Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort

Background Obesity has emerged as a significant public health issue globally. In response to the dual health and environmental challenges posed by dietary patterns, the EAT-Lancet Commission recommended a planetary health diet that promotes well-being. The present study aimed to investigate the association of the EAT-Lancet reference diet with body weight changes, incidences of overweight (Body Mass Index (BMI)≥25 kg/m 2 ) and obesity (BMI≥30 kg/m 2 ), in a large French cohort. Methods The study analyzed data from 51,711 adults who participated in the French NutriNet-Santé cohort between 2009 and 2023. Exposure was measured by the level of adherence to the EAT-Lancet reference diet, evaluated through the EAT-Lancet Diet Index (ELD-I), categorized into sex-specific quintiles (Qs) and as a continuous variable. The relationship between ELD-I and changes in body weight (BW) was examined using multivariable linear mixed models. For the incidences of overweight and obesity, multivariable Cox proportional hazards models were employed. Findings During follow-up (median=8·7y), 4,250 and 1,604 persons became overweight and obese, respectively. We observed an inverse association between the level of ELD-I and gain in BW (in kg) (β Q5 ×time=-0.18;95% CI:-0.20, -0.16; p<0·0001). Higher level of ELD-I was associated with lower risks of reaching overweight (HR Q5 compared with Q1 : 0·60; 95% CI:0·54, 0·66; p -trend <0·0001) and obesity status (HR Q5 compared with Q1 :0·54; 95% CI:0·45, 0·63; p -trend <0·0001) during follow-up. Conclusions This comprehensive prospective observational study revealed that a stronger adherence to the EAT-Lancet reference diet is associated with a lower body weight and reduced risks of overweight and obesity. Promoting a sustainable plant-based diet seems to be an effective strategy for addressing the global public health challenge of obesity. Trial registration Https://clinicaltrials.gov/study/NCT03335644