Technology-assisted 24-h dietary recalls (24HRs) have been widely adopted in population nutrition surveillance. Evaluations of 24HRs inform improvements, but direct comparisons of 24HR methods for accuracy in reference to a measure of true intake are rarely undertaken in a single study population. To compare the accuracy of energy and nutrient intake estimation of 4 technology-assisted dietary assessment methods relative to true intake across breakfast, lunch, and dinner. In a controlled feeding study with a crossover design, 152 participants [55% women; mean age 32 y, standard deviation (SD) 11; mean body mass index 26 kg/m², SD 5] were randomized to 1 of 3 separate feeding days to consume breakfast, lunch, and dinner, with unobtrusive weighing of foods and beverages consumed. Participants undertook a 24HR the following day [Automated Self-Administered Dietary Assessment Tool-Australia (ASA24); Intake24-Australia; mobile Food Record-Trained Analyst (mFR-TA); or Image-Assisted Interviewer-Administered 24-hour recall (IA-24HR)]. When assigned to IA-24HR, participants referred to images captured of their meals using the mobile Food Record (mFR) app. True and estimated energy and nutrient intakes were compared, and differences among methods were assessed using linear mixed models. The mean difference between true and estimated energy intake as a percentage of true intake was 5.4% (95% CI: 0.6, 10.2%) using ASA24, 1.7% (95% CI: -2.9, 6.3%) using Intake24, 1.3% (95% CI: -1.1, 3.8%) using mFR-TA, and 15.0% (95% CI: 11.6, 18.3%) using IA-24HR. The variances of estimated and true energy intakes were statistically significantly different for all methods (P < 0.01) except Intake24 (P = 0.1). Differential accuracy in nutrient estimation was present among the methods. Under controlled conditions, Intake24, ASA24, and mFR-TA estimated average energy and nutrient intakes with reasonable validity, but intake distributions were estimated accurately by Intake24 only (energy and protein). This study may inform considerations regarding instruments of choice in future population surveillance. This trial was registered at Australian New Zealand Clinical Trials Registry as ACTRN12621000209897.

Background: Technology-assisted 24-hour dietary recall (24HR) methods offer the potential for scalable population dietary assessment, but current challenges include balancing accuracy and cost against participant burden and acceptability of these methods. Qualitative methods present a novel approach to understanding potential barriers and enablers to the acceptability of 24HR methods, but remain relatively unexplored. Objective: This study aimed to explore users’ experience, acceptability, and preferences for 3 technology-assisted 24HR methods. Methods: Participants in a crossover controlled feeding study were invited to undertake a poststudy interview. Initially, the feeding study participants were randomized into one of three separate feeding days where they consumed breakfast, lunch, and dinner on a single day. On the following day, they undertook a 24HR via the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), Intake24, or an Image-Assisted Interviewer-Administered 24-hour dietary recall (IA-24HR). When assigned to IA-24HR, participants viewed the images they captured with a mobile food record (mFR) app on the feeding day during the interview. On completing all 3 methods, 26 participants (ages 21 to 56 years) undertook semistructured interviews. The interview audio recordings were transcribed, and inductive content analysis was undertaken. Results: Overall, participants wanted the 24HR methods to be easy, with the technology features of all methods considered helpful. A total of 5 content categories described users’ experiences of the three 24HR methods: (1) “Put my food in the list,” (2) “It’s really hard to know portions,” (3) ASA24 “was a painful process,” (4) access to “images helped jog my memory,” (5) Intake24 is “fairly quick,” and (6) IA-24HR method preference. Participants expressed a preference for taking images with the mFR app. IA-24HR helped participants recall food and beverages consumed and increased perceptions of recall accuracy. Conclusions: This novel qualitative research found that 24HR methods need to be as easy as possible for users. The participant burden of food and beverage identification and portion size estimation was evident across methods. Findings highlight the importance of using qualitative methods to explore user preferences for dietary assessment methods and confirm the need to reduce the user burden associated with 24HR methods. People want embedded technologies to enhance digitized versions of the traditional 24HR methods. The use of their own food images within the mFR app is an example of digital advancements within scalable 24-hour dietary assessments. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12621000209897; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381165 International Registered Report Identifier (IRRID): RR2-10.2196/32891

Background: Almost a third of Australian adults are living with obesity, yet most cannot access medical nutrition therapy from dietitians, that is, the health professionals trained in dietary weight management services. Across the health system, primary care doctors readily identify people who may benefit from weight management services, but there are limited referral options in the community. Dietitians are trained to provide evidence-informed dietary treatment of overweight and obesity but are underutilized and underresourced. The chat2 (Connecting Health and Technology 2) trial will test combining new technologies for dietary assessment with behavior change techniques to improve outcomes for people living with obesity. Objective: This study aimed to compare the effectiveness of a 1-year digital dietary intervention, with standard care on body weight reduction and improved diet quality, in adults living with obesity delivered by dietitians in a primary care setting. Methods: This randomized controlled trial will compare a 1-year, digitally tailored, feedback dietary intervention with a control group in 430 adults living with obesity (BMI≥30 to ≤45 kg/m2). Participants will be recruited by letters sent to individuals randomly selected from the electoral roll and supplemented by hospital site posters, newsletters, and unaddressed mailbox delivery postcards sent to residential street points. The primary outcome is change in body weight, measured face-to-face at a baseline, 6 months, and 12 months. A 4-day, image-based dietary assessment tool (mobile Food Record) will be used to measure diet quality score. Secondary outcomes include diet quality score; dual-energy absorptiometry body composition; and total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, glycated hemoglobin, and fasting glucose levels. The intervention group will receive 8 video counseling sessions with a trained dietitian delivered over 12 months to support dietary behavior change and relapse prevention. The trial is unblinded. Both groups will receive feedback on their clinical chemistry and dual-energy absorptiometry scans at each time point. Results: Participant recruitment commenced in July 2023 and ended in August 2024. Data analysis will commence in 2025, with the anticipated publication of results in 2026. Conclusions: If found to be effective, the results of this randomized controlled trial will support the delivery of effective, evidence-based weight management advice using new technologies. Improving community access to high-quality dietetic services will ensure more effective use of the dietetic workforce to improve outcomes for people living with obesity. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000803796; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383838 International Registered Report Identifier (IRRID): DERR1-10.2196/64735

