The potential of obesity medications to serve as viable alternatives to bariatric surgery to treat obesity remains an open question. This review examines whether contemporary anti-obesity pharmacotherapy can replace metabolic and bariatric surgery in the management of obesity, by critically comparing their mechanisms of action, weight loss outcomes, durability, safety profiles and roles in long-term disease control. While metabolic/bariatric surgery has been the gold standard for substantial and sustained weight loss, advancements in pharmacotherapy are producing weight loss approaching surgical outcomes without associated risks, complications and recovery time. New drug therapies demonstrate previously unattainable efficacy and long-term control of obesity. Surgery, however, induces superior short- and long-term weight loss via profound hormonal, neurological and metabolic shifts, resulting in durable outcomes without ongoing intervention, though it remains difficult to scale. Pharmacotherapy is scalable and increasingly effective but requires sustained adherence, with loss of treatment-mediated control and weight regain upon cessation. It also does not have as extensive established research on safety as surgery. While obesity medications cannot fully replicate the multifactorial physiological impacts of metabolic/bariatric surgery, they offer a scalable, less invasive treatment path that broadens patient options. So far, pharmacotherapy will not replace surgery, as there are patients who will respond better to it, while others to medication only. However, combining both surgical and pharmacological options can increase the penetrance of treatments to manage the chronic complexities of obesity.

Within Public Health Nutrition, the preconception phase, has emerged as a particularly important window for promoting a healthy diet, as it affects both current and future health as well as health in the next generation. Different approaches are used to support dietary change in this phase, and digital interventions are viewed as particularly promising. In this review, we describe digital interventions addressing preconception diet, discuss challenges in targeting the preconception population and highlight issues related to digital designs and measuring intervention effects. We draw upon six digital interventions with dietary outcomes, in different target populations. Only two of the interventions were found to be effective in improving relevant aspects of the participants’ diet, and these targeted specific and narrow groups or a single dietary component. Most of the intervention studies faced considerable challenges with recruitment. High attrition further complicated evaluation. In addition, there were difficulties related to participant engagement with the digital interventions. Challenges with lack of engagement, recruitment and attrition are not new insights within public health research, and we need to acknowledge the need for new approaches to recruitment, intervention development and evaluation. Alternative approaches such as citizen science and participatory action research in which the researchers work closely with the target population and other stakeholders during the whole process, should be explored. Moreover, as the current behavioural interventions that rely heavily on individual agency seem largely unsuccessful, future interventions should consider targeting more upstream and structural determinants of diet, rather than individual behaviour alone.

Gestational weight gain (GWG) can be defined as the total weight gained throughout pregnancy and is required for healthy fetal growth; however, gaining excessive weight during pregnancy has been linked with several adverse effects. This review aims to consider the evidence on weight management during pregnancy, with a focus on the key challenges surrounding GWG and the practical considerations related to assessing weight changes. It is estimated that nearly 50% of women gain excessive weight during pregnancy; nevertheless, this can be difficult to quantify due to the lack of global consensus on recommended GWG guidelines. Currently, there are no GWG guidelines in the UK and Ireland, as reiterated in the recent National Institute for Health and Care Excellence guidelines, due to the lack of evidence about what the optimal total weight change in pregnancy should be. This is further complicated by the conflicting results of interventions aimed at preventing excessive GWG and their resultant inconsistent effects on adverse pregnancy outcomes. Accurate calculation of GWG requires measurement of pre-pregnancy weight and weight prior to the onset of labour. However, several practical considerations are associated with obtaining these weights, as in practice, estimated or self-recalled weights are often used as an alternate, thereby introducing variability into the measurement of GWG and the potential for inaccuracies in analysis. These limitations highlight the need for a more uniform approach in assessing GWG. The WHO is in the process of developing global GWG standards, and this could potentially establish a uniform gold standard for assessing GWG and reintroduce routine weighing.

