Health, nutrition, and sleep

What can be done

Actions rated on the strength-rating scale (A strong and replicated, B solid but limited, C weak or debated, D contested or failed), applied to the specific claim made.

Malnutrition

• Small daily nutrient supplements for children aged 6 to 24 months (A). An analysis of 14 trials with more than 37,000 children found 12 to 14% lower prevalence of stunting, wasting, and underweight, 64% less iron-deficiency anemia, and fewer children in the lowest developmental scores (Dewey et al., 2021). A 27% reduction in deaths weakened and was no longer significant when only the cleanest comparisons were kept (B) (Stewart et al., 2020).
• Vitamin A capsules where deficiency is common (A). Across 19 trials with 1,202,382 children, deaths fell 12% (Imdad et al., 2022), though one very large Indian trial found a smaller, nonsignificant effect (Awasthi et al., 2013).
• Universal salt iodization (B). About 89% of people consume iodized salt (UNICEF). Iodine-deficient children score lower on IQ tests than iodine-sufficient children in mostly observational studies (C) (Qian et al., 2005, Bougma et al., 2013), but a 2026 Cochrane review found randomized evidence of only a slight cognitive gain, from one study (Velasco et al., 2026).
• Breastfeeding promotion in hospitals (B). A trial of 17,046 infants raised exclusive breastfeeding at 3 months from 6.4% to 43.3% and verbal IQ at age 6.5 (Kramer et al., 2008), but the 16-year follow-up found no overall cognitive benefit (Yang et al., 2018).
• Cash transfers (B, small effects). A meta-analysis found stunting fell about 1.35 percentage points (Manley, Alderman, and Gentilini, 2022).
• Community treatment of severe acute malnutrition (C for the cost estimate). One Zambian model estimated about $53 per healthy life-year gained (Bachmann, 2009). Treatment itself is standard care, so trials against no treatment would be unethical.
• Iron fortification of wheat flour (B, low certainty). Anemia fell 27% across 10 trials (Field et al., 2021).
• Not shown to improve growth or cognition: mass deworming and household water and sanitation alone. A Cochrane review of 51 trials found little or no effect of deworming on height, cognition, or school performance (Taylor-Robinson et al., 2019), though a 20-year Kenyan follow-up reported higher earnings, a disputed result (Hamory et al., 2021). Large trials in Zimbabwe and Bangladesh found household water, sanitation, and hygiene did not reduce stunting (A for no effect) (Humphrey et al., 2019, Luby et al., 2018).

Chronic disease, obesity, and physical inactivity

• Tobacco taxes (A). The WHO cancer research agency found sufficient evidence, its strongest level, that higher taxes reduce smoking and youth uptake (IARC Handbook 14).
• WHO "best buys" (B, a projection). WHO estimates that less than a dollar per person per year on its recommended package could prevent close to 7 million deaths by 2030 in 76 low- and lower-middle-income countries (WHO, 2021).
• Blood pressure programs led by non-physician health workers (B). In a trial in Colombia and Malaysia, blood pressure control reached 69% in the intervention group versus 30% in controls (Schwalm et al., 2019). Kaiser Permanente raised control from 43.6% to 80.4% using registries and simple medication protocols (C, observational) (Jaffe et al., 2013).
• Potassium salt substitutes (B). A trial of 20,995 people in rural China cut strokes by 14% and deaths by 12% (Neal et al., 2021).
• Sugar-sweetened beverage taxes (B for sales). Across 62 studies, sales fell about 15%, but changes in consumption were not significant (Andreyeva et al., 2022). Mexico's tax cut purchases by 6% in its first year (Colchero et al., 2016). The UK levy was linked to lower obesity in older girls only (C) (Rogers et al., 2023).
• GLP-1 medicines for obesity (B, from manufacturer-funded trials). Semaglutide produced 14.9% weight loss versus 2.4% on placebo (Wilding et al., 2021) and cut major heart events by 20% in people with heart disease (Lincoff et al., 2023), but about two-thirds of the weight lost returned within a year of stopping treatment (Wilding et al., 2022). WHO projects these medicines will reach fewer than 10% of people who could benefit by 2030 (WHO, 2025). Generic versions launched in India in March 2026 at substantially lower prices, though reported discounts vary (C) (Outlook Business).
• Not effective for obesity: school physical activity programs (A for little or no effect). Across 89 studies, they added less than one minute of activity a day (Neil-Sztramko et al., 2021).

