A new national survey from The Ohio State University Wexner Medical Center reveals 1 in 4 (25%) of 1,006 adults surveyed would consider using an injectable weight loss medication without consulting their doctor. The reasons include:

• Lower cost (18%)
• Not covered by insurance (15%)
• Unable to get a prescription from their doctor (9%)
• Lack of availability through a pharmacy (6%)

“It’s really important for those who want to lose weight to first discuss options with their doctor. It is not one size fits all, and every medication can have risks and side effects. A trusted doctor can go through a patient’s medical history and current medications to assess their particular risks and benefits,” said Shengyi Mao, MD, an Ohio State internal medicine physician.

What are these new drugs for weight loss?

GLP1-RA drugs (such as brand names Ozempic and Wegovy) were originally developed to regulate blood sugar levels in people with Type 2 diabetes. During safety and efficacy studies, researchers discovered the drugs could lead to weight loss because they can curb appetite and slow emptying of the stomach. Some studies have shown they can lower the risk of heart attack, stroke or cardiovascular death. In March, the FDA approved semaglutide for reducing cardiovascular risk in adults who are overweight or obese and have established cardiovascular disease.

This year, the FDA issued two warnings about compounded semaglutide including reports of dosing errors resulting in hospitalization and ineffective ingredients. Compounded drugs are custom-made alternatives to brand names and made in state-licensed pharmacies instead of by drug manufacturers when a drug is in short supply.

The FDA has received reports that some compounders may be using semaglutide salt, which is a different active ingredient than the one approved by the agency. The FDA is also investigating reports of counterfeit Ozempic being marketed in the U.S.

“Obesity is a serious and complex chronic disease and shouldn’t be addressed in a one-size-fits-all approach. That’s why a comprehensive weight management program is often the best choice because losing weight and keeping it off requires a lifestyle change and lifelong commitment,” Mao said. “These weight loss drugs may be effective for some people but they can cause serious side effects and the weight may return after they stop taking them.”

Survey Methodology

This survey was conducted on behalf of The Ohio State University Wexner Medical Center by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from August 16 – August 18, 2024, among a sample of 1,006 respondents. The survey was conducted via web (n=975) and telephone (n=31) and administered in English. The margin of error for total respondents is +/-3.8 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.

At least 11 of the 17 members of the Scientific Advisory Committee on Nutrition (SACN) have conflicts of interest with the likes of Nestle, sugar manufacturer Tate and Lyle, and the world’s largest ice cream producer, Unilever, reports freelance journalist Sophie Borland.

And at least six out of the 11 members of SACN’s Subgroup on Maternal and Child Nutrition have ties to food firms, including baby food manufacturers and formula milk brands.

SACN is a powerful group of people appointed as independent experts to advise the government, which in turn influences policy, explains Borland. Since being set up in 2000 it has produced high profile guidelines on daily salt and sugar intake, vitamin D supplements, and feeding babies.

But there is concern that both SACN – and the previous governments reviewing its recommendations – have not done enough to curb rising obesity levels and food-related ill health.

The BMJ looked at the interests declared by SACN members – in publicly available documents published on the government website – within the past three years.

Among them is David Mela, a retired senior scientist from Unilever, who has done consultancy work for Unilever, Tate and Lyle, Coca Cola’s Israel franchise CBC Israel, and Cargill, which produces cocoa and chocolate products among other things.

Another member, Julie Lovegrove, is chair of an expert group at the International Life Sciences Institute (ILSI) Europe, whose member companies include Pepsico, Cadbury’s US owner Mondelez, and General Mills, the American firm behind Cheerios and Haagen Dazs.

Members of SACN’s Maternal and Child Nutrition subgroup include Ann Prentice, a council member of the Nestle Foundation, and Marion Hetherington who has undertaken work for Danone and baby food brand Ella’s Kitchen, the latter on an unpaid basis. The group’s chair, Ken Ong, has also received research funding from Mead Johnston Nutrition, which makes formula milk.

The Department for Health and Social Care (DHSC) responded on behalf of SACN and all members named in this article, saying SACN members are required to declare any potential conflicts of interest annually – and new ones at the first appropriate committee meeting, which are included in the minutes and published on the SACN website.