Various strategies across food systems are needed for a systemic change, with dietary shifts representing a meaningful pathway – particularly in high-income nations. Plant-based analogues (PBA) that mimic animal-based foods represent a promising strategy to facilitate such shifts because they require minimal behaviour adjustments. This review aims to synthesise nutritional, health and environmental evidence on PBA by examining their benefits, challenges and research gaps to inform and support evidence-based policy and practice. PBA generally have lower greenhouse gas emissions, land use and water use than their animal-based counterparts. Nutritionally, PBA are complex, varying across product brands, product types, processing techniques and primary ingredients. The limited health evidence shows that consumption of plant-based meat analogues tends to be associated with positive health outcomes, while consumption of some plant-based drinks can be linked to micronutrient deficiencies. Fortified PBA can contribute to daily recommended intakes and sometimes provide more micronutrients than their animal-based counterparts, while also providing more fibre and less energy and saturated fat. Despite these potential benefits, debates persist around processing classifications and their health implications. Given this complex landscape, assessing what kind of role PBA could play in our food systems will demand product-specific evaluation, targeted dietary recommendations and expanding the range of healthier PBA. To advance the field and accelerate dietary shifts without unintended consequences, critical considerations include strengthening the nutritional evidence base, classifying PBA further for dietary recommendations and informed regulatory approaches, understanding processing effects and use of additives, and standardising environmental outcomes and research beyond single ingredients.

The aim of this review is to examine why cultural food security and cultural food sovereignty should be prioritised and embedded within conventional food security frameworks. It demonstrates how culturally grounded, community-driven approaches foster more just, sustainable and empowering food systems for ethnically diverse, Indigenous and local communities, while highlighting the limitations of conventional metrics that overlook socio-cultural, political and ecological dimensions essential to resilience. Conventional food security focuses on access to sufficient, safe and nutritious food, often sidelining access to culturally appropriate and spiritually meaningful foods that are integral to cultural identity and tradition (cultural food security) and the authority and decision-making power held by local people over their foodways (cultural food sovereignty). Its market-based, individualistic measurement paradigms further neglect collectivist, traditional and spiritual food values, resulting in assessments that may conform to global standards yet produce flawed outcomes, misaligned interventions and continued marginalisation of ethnically diverse, Indigenous and local communities. Drawing on socio-cultural, political, economic and environmental frameworks, the review demonstrates how food sovereignty and cultural food security provide more sustainable, equitable and empowering pathways for communities. It underscores the need for community-driven, culturally grounded food policies.

It is increasingly acknowledged that the transition from animal- to plant-based proteins confers substantial benefits for both human health and environmental sustainability. This review provides a critical examination of the necessity to consider not only the degree of processing applied to plant protein-based foods, particularly those derived from legume seeds, but also the nutritional quality of the resulting products. While it is well established that plant proteins exhibit a lower environmental footprint compared with their animal-derived counterparts, their digestibility is often reduced, primarily due to the matrix composition of raw ingredients. To improve protein digestibility and reduce the antinutrient content in these raw materials, a variety of processing methods are used, encompassing thermal and biological treatments (e.g. extrusion and fermentation, respectively). However, processing methods may also introduce unintended adverse effects, including protein oxidation and formation of undesirable compounds. Therefore, this review explores the paradox of sustainable processing, where process conditions may simultaneously confer environmental advantages while compromising nutritional quality. In this context, food classification systems such as NOVA are critically examined, highlighting the absence of an evidence-based system that integrates both processing conditions and product formulation in the classification of plant-based foods. Current approaches categorizing plant-based options as ultra-processed foods without accounting for the nutritional quality of their ingredients, and their ultimate digestibility, may mislead consumers and discourage the consumption of nutritionally adequate plant-based alternatives. Finally, the review emphasizes the need for the adoption of processing technologies that address the sustainability challenge and the nutritional quality of plant protein-based foods.

Infant and young child feeding (IYCF) is a critical public health priority during emergencies, yet remains poorly integrated into emergency preparedness planning in many high-income countries (HICs). Despite the availability of international guidance, such as the Operational Guidance on IYCF in Emergencies the implementation of these tools in national systems has been inconsistent within HICs. This review examines recent emergencies in HICs to identify policy and operational gaps affecting breastfeeding support, the management of commercial milk formula (CMF) and the distribution of commercially available complementary foods (CACFs). The present review focuses on the practical translation of Infant and young child feeding in Emergencies (IYCF-E) guidance into emergency responses across a range of contexts. This review highlights widespread failures to protect breastfeeding during crises, often due to a lack of trained personnel, inadequate shelter infrastructure and limited integration of IYCF into emergency protocols. CMF was frequently distributed without needs assessment or support, undermining breastfeeding and introducing risks related to hygiene and preparation. CACFs were often age-inappropriate, ultra-processed or culturally unsuitable, with potential long-term implications for child health. Even in countries with strong health systems, IYCF-E was often fragmented, under-resourced or absent from preparedness frameworks. To build nutritional resilience, IYCF-E must be embedded within public health and disaster planning, supported by legal protections, trained personnel, regulated product distribution and coordinated communication. This requires a shift in policy and perception, recognising that the right to safe and appropriate feeding in emergencies applies equally in all settings.

