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There is an increasingly diverse evidence base on promising areas of intervention to improve cardiometabolic outcomes, although in some emerging fields applied research is not yet strong and consistent enough to drive consensus across guidelines. For example, Hedrick and colleagues argue that current evidence is inadequate to inform conclusive guideline recommendations on non-sugar sweeteners, and evidence on long term effects is limited.8 And despite the depth of basic research establishing the effect of microbial metabolites on human health, Valdes and Ghosh highlight that we still have little evidence from clinical trials examining the effect of manipulating the gut microbiome on disease specific outcomes.9 Diet and nutrition related population level interventions have a vital contribution to tackling cardiometabolic disease, but the contentiousness surrounding definitions and categorisation of food groups can impede policy action. Gearhardt and colleagues examine some of the uncertainties around conceptualising certain foods as addictive but maintain that the classification is valid and clinically relevant, noting that it provides an additional avenue for policy intervention to improve health.10 Touvier and colleagues similarly argue that shortcomings in the evidence base around ultra-processed foods can no longer be used to defend inaction.11 Rather, they say, we know enough now to justify a public health response to reduce individuals’ exposure to and consumption of ultra-processed foods.

o improve health.10 Touvier and colleagues similarly argue that shortcomings in the evidence base around ultra-processed foods can no longer be used to defend inaction.11 Rather, they say, we know enough now to justify a public health response to reduce individuals’ exposure to and consumption of ultra-processed foods. Population level drivers, and consequently opportunities for improved nutrition and prevention of disease outcomes, are also discussed by Romero-Gómez and colleagues in the context of non-alcoholic fatty liver disease.12 They evaluate the evidence for the role of diet in the development of the disease and for prevention through promotion of dietary approaches such as the Mediterranean diet. Piernas and Merino also lay out the potential benefits of a healthy diet in lowering covid-19 risk and severity, especially for disadvantaged communities.13 Finally, Maessen and colleagues highlight that early childhood may offer unique opportunities for the prevention of obesity, noting that some countries seem to have been able to reverse trends towards increasing obesity rates in this age group14 but making clear this should be no excuse for complacency on policy action. We must move beyond narrowly conceived frameworks emphasising individual choice and towards action that tackles the population level structural drivers of cardiometabolic disease. The Food for Thought 2023 collection lays out some clear priorities for doing so, but also the critical uncertainties, as well as next steps to tackle the dietary drivers of obesity, diabetes, and other cardiometabolic diseases.