It added: “No members of the committee are directly employed by the food and drink industry, and all have a duty to act in the public interest and to be independent and impartial.”

But Chris van Tulleken, associate professor at University College London and author of a best-selling book on ultra-processed food, says: “Even small financial conflicts affect behaviour and beliefs in subtle or unconscious ways,” while Rob Percival, head of policy at the Soil Association, says: “We’re concerned that the committee and its integrity might be undermined by those ties to the food industry.”

Experts tell The BMJ the make-up of SACN needs to be reviewed in light of members’ ties to the food industry. However, Kat Jenner, director of the Obesity Health Alliance, says these ties are partly a result of the lack of money in relevant research.

Alison Tedstone, former chief nutritionist for Public Health England, also suggests that refusing to allow experts with industry ties on SACN would “diminish” its expertise and could delay future legislation.

Yet Van Tulleken insists: “Despite two decades of work from a conflicted SACN there has been an explosion of suffering and death from diet-related disease in the UK so I don’t think it’s credible to claim that the committee has been very effective.

“There are some excellent independent experts but they are a minority and in my view their work has been hampered by conflicts of interest with the industry that has created this health crisis. SACN must become independent of the food industry.”

Researchers from Brigham and Women’s Hospital, Harvard Medical School, and Northwestern University examined NHANES (National Health and Nutrition Examination Survey) between 2011 and 2020 to the Medicare beneficiaries who are most likely to be newly eligible for semaglutide based on SELECT trial criteria. They also describe which beneficiaries had any increased risk for future cardiac events and could be eligible pending future evidence generation and Part D coverage decisions. The researchers then estimated the maximum cost to Medicare Part D that would arise from providing coverage to these various groups of patients by multiplying the number of newly eligible Medicare beneficiaries by the annual net price of semaglutide, generated by subtracting a 41% average discount from the manufacturer list price of the medication in March 2024. The data showed that approximately 61% of Medicare-eligible adults with complete data had obesity and would potentially benefit from semaglutide for its weight loss benefits. However, when established cardiovascular disease is defined narrowly as in the SELECT trial, only 1 in 7, or 3.6 million people, would be likely to be newly eligible for semaglutide. Alternatively, if a more liberal definition of established CVD risk were used by Part D plans, then 15.2 million people would be eligible. Even in the most likely scenario where conservative definitions of CVD are used and many people do not stay on semaglutide long-term, Medicare spending could increase by $10 billion annually. The authors note that the analysis estimates maximum budgetary impacts but is not a spending projection and does not account for future payment reforms via the Inflation Reduction Act.

For the study, published in JAMA Network Open, researchers analyzed television ratings and advertising data from 2013 through 2022. The study authors found that a dramatic decline in food and drink advertisements during kids’ shows did not fully eliminate children’s exposure to ads for products high in saturated fat, trans fat, total sugars and sodium.

“Kids are still seeing about a thousand ads per year on other programs, and the majority of ads that kids see are still for unhealthy products,” said Lisa Powell, distinguished professor and director of health policy and administration in the UIC School of Public Health. “This is important as the World Health Organization has recognized that reducing children’s exposure to unhealthy food and beverage advertisements is a key strategy for improving both children’s diets and health.”

In 2006, a group of food, beverage and restaurant companies pledged to only advertise healthy products on children’s television programming, defined as shows where at least 35% of viewers are under the age of 12. Later revisions in 2014 and 2020 established nutritional criteria for what qualifies as unhealthy and therefore should not be advertised to young audiences.

Using television ratings data from The Nielsen Company, UIC researchers found that following changes in companies’ self-regulation, the number of general food and beverage commercials seen during children’s programs fell by over 95%. However, they found that 60% of the remaining food and beverage ads were still for unhealthy products.

And overall, kids under the age of 12 still saw more than 1,000 food-related advertisements per year, on average. Because of the steep decline in food and beverage ads during children’s shows, as much as 90% of this exposure came from watching shows with lower child-audience shares.

That shift suggests that regulations against advertising unhealthy food and beverages during hours when children are likely to watch television would be more effective than focusing restrictions specifically on children’s shows, the authors write.

