Procedures for dead animal removal need to be specific yet adaptable
13 August 2025
3 minute read
Pigs on sow farms often die from various causes, including contagious diseases. An association between using rendering for dead animal disposal and higher risk or porcine reproductive and respiratory syndrome virus (PRRSV) outbreaks has been reported in the literature. However, a detailed characterization of disposal practices and facilities used in the US is needed to understand and mitigate associated risks.
A study by I.A.D. Paploski and colleagues at the University of Minnesota, USA, aimed to characterize the facilities, structures and procedures for dead animal disposal on sow farms, as well as test if environmental samples collected in and around dead animal disposal structures contain detectable quantities of PRRSV and porcine epidemic diarrhea virus (PEDV). The results of the study were presented at the 2024 North American PRRS Symposium.
Ten standard operating procedures (SOPs) from different systems were obtained. Data from SOPs were categorized into sections: biosecurity, dead animal gathering space in the barn, removal from the barn, transport out of the barn, and final destination and used to create a questionnaire for on-site visits. Five farms with 2,000 to 5,000 sows on each from three systems were visited to apply the questionnaire and collect environmental samples for PRRSV and PEDV testing.
The SOPs varied significantly in detail, with the most comprehensive being 12 pages and the shortest having only 1 page containing 11 lines. Biosecurity measures were generally outlined but inconsistent, particularly regarding personnel roles. Dead animal gathering spaces were mentioned in most SOPs, often cleaned and disinfected, but methods varied.
Dead sow removal methods were usually detailed, while dead piglet removal and afterbirth were less consistently addressed. Transport methods of carcasses between the barn and the compost pile or rendering truck pick up site were done primarily using tractors or pickups and were cited in most SOPs, but cleaning protocols were often not mentioned.
Final disposal destinations were inconsistently mentioned. Farm visits revealed that dead animal removal was typically the last task of the day, regardless of PRRS status. Environmental conditions, especially wind direction, can be important if removal happens daily. Wildlife exposure to disposal areas was commonly reported.
Three finisher sites (all PRRSV positive, one PEDV positive) were visited and a total of 25 environmental samples were collected from roads, machines and structures involved in moving dead animals. All samples from one farm tested negative for PRRSV and PEDV by RT-PCR. From the remaining two farms, a total of 12 and 5 samples tested RT-PCR positive for PRRSV-2 and PEDV, respectively. Positive samples were found on dead animals, rendering boxes, skid loader buckets and nearby ground. One PRRSV isolate was obtained from a sample collected on the ground, while no viable PEDV was isolated.
Creating SOPs for dead animal removal on farms is challenging due to the need for specific yet adaptable instructions. SOPs should include detailed biosecurity protocols, procedures for removing dead animals and cleaning and disinfection guidelines.
This study shows that samples collected from or near rendering boxes can test positive for farm-specific viruses and may contain viable viruses. Positive samples on roads suggest potential PRRSV transmission pathways between farms. Further studies on different disposal methods, such as composting or incineration, are warranted to ensure effective biocontainment of viruses on farms.
The easiest high-fiber swap to help you poop is swapping popcorn in place of chips.
Popcorn is a whole grain that boasts fiber and antioxidants and is low in saturated fat and sugar.
Dietitians say regular exercise, mindful eating and proper hydration are keys to better digestion.
Struggling to go No. 2? You’re not alone. In fact, the National Institute for Diabetes and Digestive and Kidney Diseases estimates that around 16% of the adult population struggles with constipation daily. The good news is there are proactive things you can do to ease your constipation woes without spending a fortune.
Enter—simple food swaps! No, we’re not suggesting swapping cauliflower pizza crust for the real deal (though don’t knock that one until you try it). Rather, we’re encouraging you to explore the better-for-you alternatives for common snacks that pack a bit more nutritional bang per bite. Dietitians say the easiest high-fiber swap to help you poop is choosing air-popped popcorn in place of potato chips.
Why Air-Popped Popcorn Is the #1 Swap
It’s High In Fiber
Fiber is a key component of a diet that promotes regular bowel movements, and unfortunately, most Americans are falling short on eating enough of this nutrient. High sources of dietary fiber positively impact metabolic health and the microbiome. You see, popcorn contains resistant starch and serves as a prebiotic, providing food for the good gut bugs in your gut that keep your digestive system running smooth., Gut-health nutrition expert Jessie Wong, MAcc, RDN, LD, is also a popcorn advocate, sharing, “Popcorn is a whole-grain snack packed with insoluble fiber, which adds bulk to stool and helps food move more efficiently through the digestive tract. This promotes regularity and supports overall bowel health.”
The best part—swapping 1-ounce of popcorn in place of 1-ounce of chips provides 3 additional grams of dietary fiber, inching you closer to the recommended 25 to 38 grams of fiber per day.,
It’s a Whole Grain
The 2020-2025 Dietary Guidelines for Americans recommend consuming at least 50% of your grains from whole grains sources. Whole grains contain the entire bran layer of the grain kernel, meaning they pack more fiber and other nutrients that other refined grains lack. In fact, dietitian Roxana Ehsani, MS, RD, CSSD, shares, “One serving of popcorn provides one-third of your daily whole grain needs, and 4 grams of dietary fiber.” Wong points out eating more whole grains routinely helps nourish your microbiome, “contributing to more predictable bowel movements.”
