Alexander Vonderschmidt

Objective: Glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) are effective treatments for obesity, but discontinuation is common due to cost, insurance coverage limitations, side effects, patient preference, and other factors. Weight regain often occurs rapidly after cessation, yet few evidence‐based strategies exist to support weight maintenance during this transition. This pilot randomized trial examined whether a digital wellness application or medically tailored meals (MTM) could mitigate weight gain during the first 4 months after GLP‐1 cessation. Methods: In this pilot randomized trial, adults with prior GLP‐1‐induced weight loss were randomized to usual care, wellness application, or MTM at the time of GLP‐1 cessation. Surveys assessed adherence and satisfaction (primary outcome) as well as exploratory outcomes, diet quality, and perceived health. Weight (exploratory) was measured monthly using validated Bluetooth scales. Results: Participants ( n = 39) were randomized to control ( N = 14), digital wellness application ( N = 12), or MTM ( N = 13) and had a mean baseline BMI 31.4 (SD 6.3) kg/m ² . Diet quality, perceived health, adherence, and satisfaction did not significantly differ by group, though some estimates suggested possible trends favoring the wellness application. Relative to control, both the wellness application and MTM groups had less total weight gain: Wellness application −7.16% (95% CI: −12.27, −2.04) and MTM −7.17% (−12.20, −2.14). Conclusions: These findings suggest that structured support may attenuate early weight gain after GLP‐1 cessation. Larger, more diverse trials with longer follow‐up and clinical outcomes are needed to confirm results and clarify mechanisms.

BackgroundI.Important characteristicsIn 2024, approximately 48 million people lived in households experiencing food insecurity with limited or uncertain access to adequate food. In the same year, 23.4% of US adults were living with a mental illness, 5.6% a serious mental illness (SMI). According to a 2024 meta-analysis, among adults living with SMI, food insecurity prevalence was 41%, and the odds of food insecurity were 3.31 times as high as those living without SMI. Moreover, a 2020 meta-analysis of 19 studies found that food insecurity was associated with depression (OR 1.40, 95% CI: 1.30-1.58) and stress (OR 1.34, 95% CI: 1.24-1.44).This review will focus on synthesizing study-defined diagnostic criteria, selected symptom thresholds, treatment status, and disorder-specific outcomes. Food insecurity may worsen mental health through scarcity, stress, disrupted diet, stigma, and social isolation, while symptoms and functional impairment may reduce employment opportunities, income, stable housing, and the ability to obtain or prepare food, creating a bidirectional association.II.RelevanceFood is Medicine (FIM) and food assistance interventions span medically tailored meals (MTM) or groceries (MTG), produce prescription (PRx) programs, and healthy food incentives; all of which provide or subsidize access to food. As health systems, payers, and public programs expand reimbursement for and implementation of these models, evidence on mental health (MH) outcomes could inform eligibility, intervention components, reimbursement strategies, quality measurement, and future trials. III.Rationale / JustificationIn a recent evidence map of food security and mental health, 83% of studies on food security, nutrition, and mental health were observational and depression dominated the mental health outcomes reported. Furthermore, in a systematic review and meta-analysis of 39 food insecurity intervention studies, evidence for health outcomes in general was low or very-low certainty, and food provision studies showed no statistically significant effect on depressive symptoms. A 2026 US PRx scoping review identified 91 sources, with less than one-quarter measuring physical or emotional wellbeing; 65% used single group designs and only 14% used two-group designs.Thus, to our knowledge, no review has examined material FIM or food assistance interventions in populations with MH conditions or across MH and wellbeing outcomes. A systematic scoping review is therefore justified to characterize the heterogeneous area of research and identify evidence gaps.IV.ObjectiveWe aim to map the characteristics, breadth, and findings of empirical evidence on whether and how interventions that provide food or subsidize food purchases associated with MH or wellbeing outcomes. Detailed eligibility criteria for the population and outcomes of interest are described below.