The researchers also found a persistent racial difference in exposure to food-related advertisements. While the number of these ads seen by both Black and white children declined from 2013 to 2022, Black children saw significantly more advertisements than their white counterparts, due in part to more time spent watching television.

In general, children’s time watching television has declined, indicating the need for research on their exposure to advertising on other media. Powell’s group is in the early stages of launching a new project to measure the ads children encounter through social media platforms and digital entertainment.

“We know that the media kids consume is changing. They’re spending more time on their mobile devices, whether it be a tablet or a phone, and they’re seeing a lot of ads,” Powell said. “We really need to understand where else the food companies target kids and what they’re seeing.”

In addition to Powell, UIC co-authors include Julien Leider, Rebecca Schermbeck and Aline Vandenbroeck, along with University of Connecticut co-author Jennifer Harris. The study was supported by grants from Bloomberg Philanthropies and the Robert Wood Johnson Foundation.

Written by Rob Mitchum

Global meat production has increased rapidly in recent decades and meat consumption exceeds dietary guidelines in many countries.  Earlier research indicated that higher intakes of processed meat and unprocessed red meat are associated with an elevated risk of type 2 diabetes, but the results have been variable and not conclusive.

Poultry such as chicken, turkey, or duck is often considered to be an alternative to processed meat or unprocessed red meat, but fewer studies have examined the association between poultry consumption and type 2 diabetes.

To determine the association between consumption of processed meat, unprocessed red meat and poultry and type 2 diabetes, the team led by researchers at the University of Cambridge used the global InterConnect project to analyse data from 31 study cohorts in 20 countries. Their extensive analysis took into account factors such as age, gender, health-related behaviours, energy intake and body mass index.

The researchers found that the habitual consumption of 50 grams of processed meat a day – equivalent to 2 slices of ham – is associated with a 15% higher risk of developing type 2 diabetes in the next 10 years. The consumption of 100 grams of unprocessed red meat a day – equivalent to a small steak – was associated with a 10% higher risk of type 2 diabetes.

Habitual consumption of 100 grams of poultry a day was associated with an 8% higher risk, but when further analyses were conducted to test the findings under different scenarios the association for poultry consumption became weaker, whereas the associations with type 2 diabetes for each of processed meat and unprocessed meat persisted.

Professor Nita Forouhi of the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, and a senior author on the paper, said:

“Our research provides the most comprehensive evidence to date of an association between eating processed meat and unprocessed red meat and a higher future risk of type 2 diabetes. It supports recommendations to limit the consumption of processed meat and unprocessed red meat to reduce type 2 diabetes cases in the population.

While our findings provide more comprehensive evidence on the association between poultry consumption and type 2 diabetes than was previously available, the link remains uncertain and needs to be investigated further.”

InterConnect uses an approach that allows researchers to analyse individual participant data from diverse studies, rather than being limited to published results. This enabled the authors to include as many as 31 studies in this analysis, 18 of which had not previously published findings on the link between meat consumption and type 2 diabetes. By including this previously unpublished study data the authors considerably expanded the evidence base and reduced the potential for bias from the exclusion of existing research.

Lead author Dr Chunxiao Li, also of the MRC Epidemiology Unit, said:

“Previous meta-analysis involved pooling together of already published results from studies on the link between meat consumption and type 2 diabetes, but our analysis examined data from individual participants in each study. This meant that we could harmonise the key data collected across studies, such as the meat intake information and the development of type 2 diabetes.

Using harmonised data also meant we could more easily account for different factors, such as lifestyle or health behaviours, that may affect the association between meat consumption and diabetes. “

Professor Nick Wareham, Director of the MRC Epidemiology Unit, and a senior author on the paper said:

“InterConnect enables us to study the risk factors for obesity and type 2 diabetes across populations in many different countries and continents around the world, helping to include populations that are under-represented in traditional meta-analyses.

Most research studies on meat and type 2 diabetes have been conducted in USA and Europe, with some in East Asia. This research included additional studies from the Middle East, Latin America and South Asia, and highlighted the need for investment in research in these regions and in Africa.

Using harmonised data and unified analytic methods across nearly 2 million participants allowed us to provide more concrete evidence of the link between consumption of different types of meat and type 2 diabetes than was previously possible.”