Sleep

• Cognitive behavioral therapy for insomnia, including digital versions (A). A meta-analysis of 20 trials found people fell asleep 19 minutes faster and spent 26 fewer minutes awake at night (Trauer et al., 2015). A digital version helped 3,755 university students (B) (Freeman et al., 2017).
• Secondary school start times of 8:30 a.m. or later (B). The American Academy of Pediatrics recommends this (AAP, 2014). California's statewide law raised the share of students sleeping at least 8 hours by 13% and grade 8 math and English scores by 0.08 to 0.10 standard deviations (Dou et al., 2026). Smaller studies, including Seattle's 34-minute sleep gain, support this but lack control groups (C) (Dunster et al., 2018, Minges and Redeker, 2016).
• Limits on extended overnight work shifts (C). In one trial in two intensive care units, interns on traditional schedules with shifts of 24 hours or more made 35.9% more serious medical errors than on shorter shifts (Landrigan et al., 2004). A later multicenter trial by the same group found more errors without extended shifts, a difference that disappeared after adjusting for workload (Landrigan et al., 2020), and a national trial in surgical training found flexible duty hours no worse for patient outcomes (Bilimoria et al., 2016).
• Not shown to improve sleep: screen-time interventions (C). In a review of 60 trials, interventions targeting screen time did not change sleep (Feng et al., 2024).

Proposed and experimental methods

Methods that are proposed, under trial, approved in some places, or tried and then failed. Each shows a stage label and an evidence rating. A stage label shows how far a method has progressed, not whether it works. The stage labels are explained on the biological factor page.

Malnutrition

• Microbiota-directed complementary food, MDCF-2 (Early trial, B). A food made from local ingredients (chickpea, soy, peanut, green banana) designed to help the immature gut bacteria of malnourished children develop normally. In 123 Bangladeshi children aged 12 to 18 months with moderate acute malnutrition, weight-for-length and weight-for-age improved faster with MDCF-2 than with a standard ready-to-use supplement (Chen et al., 2021), and over two years of follow-up of 124 of these children the MDCF-2 group was less stunted (Mostafa et al., 2024). A second trial in children recovering from severe acute malnutrition found faster weight-for-length gains than with a more calorie-dense standard supplement, but it is a preprint (Hartman et al., 2024). All trials come from one research collaboration in Bangladesh and have not been independently replicated.
• Cultivated meat (Approved but not scaled, contested, C). Animal cells grown in tanks to make meat without slaughter, proposed as a protein source that needs less land. No health or nutrition outcome evidence was found. The U.S. FDA first approved its sale for human consumption in November 2022, Florida banned its sale in May 2024 (SB 1084, a second-degree misdemeanor) (Sachs and Johnson, 2024), and six more states (Alabama, Indiana, Mississippi, Montana, Nebraska, and Texas) followed. In March 2026 a federal appeals court upheld the Florida ban against a challenge by the producer Upside Foods (Rohrer, 2026).
• Precision nutrition (Early trial, C). Diets tailored by algorithms that predict each person's blood sugar response from glucose monitoring, gut bacteria, and other data. In an 800-person cohort with 46,898 meals, responses to identical meals varied widely, a machine learning model predicted them (confirmed in 100 more people), and a small blinded randomized diet based on the model lowered after-meal glucose (Zeevi et al., 2015). In a later trial of 204 adults with obesity and abnormal glucose, a personalized diet built on this kind of algorithm did not produce more weight loss than a standard low-fat diet at 6 months (3.26% versus 4.31%) (Popp et al., 2022). The approach was developed for metabolic disease in wealthy settings, not for undernutrition.
• Machine learning famine early warning (Early trial, C). Models that combine conflict, weather, price, and satellite data to forecast food crises months ahead. A World Bank model covering 1,162 districts in 21 countries cut the share of missed crises (false negative rate) to 19.7% at a 4-month horizon with about 7% false alarms, compared with over 74% missed crises for existing FEWS NET outlooks, but in a test on later years the gain was smaller (a combined error score of about 22% versus about 30%) (Andrée et al., 2020). The human-led U.S. FEWS NET system was itself suspended for six months in early 2025, and Somalia, Afghanistan, and Yemen were left out of its August 14, 2026 outlook brief (Bouscaren, 2026). Forecasts help only if funding and a response follow.
• Reversed: Genetically engineered biofortification, Golden Rice (Failed or reversed, contested, B). Rice engineered to produce beta-carotene, which the body turns into vitamin A. In April 2024 the Philippine Court of Appeals issued a Writ of Kalikasan (an environmental protection order) that stopped commercial propagation and field testing of Golden Rice and Bt eggplant and revoked their biosafety permits, citing a lack of full scientific certainty about their effects and the precautionary principle (Pulta, 2024). The Philippine Rice Research Institute asked the Supreme Court to reverse the ruling (PhilRice, 2024), and no Supreme Court decision was found as of October 2026.

