Purpose of ReviewTo present the evidence base in support of high-income country investment in universal school-provided meals (SPMs) for the purposes of optimising child health and wellbeing, including obesity prevention.Recent findingsMany countries provide some form of SPMs. Models (universal, free; targeted; subsidised) vary globally, however optimal growth and development of children as a potential outcome is a consistent feature. SPMs can positively impact diet quality, household food and nutrition security and potentially weight status but is dependent on the model. Universal school meals offered as part of whole-of-school approaches appear to be most effective in optimising children’s growth and development. Critical elements for successful SPMs include being underpinned by enforceable nutrition and sustainability standards, offered in ways that are stigma-free, being embedded within a whole-school approach and conceptualising SPMS as part of transformative food systems.SummaryWeight status is only one of many potential outcomes of SPMs. Implementing universal SPMs is a triple duty action that can address the global syndemic of obesity, undernutrition and climate change. Attention needs to be paid to the model of implementation and key principles for success.

This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care. The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.

Purpose of ReviewInsulin resistance is a key component of the metabolic syndrome, type 2 diabetes mellitus (T2DM), and related cardiovascular complications. However, despite its clinical relevance, a simple and reliable surrogate marker of insulin resistance is lacking. The body muscle-to-fat ratio (BMFR) is a novel anthropometric index, and particularly in treatment-naïve patients with T2DM, BMFR correlates more closely with insulin sensitivity, assessed using the hyperinsulinemic–euglycemic clamp, than conventional indices, such as the Matsuda Index and the Quantitative Insulin Sensitivity Check Index. In this review, we critically evaluate the current evidence regarding the BMFR as an index of insulin resistance and metabolic disease risk, highlight its strengths and limitations versus conventional measures, and discuss future directions.Recent FindingsSeveral recent studies have demonstrated the importance of body composition metrics for the evaluation of metabolic health, including those by Guan et al. (Adv Nutr), Oliver et al. (J Cachexia Sarcopenia Muscle), and Vieira et al. (Rev Endocr Metab Disord). The findings have resulted in a growing recognition of the need for reliable, accessible markers of muscle quality and metabolic risk.SummaryBMFR offers advantages over the fat-to-muscle ratio and conventional anthropometric indices as an intuitive and clinically relevant marker of insulin resistance. It represents a promising method of screening for obesity-related complications, evaluating treatment responses, and guiding personalized care, including in patients with high-risk phenotypes, such as sarcopenic obesity. With further validation, BMFR could become a standard tool for the evaluation of metabolic health and risk in clinical practice.

Purpose of ReviewThis narrative review comprehensively analyzes VLEKT as an advanced nutritional strategy for obesity management. The focus is on the beneficial effects on key disease organs, such as adipose tissue and liver, as well as the modulation of intestinal permeability and its fundamental role in influencing the gut microbiota and inflammatory pathways.Recent FindingsThe impact of VLEKT on obesity-related comorbidities, including metabolic syndrome, cardiovascular disease, endocrine disorders, metabolic dysfunction-associated steatotic liver disease (MASLD), neurological disorders, and kidney alterations, is also investigated. Moreover, to assess its wider application in obesity treatment, the combination of ketogenic regimes with additional strategies such as physical activity, bariatric surgery, and digital health technologies is examined. Despite promising clinical results, adherence to VLEKT and potential nutritional deficiencies require careful follow-up and individualized programming monitored by specialists. Future research should focus on elucidating the molecular mechanisms underlying the effects on physiological systems, and long-term safety. Nevertheless, VLEKT is an innovative approach to obesity treatment, offering a target-oriented and highly effective strategy for people fighting against overweight and its associated medical complications.SummaryObesity is a multifactorial and chronic disease associated with numerous comorbidities; given its increasing prevalence, effective and personalized intervention strategies are crucial to inhibit the “obesity pandemic” according to a “food re-educational” protocol. Among dietary interventions, the ketogenic diet (KD) has attracted attention for its effectiveness in weight management and metabolic benefits. A variant, the very low-calorie ketogenic diet (VLCKD), more recently defined as very low-energy ketogenic diet (VLEKD), combines the metabolic benefits of ketosis with substantial calorie restriction, improving overall health.Graphical

Purpose of ReviewIn this review, we summarize the molecular effects of time-restricted eating (TRE) and its possible role in appetite regulation. We also discuss the potential clinical benefits of TRE in obesity.Recent FindingsTRE is an emerging dietary approach consisting in limiting food intake to a specific window of time each day. The rationale behind this strategy is to restore the circadian misalignment, commonly seen in obesity. Preclinical studies have shown that restricting food intake only during the active phase of the day can positively influence several cellular functions including senescence, mitochondrial activity, inflammation, autophagy and nutrients’ sensing pathways. Furthermore, TRE may play a role by modulating appetite and satiety hormones, though further research is needed to clarify its exact mechanisms. Clinical trials involving patients with obesity or type 2 diabetes suggest that TRE can be effective for weight loss, but its broader effects on improving other clinical outcomes, such as cardiovascular risk factors, remain less certain.SummaryThe epidemic proportions of obesity cause urgency to find dietary, pharmacological and surgical interventions that can be effective in the medium and long term. According to its molecular effects, TRE can be an interesting alternative to caloric restriction in the treatment of obesity, but the considerable variability across clinical trials regarding population, intervention, and follow-up duration makes it difficult to reach definitive conclusions.

As obesity and chronic kidney disease (CKD) remain a public health issue, we aim to elaborate on their complex relationship regarding pathogenetic mechanisms and therapeutic potential as well. The purpose of this review is to enhance our understanding of the interplay between obesity and CKD in order to timely diagnose and treat obesity-related CKD. Obesity and CKD pose significant intertwined challenges to global health, affecting a substantial portion of the population worldwide. Obesity is recognized as an independent risk factor, intricately contributing to CKD pathogenesis through mechanisms such as lipotoxicity, chronic inflammation, and insulin resistance. Recent evidence highlights additional factors including hemodynamic changes and intestinal dysbiosis that exacerbate kidney dysfunction in obese individuals, leading to histologic alterations known as obesity-related glomerulopathy (ORG). This narrative review synthesizes current knowledge on the prevalence, pathophysiology, clinical manifestations, and diagnostic strategies of obesity-related kidney disease. Furthermore, it explores mechanistic insights to delineate current therapeutic approaches, future directions for managing this condition and controversies. By elucidating the multifaceted interactions between obesity and kidney health, this review aims to inform clinical practice and stimulate further research to address this global health epidemic effectively.