InterConnect was initially funded by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602068.

Reference

Li, C et al. Meat consumption and incident type 2 diabetes: a federated meta-analysis of 1·97 million adults with 100,000 incident cases from 31 cohorts in 20 countries. Lancet Diabetes Endocrinol.; 20 August 2024. DOI:10.1016/S2213-8587(24)00179-7

In the absence of US-specific nutrition or promotional guidelines for these foods, researchers at The George Institute for Global Health assessed data on 651 infant and toddler food products sold in the top ten US grocery chains held in the Institute’s FoodSwitch database against this international benchmark.²

Among all products, 70 percent failed to meet protein requirements and 44 percent exceeded total sugar requirements. A further one in four products did not meet calorie requirements and one in five exceeded recommended sodium limits.

Dr Elizabeth Dunford, Research Fellow at The George Institute, and Adjunct Assistant Professor, Department of Nutrition at the University of North Carolina said that the rising popularity of processed convenience foods for infants and young children was concerning.

“Early childhood is a crucial period of rapid growth and when taste preferences and dietary habits form, potentially paving the way for the development of chronic diseases such as obesity, diabetes and some cancers later in life,” she said.

“Time-poor parents are increasingly choosing convenience foods, unaware that many of these products lack key nutrients needed for their child’s development and tricked into believing they are healthier than they really are.”

Researchers found that baby food pouches are the fastest growing products in the sector, with a 900 percent increase in the proportion of sales deriving from pouches in the last 13 years. Concerningly, pouches ranked among the unhealthiest products assessed, with fewer than 7 percent meeting total sugar recommendations.*

The study also revealed the extent of misleading marketing practices, with almost all (99.4 percent) products featuring at least one prohibited claim on their packaging. On average, products displayed four prohibited claims, with some displaying as many as 11. Common claims included ‘non genetically modified (GM)’ (70 percent), ‘organic’ (59 percent), ‘no BPA’ (37 percent), and ‘no artificial colors/flavors’ (25 percent).

Dr Daisy Coyle, Research Fellow and Dietitian at The George Institute said that claims like these create a so-called ‘health halo’ around these products.

“The lack of regulation in this area leaves the door wide open for the food industry to deceive busy parents,” she said.

“We saw this not only in the use of misleading claims but also in the use of misleading names, where the product name did not reflect the main ingredients found on the ingredient list.”

“For example, snack and finger foods often referred to fruit or vegetables in the product name, despite primarily being made of flour or other starches,” Dr Coyle added.

Obesity in children aged two to five has more than doubled in the US since the 1970s, with approximately 13% of preschool children living with obesity.³ This has only worsened since the COVID-19 pandemic.⁴

“While reducing childhood obesity was a priority under the Obama administration, the issue appears to have fallen by the wayside in recent years,” added Dr Dunford.

“Our findings highlight the urgent need for better regulation and guidance in the infant and toddler foods market in the United States – the health of future generations depends on it.”

1. Coyle DH et al. An evaluation of the nutritional and promotional profile of commercial foods for infants and toddlers in the United States. Nutrients 2024. 16,0
2. World Health Organization. Nutrient and Promotion Profile Model: Supporting appropriate promotion of food products for infants and young children 6–36 months in the WHO European Region. 2022
   https://www.who.int/europe/publications/i/item/WHO-EURO-2022-6681-46447-67287
3. Fryar CD, et al. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. 2020. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf
4. Lange SJ et al. Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1278–1283
   https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w

*This represents 7 percent of all pouches, but fruit-based pouches (which contain the most sugar) aren’t included in the WHO criteria. This figure becomes 69% if fruit-base pouches are excluded.

“Compared to prior studies that relied solely on epidemiological data, we integrated multiple layers of information, including epidemiological data, conventional metabolic biomarkers, and cutting-edge metabolomics,” said lead author Fenglei Wang, research associate in the Department of Nutrition. “This allowed us to achieve a more comprehensive understanding of the association between iron intake and T2D risk, as well as potential metabolic pathways underlying this association.”

The study will be published August 13 in Nature Metabolism.

