimo de 300 a 400 minutos por semana de actividad aeróbica de intensidad, al menos, moderada. La evidencia en torno al volumen de actividad física aeróbica requerida para reducir la adiposidad central está surgiendo, y las investigaciones apuntan a que puede ser sustancialmente menor que la que se requiere para la pérdida de peso. El impacto de la actividad física de alta intensidad y el ejercicio de resistencia para la gestión del peso es incierto. Durante las consultas para la gestión del peso, los profesionales en ejercicio deben aconsejar que se pueden lograr beneficios para la salud metabólica y cardiovascular por medio de la actividad física a cualquier peso, e independientemente del cambio de peso.

Males are under-represented in weight loss clinical trials, usually comprising fewer than one-quarter of participants. Our study aimed to investigate people's motivations for participating in weight loss trials and determine any relationship with gender. Eighty individuals from an existing registry for weight loss trials were contacted, of whom 24 (9 males, 15 females) agreed to participate in a 20-min semi-structured interview around their expectations and motivations for volunteering. Interviews were audio-recorded and transcribed in Zoom. A transcript of each interview was uploaded into NVivo for preliminary thematic analysis. Improved health was a common motivation for pursuing weight loss in all subjects regardless of gender. Male recruitment to weight loss trials was often influenced by advice from a healthcare professional to lose weight for the prevention of obesity-related comorbidities, whereas family and aesthetic expectations (e.g., clothes and fashion) were key elements of female participation. Identification of gender differences in motivations for volunteering in weight loss trials will help improve tailoring of recruitment strategies and interventions to enhance male participation in the future.

Macronutrients are a major component of the human diet. However, few studies have assessed their collective association with mortality. We sought to evaluate the associations of macronutrient intake with all-cause, cardiovascular, and cancer mortality in US adults using a multi-nutrient approach. This prospective cohort analysis used data from the National Health and Nutrition Examination Survey from the years 1999 to 2014. The participants included 33,681 US adults aged 20–85 years (52.5% female). The maximum follow-up time was 16.8 years, with a total of 4398 total deaths, including 772 cardiovascular deaths and 952 cancer deaths. The associations between mortality and dietary macronutrients were explored using three-dimensional generalized additive models, allowing for visual and statistical inference of complex nonlinear associations. Absolute macronutrient intake demonstrated a three-way interactive association with all-cause mortality (p < 0.001), cardiovascular mortality (p = 0.02), and cancer mortality (p = 0.05), adjusted for age, sex, ethnicity, socioeconomic status, dietary quality, and lifestyle. Compositionally, a high caloric diet composed of moderately high protein (20%), moderate fat (30%), and moderate carbohydrate (50%) levels was associated with the highest mortality risk. Across the total energy intake levels, lower mortality risk was observed in two separate regions consisting of higher protein (30%), higher carbohydrate (60%), and lower fat levels (10%) or lower protein (10%), moderate carbohydrate (45%), and higher fat levels (45%). These findings highlight a complex nonlinear and interactive association between macronutrients and all-cause mortality such that several distinct dietary compositions are associated with similarly high or low risk. Future research is needed to explore the drivers of these associations and whether they differ across varying dietary patterns and populations.

The gut microbiome has been shown to play a role in the relationship between diet and cardiometabolic health. We sought to examine the degree to which key microbial lignan metabolites are involved in the relationship between diet quality and cardiometabolic health using a multidimensional framework. This analysis was undertaken using cross-sectional data from 4685 US adults (age 43.6 ± 16.5 years; 50.4% female) participating in the National Health and Nutrition Examination Survey for 1999–2010. Dietary data were collected from one to two separate 24-hour dietary recalls and diet quality was characterized using the 2015 Healthy Eating Index. Cardiometabolic health markers included blood lipid profile, glycemic control, adiposity, and blood pressure. Microbial lignan metabolites considered were urinary concentrations of enterolignans, including enterolactone and enterodiol, with higher levels indicating a healthier gut microbial environment. Models were visually examined using a multidimensional approach and statistically analyzed using three-dimensional generalized additive models. There was a significant interactive association between diet quality and microbial lignan metabolites for triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, insulin, oral glucose tolerance, adiposity, systolic blood pressure, and diastolic blood pressure (all p < 0.05). Each of these cardiometabolic health markers displayed an association such that optimal cardiometabolic health was only observed in individuals with both high diet quality and elevated urinary enterolignans. When comparing effect sizes on the multidimensional response surfaces and model selection criteria, the strongest support for a potential moderating relationship of the gut microbiome was observed for fasting triglycerides and oral glucose tolerance. In this study, we revealed interactive associations of diet quality and microbial lignan metabolites with cardiometabolic health markers. These findings suggest that the overall association of diet quality on cardiometabolic health may be affected by the gut microbiome.