Chronic disease, obesity, and physical inactivity

• Polypill (Approved but not scaled, A). One daily pill combining a statin, blood pressure drugs, and often aspirin. In PolyIran (6,838 people in 236 village clusters), major cardiovascular events occurred in 5.9% with the polypill versus 8.8% with minimal care (adjusted HR 0.66) (Roshandel et al., 2019). In SECURE (2,499 patients after a heart attack), the main outcome occurred in 9.5% versus 12.7% with usual care (HR 0.76) (Castellano et al., 2022). A pooled analysis of three large prevention trials (18,162 people) found 38% fewer major cardiovascular events (HR 0.62), with gastrointestinal bleeding uncommon and not significantly more frequent in the versions with aspirin (0.4% versus 0.2%) (Joseph et al., 2021).
• Oral and next-generation incretin drugs (Approved but not scaled, B). Builds on the GLP-1 medicines above. Orforglipron is a daily GLP-1 pill. In ATTAIN-1 (3,127 adults with obesity), the 36 mg dose gave 11.2% weight loss at 72 weeks versus 2.1% with placebo, and 5.3 to 10.3% of those on the drug stopped because of side effects (Wharton et al., 2025). FDA approval, as Foundayo, was announced on April 1, 2026 (Eli Lilly and Company, 2026). Retatrutide, a weekly injection acting on three hormone receptors, gave 24.2% weight loss at 48 weeks in phase 2 (Jastreboff et al., 2023) and 25.0% at 80 weeks on 12 mg versus 3.9% with placebo in the 2,339-person phase 3 TRIUMPH-1 trial (Jastreboff et al., 2026). All of these trials were funded by the manufacturer.
• Front-of-package warning labels with marketing limits (Approved but not scaled, B). Laws requiring black warning labels on foods high in sugar, salt, saturated fat, or calories, together with limits on marketing to children and on school sales. After Chile's 2016 law, purchases of "high-in" beverages by 2,383 households fell 23.7% and calories from them 27.5% compared with the pre-law trend, in an observational before-and-after design (Taillie et al., 2020). A 2026 study of 321,597 Chilean schoolchildren found that exposure to the law's first phase lowered the probability of excess weight by 1.91% to 2.85% depending on sex and length of exposure (Paraje et al., 2026).
• Superblocks, car-free neighborhood design (Approved but not scaled, C). Closing groups of city blocks to through traffic to create space for walking and greenery. A health impact model for 503 planned Barcelona superblocks estimated 667 premature deaths prevented per year (95% CI 235 to 1,098), almost 200 days of added life expectancy, and a €1.7 billion annual economic impact, but only 36 of these deaths were attributed to more physical activity, with most of the rest due to less air pollution, noise, and heat (Mueller et al., 2020). An evaluation of the first three superblocks actually built found residents reported better well-being and less noise, and air quality improved where car traffic fell, but the same changes calmed traffic in one area and not in another (Pérez et al., 2025).
• Exergaming (Early trial, C). Video games that require physical movement. A meta-analysis of 15 studies in children with overweight or obesity found small reductions in BMI (mean difference -0.21) and body fat percentage (-0.88) (Comeras-Chueca et al., 2021). An umbrella review of 133 reviews found that exergames were among the exercise types with the largest effects on general cognition and memory (Singh et al., 2025).