The researchers assessed the link between iron and T2D using 36 years of dietary reports from 206,615 adults enrolled in the Nurses’ Health Studies I and II and the Health Professionals Follow-up Study. They examined participants’ intake of various forms of iron—total, heme, non-heme, dietary (from foods), and supplemental (from supplements)—and their T2D status, controlling for other health and lifestyle factors.

The researchers also analyzed the biological mechanisms underpinning heme iron’s relationship to T2D among smaller subsets of the participants. They looked at 37,544 participants’ plasma metabolic biomarkers, including those related to insulin levels, blood sugar, blood lipids, inflammation, and two biomarkers of iron metabolism. They then looked at 9,024 participants’ metabolomic profiles—plasma levels of small-molecule metabolites, which are substances derived from bodily processes such as breaking down food or chemicals.

The study found a significant association between higher heme iron intake and T2D risk. Participants in the highest intake group had a 26% higher risk of developing T2D than those in the lowest intake group. In addition, the researchers found that heme iron accounted for more than half of the T2D risk associated with unprocessed red meat and a moderate proportion of the risk for several T2D-related dietary patterns. In line with previous studies, the researchers found no significant associations between intakes of non-heme iron from diet or supplements and risk of T2D.

The study also found that higher heme iron intake was associated with blood metabolic biomarkers associated with T2D. A higher heme iron intake was associated with higher levels of biomarkers such as C-peptide, triglycerides, C-reactive protein, leptin, and markers of iron overload, as well as lower levels of beneficial biomarkers like HDL cholesterol and adiponectin.

The researchers also identified a dozen blood metabolites—including L-valine, L-lysine, uric acid, and several lipid metabolites—that may play a role in the link between heme iron intake and TD2 risk. These metabolites have been previously associated with risk of T2D.

On a population level, the study findings carry important implications for dietary guidelines and public health strategies to reduce rates of diabetes, according to the researchers. In particular, the findings raise concerns about the addition of heme to plant-based meat alternatives to enhance their meaty flavor and appearance. These products are gaining in popularity, but health effects warrant further investigation.

“This study underscores the importance of healthy dietary choices in diabetes prevention,” said corresponding author Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology. “Reducing heme iron intake, particularly from red meat, and adopting a more plant-based diet can be effective strategies in lowering diabetes risk.”

The researchers noted that the study had several limitations, including the potential for incomplete accounting for confounders and measurement errors in the epidemiological data. In addition, the findings—based on a study population that was mostly white—need to be replicated in other racial and ethnic groups.

Other Harvard Chan authors included Andrea Glenn, Anne-Julie Tessier, Danielle Haslam, Marta Guasch-Ferré, Deirdre Tobias, Heather Eliassen, JoAnn Manson, Kyu Ha Lee, Eric Rimm, Dong Wang, Qi Sun, Liming Liang, and Walter Willett.

“Integration of epidemiological and blood biomarker analysis links heme iron intake to increased type 2 diabetes risk,” Fenglei Wang, Andrea J. Glenn, Anne-Julie Tessier, Zhendong Mei, Danielle E. Haslam, Marta Guasch-Ferré, Deirdre K. Tobias, A. Heather Eliassen, JoAnn E. Manson, Clary Clish, Kyu Ha Lee, Eric B. Rimm, Dong D. Wang, Qi Sun, Liming Liang, Walter C. Willett, Frank B. Hu, Nature Metabolism, August 13, 2024, doi: 10.1038/s42255-024-01109-5

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

“Our findings should raise alarm bells in nearly every nation worldwide,” said senior author Dariush Mozaffarian MD, Jean Mayer Professor of Nutrition and director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. “The intakes and trends we’re seeing pose a significant threat to public health, one we can and must address for the future of a healthier population.”

The investigators extracted and analyzed data from the Global Dietary Database, a comprehensive accounting of what people worldwide eat and drink.

They generated the first global estimates of trends in sugar-sweetened beverage consumption among young people.

They defined sugar-sweetened beverages as soda, juice drinks, energy drinks, sports drinks, and home-sweetened fruit drinks such as aguas frescas with added sugars and containing more than 50 kcal per 1 cup serving.

In 2018, sugar-sweetened beverage intake among young people varied significantly by world region, averaging 3.6 servings per week worldwide and ranging from 1.3 servings per week in South Asia to 9.1 in Latin America and the Caribbean..