Shifting diets away from high levels of meat and dairy is increasingly considered an important part of climate mitigation, yet the best pathways for achieving these reductions without compromising nutrition, health or affordability remain unclear. Here, in a representative sample of Scottish adults, we evaluate 33 pathways to meeting the UK Climate Change Committee’s recommendations to reduce meat and dairy consumption by 20% by 2030, increasing to a 35% reduction in meat by 2050. The pathways incorporate existing dietary guidance, and modelled outcomes include intakes of 54 nutrients, obesity, type 2 diabetes, cardiovascular disease, all-cause mortality, diet costs, greenhouse gas emissions, freshwater use, land use and eutrophication. Nearly all pathways were estimated to benefit most nutritional, health and environmental outcomes without increasing diet costs. Benefits were greater when reductions targeted high consumers of red meat and when meat and dairy were replaced gram for gram with foods such as vegetables, beans, eggs and plant-based dairy alternatives.

Randomised controlled studies evaluating vitamin D supplementation in pregnancy or early childhood for preventing childhood asthma have yielded inconclusive results. Previous systematic reviews of vitamin D for asthma prevention focused on studies comparing vitamin D to placebo or studies intervening in pregnancy, limiting the body of evidence. Primary: to evaluate the efficacy of any vitamin D supplementation and high-dose vitamin D supplementation in early life, including the prenatal period, for preventing asthma in children. Secondary: to assess the efficacy of vitamin D supplementation: • for preventing asthma in children at risk of vitamin D deficiency at the start of the trial or whose mothers were at risk; • by intervention timing and the cumulative dose administered; • in preventing factors associated with early childhood asthma, including atopic dermatitis, respiratory tract infections, sensitisation to allergens, and airway inflammation. We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the International Clinical Trials Registry Platform, and the Cochrane Airways and Skin Trial Registers. We checked the reference lists of relevant systematic reviews and meta-analyses. We contacted authors to obtain additional study information as needed. Date of last search: October 2023. We included randomised controlled studies comparing higher versus lower/standard dose vitamin D (≤ 400 international units (IU)/day) or any vitamin D versus placebo/no treatment in generally healthy pregnant or lactating women or children up to five years of age that evaluated childhood asthma, wheeze, atopic dermatitis, airway infections, allergic sensitisation, and airway inflammation. We excluded trials recruiting populations with pre-existing conditions. We followed standard Cochrane methodological procedures, including using Cochrane's Screen4Me workflow. We considered participants rather than events as the unit of analysis, performed fixed-effect meta-analysis, and reported risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) for four comparisons: (1) any vitamin D versus placebo/no supplementation in pregnant or breastfeeding women; (2) any vitamin D versus placebo/no supplementation in infants or children; (3) high versus low/standard dose vitamin D in pregnant or breastfeeding women; (4) high versus low/standard dose vitamin D in infants or children. Our outcomes were: asthma, wheeze, atopic dermatitis, airway infections, allergic sensitisation, airway inflammation, and adverse events. We narratively described results that could not be meta-analysed. We used the Cochrane risk of bias tool (RoB) to assess bias in the studies. We used GRADE to assess the certainty of the evidence. We included 18 studies involving a total of 10,611 participants, of which 16 contributed data to meta-analyses. Studies were conducted around the world, with most taking place in higher-income countries. The dose and frequency of vitamin D ranged from 200 IU/day to 100,000 IU bolus quarterly, and the duration of supplementation ranged from 28 days to two years. Comparison 1. Any vitamin D versus placebo/no supplementation in pregnant or breastfeeding women (4 studies) Compared to placebo or no supplementation, any vitamin D given to pregnant or breastfeeding women may reduce the risk of early childhood asthma (RR 0.17, 95% CI 0.05 to 0.61; 1 study, 236 participants; low-certainty evidence) and likely has little to no effect on childhood airway infections (RR 1.00, 95% CI 0.97 to 1.04; 3 studies, 1564 participants; moderate-certainty evidence). The evidence is very uncertain for wheeze, atopic dermatitis, allergic sensitisation, airway inflammation, or adverse events. Comparison 2. Any vitamin D versus placebo/no supplementation in infants or children (5 studies) Compared to placebo or no supplementation, any vitamin D given to infants or children may have little to no effect on childhood wheeze (RR 0.89, 95% CI 0.68 to 1.16; 2 studies, 431 participants; low-certainty evidence), atopic dermatitis (RR 1.01, 95% CI 0.80 to 1.28; 2 studies, 448 participants; low-certainty evidence), airway infections (RR 0.92, 95% CI 0.83 to 1.01; 2 studies, 500 participants; low-certainty evidence), allergic sensitisation (RR 2.25, 95% CI 0.60 to 8.50; 1 study, 228 participants; low-certainty evidence), or airway inflammation measured by eosinophil counts (RR 1.06, 95% CI 0.65 to 1.74; 1 study, 226 participants; low-certainty evidence). The evidence is very uncertain for asthma and adverse events. Comparison 3. High versus low/standard dose vitamin D in pregnant or breastfeeding women (4 studies) Compared to low/standard dose, high-dose vitamin D given to pregnant or breastfeeding women likely reduces the risk of childhood wheeze (RR 0.79, 95% CI 0.64 to 0.98; 3 studies, 1439 participants; moderate-certainty evidence), but likely results in little to no difference in childhood asthma, although the direction and magnitude of effect is similar to that for wheeze (RR 0.81, 95% CI 0.63 to 1.04; 2 studies, 1355 participants; moderate-certainty evidence). Compared to low/standard dose, high-dose vitamin D in pregnancy likely has little to no effect on childhood atopic dermatitis (RR 0.91, 95% CI 0.75 to 1.11; 3 studies, 1439 participants; moderate-certainty evidence), airway infections (RR 0.95, 95% CI 0.82 to 1.11; 3 studies, 1441 participants; moderate-certainty evidence), or allergic sensitisation (RR 1.01, 95% CI 0.87 to 1.18; 2 studies, 1110 participants; moderate-certainty evidence). The evidence is very uncertain for adverse events. No studies evaluated airway inflammation. Comparison 4. High versus low/standard dose vitamin D in infants or children (7 studies) Compared to low/standard dose, high-dose vitamin D given to infants or children may slightly reduce airway infections (RR 0.94, 95% CI 0.90 to 0.98; 6 studies, 2385 participants; low-certainty evidence) but may have little...