Sleep

• Dual orexin receptor antagonists (Approved but not scaled, B). Insomnia drugs such as daridorexant that block the brain's wake-promoting orexin signal instead of sedating the brain broadly. In two phase 3 trials (930 and 924 participants), daridorexant 50 mg reduced time awake after falling asleep by 22.8 minutes at month 1 and 18.3 minutes at month 3 versus placebo, and increased self-reported total sleep time by about 20 minutes (Mignot et al., 2022). The trials were funded by the developer.
• Paying for digital CBT for insomnia at national scale (Approved but not scaled, B). Builds on the CBT for insomnia, including digital versions, above. NICE recommended the Sleepio app in May 2022 as a cost-saving option in primary care at £45 per person, with an estimated saving of £4.52 per person after one year that the committee considered uncertain, and the guidance was carried over unchanged as HTG624 in December 2025 (NICE, 2022). In the U.S., Pear Therapeutics, whose prescription CBT-I app Somryst received FDA authorization in March 2020 (Pear Therapeutics, 2020), filed for Chapter 11 bankruptcy in April 2023 and sought to sell its assets (Pear Therapeutics, 2023).
• Permanent standard time (Theoretical, C). Ending twice-yearly clock changes and keeping standard time all year, so that clock time stays closer to the body's internal clock. The American Academy of Sleep Medicine concludes that the spring change to daylight saving time raises the risk of heart events, mood disorders, and car crashes, and supports permanent standard time, while noting that the long-term effects of year-round daylight saving time have not been well studied (Rishi et al., 2020).
• Four-day school week (Approved but not scaled, contested, C). Builds on the school start times above. Some U.S. districts compress the school week into four longer days, mainly to save money. In Colorado high schools, four-day weeks were associated with less sleep, less breakfast, and more bullying, but also less substance use and more physical activity (Israel et al., 2020), while an Oregon study found more reported drug use among students in four-day schools (Tomayko et al., 2021). Both studies are observational and rely on student self-report.