It’s Filled with Polyphenols
Popcorn contains compounds known as polyphenols, which have antioxidant properties. Antioxidants help protect cells from damage caused by free radicals–the “bad guys” that may cause harm to our health in the long run. Research has explored the health benefits of popcorn throughout the decades, concluding it has a positive influence on gut health thanks to its polyphenol activity specifically. Ehsani shares, “Popcorn’s polyphenols can help reduce inflammation in the gut and support the growth of healthy gut bacteria. A healthy gut microbiome results in better digestion and more regular bowel movements.”
It’s Low in Saturated Fat & Sugar
The high fiber content of air-popped popcorn helps fill you up while delivering important vitamins and minerals with no saturated fat or added sugar. Research shows that people who struggle with constipation may have poor diet quality, such as high intakes of saturated fat and added sugar. Replacing foods high in these with better-for-you options, like popcorn or other high fiber foods, provides support for your microbiome and can ease constipation while promoting better digestion. Wong shares, “Air-popped popcorn is low in calories, but high in volume, providing a satisfying crunch and fullness without the heavy fats or additives often found in chips, making it a gut-friendly choice for snacking.”
Strategies for Better Digestion
Better gut health is possible, but it involves taking a close look at both diet and lifestyle. Wong shares, “Bowel health isn’t just about eating more fiber — it’s about the whole picture. Managing stress, getting enough sleep, and listening to your body’s natural cues are just as important as what’s on your plate.” Consider these dietitian-recommended tips for better digestion too.
Move Your Body: Regular exercise is essential for better bowel health. Wong and Ehsani recommend consistent daily movement in whatever form feels enjoyable. Pick your favorite–a short walk, resistance exercise, or a swim all count.
Stay Hydrated: Drinking water throughout your day helps prevent dehydration, a common culprit in struggling to go number 2. Carry a large reusable water and make a goal to refill it with every mealtime, ensuring you’re constantly drinking throughout your day.
Eat probiotic rich foods: Probiotics help nourish a healthy gut and aid digestion, helping to keep your bowel movements regular. Consider adding more probiotic rich foods into your diet, like kefir, yogurt, sauerkraut, kimchi, or kombucha.
Slow down. Being mindful as you eat is important, notes Braddock, as quickly consuming large volumes of food can disrupt your digestion. Consider taking some deep breaths before eating to help calm your nervous system and prepare to properly digest.
And yes, eat more fiber. Braddock recommends eating more high-fiber fruits and veggies routinely to find relief. She writes, “Raspberries are one of the highest fiber fruits per serving. Plus, eating two kiwis a day can help improve constipation and abdominal discomfort.”
Meal Plan to Try
Simple 7-Day Meal Plan to Help You Poop, Created by a Dietitian
Our Expert Take
Smart foods swaps can help improve your gut health—in turn offering relief from constipation that may be weighing you down. While fruits and vegetables are natural choices to swap in for other less nutritious choices, they don’t always satisfy you the same way. That’s why nutrition experts recommend starting small with easy swaps that may be more satisfying, like trying air-popped popcorn in lieu of potato chips to get that same crunch with more fiber and antioxidants. Fiber is a key component to helping you poop, and every gram counts! Consider making a bowl of our EatingWell reader favorite, Cinnamon Popcorn, to nosh on when hunger strikes.
From kimchi to leafy greens, scientists uncover how mineral-rich diets, especially potassium, may help protect mental health across cultures.
Study: Mineral Intake and Depression: A Cross-Sectional Comparative Study Based on National Health and Nutrition Examination Surveys in Korea and the United States. Image Credit: Yulia Furman / Shutterstock
In a recent article published in the journal Nutrients, researchers investigated the relationship between the intake of minerals such as calcium, zinc, and iron, and the incidence of depression among adults in the United States and Korea.
They found that Korean adults with higher intakes of potassium and sodium were less likely to experience depression, with phosphorus showing a borderline association, a finding similar to that of American adults with higher intakes of potassium and zinc, with iron showing borderline significance.
Background
Depression is a widespread mood disorder marked by persistent sadness and hopelessness, and is expected to become a major global health burden. In South Korea, about 5% of adults report depressive disorders, while in the U.S., over 17 million adults experience at least one major depressive episode each year.
Many affected individuals remain untreated, often due to stigma and reluctance to seek help, while high recurrence rates make management challenging. Nutrition has been increasingly linked to mental health, with deficiencies in minerals such as magnesium, zinc, and selenium associated with cognitive decline and psychiatric conditions.
However, the roles of sodium and potassium in depression have received little attention, despite their abundance in everyday diets. Sodium is mainly consumed as table salt, while potassium is found in a variety of foods.
