We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento–structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento–structural type interventions, remains crucial.

Objective: To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPF) in a cross-sectional nationally representative survey of Australian adults.Design: Using a 24-h recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI–2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPF.Setting: Australian Health Survey 2011–2013.Participants: Australian adults aged ≥ 19 years (n 8209).Results: Consumption of UPF was higher among younger adults (aged 19–30 years), adults born in Australia, those experiencing greatest area-level disadvantage, lower levels of education and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPF was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar.Conclusions: This research adds to the evidence on dietary inequalities across Australia and how UPF are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality.

Issue addressed: Since 2005, all states and territories across Australia have progressively introduced policy guidelines to promote nutritious food sales in school canteens. This study aimed to assess the compliance of school canteens with their state or territory canteen guidelines.Methods: School canteen menus from a convenience sample of online government school websites were assessed for compliance with guidelines for the inclusion of foods meeting the criteria for ‘red’ (‘not recommended’ or ‘only occasional – no more than twice per term’), ‘amber’ (‘select carefully’) and ‘green’ (‘always on the menu’, ‘everyday’, ‘fill the menu’ or ‘plenty’). The costs of a salad and a regular pie were also collected where present.Results: A total of 263 school menus were sourced and assessed (4% of government schools). Western Australia was the most compliant, with 62% of menus adhering to the state guidelines; compliance in other jurisdictions ranged from 5–35%. Compared with primary schools, a higher proportion of secondary schools offered ‘red’ items on the menu (P < 0.05). The mean cost of a regular pie (A$3.17 ± 0.51) was significantly cheaper than the cost of a salad (A$4.25 ± 0.82) (P < 0.001). A range of discretionary food items were present on a large proportion of menus.Conclusion: This study found that the majority of school canteens were not complying with relevant state or territory guidelines, particularly those schools in which no monitoring or enforcement of the guidelines was conducted.So what?: Monitoring and enforcement by those responsible for the policy, together with efforts to build the capacity for schools and manufacturers to improve the food supply, may increase compliance.

Public health nutrition (PHN) seeks to protect and promote the nutrition-related health and wellbeing of populations. PHN science is dynamic and has evolved over time, helping to inform our understanding of the changing nature, scope, causes and solutions to PHN problems. This scientific basis has informed nutrition guidance and policy. Using a narrative synthesis method and guided by Kuhn’s theory on the structure of scientific revolutions, this paper reviews the historical development of PHN, aiming to understand the emergence of major scientific paradigms, paradigm shifts and evidence-informed guidance and policy. We propose that the development of PHN is characterized by the successive layering of paradigms resulting from interactions between science, social change and policy-making. Four eras of PHN are evident: the foundation, nutrient deficiency, dietary excess and imbalances, and environmental sustainability (ES). Dominant paradigms have been communicated through nutrient reference standards, dietary goals and dietary guidelines. Transitions from one era to the next indicated new ways of thinking about PHN, amounting to a paradigm shift. The bidirectional relationship between nutrition and ES is the latest challenge confronting PHN. Investigating PHN paradigm transitions reveals how we have arrived at current guidance and policies, and how PHN might progress into the future.

(1) Background: Supplement use is prevalent worldwide; however, there are limited studies examining the characteristics of people who take supplements in Australia. This study aimed to investigate the demographics, lifestyle habits and health status of supplement users; (2) Methods: Adults aged >19 years (n = 4895) were included from the 2011–2012 National Nutrition and Physical Activity Survey (NNPAS). A supplement user was defined as anyone who took one or more supplements on either of two 24-h dietary recalls. Poisson regression was used to estimate the prevalence ratio (PR) of supplement use, according to demographics, lifestyle characteristics and health status of participants; (3) Results: Supplement use was reported by 47% of women and 34% of men, and supplement use was higher among older age groups, among those with higher education levels and from areas reflecting the least socioeconomic disadvantaged. An association was found between blood pressure and supplement use; (4) Conclusions: A substantial proportion of Australians take supplements. Further investigation into the social, psychological and economic determinants that motivate the use of supplements is required, to ensure appropriate use of supplements among Australian adults.

Food-based Dietary Guidelines (FBDGs) promote healthy dietary patterns. Nutrient-based Front-of-Pack Labelling (NBFOPL) schemes rate the ‘healthiness’ of individual foods. This study aimed to investigate whether the Australian Health Star Rating (HSR) system aligns with the Australian Dietary Guidelines (ADGs). The Mintel Global New Products Database was searched for every new food product displaying a HSR entering the Australian marketplace from 27 June 2014 (HSR system endorsement) until 30 June 2017. Foods were categorised as either a five food group (FFG) food or ‘discretionary’ food in accordance with ADG recommendations. Ten percent (1269/12,108) of new food products displayed a HSR, of which 57% were FFG foods. The median number of ‘health’ stars displayed on discretionary foods (2.5; range: 0.5–5) was significantly lower (p < 0.05) than FFG foods (4.0; range: 0.5–5), although a high frequency of anomalies and overlap in the number of stars across the two food categories was observed, with 56.7% of discretionary foods displaying ≥2.5 stars. The HSR system is undermining the ADG recommendations through facilitating the marketing of discretionary foods. Adjusting the HSR’s algorithm might correct certain technical flaws. However, supporting the ADGs requires reform of the HSR’s design to demarcate the food source (FFG versus discretionary food) of a nutrient.