Sources cited on this page

1. WHO: Congenital disorders fact sheet (2023) B Moderate
2. Victora, C. G., Adair, L., Fall, C., et al. (2008). Maternal and child undernutrition: consequences for adult health and human capital. Lancet, 371(9609), 340-357. DOI61692-4) B Moderate
3. Van Dongen, H. P. A., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness. Sleep, 26(2), 117-126. DOI A Strong
4. WHO: Nearly 1.8 billion adults not doing enough physical activity (2024) B Moderate: agency estimate
5. Andreyeva, T., Marple, K., Marinello, S., Moore, T. E., & Powell, L. M. (2022). Outcomes following taxation of sugar-sweetened beverages: A systematic review and meta-analysis. JAMA Network Open, 5(6), e2215276. link B Moderate
6. Awasthi, S., Peto, R., Read, S., Clark, S., Pande, V., Bundy, D., & the DEVTA Team. (2013). Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial. The Lancet, 381(9876), 1469-1477. link B Moderate
7. Bachmann, M. O. (2009). Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: Decision tree model. Cost Effectiveness and Resource Allocation, 7, Article 2. link C Limited
8. Bilimoria, K. Y., Chung, J. W., Hedges, L. V., et al. (2016). National cluster-randomized trial of duty-hour flexibility in surgical training. New England Journal of Medicine, 374(8), 713-727. link B Moderate
9. Bougma, K., Aboud, F. E., Harding, K. B., & Marquis, G. S. (2013). Iodine and mental development of children 5 years old and under: A systematic review and meta-analysis. Nutrients, 5(4), 1384-1416. link C Limited
10. Colchero, M. A., Popkin, B. M., Rivera, J. A., & Ng, S. W. (2016). Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: Observational study. BMJ, 352, h6704. link B Moderate
11. Dewey, K. G., Stewart, C. P., Wessells, K. R., Prado, E. L., & Arnold, C. D. (2021). Small-quantity lipid-based nutrient supplements for the prevention of child malnutrition and promotion of healthy development: Overview of individual participant data meta-analysis and programmatic implications. American Journal of Clinical Nutrition, 114(Suppl. 1), 3S-14S. link A Strong
12. Dou, J., Gihleb, R., Giuntella, O., & Lonsky, J. (2026). Breaking the early bell: Lessons from the first statewide mandate on school start times (NBER Working Paper No. 35184). National Bureau of Economic Research. link B Moderate
13. Dunster, G. P., de la Iglesia, L., Ben-Hamo, M., Nave, C., Fleischer, J. G., Panda, S., & de la Iglesia, H. O. (2018). Sleepmore in Seattle: Later school start times are associated with more sleep and better performance in high school students. Science Advances, 4(12), eaau6200. link C Limited
14. Feng, J., Huang, W. Y., Zheng, C., Jiao, J., Khan, A., Nisar, M., & Wong, S. H.-S. (2024). The overflow effects of movement behaviour change interventions for children and adolescents: A systematic review and meta-analysis of randomised controlled trials. Sports Medicine, 54(12), 3151-3167. link C Limited
15. Field, M. S., Mithra, P., & Peña-Rosas, J. P. (2021). Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations. Cochrane Database of Systematic Reviews, 2021(1), CD011302. link B Moderate
16. Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Nickless, A., Harrison, P. J., et al. (2017). The effects of improving sleep on mental health (OASIS): A randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), 749-758. link B Moderate
17. Hamory, J., Miguel, E., Walker, M., Kremer, M., & Baird, S. (2021). Twenty-year economic impacts of deworming. Proceedings of the National Academy of Sciences, 118(14), e2023185118. link B Moderate
18. Humphrey, J. H., Mbuya, M. N. N., Ntozini, R., Moulton, L. H., Stoltzfus, R. J., Tavengwa, N. V., et al. (SHINE Trial Team). (2019). Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: A cluster-randomised trial. The Lancet Global Health, 7(1), e132-e147. link A Strong
19. Imdad, A., Mayo-Wilson, E., Haykal, M. R., Regan, A., Sidhu, J., Smith, A., & Bhutta, Z. A. (2022). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2022(3), CD008524. link A Strong