Given the limited research and the potential for dietary guidance to improve mental health outcomes, this study aimed to comprehensively assess the association between seven dietary minerals and depression in Korean and American adults.
The comparison between these two culturally and nutritionally distinct populations could help identify shared and unique patterns, offering a foundation for future research and public health strategies in mental health nutrition.
About the Study
In this cross-sectional analysis, researchers utilized data from nationally representative health and nutrition surveys in both countries, employing multistage, stratified sampling. Korean adults aged 19 and above and American adults aged 18 and above who completed depression screening were included, excluding those who were pregnant, under depression treatment, or with missing key data.
The final sample included 12,996 Koreans and 9,547 Americans. People with a depression score of 10 or over were considered to be depressed. Dietary mineral intake (calcium, zinc, iron, magnesium, phosphorus, sodium, and potassium) was estimated from 24-hour dietary recalls, using national food composition databases.
Covariates included demographics, socioeconomic factors, body mass index (BMI), lifestyle habits, comorbidities, and total energy intake. Associations between mineral intake and depression were assessed using multivariable logistic regression, adjusting for potential confounders. Survey-specific sampling weights ensured national representativeness.
Key Findings
In the Korean sample, 4.1% of 12,996 participants had depression, while in the American sample, 6.2% of 9,547 participants were affected.
In both countries, individuals with depression were more often female, had lower income and education levels, were more likely to live alone, and showed higher depression screening scores, smoking rates, diabetes prevalence, and comorbidity scores.
Regular exercise was less common in the U.S. depression group. Mineral intake was generally lower among those with depression, except for calcium, which did not follow this pattern.
Multivariable-adjusted analyses showed that in Korea, higher sodium and potassium intakes were significantly associated with lower odds of depression, with phosphorus showing borderline significance.
In the U.S., potassium and zinc were significantly associated, and iron showed borderline significance. Restricted cubic spline analysis indicated that intakes below certain thresholds were linked to higher depression risk.
Subgroup analysis revealed population- and group-specific patterns: for example, sodium was protective among Korean men, potassium among older Americans, and zinc among non-obese Americans. Additional subgroup findings included significant associations for phosphorus among Korean females, potassium, iron, and zinc among U.S. males, and sodium among Koreans aged ≤65 years.
Some minerals were associated with depression in one sex or BMI category but not the other. Potassium was the only mineral consistently linked to lower depression risk in both countries, highlighting its potential universal relevance for mental health. Notably, magnesium and calcium showed no significant associations with depression in either population.
Conclusions
This study found inverse associations between certain minerals and depression, with patterns differing between Korea and the U.S. Potassium consistently showed protective effects in both populations, while sodium was significant in Korea, phosphorus showed borderline significance in Korea, and iron showed borderline significance, and zinc was substantial in the U.S.
These differences may reflect variations in average intake, dietary sources, and nutrient bioavailability, such as substantially higher sodium intake in Korea from fermented vegetables, soups, and stews, or greater bioavailable heme iron and zinc from red meat in the U.S.. In contrast, Korean diets feature more plant-based and seafood sources with lower nutrient bioavailability.
Strengths include large, nationally representative datasets from two culturally distinct countries, the examination of seven minerals, and subgroup analyses revealing demographic and lifestyle influences.
Limitations involve the cross-sectional design, preventing causal inference, possible reverse causation, reliance on 24-hour recall, which may be particularly inaccurate, especially due to depression-related memory impairment, and the use of self-reported depression measures that can be subject to bias.
Overall, the findings suggest that dietary mineral intake could be integrated into mental health strategies. Longitudinal studies are needed to confirm causality and clarify mechanisms linking minerals to depression risk.
Journal reference:
Mineral Intake and Depression: A Cross-Sectional Comparative Study Based on National Health and Nutrition Examination Surveys in Korea and the United States. Kim, J., Kim, I., Lee, J., Jeon, K., Kang, J., Lee, D., Choi, S., Kim, H.S., Son, M. Nutrients (2025). DOI: 10.3390/nu17162593 https://www.mdpi.com/2072-6643/17/16/2593
Residents in Fort Collins and other parts of Colorado have spotted wild rabbits with ‘scary’ horn-like and tentacle-shaped growths protruding from their heads and faces. Photos circulating on social media have startled locals. They show the animals with black, spiny structures resembling toothpicks or quills, sparking alarm and speculation about possible diseases.
Colorado residents have spotted several rabbits with tentacle-like growth(X)
Wildlife experts revealed that the unsettling condition is caused by Shope papilloma virus, a disease that creates wart-like tumors on rabbits, often around the head, ears, and eyelids. While the growths may look disturbing, officials stressed they do not pose a threat to humans, pets, or other wildlife.
The virus only spreads between rabbits, typically through bites from insects such as mosquitoes and ticks. According to the University of Missouri, the condition is a DNA virus ‘seen most frequently in cottontail rabbits of the Midwest with outbreaks in domestic rabbits’.
Local Sightings and reactions
Fort Collins residents have reported multiple sightings, including one rabbit that returned to a homeowner’s yard for two consecutive years with increasingly severe growths.