They reported that sugar-sweetened beverage intake among children and adolescents increased by an average of 23% (0.68 servings/week) from 1990 to 2018. The largest increases were in sub-Saharan Africa (2.17 servings/week).

Notably, 56 (30%) of the 185 countries included in the analysis had an average sugar-sweetened beverage intake of 7 or more servings/week.

The authors concluded, “This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa.”

Malnutrition during early pregnancy is known to elevate diabetes risk later in life. With 187,000 children born in Ukraine in 2023, Klimek and Thurner suggest that the current diabetes prevalence rate of 7.1% could result in an additional 13,000 to 19,000 cases of diabetes in this birth cohort alone.

Global impact

Globally, the disruption of crucial food exports due to the conflict has pushed an estimated 23 million people into hunger. Considering other supply chain interruptions and weather-related shocks, projections suggest that up to 122 million more people could suffer from hunger compared to 2019. “This could potentially lead to up to 180,000 additional Type 2 diabetes cases worldwide,” the researchers say.

They caution that while these estimates are not intended to be quantitative predictions, they do underscore the profound and often overlooked—especially indirect—effects of geopolitical events on public health.

Ukraine – a key producer

Prior to the war, Ukraine was a major global agricultural producer, ranking as the largest exporter of sunflower oil, the fourth-largest exporter of corn, and the fifth-largest exporter of wheat. The modeled impacts of Ukraine’s agricultural production loss suggest that countries like Moldova, Libya, Lebanon, and Tunisia could face significant wheat shortages, with extensive repercussions for food products that rely on wheat as an ingredient.

Why this matters

Klimek and Thurner emphasize the importance of addressing these indirect consequences of conflicts and supply chain disruptions: “Our estimates are meant to illustrate the scale of the impact on public health, so that health authorities can become aware of these emerging high-risk groups and potentially adjust screening and early prevention measures for the coming decades,” the researchers stated. They also stress the urgent need to diversify global food supply chains and reduce dependencies.

Famine and diabetes

The link between hunger and diabetes is well-documented, with studies from historical famines in the Netherlands, China, and Austria, for example, showing that malnutrition during early pregnancy can significantly increase type 2 diabetes risk later in life. Recent research into the Ukrainian famine of 1932-33 by Lumey et al. has provided new insights into this relationship at a more granular level. By analyzing monthly birth cohorts and regional variations in famine severity, they found that severe malnutrition during early pregnancy can increase diabetes risk by 1.5 to 2 times.

This heightened risk is believed to stem from metabolic changes triggered by fetal exposure to poor nutrition, which prepares the body for a nutrient-scarce environment. When this environment changes, the mismatch can result in a higher likelihood of developing diabetes.

About CSH

The Complexity Science Hub (CSH) is Europe’s research center for the study of complex systems. We derive meaning from data from a range of disciplines – economics, medicine, ecology, and the social sciences – as a basis for actionable solutions for a better world. Established in 2015, we have grown to over 70 researchers, driven by the increasing demand to gain a genuine understanding of the networks that underlie society, from healthcare to supply chains. Through our complexity science approaches linking physics, mathematics, and computational modeling with data and network science, we develop the capacity to address today’s and tomorrow’s challenges.

The reduction of dietary AGEs on the low-fat vegan diet came mainly from excluding the consumption of meat (41%), minimizing the consumption of added fats (27%), and avoiding dairy products (14%).

“The study helps bust the myth that a Mediterranean diet is best for weight loss,” says lead study author Hana Kahleova, MD, PhD, director of clinical research at the Physicians Committee for Responsible Medicine. “Choosing a low-fat vegan diet that avoids the dairy and oil so common in the Mediterranean diet helps reduce intake of harmful advanced glycation end-products leading to significant weight loss.”

AGEs may be ingested through the diet, and animal products are generally higher in AGEs than plant foods. Cooking with high heat under dry conditions, such as grilling, leads to significant formation of AGEs, especially in animal-derived foods, which are also rich in fats. High amounts of AGEs circulating in the body can contribute to insulin resistance, which can lead to weight gain. AGEs are also linked to inflammation and oxidative stress, which contribute to chronic diseases like heart disease and type 2 diabetes.