20. Jaffe, M. G., Lee, G. A., Young, J. D., Sidney, S., & Go, A. S. (2013). Improved blood pressure control associated with a large-scale hypertension program. JAMA, 310(7), 699-705. link C Limited
21. John, C. C., Opoka, R. O., Latham, T. S., Hume, H. A., Nabaggala, C., Kasirye, P., et al. (2020). Hydroxyurea dose escalation for sickle cell anemia in sub-Saharan Africa. New England Journal of Medicine, 382(26), 2524-2533. link B Moderate
22. Kramer, M. S., Aboud, F., Mironova, E., Vanilovich, I., Platt, R. W., Matush, L., Igumnov, S., Fombonne, E., Bogdanovich, N., Ducruet, T., Collet, J.-P., Chalmers, B., Hodnett, E., Davidovsky, S., Skugarevsky, O., Trofimovich, O., Kozlova, L., Shapiro, S., & PROBIT Study Group. (2008). Breastfeeding and child cognitive development: New evidence from a large randomized trial. Archives of General Psychiatry, 65(5), 578-584. link B Moderate
23. Landrigan, C. P., Rothschild, J. M., Cronin, J. W., Kaushal, R., Burdick, E., Katz, J. T., et al. (2004). Effect of reducing interns' work hours on serious medical errors in intensive care units. New England Journal of Medicine, 351(18), 1838-1848. link C Limited: (lowered from B on October 7, 2026, because a later multicentre trial did not replicate it)
24. Landrigan, C. P., Rahman, S. A., Sullivan, J. P., Vittinghoff, E., Barger, L. K., Sanderson, A. L., et al. (2020). Effect on patient safety of a resident physician schedule without 24-hour shifts. New England Journal of Medicine, 382(26), 2514-2523. link B Moderate
25. Lincoff, A. M., Brown-Frandsen, K., Colhoun, H. M., Deanfield, J., Emerson, S. S., Esbjerg, S., et al. (SELECT Trial Investigators). (2023). Semaglutide and cardiovascular outcomes in obesity without diabetes. New England Journal of Medicine, 389(24), 2221-2232. link B Moderate
26. Luby, S. P., Rahman, M., Arnold, B. F., Unicomb, L., Ashraf, S., Winch, P. J., et al. (2018). Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: A cluster randomised controlled trial. The Lancet Global Health, 6(3), e302-e315. link A Strong
27. Manley, J., Alderman, H., & Gentilini, U. (2022). More evidence on cash transfers and child nutritional outcomes: A systematic review and meta-analysis. BMJ Global Health, 7(4), e008233. link B Moderate
28. Minges, K. E., & Redeker, N. S. (2016). Delayed school start times and adolescent sleep: A systematic review of the experimental evidence. Sleep Medicine Reviews, 28, 86-95. link C Limited
29. Neal, B., Wu, Y., Feng, X., Zhang, R., Zhang, Y., Shi, J., et al. (2021). Effect of salt substitution on cardiovascular events and death. New England Journal of Medicine, 385(12), 1067-1077. link B Moderate
30. Neil-Sztramko, S. E., Caldwell, H., & Dobbins, M. (2021). School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database of Systematic Reviews, 2021(9), CD007651. link A Strong
31. Qian, M., Wang, D., Watkins, W. E., Gebski, V., Yan, Y. Q., Li, M., & Chen, Z. P. (2005). The effects of iodine on intelligence in children: A meta-analysis of studies conducted in China. Asia Pacific Journal of Clinical Nutrition, 14(1), 32-42. link C Limited
32. Rogers, N. T., Cummins, S., Forde, H., Jones, C. P., Mytton, O., Rutter, H., et al. (2023). Associations between trajectories of obesity prevalence in English primary school children and the UK soft drinks industry levy: An interrupted time series analysis of surveillance data. PLOS Medicine, 20(1), e1004160. link C Limited
33. Schwalm, J.-D., McCready, T., Lopez-Jaramillo, P., Yusoff, K., Attaran, A., Lamelas, P., et al. (2019). A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): A cluster-randomised controlled trial. The Lancet, 394(10205), 1231-1242. link B Moderate
34. Stewart, C. P., Wessells, K. R., Arnold, C. D., Huybregts, L., Ashorn, P., Becquey, E., Humphrey, J. H., & Dewey, K. G. (2020). Lipid-based nutrient supplements and all-cause mortality in children 6-24 months of age: A meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 111(1), 207-218. link B Moderate