Some residents initially feared the animals had plague or another dangerous illness.
Descriptions of the appearance range from ‘black quills’ to a ‘scabby growth’ covering parts of the face.
“I thought he would die off during the winter, but he didn’t,” a local, Susan Mansfield, told NBC local affiliate KUSA.“He came back a second year, and it grew.”
What is Shope Papilloma Virus?
The virus causes benign wart-like tumors, but in some cases, these can become malignant (cancerous). While generally not harmful to the rabbit’s overall health, tumors can create problems if they obstruct the mouth, nose, or eyes.
The disease is relatively common in wild rabbit populations, particularly during warmer months when insect activity is high.
There is no known cure for the virus; surgical removal of tumors is sometimes performed for domestic rabbits.
Colorado Parks and Wildlife is advising residents to keep their distance. The rabbits are not dangerous.
Editor’s note: This article was adapted from a release from the University of Utah.
Nearly a quarter of people over the age of 40 experience painful osteoarthritis, making it a leading cause of disability in adults. Osteoarthritis involves degradation of joint-cushioning cartilage, and there is currently no way of reversing this damage: the only option is to manage pain with medication, and eventually, joint replacement.
A study conducted at Stanford University is now demonstrating the potential for another option: gait retraining.
By making a small adjustment to the angle of their foot while walking, participants in a year-long randomized control trial experienced pain relief equivalent to medication. Critically, those participants also showed less knee cartilage degradation over that period as compared to a group that received a placebo treatment.
Published in The Lancet Rheumatology, it is the first placebo-controlled study to demonstrate the potential effectiveness of a biomechanical intervention for osteoarthritis.
The study was led by an interdisciplinary team at Stanford: Scott Uhlrich, who is now an assistant professor in the John and Marcia Price College of Engineering’s Department of Mechanical Engineering at the University of Utah; Valentina Mazzoli, who is now an assistant professor in New York University’s Department of Radiology; and Julie Kolesar, a research engineer in Stanford’s Human Performance Lab who worked for the Veteran’s Administration at the time of the study.
“We’ve known that for people with osteoarthritis, higher loads in their knee accelerate progression, and that changing the foot angle can reduce knee load,” said Uhlrich. “So the idea of a biomechanical intervention is not new, but there have not been randomized, placebo-controlled studies to show that they’re effective.”
A personalized approach
The researchers were specifically looking at patients with mild-to-moderate osteoarthritis in the medial compartment of the knee – on the inside of the leg – which tends to bear more weight than the lateral, outside, compartment. This form of osteoarthritis is the most common, but the ideal foot angle for reducing load in the medial side of the knee differs from person to person depending on their natural gait and how it changes when they adopt the new walking pattern.
“Previous trials prescribed the same intervention to all individuals, resulting in some individuals not reducing, or even increasing, their joint loading,” said Uhlrich. “We used a personalized approach to selecting each individual’s new walking pattern, which improved how much individuals could offload their knee and likely contributed to the positive effect on pain and cartilage that we saw.”
“This study not only demonstrates a promising approach to help individuals with osteoarthritis,” said Scott Delp, a senior author of the paper, director of the Wu Tsai Human Performance Alliance at Stanford, and James H. Clark Professor in the School of Engineering, “It also showcases how powerful a more personalized approach can be.”
Scott Delp | Andrew Brodhead
In their first two visits, participants received a baseline MRI and practiced walking on a pressure-sensitive treadmill while motion-capture cameras recorded the mechanics of their gait. This allowed the researchers to determine whether turning the patient’s toe inward or outward would reduce load more, and whether a 5- or 10-degree adjustment would be ideal.
This personalized analysis also screened out potential participants who could not benefit from the intervention, as none of the foot angle changes could decrease loading in their knees. These participants were included in previous studies, which may have contributed to those studies’ inconclusive pain results.
Moreover, after their initial intake sessions, half of the 68 participants were assigned to a sham treatment group to control for the placebo effect. These participants were prescribed foot angles that were identical to their natural gait. Conversely, participants in the intervention group were prescribed the change in foot angle that maximally reduced their knee loading.
Participants from both groups returned to the lab for six weekly training sessions, where they received biofeedback – vibrations from a device worn on the shin – that helped them maintain the prescribed foot angle while walking on the lab’s treadmill. After the six-week training period, participants were encouraged to practice their new gait for at least 20 minutes a day, to the point where it became natural. Periodic check-in visits showed that participants were adhering to their prescribed foot angle within a degree on average.
After a year, all participants self-reported their experience of knee pain and had a second MRI to quantitatively assess the damage to their knee cartilage.
“The reported decrease in pain over the placebo group was somewhere between what you’d expect from an over-the-counter medication, like ibuprofen, and a narcotic, like OxyContin,” Uhlrich said.
Delp added, “The MRIs also showed improved biomarkers of cartilage health in the intervention group. This is an exciting finding that gives hope to people with osteoarthritis.”
