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Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity-promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities. I propose a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. My core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health. I describe the framework rationale and elements and provide research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II.Design Long term follow-up assessed 10-15 years after the original trial.Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone.Participants Adults aged 30-54 years with prehypertension.Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II).Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death).Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34).Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.

Public mobilisation is needed to enact obesity-prevention policies and to mitigate reaction against their implementation. However, approaches in public health focus mainly on dialogue between public health professionals and political leaders. Strategies to increase popular demand for obesity-prevention policies include refinement and streamlining of public information, identification of effective obesity frames for each population, strengthening of media advocacy, building of citizen protest and engagement, and development of a receptive political environment with change agents embedded across organisations and sectors. Long-term support and investment in collaboration between diverse stakeholders to create shared value is also important. Each actor in an expanded coalition for obesity prevention can make specific contributions to engaging, mobilising, and coalescing the public. The shift from a top-down to a combined and integrated bottom-up and top-down approach would need an overhaul of current strategies and reprioritisation of resources.

Background As implementation science evolves, it is essential to expand training capacity to build intellectual capital continually. The demand for training in implementation science far outstrips the current supply. This paper presents the methods and findings from the Institute for Implementation Science Scholars (IS-2) national training program (2020–2024). Methods The IS-2 was a US-based, two-year training program that provided mentored training for early- and mid-career researchers interested in applying implementation science principles to reduce the burden of chronic disease disparities. Scholars attended two annual, 2.5-day intensive training sessions, received ongoing remote and in-person mentoring, and were supported by other activities (e.g., pilot funding, networking events, mock grant reviews). A quasi-experimental (pre/post) design evaluated IS-2 on skill building, mentoring, and networking. We used descriptive and inferential statistics to characterize the sample and analyzed primary outcomes and networks. Results A majority of the 59 scholars were female (86%), white (61%), and assistant professors (61%). Forty-three implementation science competencies were assessed; all skill categories increased from baseline to 10 months and from 10 to 22 months post-enrollment. The relative change was largest for advanced competencies. Scholars rated their assigned mentors as highly competent across all mentoring competencies. A vibrant mentoring network was established, with the highest number of network ties in 2023, facilitating manuscript publication and joint research. Under-represented scholars ( n  = 21) had similar skill gains relative to scholars not-under represented, yet were less likely to hold network ties in 2024. After accounting for other predictors, sharing a mentoring relationship within the previous two years was a strong positive predictor of forming collaboration ties between network members in 2024 (odds ratio = 9.66; 95% confidence interval = 6.34–14.74). IS-2 showed multiple impacts of practice and societal relevance (e.g., improving intervention reach, building cost data in patient decision aids). Conclusions The approaches used in IS-2 effectively helped mentees gain skills in implementation science, experience mentorship for career development, and establish collaborative networks. The results demonstrate how the field can develop and utilize a mentoring program to reach diverse scholars, incorporate equity into curricula, and conduct high-quality mentoring to address critical implementation science topics.

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n = 20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.

Fast-food marketing to children is considered a contributor to childhood obesity. Effects of marketing on parents may also contribute to childhood obesity. The authors explore relevant hypotheses with data from caregivers of 2- to 12-year-old children in medically underserved communities. The results have implications for obesity-related public policies and social marketing strategies.

[...]the Institute of Medicine Committee on Accelerating Progress in Obesity Prevention reviewed >800 reports to identify policy, systems, and environmental change strategies most well supported by evidence.2 There have been some signs of progress among the youngest children.3,4 However, progress is not yet stable or visible in the national trend data, and even where observed in states or localities, progress has not been translated into clearly scalable approaches.5 Moreover, there is well-founded concern about a lack of progress in reducing obesity prevalence in racial/ethnic minority populations and in low-resource settings where disparities vis a vis reference populations are observed.6 Taken together, the lack of evidence of progress overall and especially with respect to health disparities has led to calls for new approaches.1,7–9 The Childhood Obesity Evidence Base (COEB) project, described in this supplement, is a novel approach for deriving new insights from existing evidence. Results for each taxonomic component were tabulated according to frequency of occurrence and associated with one or more levels of intervention according to a socioecological model, that is, individual, interpersonal, organizational, community, and societal level.15 Thus, the project has so far contributed to the evidence base on early childhood obesity prevention interventions in three ways: (1) results of a scoping review of studies conducted with 2- to 5-year-old children during the past 15 years, (2) a database of these studies coded according to an empirically derived classification of key study variables (i.e., not limited to categories based on existing theory), and (3) an example of one way to use the database in meta-analysis. Increased awareness of the need for more deliberate focus on translation and implementation in the obesity prevention field is motivated by an interest in improving intervention outcomes related to prevention of excess weight gain or achieving initial or sustained weight control. Because health disparities and health equity-oriented research emphasize understanding of and adapting to context, implementation research is viewed as especially relevant to such research in both health care delivery and community settings.18,19 The contexts to be addressed through research translation differ from those in controlled research settings.

Heightened obesity risk among food-insecure food pantry clients is a health equity issue because the co-occurrence of obesity and hunger is deeply-rooted in systematic social disadvantage and historical oppression. This qualitative study examined key stakeholders' perspectives of the relationship between the U.S. food banking system and obesity disparities among food insecure clients. We conducted in-depth, semi-structured interviews with 10 key stakeholders (e.g., food bank director, food bank board member, advocate) who are familiar with food bank operations. Data were transcribed verbatim, coded in NVivo [v11], and analyzed using thematic analysis. Multiple themes emerged drawing linkages between structural characteristics of the food banking system and disparities in the dual burden of food insecurity and obesity: [a] access to unhealthy food from donors; [b] federal emergency food policy and programming; [c] state-level emergency food policy and programming; [d] geography-based risk profiles; and [e] inadequate food supply versus client need. Interviewees also identified social challenges between system leaders and clients that maintain disparities in obesity risk among individuals with very low food security including: [a] media representation and stereotypes about food pantry clients; [b] mistrust in communities of color; [c] lack of inclusion/representation among food bank system leaders; and [d] access to information. Future efforts to alleviate obesity inequities among clients chronically burdened by food insecurity, especially among certain subpopulations of clients, should prioritize policy, systems, and environmental strategies to overcome these structural and social challenges within the food banking system.