Michael Vallis

Background: Cardiovascular disease remains the leading cause of death and hospitalization globally. Clinical practice guidelines recommend various plant‐based dietary patterns that target specific cardiometabolic risk factors, including the Dietary Approach to Stop Hypertension (DASH) diet for blood pressure and the Portfolio diet for low‐density lipoprotein cholesterol. Combining key elements of these patterns may enhance cardiovascular disease risk reduction. However, many soy‐based products, a key Portfolio component, are classified as ultra‐processed foods (UPFs). This trial will answer 2 questions: (1) Does a DASH‐enhanced Portfolio diet result in clinically meaningful reductions in blood pressure compared with standard of care and (2) Is a high‐UPF noninferior to a low‐UPF soy protein‐containing DASH‐enhanced Portfolio diet for blood pressure reduction? Methods: The SWITCH (Substitution of High With Low Ultra‐Processed Soy Protein Foods in a Guideline‐Based Diet Intervention for Cardiometabolic Health) trial is a parallel, randomized, 3‐arm, open‐label, superiority–noninferiority trial. Three hundred adults with hypertension and obesity, including 50% with type 2 diabetes, will be randomized to a high‐UPF or low‐UPF soy protein‐containing DASH‐enhanced Portfolio diet or standard of care for 12 weeks. The primary outcome is systolic blood pressure. Key secondary outcomes are non–high‐density lipoprotein cholesterol and body weight. Other outcomes include cardiometabolic risk factors. Conclusions: Findings will provide high‐quality evidence on the use of a DASH‐enhanced Portfolio diet and the role of nutrient‐dense soy foods classified as UPFs within the combination of the 2 guideline‐based dietary patterns to support dietary strategies for cardiometabolic risk reduction. REGISTRATION: URL: https://clinicaltrials.gov/ ; Unique identifier: NCT06907862.

Background: Evidence for the role of health behaviour and lifestyle treatment (HBLT) on the effectiveness of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) in paediatric obesity is limited. Objectives: To assess the role of HBLT on the effectiveness of GLP‐1RAs in youth with obesity. Methods: Patients aged 8–18 years with obesity ( n = 51) receiving liraglutide were retrospectively divided into continuers (ongoing liraglutide treatment), discontinuers, or switches to semaglutide or metabolic‐bariatric surgery. All were offered multidisciplinary HBLT and consecutively allocated to either high‐frequency (HF) HBLT (≥ 26 contact hours/year) or low‐frequency obesity medication (OM)‐specific HBLT (9 contacts of 0.5 h/year). Results: After 9.7 ± 6.6 months, a BMI reduction of ≥ 5% and ≥ 10% was observed in 37.3% and 13.7%, respectively. Relative change in BMI was higher in continuers compared to discontinuers (−6.7% ± 7.5% vs. −0.7% ± 5.1%, p = 0.03). Whereas 39.2% of patients continued liraglutide, 33.3% discontinued, mainly due to gastrointestinal symptoms. 27.4% of patients switched treatment to semaglutide or underwent surgery. Patients with combined HBLT and liraglutide had markedly higher odds of continuation (OR 18.5, 95% CI 2.0–929.8, p < 0.01) and greater reductions in BMI, which was by trend higher with OM‐HBLT compared to HF‐HBLT (BMI change −6.9% ± 7.2% vs. −4.0% ± 6.6%). Conclusions: GLP‐1RAs were effective in the real‐world treatment of paediatric obesity. HBLT appears to be essential to increase persistence and efficacy of GLP‐1RAs.

Objectives: To determine the prevalence and correlates of COVID-19 vaccine hesitancy among Canadian health care workers (HCWs) and identify motivators for COVID-19 vaccination, compared with the general population (GPop). Methods: As part of the iCARE study, 4 cross-sectional age-, sex-, and province-weighted population-based samples of 12 009 Canadians aged 18+ years were recruited between May 2021 and February 2022. Participants self-reported HCW and vaccine status. Results: A total of 738 participants identified as HCWs, with 8.5% being vaccine hesitant, versus 12.6% of the GPop (P = .005). In multivariate analyses, those with a chronic disease were less likely (HCW odds ratio [OR] = 0.34; GPop OR = 0.77) and parents with children <18 years of age in the household were more likely (HCW OR = 2.29; GPop OR = 1.39) to be vaccine hesitant. Needing only a single-dose vaccine (86%; 82.6%), and vaccine safety (46%; 42%) and effectiveness (38%; 37%) were most likely to motivate hesitant HCWs and GPop to get vaccinated. Conclusions: Our findings highlight less vaccine hesitancy in HCWs compared with the GPop, despite demographic and motivator correlates being similar. In terms of policy implications, shared interventions emphasizing vaccine safety, reduced illness severity, shorter disease duration, and the advantages of single-dose options may benefit all groups.