A lasting intervention
Beyond the quantitative measures of effectiveness, participants in the study expressed enthusiasm for both the approach and the results. One participant said: “I don’t have to take a drug or wear a device … it’s just a part of my body now that will be with me for the rest of my days, so that I’m thrilled with.”
Participants’ ability to adhere to the intervention over long periods of time is one of its potential advantages.
“Especially for people in their 30s, 40s, or 50s, osteoarthritis could mean decades of pain management before they’re recommended for a joint replacement,” said Uhrlich. “This intervention could help fill that large treatment gap.”
Before this intervention can be clinically deployed, the gait retraining process will need to be streamlined. The motion-capture technique used to make the original foot angle prescription is expensive and time-consuming; the researchers envision this intervention to eventually be prescribed in a physical therapy clinic and retraining can happen while people go for a walk around their neighborhood.
“We and others have developed technology that could be used to both personalize and deliver this intervention in a clinical setting using mobile sensors, like smartphone video and a ‘smart shoe,’” said Uhlrich. Future studies of this approach are needed before the intervention can be made widely available to the public.
For more information
Additional Stanford co-authors include Amy Silder, former associate director of the Human Performance Lab; Andrea Finlay, a staff statistician in the Ladd Lab; Feliks Kogan, assistant professor (research) of radiology in Stanford Medicine; and Garry Gold, professor of radiology in Stanford Medicine. Gary S. Beaupre of the Palo Alto VA is also a co-author.
Delp is also a professor of bioengineering, of mechanical engineering and, by courtesy, of orthopaedics in the Schools of Medicine and Engineering. He is also a member of Stanford Bio-X, the Maternal & Child Health Research Institute (MCHRI), and the Wu Tsai Neurosciences Institute. Gold is also a member of Bio-X, the Cardiovascular Institute, the Wu Tsai Human Performance Alliance, and the Wu Tsai Neurosciences Institute. Kogan is also a member of Bio-X and the Wu Tsai Human Performance Alliance.
The research was supported by fellowships from the National Science Foundation (DGE-114747) and the Stanford Office of the Vice Provost for Graduate Education, Merit Review Award I01 RX001811 from the United States Department of Veterans Affairs Rehabilitation Research and Development Service, and Award P2CHD101913 from the United States National Institutes of Health.
Two papers published in the Lancet Psychiatry Physical Health Commission look at monitoring the physical health of people prescribed psychiatric medication and lifestyle interventions in mental health care.
Comment on the paper on physical health monitoring for people prescribed psychiatric medication*:
Dr Natalie Shoham, Senior Clinical Lecturer in the Unit for Psychological Medicine at the Centre for Psychiatry and Mental Health, QMUL, and honorary consultant psychiatrist, said:
“The second report of the Lancet Commission provides an up-to-date, comprehensive and practical guide for clinicians on how to reduce the burden of side effects caused by psychotropic medications, based on a review of a wide range of evidence. The report has direct real-world implications for healthcare provision, and potential to improve quality of life for many individuals prescribed antipsychotic medications. The challenges inherent in ensuring that all people prescribed antipsychotics benefit from the recommendations must now be addressed.”
Dr Paul Keedwell, Consultant Psychiatrist and Fellow of the Royal College of Psychiatrists, said:
“The report is a well-meaning set of recommendations for improving the physical health outcomes of people prescribed medication for mental illness. Although clients often benefit from medication from a mental health point of view, many psychotropic medications put on weight and contribute to the development of metabolic syndrome.
“Feedback from service users was included in the report. This was particularly valuable. Most individuals receive advice on diet and exercise, and even have gym memberships subsidised by the health service, but they commonly struggle to enact these for two main reasons.
“Firstly, many individuals suffer with treatment-resistant illness, including disabling depression and schizophrenia, where the symptoms deter them from exercising and planning/preparing healthy meals.
“Secondly, many medications that individuals might need to stay well provide a barrier to exercise by inducing sedation and lethargy. This is particularly true with antipsychotics like clozapine, which commonly induce weight gain.
“Until more effective and better-tolerated medications are developed for mental illness more consideration should be given to the use of additional medications like metformin which can help with weight loss, even in the absence of diabetes. Also, it seems to me that this is a population that would benefit greatly from access to GLP agonists if they have medication induced obesity, including Wegovy and Mounjaro.”
Dr Prasad Nishtala, Reader in the Department of Life Sciences, University of Bath, said:
“This report is a landmark in bringing together the best available evidence on preventing and managing the physical health side effects of psychiatric medication. Cardiometabolic and neurological complications can shorten life expectancy, while sexual health problems may reduce treatment adherence. Together, these issues significantly affect the overall quality of life. The Commission rightly emphasises proactive prevention, shared decision-making, and coordinated care, and adding a standardised psychotropic adverse event monitoring tool would further strengthen clinical monitoring. Or even better, integrated digital tools that combine intervention tracking with proactive side-effect monitoring, particularly during the early stages of treatment, would help clinicians act quickly and consistently to protect patients’ physical health.”