Malnutrition is highly prevalent among oncology patients, with large-scale studies reporting involuntary weight loss in 31–87%, depending on tumour site and disease stage. A combination of nutrition-impact symptoms, reduced oral intake and systemic inflammation lead to poor tolerance to treatment, diminished quality of life and reduced survival. Systemic inflammation is a hallmark of cancer-associated malnutrition and contributes to loss of lean mass and abnormal body composition phenotypes (sarcopenia, cachexia and low muscle density) which may coexist with overweight and obesity. Malnutrition screening tools are widely used to identify patients at risk; however, traditional weight and BMI-based instruments such as the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) frequently misclassify patients with cancer as well-nourished. These tools fail to account for nutrition-impact symptoms, inflammation and muscle wasting. Although obesity is an established cancer risk factor, 40–60% of patients with metastatic disease remain overweight or obese during treatment. When screening tools are BMI-based, high fat stores mask muscle wasting, leading to misclassification of nutritional risk and delayed dietetic referrals. To improve detection, screening tools should incorporate patient-reported symptoms, inflammatory markers and body composition assessment, enabling earlier, proactive nutritional care. Alternatively, it may be time to acknowledge that all cancer patients are inherently ‘at-risk’ of malnutrition and to prioritise universal access to dietetic support from diagnosis through treatment. This review summarises current malnutrition screening and assessment practices in oncology and outlines key considerations for future research and clinical practice.

Nutrition plays a pivotal role in cancer survivorship, influencing not only long-term health outcomes but also quality of life and risk of recurrence. As advances in early detection and treatment have led to a growing global population of cancer survivors, attention has increasingly shifted from acute care to the promotion of sustained well-being and prevention of secondary health challenges. Despite growing evidence linking dietary patterns, body composition and metabolic health with survivorship outcomes, there remains significant variability in nutritional guidance, access to evidence-based interventions and integration of nutrition into oncology care. This review explores the current state of knowledge on nutrition in cancer survivorship, highlights key challenges faced by healthcare systems and patients and presents a new proposed model of care to optimise nutrition within survivorship care, bridging the evidence-practice gap.

In the UK, approximately 64,000 individuals are living with an ileostomy. This surgery creates an opening in the abdominal wall (stoma), allowing for diversion of egesta into a disposable pouch. This procedure impacts nutrient absorption meaning people living with an ileostomy may be subject to sub-optimal nutrition, often compounded by the low-fibre diet – which is frequently encouraged post-operatively. This review explores the restrictive dietary patterns of this population and their effects on nutrition and quality of life, alongside current approaches to improve dietary management and health outcomes. Dietary restriction beyond the post-operative period is frequently reported, with avoidance of high-fibre foods (e.g., fruits and vegetables) being most prevalent. These long-term dietary changes are presumed to impact nutritional status, with current evidence suggesting diminished bone mineral density and vitamin B12. High-output stoma (HOS) and dehydration are significant issues for people living with an ileostomy, and dietary management of stoma output and other ileostomy-related symptoms is a major contributor to food avoidance. The efficacy of oral rehydration solutions (ORS) in management of HOS is well-established; however, due to high concentrations of glucose and sodium, the palatability of such treatments is poor, impacting patient adherence. Encouragingly, personalised dietary advice has shown some positive effects on both quality of life and nutritional outcomes for people living with an ileostomy. However, a greater understanding of dietary management is needed, and there remains scope to improve current dietary advice and enable people living with an ileostomy to benefit from a more complete and unrestricted diet.