Background: Inflammatory bowel disease-related psychological distress (IBD-PD) refers to the emotional impact of IBD and has been shown to be associated with increased disease severity, comorbid mental health disorders, and increased mortality. Aims: This study aims to identify the facilitators for accessing evidence-based interventions for IBD-PD to inform the design and implementation of patient-centred models for IBD mental health support in the future. Methods: This was a qualitative research study in which a semistructured interview script was developed by a multidisciplinary team guided by the domains of the COM-B Behaviour Change Wheel framework. Using thematic analysis, codes were generated to identify themes using an inductive approach. Results: Fourteen participants were successfully recruited (n = 14). Thematic analyses identified the following major themes: (1) mental health should be treated as an integrated component of specialty IBD care; (2) use of self-help strategies alongside existing supports is feasible, acceptable, and accessible; (3) accessing support for IBD-PD through virtual care is often acceptable; and (4) flexible, multifaceted delivery models for IBD-PD are needed. All participants felt that mental health should be discussed at IBD clinic visits. Preferences for hybrid formats for IBD-PD care were clear. Most participants felt that it was important for psychological support persons to also have IBD knowledge. Participants felt strongly that a more qualified psychologist, even in the absence of IBD knowledge, was their top priority. Conclusions: Some key facilitators identified from this study include healthcare professionals discussing IBD-PD directly with their patients, offering hybrid formats for IBD-PD, and integrating self-help strategies into care.

Aims: To conduct a multi‐study, cross‐country examination of diabetes stigma among adults with type 1 and type 2 diabetes (T1D, T2D). Methods: Pre‐existing, cross‐sectional studies of adults (aged ≥18) completing the T1D or T2D Diabetes Stigma Assessment Scales (DSAS‐1/DSAS‐2) were collated. Descriptive statistics were calculated for (sub)scale and item scores. Variance‐components linear random‐effect multi‐level modelling (nested random intercepts for country and study) estimated overall mean (sub)scale scores, 95% confidence intervals, intraclass correlation coefficients (ICC) and 95% prediction intervals. Likelihood ratio (LR) tests provided inference for country‐ and study‐specific heterogeneity. Results: Eleven studies were included from six countries (Australia k = 2, Canada k = 1, Japan k = 2, New Zealand k = 1, UAE k = 1, USA k = 4) in four languages (Arabic k = 1, English k = 7, Japanese k = 2, Spanish k = 1). Six studies included n = 3114 adults with T1D (insulin pump: 42%; 75% aged n = 6586 adults with T2D (insulin‐treated: 37%; 44% aged p < 0.001; DSAS‐2: 44 [1.1], ICC ≤0.4, p < 0.001). Conclusions: Findings suggest a high and relatively consistent prevalence of diabetes stigma across studies and within and across countries, supporting calls for local and global action.

Disordered eating, such as binge-eating and loss of control eating (LOCE), contribute to suboptimal weight loss and weight regain in some patients who undergo weight loss surgery (WLS). Despite robust evidence linking disordered eating and poor WLS outcomes, there is no consensus on standardized screening and treatment practices for this population. To address this gap, our team conducted a literature review using Ovid MEDLINE, Scopus, CINAHL, EMBASE, and Cochrane CENTRAL, focusing on studies examining screening and treatment of disordered eating in WLS populations. Our review identified key findings related to (a) screening and diagnostic tools, including semi-structured interviews and self-report measures, and (b) psychotherapeutic interventions, including cognitive behavioral therapy (CBT) and other modalities. Findings are inconclusive but suggest avenues for future research examining the routine implementation of post-WLS screening and treatment protocols (including adjunctive pharmacotherapy) for disordered eating.