Dubai has experienced enormous economic and population growth, transforming the city from a small regional business hub in the 1970s to a global business hub of financial and tourism activities in the 21st century. Relevant Dubai Municipality reports were reviewed and semi-structured interviews and focus group discussions conducted with representatives of large food importers and local producers to evaluate the link between the food importation requirements and minimising food loss. Measures taken by the Municipality of Dubai to successfully reduce food loss and improve food security include the diversion of potential food loss to the United Arab Emirates Food Bank and recycling it into animal feed when appropriate. These measures significantly reduced food loss by 93% in the four years from 2016 to 2019. Some political and managerial implications of the study are highlighted.

NOVA classification distinguishes foods by level of processing, with evidence suggesting that a high intake of ultra-processed foods (UPFs, NOVA category 4) leads to obesity. The Australian Dietary Guidelines, in contrast, discourage excess consumption of “discretionary foods” (DFs), defined according to their composition. Here, we (i) compare the classification of Australian foods under the two systems, (ii) evaluate their performance in predicting energy intakes and body mass index (BMI) in free-living Australians, and (iii) relate these outcomes to the protein leverage hypothesis of obesity. Secondary analysis of the Australian National Nutrition and Physical Activity Survey was conducted. Non-protein energy intake increased by 2.1 MJ (p < 0.001) between lowest and highest tertiles of DF intake, which was significantly higher than UPF (0.6 MJ, p < 0.001). This demonstrates that, for Australia, the DF classification better distinguishes foods associated with high energy intakes than does the NOVA system. BMI was positively associated with both DFs (−1. 0, p = 0.0001) and UPFs (−1.1, p = 0.0001) consumption, with no difference in strength of association. For both classifications, macronutrient and energy intakes conformed closely to the predictions of protein leverage. We account for the similarities and differences in performance of the two systems in an analysis of Australian foods.

Introduction: There is a large body of evidence detailing the associations of individual macronutrients and fatty acids with all-cause and cardiovascular mortality. Studying nutrients in combination may provide additional information concerning complex associations and interactions. Hypothesis: We hypothesize that overall macronutrient and fat class composition are associated with all-cause and cardiovascular mortality. Methods: This analysis was undertaken using 24-hour food recall data from the National Health and Nutrition Examination Survey from years 1999-2014 (n = 36,138). Participants included both males and females ≥20 years of age (49.8 ± 18.4 years; 53% Female). All-cause (4764 deaths) and cardiovascular mortality (834 deaths) were obtained via linkage to the National Death Index. Associations of diet composition with mortality adjusting for age, sex, total energy intake, ethnicity, education level, household income, physical activity, alcohol intake, and smoking were assessed using 3-dimensional general additive Cox proportional hazard models of macronutrients (Protein; Carbohydrate; Fat) or fat classes (Polyunsaturated; Monounsaturated; Saturated). Response surfaces were generated on the survival function scale to aid interpretation. Results: There is a complex 3-way interactive non-linear association of macronutrient composition with both all-cause (Figure A-B) and cardiovascular mortality (both p <0.001). Dietary fatty acid composition was associated with all-cause mortality (p <0.001; Figure C-D), but there was no significant association for cardiovascular mortality (p = 0.09). In general, diets composed of moderate intake of all three macronutrients or low amounts of monounsaturated and polyunsaturated fat were associated with the highest risk of mortality. Conclusions: In conclusion, these findings indicate that associations between diet composition and mortality are more complex than previously understood with evidence of interactive and non-linear relationships.

It has been widely demonstrated that there are a broad range of individual responses to all weight management regimens, often masked by reports of the mean. Identifying features of responders and non-responders to weight loss regimens enables a more tailored approach to the provision of weight management advice. Low-carbohydrate diets are currently popular, and anecdote suggests that males are more successful at losing weight using this approach. This is feasible given the physiological and socio-psychological differences between the genders. We analysed the extent and variation in weight change for males and females separately through a systematic search for all low-carbohydrate diet trials published since 1985. Very few studies compared weight loss outcomes by gender and, of those that did, most lacked supporting data. The majority of studies reported no gender difference but when a gender difference was found, males were more frequently reported as losing more weight than females on a low-carbohydrate diet. The lack of gender stratification in weight loss trials is concerning, as there are a range of gender-based factors that affect weight loss outcomes. This study highlights the importance of examining weight change for males and females separately, since as failure to do so may mask any potential differences, which, if detected, could assist with better weight loss outcomes.

Background Public health bodies in Australia remain concerned about marketing of unhealthy commodities; namely unhealthy food, alcohol and gambling products. Children are particularly susceptible to the influence of unhealthy commodity marketing. This study explored adults’ perceptions of unhealthy commodities sponsorship in elite sport and policies to restrict them. Methods Four focus groups of 7–8 frequent sport spectators were recruited, including parents and non-parents, and located in inner and outer suburbs of Sydney, Australia. Results were analysed thematically. Results Participants identified the contradictions of healthy messages of sport and unhealthy commodities, while highlighting the commercial value of sport sponsorship to sporting clubs. There is concern around children’s exposure to effective and integrated marketing techniques when viewing sport, which encouraged unhealthy habits. Support for restricting sponsorship related to perceived product harm, with gambling viewed as having the greatest health impact. Participants were supportive of policies that reduced exposure of unhealthy commodities to children, but were concerned about the financial risk to sporting clubs. Governments and sports associations were identified as holding responsibility for enacting changes. Conclusion A number of options were identified for advocates to gain public and political traction to reduce unhealthy commodity sponsorship. There is potential for shifts away from unhealthy sponsorship by both governments and sports associations.