The new research is a secondary analysis of a previous Physicians Committee study comparing a low-fat vegan diet to a Mediterranean diet. The study randomly assigned participants to either a low-fat vegan diet, which consisted of fruits, vegetables, grains, and beans, or a Mediterranean diet, which focused on fruits, vegetables, legumes, fish, low-fat dairy, and extra virgin olive oil, for 16 weeks. Neither group had a calorie limit. Participants then went back to their baseline diets for a four-week washout period before switching to the opposite group for an additional 16 weeks. Dietary AGEs were calculated based on self-reported dietary intake records. AGE scores were assigned to each food item, using a published database of AGE content.

“Our research shows that you can use the power of your plate to lose weight with a low-fat vegan diet that’s rich in fruits, vegetables, grains, and beans and low in AGEs,” adds Dr. Kahleova. “It’s a simple and delicious way to maintain a healthy weight and fight chronic disease.”

The study found that UPF consumption was highest among adolescents from deprived backgrounds, those of white ethnicity, and younger adolescents.

UPFs are food items that are manufactured from industrial substances and contain additives such as preservatives, sweeteners, colourings, flavourings, and emulsifiers. UPFs vary greatly, but tend to indicate poor dietary quality, with higher levels of added sugars, saturated fat, and sodium, as well as decreased fibre, protein, and micronutrient content. They have been suggested as one of the key drivers of the global rise in diseases such as obesity, type 2 diabetes, and cancer.

Globally, the availability and sales of UPFs have increased over time and previous evidence suggests that this has led to increased consumption among adolescents. To look at trends within the UK, researchers from Cambridge and Bristol analysed data from four-day food diaries of almost 3,000 adolescents in the UK National Diet and Nutrition Survey between 2008/09 and 2018/19.

In research published today in the European Journal of Nutrition, the researchers found that a mean of 66% of adolescents’ energy intake came from UPF consumption during this period, though there was a slight fall from 68% to 63% between 2008/09 and 2018/2019.

Parents’ occupation, ethnic group and UK region all influenced the proportion of calorie intake from UPFs:

• Adolescents from disadvantaged backgrounds consumed a higher proportion of their calorie intake from UPFs compared to adolescents from less disadvantaged backgrounds (68.4% compared with 63.8%).
• Adolescents from a non-white ethnicity consumed a lower proportion of their calorie intake from UPFs (59.0% compared with 67.3%).
• Adolescents living in the North of England consumed a higher proportion of their calorie intake from UPFs compared with those living in the South of England and London (67.4% compared with 64.1%).
• 18-year-olds consumed a lower proportion of their calorie intake from UPFs compared with 11-year-olds (63.4% compared with 65.6%).

Dr Yanaina Chavez-Ugalde from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, the study’s first author, said: “Adolescents’ food patterns and practices are influenced by many factors, including their home environment, the marketing they are exposed to and the influence of their friends and peers. But adolescence is also an important time in our lives where behaviours begin to become ingrained.

“It’s clear from our findings that ultra-processed foods make up the majority of adolescents’ diets, and their consumption is at a much higher level than is ideal, given their potential negative health impacts.”

The researchers argue that the observed reduction in UPF intake pre-pandemic could be partly explained by an increased public awareness and health concerns associated with sugar consumption, government-led campaigns, sugar-taxes in other countries and the reformulation of sugary drinks to reduce their sugar content.

Dr Esther van Sluijs from the MRC Epidemiology Unit at Cambridge, joint senior author, said: “Ultra-processed foods offer convenient and often cheaper solutions to time- and income-poor families, but unfortunately many of these foods also offer poor nutritional value. This could be contributing to the inequalities in health we see emerging across childhood and adolescence.”

Dr Zoi Toumpakari from the Centre for Exercise, Nutrition and Health Sciences at the University of Bristol, joint senior author, added: “Our findings suggest that disparities in consumption of ultra-processed foods are not just down to individual choices. We hope this evidence can help guide policymakers in designing more effective policies to combat the negative effects of ultra-processed food consumption among youth and the ripple effects this has on public health.”

