Jimmy Chun Yu Louie

National breastfeeding statistics are conventionally read as a measure of maternal behaviour, and the dominant policy response has been to educate and encourage individual women. This Perspective argues that breastfeeding statistics should be interpreted primarily as indicators of system performance rather than maternal behaviour. In high‐income countries, much early cessation occurs among women who intended to continue breastfeeding but could not obtain timely, effective support. The resulting shortfall therefore reflects constrained choice as much as personal preference. That both the systems framing and the intention‐to‐cessation indicator already exist in the literature is acknowledged directly: surveillance research has measured the gap, described its risk factors, and mapped its social patterning. Viewed through a quality‐and‐safety lens, unwanted early cessation has many of the characteristics of a preventable harm. It is common, patterned by identifiable failures of care, and partly avertable with known interventions such as evidence‐based maternity practices, proactive post‐discharge contact, adequate paid leave, and protection from substitute marketing. The contribution of this Perspective is not a new metric, but a new use for an existing one. I argue that unwanted early cessation should be treated as an accountable quality indicator within the quality‐and‐safety systems already used for other preventable harms. Rather than remaining a descriptive statistic, it should become a measure for which health services, employers, and policymakers share accountability. The paper also addresses how intention should be measured, considers the risks of increased surveillance, safeguards maternal autonomy, avoids shifting blame onto clinicians, and distinguishes challenges in high‐income settings from priorities in lower‐income contexts.

Background and Objectives: Exercise combined with a hypocaloric high-protein diet is recommended for sarcopenic obesity (SO), yet accessible dietary support remains limited. EatWelLog^®, a mobile health (mHealth) nutrition application, was developed to facilitate dietary self-management. This study evaluated the feasibility, acceptability, and preliminary effects of an EatWelLog^®-supported lifestyle intervention for community-dwelling older adults with SO. Methods: In this two-arm randomized controlled trial (RCT), 40 adults aged ≥65 years at risk of SO were randomized to Conventional Supervised (CS) or mHealth-supported (MH) groups. Both groups received an 8-week intervention that included three individualized dietitian consultations, five group nutrition classes, and eight weekly 60 min multicomponent exercise sessions. The MH group also used EatWelLog^® during the intervention and the 6-month follow-up. Outcomes were assessed at baseline (T0), immediately post-intervention (T1), and at the 3-month (T2) and 6-month (T3) follow-ups. Results: Recruitment (48.8%) and attendance (83.3%) rates supported feasibility. Four participants in the MH group dropped out after the beginning of the intervention. The App demonstrated moderate-to-high acceptability. Between-group differences and group × time interactions were not detected for primary outcomes. Muscle strength improved from baseline to post-intervention in both groups, and physical performance showed improvements in MH across all follow-up assessments. Focus group participants valued the App’s dietary tracking, feedback, and reminders, though they identified limitations in food-recording functions. Conclusions: Findings support feasibility and acceptability, but strategies are needed to reduce attrition and improve compliance with recording diets. As this pilot was not powered for effectiveness, the App’s added benefit remains uncertain. A larger, adequately powered RCT is warranted.

Purpose of Review: Almost every study linking ultra-processed foods (UPFs) to obesity measures exposure as the proportion of energy or weight derived from Nova group 4 foods, averaged across days. This scalar is commonly treated as though it were the exposure itself, yet it embodies an untested assumption: that the timing and context of intake carry no information beyond total amount. This review examines what is lost when occasion-level intake is collapsed to a daily average and how that loss may affect epidemiological inference. Recent Findings: Controlled circadian-misalignment protocols and time-restricted eating trials show that the metabolic response to a fixed quantity of food varies with its timing. Postprandial studies further show that meal sequence, co-ingestion and eating-occasion structure modify glycaemic and appetite responses at equal daily totals. These findings expose a mismatch between the timescale at which relevant processes operate and the daily scale at which UPF exposure is conventionally measured. Measurement-error and causal-inference frameworks show how such temporal collapse could attenuate or otherwise distort effect estimates, reduce transportability and obscure the intervention to which an association refers. Summary: The daily group 4 fraction is a modelling choice, not a complete representation of the diet. It discards temporal and contextual structure that may explain heterogeneity across UPF-obesity cohorts and determine the causal contrast represented by their estimates. This review proposes a time-resolved, context-aware construct and specifies the studies needed to test whether it adds information beyond the conventional scalar. The controlled timing literature manipulated total energy, macronutrients or glucose loads rather than Nova group 4 foods, so its extension to UPFs remains a testable inference rather than an established finding. The immediate priority is therefore not to replace the scalar, but to analyse cohorts whose dietary records retain item-level time stamps and determine whether the discarded structure predicts outcomes beyond total amount.