Abstract Background Human nutrition is a leading modifiable risk factor for the prevention of cardiometabolic diseases. However, most nutritional research focuses on the role of specific nutrients rather than compositional analysis of the diet. Purpose We aimed to assess the association of dietary macronutrient composition with various markers of cardiometabolic health. Methods This study was undertaken using 24-hour food recall data from the National Health and Nutrition Examination Survey from years 1999–2014 (n=36,637). Participants included both males and females ≥20 years of age (49.8±18.3 years; 53% Female). Caloric outliers for males (<800 kcal/day or >4200 kcal/day) and females (<600 kcal/day or >3500 kcal/day) were removed from the analysis (n=1844). Cardiometabolic health markers were collected via mobile examination center and included triglycerides (n=16,444), total cholesterol (n=31,155), LDL cholesterol (n=15,798), HDL cholesterol (n=33,435), blood pressure (n=34,121), body fat percentage (n=4269), body mass index (n=35,187), glucose (n=17,208), insulin (n=16,273), oral glucose tolerance test (n=8280), and HbA1c (n=27,288). Associations of dietary macronutrients with cardiometabolic health markers were assessed using 3-dimensional general additive models (Protein; Carbohydrate; Fat) with adjustment for age, sex, misreporting, ethnicity, education level, household income, physical activity, alcohol intake, and smoking. Response surfaces on right-angled mixture triangles were generated as predictions from absolute macronutrient intake at the 50th percentile of total energy intake. Macronutrient intakes were transformed to a percentage of energy to visualize and interpret associations compositionally. Results There was a complex 3-way interactive non-linear association of macronutrient composition with lipid profile (Figure A-D; all p<0.04), blood pressure (Figure E-F; all p<0.001), body fat percentage (Figure G; p<0.001), body mass index (Figure H; p<0.001), and all markers of glycemic control (Figure I-L; all p<0.001). Diets comprised of high protein coupled with low fat were associated with higher triglycerides but generally more favorable total cholesterol, blood pressure, and body fatness. Conversely, diets composed of high protein coupled with high fat were associated with higher HDL cholesterol but worse total cholesterol, body fatness, body mass index, and glycemic control. Conclusions These findings display a complex relationship between dietary macronutrient composition and cardiometabolic health. Future research is needed to evaluate how dietary source and quality may modify the observed associations. Funding Acknowledgement Type of funding sources: Private company.

This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300-420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change. (c) 2021 Published by Elsevier Ltd on behalf of Sports Medicine Australia.

ABSTRACT Children’s play is increasingly controlled, costly and standardised. Risk aversion has resulted in attempts to eliminate all danger despite the limited health burden of play-related injuries and missing cost–benefit evidence. The current role and implementation of playground safety standards is a key inhibitor of stimulating play provision. Playground safety standards assume that play is about engineered structures. Standard creating bodies and playground inspectors tend to be missing key voices and knowledge. The proper domain of playground standards is engineering-related issues, such as structural integrity. However, they make judgments about children’s play behaviours, which are shaped by the children using the space and local circumstances: they are not standardised and should lay outside the scope of standards. We recommend that the value-based judgments currently included in standards and inspections should rest with play providers using Risk Benefit Assessment frameworks. We provide recommendations for play providers, standard setters, inspectors and public health.

OBJECTIVE:There is an urgent need to identify and develop cross-sectoral policies which promote and support a healthy, safe and sustainable food system. To help shape the political agenda, a critical first step is a shared definition of such a system among policy makers across relevant sectors. The aim of the present study was to determine how Australian policy actors define, and contribute to, a healthy, safe and sustainable food system.DESIGN:A Delphi survey, consisting of two rounds, was conducted. Participants were asked how they define, and contribute to, a healthy, safe and sustainable food system (Round 1) and indicate their level of agreement with summary statements (Round 2).SETTING:This was an online Delphi survey conducted in Australia.PARTICIPANTS:Twenty-nine and fourteen multisectoral and multilevel policy makers completed Round 1 and Round 2, respectively.RESULTS:The definition included food processing regulation, environmentally friendly food production and access to nutritious food. All agreed that it was important for them to improve access and supply of healthy food and ensure healthy planning principles are applied.CONCLUSIONS:There were cross-sectoral differences in definitions and contributions; however, critical consensus was achieved. The study contributes to the definition of key elements of a cross-sectoral food and nutrition policy to meet today's environmental, health, social and economic challenges; however, further research using a more representative multisectoral sample is warranted.