Introduction: Culturally and linguistically diverse population groups disproportionately experience higher weight and other non–weight‐related discrimination in healthcare settings outside of their ancestral country. Little is known about the experiences of individuals with Arab heritage. This study aimed to qualitatively explore the intersectional weight‐related healthcare experiences of individuals of Arab heritage with higher weight in Australia.Methods: A general inductive enquiry approach was used. Purposive, convenience and snowball sampling was used to recruit individuals of Arab heritage residing in Australia. Individuals were invited to participate in an online semistructured interview. Interviews were recorded, transcribed and thematically analysed.Results: Fifteen participants took part in the study. Of these participants, 93% were female (n = 14), 80% were aged between 18 and 44 years (n = 12), 73% were university educated (n = 11), 53% were born outside of Australia (n = 8) and all were Muslim (n = 15). Four main themes were identified: (1) appearance‐based judgement, (2) generalised advice and assumptions, (3) cultural responsiveness and (4) healthcare system constraints.Conclusion: Individuals of Arab heritage with higher weight in Australia, namely, females, often perceive their healthcare experiences as dismissive of their cultural and religious needs and driven by causality assumptions around weight. It is crucial that care delivered encompasses cultural humility, is weight‐inclusive and acknowledges systemic constraints. Cultural safety training benchmarks, healthcare management reform and weight‐inclusive healthcare approaches are recommended to assist healthcare providers in delivering effective, holistic and culturally safe care.Patient or Public Contribution: Insights gained from conversations with Arab heritage community members with lived experiences regarding weight‐related healthcare encounters informed the study design and approach.

Introduction: Digital health interventions are effective for weight management and improving dietary intake, but studies in culturally and linguistically diverse (CALD) and Indigenous populations are limited. The aim of this systematic review is to evaluate the effectiveness of digital health interventions on body weight and dietary intake outcomes in CALD and Indigenous populations. Methods: MEDLINE, Embase, Scopus, and Cochrane databases were searched on December 28, 2022 (PROSPERO: CRD42023394058). Inclusion criteria were randomized controlled trials (RCTs) conducted in high‐income English‐speaking countries with free‐living adults ≥ 18 years. Trials had to report both weight and dietary outcomes, with ≥ 50% participants from CALD/Indigenous backgrounds or outcomes reported by race/ethnicity. Two reviewers independently screened records. Risk of bias was assessed using the Cochrane RoB 2 tool. Results were synthesized descriptively and presented in graphs and tables. Results: From the 1984 records identified, nine RCTs were included, which involved a total of 2716 participants. Eight trials were conducted in the United States, and only one trial included Indigenous participants. Significant body weight changes occurred in three trials. Significant diet quality changes occurred in three trials. Most trials had high retention rates (≥ 80%) but low intervention adherence (< 50%). Risk of bias was low for most trials. Conclusion: Limited evidence supports the effectiveness of digital health interventions for improving body weight and dietary intake outcomes in CALD and Indigenous populations. The predominance of US‐based trials, female‐dominated samples, and hybrid intervention designs limits generalizability. Future research should prioritize inclusive practices and standalone digital designs to establish effectiveness in these populations.

Aim: Weight management is a core area of dietetic primary practice. Understanding the behavioural drivers that influence dietitians' weight management practice is essential for gaining insight into how to better support dietitians in this area. This study used the Capability, Opportunity, Motivation‐Behaviour (COM‐B) model, a behavioural framework, to explore how dietitians' practice is influenced by their skills and knowledge (capability), environmental factors (opportunity) and professional desires and habits (motivation). Methods: This qualitative descriptive study used an interpretivist approach guided by social constructionism. Primary care dietitians practising in Australia were recruited through purposive and snowball sampling for semi‐structured interviews. Interviews were audio‐recorded, transcribed verbatim, and analysed using content analysis. Constructed content categories were then mapped to the COM‐B model to understand the behavioural factors shaping dietitians' weight management practice. Results: Fourteen primary care dietitians participated in the study; 13 were women, 11 were aged between 20 and 50 years, and 8 had over 9 years dietetic practice experience. Eight content categories were constructed and mapped against the COM‐B components. Aligned with Capability, dietitians demonstrated comprehensive ‘Understanding [of] Weight Management Complexity’ and employed ‘Holistic Practice Approaches’ in their care delivery, though they found ‘Navigating Clients’ Psychosocial Needs’ challenging. Opportunity was shaped by ‘System Constraints’ that influenced care provision, ‘Multidisciplinary Care Environment[s]’ that had varied impacts on collaborative care delivery, and ‘Digital Solutions’ that offered service delivery advantages. Motivation was characterised by dietitians exhibiting strong ‘Professional Drive’ and commitment to ‘Client‐centred Strategies’. Conclusion: Supporting primary care dietitians requires targeted interventions across all COM‐B components. Potential approaches include enhancing capability through behaviour change counselling training, improving opportunity with integration of digital technologies, and sustaining motivation through established clinical pathways that align with dietitians’ client‐centred values.