Iodine deficiency is now a significant public-health concern in the UK. Data from the National Diet and Nutrition Survey (NDNS; 2019–2023) shows that several population groups are now classified as mildly iodine deficient, including women of childbearing age. This is a change from previous NDNS data where these groups were iodine sufficient. As iodine is needed for thyroid-hormone production, which are essential for brain development, iodine deficiency prior to, and during, pregnancy may have implications for child cognition – including lower IQ. However, the evidence base for the health effects of mild deficiency is not as strong as in severe deficiency. The WHO recommends salt iodisation to control iodine deficiency in a population, but such a policy was never introduced in the UK and iodised salt is not widely available. While UK milk is rich in iodine and is the principal source, the rise in popularity of plant-based milk alternatives may increase the risk of iodine deficiency. It may be necessary to give personalised advice to those with low iodine intake, but identify those at risk is challenging owing to a lack of a biomarker for iodine in an individual. Population-wide approaches may be required in the UK – for example, fortification of bread with iodised salt or mandatory iodine fortification of plant-based dairy alternatives. This review will critically discuss (i) the data on iodine deficiency in the UK (ii) the evidence base for the health implications of mild deficiency and (iii) the potential public-health solutions.

Biliary atresia is a rare bile duct disease resulting in intestinal bile salt depletion due to poor bile flow. Medium-chain triglyceride (MCT) supplementation is widely recommended and used as the main dietary management in infants, however evidence for its use is limited and there is uncertainty regarding the optimal percentage (proportion of total fat that is MCT) and dose (grams/kilogram/day, g/kg/d). The aim was to review the evidence for the impact of MCT on fat absorption, growth, nutritional status and clinical outcomes in infants with biliary atresia and the optimal nutrition profile of MCT supplementation. A scoping review found that the mostly observational, historic evidence for MCT supplementation pointed to greater fat absorption during MCT supplementation compared to no supplementation, but also some evidence of a risk of essential fatty acid deficiency with very high MCT percentage. Only six studies have investigated MCT percentages and only three reported MCT dose. One analysis of MCT in the largest cohort of biliary atresia patients ever presented (n = 200), found no association between MCT percentage with growth, nutritional status or clinical outcomes. Counterintuitively, there was an unexpected inverse association between MCT dose and growth. A possible interpretation was that increased MCT was a consequence of poor growth rather than a cause, as infants either drank more or dietitians prescribed more MCT as fat malabsorption worsened. In conclusion, MCT is widely recommended, however, the evidence for its use is lacking and there remains uncertainty about the optimum percentage and dose for infants with biliary atresia.

UK food system transformation is urgently needed, but to date, minimal research has investigated ‘blue foods’ probably because they are ethically nuanced. There exists a paradox whereby materially deprived communities should be eating more fish to meet nutritional requirements, yet there is a global ‘red flag’ around global overfishing. New collaborative and creative solutions are, therefore, needed to tackle such food system inequities. By working together, all voices can be equally heard when decisions are being made to improve the system. Similarly, innovation and disruption of established supply chains will enable better access to healthy, affordable and tasty food that will support better nutrition, health and wellbeing. This review paper will present a critique of the ‘The Plymouth Fish Finger’ as a collaborative social innovation case study. Part of the FoodSEqual research project, this exploratory pilot project championed ‘co-production’ approaches to achieve multiple (potential) impacts. This review will critically explore how this social innovation case study has exemplified the complex interplay between factors driving distortions in access to and availability of fish within the local food system. Through collaborative multi-stakeholder (transdisciplinary) processes, using participatory creative methods, new strategies and recommendations for research, practice, action and policy are informed, all of which offer great potential for progressive and transformative systemic (blue) food system change.