This study was largely funded by the National Institute for Health and Care Research School for Public Health Research.

Reference
Chavez-Ugalde, Y et al. Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19. Eur J Nutr; 17 Jul 2024; DOI: 10.1007/s00394-024-03458-z

Prescription fills for the drug best known as Ozempic or Wegovy — semaglutide — increased by more than 400% between January 2021 and December 2023, according to research out today in  JAMA Health Forum.

Approved first for type 2 diabetes, then for weight loss, studies show that semaglutide also improves blood pressure and reduces cardiovascular disease — problems that plague millions of Americans. Yet the lion’s share of prescriptions went to people with private insurance.

“Given the proven cardiovascular benefits of Ozempic and Wegovy when used for diabetes or obesity, and the disproportionate burden of diabetes and obesity in Black/Latinx Medicaid and Part D populations, these findings suggest that their lower use in Medicaid and Part D may worsen disparities in diabetes and obesity outcomes,” said senior author Dima Qato, an associate professor at the USC Mann School of Pharmacy & Pharmaceutical Sciences and senior scholar at the USC Leonard D. Schaeffer Center for Health Policy & Economics.

“I think all the current attention in the media on semaglutide’s anti-obesity effect obscures the fact that the drug is also hugely important for treating diabetes. It’s the reason why I’ve been able to get some of my patients off insulin,” said first author Christopher Scannell, a physician and postdoctoral researcher at the Schaeffer Center. “If only certain patient populations get access to these medications — those primarily with private insurance, more generous health plans — then there’s a huge percentage of the U.S. population that isn’t getting access to these medications. And that brings up a very significant equity issue.”

Ozempic and Wegovy are once-weekly injections. Another form of semaglutide, Rybelsus, is a daily pill. Ozempic was approved in 2017, followed by Rybelsus in 2019, to treat type 2 diabetes. Wegovy, approved 2021, is a higher-dose version that’s specifically approved for weight loss. Ozempic’s sticker price is about $1,000 per month, while Wegovy is listed around $1,350.

For the study, researchers used data from IQVIA’s National Prescription Audit PayerTrak, which captures 92% of prescriptions filled and dispensed to individuals at retail pharmacies in the United States.

Then, they calculated monthly fills for semaglutide by drug brand (Ozempic, Wegovy, and Rybelsus) and by payment method (commercial insurance, Medicaid, Medicare Part D, and cash) between January 2021 and December 2023.

Prescription fills reached 2.6 million by December 2023. Ozempic persistently accounted for most of the prescriptions, but prescription fills for Wegovy, approved for weight loss in June 2021, soared by more than 1,361% between July 2021 and December 2023.  Awareness of the drugs’ weight-loss benefits shot up in late 2022 and likely contributed to shortages of Ozempic and Wegovy, first reported by the FDA in March 2022.

• Medicaid accounted for less than 10% of semaglutide fills for all three drug brands in 2023. Access via Medicaid is a state-level decision, Scannell said. Depending on the budget — and politics — of where you live, the drugs may or may not be covered. (Medicaid provides assistance to low-income people, the elderly and some people with disabilities.)
• Medicare Part D accounted for 28.5% and 32.9% of Ozempic and Rybelsus fills, respectively, in 2023; it only accounted for 1.2% of Wegovy fills. Medicare Part D doesn’t cover the drugs for obesity unless a patient also has a co-morbidity such as cardiovascular disease as well  — the very problem Wegovy or Ozempic can prevent.
• Approximately 1% or less of all semaglutide fills went to people paying cash in 2023.

In the context of treating obesity, Scannell said, “if Medicare is only covering these drugs for patients who have obesity and a co-morbidity, it may be forcing patients who only have obesity to develop these additional chronic conditions before they can get access to the medications. It’s like saying ‘You have to be sick enough, then we’ll cover that medication for you.’”

The researchers said future studies should examine how changes in Medicare Part D and Medicaid coverage restrictions influence disparities in access to these essential medications. In addition, further research could examine individual-level variables such as age, race, and ethnicity and whether the drugs were prescribed for obesity or diabetes.

In addition to Scannell and Qato, other authors include John Romley, Rebecca Myerson and Dana Goldman, all of USC.