Comments on both papers:
Dr Jo Howe, Research Associate for the RESOLVE study, Aston University, said:
“These two reports offer an evidence-based roadmap for preventing and managing the physical health side-effects of psychotropic medication and embedding lifestyle interventions in mental health care. They highlight practical measures such as early monitoring, shared decision making, integrating lifestyle interventions like physical activity and nutrition support, and the prophylactic use of metformin for high-risk prescriptions. Our research on antipsychotic-induced weight gain reinforces the value of preventative care — acting early to anticipate risks and making interventions sustainable within routine practice. Many services still need clear guidance on when and how to initiate metformin, and clarity over responsibility for physical health. Too often, mental and physical health care are delivered in silos, meaning opportunities for prevention are missed. These reports are rigorous and grounded in current evidence, but their real-world impact will depend on breaking down these silos, alongside workforce capacity, service redesign, and policy commitment. If implemented well, they could help close the unacceptable 13–15 year life expectancy gap for people with severe mental illness.”
Prof Ian Maidment, Professor of Clinical Pharmacy, and Associate Dean Research and Enterprise (Pharmacy), Aston University, said:
“Life expectancy in people with mental illnesses such as schizophrenia is reduced by up to 20 years partly related to physical health issues; managing the physical health of people with mental illness has been an international priority for many years. Many psychotropic medications cause physical health problems for people with mental illness, for example anti-psychotics are associated with significant weight gain potentially 30kg or more. The commission has synthesised the evidence and produced clear recommendations for practice. One key challenge is implementation of the recommendations into day-to-day routine clinical care. Successful implementation will require a system wide approach working across primary, secondary and social care. In summary, we desperately need to improve the physical healthcare in people with mental illnesses; implementation of the evidence is a vital next step.”
*‘Holistic prevention and management of physical health side-effects of psychotropic medication: second report of the Lancet Psychiatry Physical Health Commission’ by Sean Halstead et al. was published in the Lancet Psychiatry at 23:30 UK time on Tuesday 12 August 2025.
DOI: 10.1016/S2215-0366(25)00162-2
‘Implementing lifestyle interventions in mental health care: third report of the Lancet Psychiatry Physical Health Commission’ by Scott B Teasdale et al. was published in the Lancet Psychiatry at 23:30 UK time on Tuesday 12 August 2025.
Declared interests
Dr Natalie Shoham: “My COI is that one author was a subsidiary supervisor for my PhD.”
Dr Paul Keedwell: “No conflicts of interest.”
Dr Prasad Nishtala: “No COI to declare.”
Dr Jo Howe: “I am a chartered psychologist and research consultant specialising in mental and physical health integration, including NIHR-funded work on antipsychotic-induced weight gain and preventative care pathways (https://doi.org/10.1111/obr.13962). I have no relevant industry funding and no current advisory roles with pharmaceutical companies.”
Prof Ian Maidment: “I’m an active researcher in this area, but don’t believe that this represents a Conflict of Interest. See: Non-pharmacologicaL InterVEntions for Antipsychotic-Induced Weight Gain (RESOLVE) in People Living With Severe Mental Illness: A Realist Synthesis. Obesity Reviews. e13962, https://doi.org/10.1111/obr.13962.”
A study published in the BMJ Nutrition Prevention & Health looks at calorie labelling and takeaway food choices.
Prof Amelia Lake, Professor of Public Health Nutrition, Teesside University, said:
“The complexity of trying to make highly accessible, highly palatable, high fat, high salt, high sugar food healthier.
“This analysis is helpful as it illustrates how unlikely people are to check calorie labelling but may find a traffic light system more useful.
“As the takeaway food environment expands before our eyes with the rise and rise of the digital food environment, these findings are very important in a real world setting.
“As with all surveys, there are limitations to this research – namely those under 35 and males – but largely this is a very helpful piece of research to think about how we make healthier choices easier for people who are ordering online takeaway food.”
Prof Amanda Daley, Professor of Behavioural Medicine and an NIHR Research Professor in Public Health, Loughborough University, said:
“Takeaways are an important focus for research of this kind because takeaway orders are typically very high in calories. However, this is a small observational study, so it is difficult to draw any firm conclusions from the findings. The results are not surprising either given that people often order takeaways as a treat, where they are less likely to want to focus on the number of calories in their order.
“We have known for some time that calorie labelling alone has only a small impact of the decisions people make about what food to purchase. One reason for this is calorie information is just a number and there is no meaning or context to this information. We need to find other ways of expressing to the public what calories mean for them. Regarding takeaways specifically, often people order takeaways as a treat where they are less likely to want to focus on the number of calories in their order. The problem here however is that takeaways are often very high in calories.”
Prof Fiona Gillison, a chartered member of the British Psychological Society, said:
“This study’s large and diverse sample, along with its clear focus on takeaway outlets, offers useful insight into calorie labelling in the UK. It suggests that calorie labels in takeaway food can reduce the number of calories ordered for a minority of people, which scaled up to the whole population could make it a useful tool alongside other public health initiatives.