35. Taylor-Robinson, D. C., Maayan, N., Donegan, S., Chaplin, M., & Garner, P. (2019). Public health deworming programmes for soil-transmitted helminths in children living in endemic areas. Cochrane Database of Systematic Reviews, 2019(9), CD000371. link B Moderate
36. Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191-204. link A Strong
37. Velasco, I., Rueda-Etxebarria, M., Trak-Fellermeier, M. A., Taylor, P., Rabassa Bonet, M., Chi, Y., Janka, H., & Rueda, J. R. (2026). Iodine supplementation for preventing iodine deficiency disorders in children and adolescents. Cochrane Database of Systematic Reviews, 2026(9), CD014475. link B Moderate
38. Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., et al. (STEP 1 Study Group). (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002. link B Moderate: (lowered from A on October 7, 2026, because the trial is manufacturer sponsored)
39. Wilding, J. P. H., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553-1564. link B Moderate
40. Yang, S., Martin, R. M., Oken, E., et al. (2018). Breastfeeding during infancy and neurocognitive function in adolescence: 16-year follow-up of the PROBIT cluster-randomized trial. PLOS Medicine, 15(4), e1002554. link B Moderate
41. Yan, X., Zheng, W., Wang, J., Yuan, X., & Li, G. (2024). Low-dose aspirin for the prevention of preterm birth in nulliparous women: Systematic review and meta-analysis. BMC Pregnancy and Childbirth, 24(1), 260. link B Moderate
42. Andrée, B. P. J., Chamorro, A., Kraay, A., Spencer, P., & Wang, D. (2020). Predicting food crises (Policy Research Working Paper No. 9412). World Bank. link C Limited
43. Bouscaren, D. (2026, August 31). Whatever happened to the U.S. famine alert system that Trump shut down, then reopened. NPR, via KPBS. link B Moderate
44. Chen, R. Y., Mostafa, I., Hibberd, M. C., Das, S., Mahfuz, M., Naila, N. N., et al. (2021). A microbiota-directed food intervention for undernourished children. New England Journal of Medicine, 384(16), 1517-1528. link B Moderate
45. Hartman, S. J., Hibberd, M. C., Mostafa, I., Nahar, N. N., Islam, M. M., Uz Zaman, M., et al. (2024). A microbiome-directed therapeutic food for children recovering from severe acute malnutrition [Preprint]. medRxiv. link B Moderate
46. Mostafa, I., Hibberd, M. C., Hartman, S. J., Hafizur Rahman, M. H., Mahfuz, M., Hasan, S. M. T., et al. (2024). A microbiota-directed complementary food intervention in 12-18-month-old Bangladeshi children improves linear growth. eBioMedicine, 104, 105166. link B Moderate
47. Popp, C. J., Hu, L., Kharmats, A. Y., Curran, M., Berube, L., Wang, C., et al. (2022). Effect of a personalized diet to reduce postprandial glycemic response vs a low-fat diet on weight loss in adults with abnormal glucose metabolism and obesity: A randomized clinical trial. JAMA Network Open, 5(9), e2233760. link B Moderate
48. Pulta, B. (2024, April 23). CA issues Writ of Kalikasan vs. Golden Rice, Bt Eggplant. Philippine News Agency. link B Moderate
49. Rohrer, G. (2026, March 24). Appeals court upholds Florida's ban on lab-grown meat. News Service of Florida, via WLRN. link B Moderate
50. Sachs, A. J., & Johnson, E. A. (2024, May 7). Florida bans "cultivated" meat: First in a potential series of similar bans. Beveridge & Diamond. link B Moderate
51. Zeevi, D., Korem, T., Zmora, N., Israeli, D., Rothschild, D., Weinberger, A., et al. (2015). Personalized nutrition by prediction of glycemic responses. Cell, 163(5), 1079-1094. link B Moderate
52. Castellano, J. M., Pocock, S. J., Bhatt, D. L., Quesada, A. J., Owen, R., Fernandez-Ortiz, A., et al. (2022). Polypill strategy in secondary cardiovascular prevention. New England Journal of Medicine, 387(11), 967-977. link B Moderate