Ensuring adequate food intake among older people is essential for maintaining health and preventing malnutrition. This review explores strategies to enhance dietary intake in this population group. Several key interventions are highlighted, including offering high-energy and protein-fortified meals and snacks, optimising the visual appeal and presentation of foods, enhancing flavours, and providing finger foods or modified textures to support consumption. Familiarity with fortified foods may encourage acceptance and increase intake, while improving food aesthetics and incorporating varied flavours can enhance enjoyment and promote consumption. Flavour enhancement may help compensate for decline in smell and taste sensitivity often experienced by older people, helping to sustain interest in food and promote greater intake. Finger foods present a practical solution for older adults with physical impairments, allowing for easier handling and self-feeding. Additionally, for individuals with dysphagia or chewing difficulties, texture-modified diets tailored to their needs support safe food intake. Research suggests that refining food presentation through techniques such as moulding and 3D printing may improve palatability and appeal, potentially boosting consumption among older adults. Addressing sensory preferences and physical challenges associated with eating is critical to ensuring adequate nutrition and promoting overall wellbeing in the elderly population. This review underscores the importance of multifaceted dietary strategies, advocating for personalised interventions that align with older individuals’ needs and preferences to enhance food intake and nutritional status.

Positive food consumption remains one of the most common challenges among older adults in the UK with at least 10% in community settings and up to 45% in care homes affected by malnutrition. It is strongly associated with frailty, functional and health decline. Tracking and understanding the impact of diet is not easy. There are problems with monitoring diet and malnutrition screening such as difficulty remembering, lack of time, or needing a dietician to interpret the results. Computerised tailored education may be a positive solution to these issues. Due to the rise in smartphone ownership the use of technology to monitor diet is becoming more popular. This review paper will aim to look at the issues with current methods of dietary monitoring particularly in older adults, it will present the benefits and barriers of using to monitor food intake. It will discuss how a photo food monitoring app was developed to address the current issues with technology and how it was tested with older adults living in community and care settings. The prototype was co-developed and incorporated automated food classification to monitor dietary intake and food preferences and tested with older adults. The prototype was usable to both older adults and care workers and feedback on how to improve its use was collected. Key design improvements to make it quicker and more accurate were suggested for future testing in this population. With adaptions this prototype could be beneficial to older adults living in both community and care settings.

Undernutrition is common amongst older people and can lead to adverse health outcomes and increased dependence. This review focuses on an aspect of undernutrition that is often overlooked, namely loss of appetite, and will discuss the challenges in this under-researched field from the perspective of geriatric medicine. Appetite decline is common in later life and predicts undernutrition in older populations. As such, timely identification and intervention on poor appetite could delay onset or progression of undernutrition to optimise healthy ageing and maintain independence. In addition, management of undernutrition ultimately requires the individual to meet their nutritional requirements. However, unless attention is paid to mitigating appetite decline, strategies to improve intake are likely to be ineffective. Treatment for appetite decline is challenging due to the multiple and complex underlying mechanisms. Current evidence is limited to a few trials targeting older people including flavour enhancement and fortification or supplementation, lifestyle measures such as increasing physical activity and social interaction, and medications, all with mixed results. Progress on treatments for appetite decline has been hampered by a lack of distinction from undernutrition but also perhaps the approach to it as a concept. Categorising appetite decline in ageing as a geriatric syndrome could aid progress in the unification of approaches to mechanistic research, assessment and management strategies, which are likely to be most effective when in multi-component form and underpinned by the principles of Comprehensive Geriatric Assessment (CGA).

This review aims to (1) provide an overview of research investigating the relationship between body composition, specifically fat-free mass (FFM) and fat mass (FM), appetite and energy intake (EI) and (2) to investigate potential mechanisms underlying these relationships, with a focus on ageing. Appetite and EI are influenced by complex, multifactorial pathways involving physiological, psychological, environmental, social and cultural factors. Early research investigating the association of body composition with appetite and EI focused on FM; however, the role of FFM in appetite control is gaining increasing attention. Studies have shown that FFM is positively associated with EI in younger populations, including infants, adolescents and adults. In contrast, FM appears to have no association or a weak inverse association with appetite/EI. However, research in older adults is limited, and the underlying mechanisms are not fully understood. It has been suggested that one way in which FFM may influence appetite and EI is by impacting resting metabolic rate (RMR). FFM, which includes metabolically active tissues including skeletal muscle and organs, represents the largest determinant of RMR and therefore may influence appetite and EI by ensuring the energetic requirements of crucial tissue-organs and metabolic processes are reached. Given that declines in FFM and RMR are common with ageing, they may be possible targets for interventions aimed at improving appetite and EI. While current evidence in older adults supports a positive association between FFM and appetite, further longitudinal studies are needed to explore this relationship in different contexts, along with the underlying mechanisms.