In light of nationalist trends, disruptions to global food supply chains and efforts to concurrently promote sustainable diets, we assess national capacities to achieve dietary guidelines based on domestic production alone. Over a third of all countries cannot meet self-sufficiency for more than two of the seven essential food groups. Low self-sufficiency and overdependence on a few countries for imports threaten their capability to respond to global shocks, particularly for small states.

In a representative sample of Scottish adults, we evaluate 33 pathways to meeting the UK Climate Change Committee’s (CCC) recommendations to reduce all meat and dairy consumption by 20% by 2030, rising to a reduction of 35% in meat by 2050. Our pathways take into account existing dietary guidance, and modelled outcomes include intakes of 54 nutrients, obesity, type 2 diabetes and cardiovascular disease, all-cause mortality, cost of diets, greenhouse gas emissions, water and land use, and eutrophication. Nearly all modelled pathways are estimated to have benefits for most nutrition, health, and environmental outcomes, without negatively affecting diet costs. These benefits could be increased with targeted reductions in red meat among high consumers of red meat, and gram-for-gram replacement of meat and dairy with substitutes ranging from vegetables to beans to eggs to plant-based dairy alternatives.

Reducing meat consumption can help improve environmental and health outcomes, yet the effect of specific meat-reducing strategies is context dependent. Here, using decomposition analysis of National Diet and Nutrition Survey data (2008–2009 to 2018–2019), we found that in the United Kingdom, reduced meat portions had the largest impact on total meat consumption decline (52%), followed by fewer meat-eating days (24%), fewer meat consumers (17%) and fewer meat-eating meal occasions (7%). Understanding meat consumption behaviour patterns is key for more effective policies.

In light of increasing nationalist trends, recent disruptions to global food supply chains, and efforts to concurrently promote sustainable diets, we utilize the World Wildlife Fund's (WWF) Livewell report to assess national food self-sufficiency. We observed that one in three countries cannot meet self-sufficiency for more than two of the seven essential food groups. This underscores significant inter-regional trade reliance, notably in the Caribbean, West Africa, and Gulf states.