“However, the study relies on people’s self-reports of their behaviour which has its limitations in terms of memory and social desirability, so there is still a case for more objective measurement of people’s behaviour in response to calorie labelling.
“As always, we should balance the potential for benefit for people trying to reduce their weight with the potential for harm for those with eating disorders.”
Rachel Richardson, Acting Head of Methods Support, The Cochrane Collaboration, said:
“The up-to-date evidence on the effectiveness of calorie labelling is best represented by a recent review from The Cochrane Collaboration, published in January 2025. The review examined evidence from 25 studies and concluded that calorie labels in supermarkets, restaurants and other food outlets led to a small reduction in the calories people selected and purchased. Importantly, the studies included 18 randomised controlled trials and most were conducted in real-world field settings. The authors concluded that the cumulative effect at a population level could make a meaningful contribution to public health.
“The findings from this study published in BMJ Nutrition, Prevention and Health seem to suggest that calorie labelling rarely influences food choices when ordering a takeaway. However, it is important to interpret these findings with caution.
“Firstly, the study reports the results from a survey of a small number of people – 1,040, and only 235 people responded to the question about the impact of calorie information. It also seems as if the sample for the survey may not be representative of the general UK population – for example 46% reported ordering takeaway once every two weeks or more and younger people and men were underrepresented in the sample.
“Secondly, participants were asked if they noticed calorie information the last time they ordered takeaway food online and only 23% did. However, smaller businesses are not required to provide calorie information on menus, so it may be that some menus did not include any calorie information.
“Lastly, this study does not measure people’s actual behaviour and only reports on what people say they will do or have done. Such data are not a reliable measure of real-world behaviour.
“In summary, there is some interesting information in this study – particularly the comments made by participants on healthy eating, but the most reliable evidence on the effectiveness of calorie labelling comes from thorough and systematic reviews of multiple well-conducted studies, such as the recent publication from The Cochrane Collaboration.”
Dr Amanda Avery, Associate Professor in Nutrition and Dietetics, University of Nottingham, said:
Context summary:
“The research, led by researchers from the London School of Hygiene & Tropical Medicine (LSHTM), University of Reading and University of Exeter, looked at the impact of mandatory calorie labelling on take-away choice.
“Calorie labelling was mandated from April 2022 for large out of home food businesses across England, including restaurants, cafes and takeaways. As well as listing the calories for each food item, menus also need to include a statement of the recommended daily calorie intake.
“The researchers surveyed 1,040 adults living in England who had reported buying takeaways at least once in the past 12 months. Over a quarter of the sample (27%) reported having takeaways weekly or more often and a further 41% reported having takeaways every two weeks to once a month
Comments:
“This is a reasonably representative sample of adult consumers of take-aways and over a quarter were consuming take-aways at least once per week. The results very clearly demonstrate that taste and price are the most important factors for adults in England deciding which takeaway to order, while healthiness and low carbon footprint are the least important – equally so. The majority (77%) of respondents did not notice any calorie information during their most recent online takeaway purchase. Of those who did, most said it did not affect their food choices. When asked questions on recommended energy content, very few correctly identified the recommended 600kcal content for a meal.
“Whilst fewer young adults responded to the survey, those who did and were under the age of 35 were more than twice as likely to order takeaways weekly or more often than those who were older. Notably individuals with overweight or obese BMI category levels were also found to be twice as likely to have weekly or more frequent takeaways compared to those with healthy or underweight BMI scores. But one of the study limitations is that weight and height were self-reported and not all participants reported their weight and height. Thus this finding could be an over- or under-reporting.
“It would definitely be good to know why calorie labels are not being noticed or taken into account when adults are choosing take-aways and why so many are ordering take-aways so frequently. Having a tasty take-away that exceeds calorie recommendations would not matter so much if people consume take-aways less frequently.
“Future studies need to include more men and people aged under 35 years.
“The research also asked for ideas from participants. Participants suggested that a traffic light system might be more helpful than calorie labelling in guiding choices.
“The mandatory calorie labelling probably has had limited impact on out-of-the home food choices, including take-away choices but that is not to say that it is not helpful as part of a wider public healthy strategy to try and help reduce levels of obesity across England.
“The helpful take-away messages from this research are that people could be guided to make healthier, quick and easy fake-aways at home and if people do choose to have a take-away, healthier options need to be available that are tasty and cheaper.”
Dr Tom Jewell, Senior Lecturer in Child and Adolescent Mental Health, said:
“These interesting findings suggest that calorie information has a limited influence on takeaway choices for consumers in England. A limitation of the study is that it is a survey, so people have to recall their decision-making choices and report them. This introduces some degree of bias, as food choices may have been made days or even weeks ago. Also, the authors were not able to provide data on the participants’ ethnicity, which is unfortunate, as it would be interesting to understand any potential impact of ethnicity on takeaway choices.”
‘Calorie labelling and other drivers of takeaway food choices’ by Laura Cornelsen et al. was published in the BMJ Nutrition Prevention & Health at 23:30 UK time on Tuesday 12 August 2025.