53. Comeras-Chueca, C., Marin-Puyalto, J., Matute-Llorente, A., Vicente-Rodriguez, G., Casajus, J. A., & Gonzalez-Aguero, A. (2021). Effects of active video games on health-related physical fitness and motor competence in children and adolescents with overweight or obesity: Systematic review and meta-analysis. JMIR Serious Games, 9(4), e29981. link C Limited
54. Jastreboff, A. M., Kaplan, L. M., Davies, M. J., Wilding, J. P. H., Ahmad, N. N., Murray, M., et al. (2026). Retatrutide, a triple hormone receptor agonist, for treatment of obesity. New England Journal of Medicine. Advance online publication. link B Moderate
55. Jastreboff, A. M., Kaplan, L. M., Frías, J. P., Wu, Q., Du, Y., Gurbuz, S., et al. (2023). Triple-hormone-receptor agonist retatrutide for obesity: A phase 2 trial. New England Journal of Medicine, 389(6), 514-526. link B Moderate
56. Joseph, P., Roshandel, G., Gao, P., Pais, P., Lonn, E., Xavier, D., et al. (2021). Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: An individual participant data meta-analysis. The Lancet, 398(10306), 1133-1146. link A Strong
57. Mueller, N., Rojas-Rueda, D., Khreis, H., Cirach, M., Andrés, D., Ballester, J., et al. (2020). Changing the urban design of cities for health: The superblock model. Environment International, 134, 105132. link C Limited
58. Paraje, G., Valdés, N., Macaya, A. V., Corvalán, C., & Popkin, B. (2026). The impact of Chile's multipronged food labelling and advertising law on early childhood excess weight: A cohort difference-in-differences study. The Lancet, 407(10548), 2630-2640. link B Moderate
59. Pérez, K., Palència, L., López, M. J., León-Gómez, B. B., Puig-Ribera, A., Gómez-Gutiérrez, A., et al. (2025). Environmental and health effects of the Barcelona superblocks. BMC Public Health, 25(1), 634. link C Limited
60. Roshandel, G., Khoshnia, M., Poustchi, H., Hemming, K., Kamangar, F., Gharavi, A., et al. (2019). Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): A pragmatic, cluster-randomised trial. The Lancet, 394(10199), 672-683. link B Moderate
61. Singh, B., Bennett, H., Miatke, A., Dumuid, D., Curtis, R., Ferguson, T., et al. (2025). Effectiveness of exercise for improving cognition, memory and executive function: A systematic umbrella review and meta-meta-analysis. British Journal of Sports Medicine, 59(12), 866-876. link B Moderate: A for exercise in general
62. Taillie, L. S., Reyes, M., Colchero, M. A., Popkin, B., & Corvalán, C. (2020). An evaluation of Chile's Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study. PLoS Medicine, 17(2), e1003015. link B Moderate
63. Wharton, S., Aronne, L. J., Stefanski, A., Alfaris, N. F., Ciudin, A., Yokote, K., et al. (2025). Orforglipron, an oral small-molecule GLP-1 receptor agonist for obesity treatment. New England Journal of Medicine, 393(18), 1796-1806. link B Moderate
64. Israel, W., Mulitauopele, C., Ma, M., Levinson, A. H., Cikara, L., & Brooks-Russell, A. (2020). Adolescent health behaviors in schools with 4- versus 5-day school weeks. Journal of School Health, 90(10), 794-801. link C Limited
65. Mignot, E., Mayleben, D., Fietze, I., Leger, D., Zammit, G., Bassetti, C. L. A., et al. (2022). Safety and efficacy of daridorexant in patients with insomnia disorder: Results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. The Lancet Neurology, 21(2), 125-139. link B Moderate
66. Rishi, M. A., Ahmed, O., Barrantes Perez, J. H., Berneking, M., Dombrowsky, J., Flynn-Evans, E. E., et al. (2020). Daylight saving time: An American Academy of Sleep Medicine position statement. Journal of Clinical Sleep Medicine, 16(10), 1781-1784. link C Limited: B for the transition harms
67. Tomayko, E. J., Thompson, P. N., Smith, M. C., Gunter, K. B., & Schuna, J. M. (2021). Impact of reduced school exposure on adolescent health behaviors and food security: Evidence from 4-day school weeks. Journal of School Health, 91(12), 1055-1063. link C Limited
68. Hart, H., & Caddy, P. (2026, May 7). Tobacco and Vapes Act 2026 becomes law. Lewis Silkin. link B Moderate

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