DOI: 10.1136/bmjnph-2025-001268
Declared interests
Prof Amelia Lake: “Amelia is Deputy Director of Fuse the Centre for Translational Research in Public Health and is Professor of Public Health Nutrition at Teesside University.
Amelia sits on the scientific committee of the British Nutrition Foundation and is an executive for Nutrition North (Northern Health Science Alliance).
She has no industry CoIs.”
Prof Amanda Daley: “I conduct research in a similar field to the research and have no conflicts of interest to declare.”
Rachel Richardson: “I am an employee of The Cochrane Collaboration, but was not involved in the recent review.”
Dr Amanda Avery: “Besides academic position (Programme Director for Master of Nutrition & Dietetics & MSc Clinical Nutrition, Associate Professor in Nutrition and Dietetics, and Senior Fellow of the Higher Education Academy in the Division of food, Nutrition & Dietetics at the University of Nottingham), Amanda holds a position as Consultant dietitian in weight management at Slimming World.”
Dr Tom Jewell: “My conflict of interest is that I hold a NIHR grant to investigate the impact of calorie labelling on people with eating disorders – NIHR award 205226: https://fundingawards.nihr.ac.uk/award/NIHR205226.”
A 74-year-old female with a medical history of hypertension and type 2 diabetes mellitus was admitted to ICU following severe trauma from a road traffic accident. On admission, her home medications included empagliflozin, gliclazide, metformin, ramipril, amlodipine, and esomeprazole.
Initially, the patient presented with no hemorrhagic shock or organ failure. Her Glasgow Coma Scale (GCS) score was 14 upon arrival at the trauma center.
A computed tomography (CT) scan revealed:
Mild traumatic brain injury with brain contusion hemorrhage and subarachnoid hemorrhage.
Facial bone fractures.
Thoracic trauma (Thoracic Trauma Score = 11) with a left-sided hemopneumothorax, which did not require drainage.
American Association for the Surgery of Trauma (AAST) grade 3 traumatic splenic injury.
Non hemorrhagic, non surgical pelvic trauma.
None of these injuries necessitated surgical intervention. An occipital scalp wound was debrided and sutured. Apart from esomeprazole, none of her long-term medications were resumed upon initial management. The patient’s initial medical course was favorable. Consequently, on Day 4, oral antidiabetic medications, including empagliflozin, were reintroduced.
From Day 5, the patient developed an unexplained fever without deterioration in her general condition.
By Day 7, while awaiting discharge from the ICU, her overall condition acutely deteriorated. She presented with a decreased level of consciousness (GCS 7/15), atrial fibrillation (heart rate 150–160 bpm), hemodynamic instability (90/54 mmHg), tachypnea (25–30 breaths per minute), hyperthermia (40 °C), and facial and left arm edema.
Arterial blood gas analysis revealed severe metabolic acidosis (pH 6.99, bicarbonate 6 mmol/L, pCO2 15 mmHg, pO2 105 mmHg, base excess − 23.4 mmol/L) with a lactate concentration of 1.8 mmol/L and a glucose concentration of 13.7 mmol/L.
Management initiated for septic shock included fluid resuscitation, vasopressor therapy, and broad-spectrum antibiotics. Subsequent cranial and thoraco-abdomino-pelvic CT scans revealed dermo-hypodermitis of the face, secondary to an occipital skin wound infection.
Further laboratory analysis showed a serum creatinine level of 55 µmol/L, discordant with her profound metabolic acidosis. This biochemical dissociation excluded acute kidney injury as the primary etiology, prompting evaluation for alternative causes such as diabetic ketoacidosis or toxic-mediated acidosis. In this context, a plasma ketone measurement was performed, revealing a level greater than 6 mmol/L. This strongly supported a diagnosis of EDKA associated with SGLT2i use.
All oral antidiabetic drugs, including empagliflozin, were discontinued. After achieving hemodynamic stability with aggressive crystalloid fluid resuscitation and correction of hypokalemia, a continuous intravenous insulin infusion was initiated, concurrently with a 10% dextrose infusion to prevent hypoglycemia.
Microbiological analysis confirmed methicillin-susceptible Staphylococcus aureus bacteremia, with positive blood cultures for nearly six days. Based on the antibiogram, antibiotic therapy was adjusted, and cloxacillin was subsequently introduced. A mitral valve endocarditis, characterized by a 12 mm mobile vegetation with renal and splenic emboli, developed as a secondary complication of the bacteremia. The patient was deemed unsuitable for surgical treatment due to her head trauma, which contraindicated extracorporeal circulation.
The shock resolved after 4 days, leading to the discontinuation of norepinephrine. After 5 days of insulin therapy, the patient’s acidosis resolved, and serum ketone bodies were negative. The continuous intravenous insulin infusion was then transitioned to a basal-bolus insulin regimen.
Ultimately, the clinical course of this infectious episode was favorable under well-managed antibiotic therapy for 6 weeks. The patient was transferred to a rehabilitation center after a 62-day ICU stay.
