REFERENCES: ROLES FOR DIETITIANS/NUTRITION PROFESSIONALS/HEALTHCARE PROVIDERS FOR IMPLEMENTING SUSTAINABLE DIETS/FOOD SYSTEMS

While these papers specifically address the role of dietitians/health care providers, be sure to take a look at other reference and resource sections which will provide additional/crossover information that health professionals/dietitians can apply to their practice, work setting, communities and educational platforms.  Be sure to look at papers here and in other sections about the dietary guidelines.  The papers with the *** are, in my opinion, extremely helpful and relevant

• Alberdi G, Begiristain-Zubillaga M. The Promotion of Sustainable Diets in the Healthcare System and Implications for Health Professionals: A Scoping Review. Nutrients. 2021 Feb 26;13(3):747. ***.
  • The healthcare system could be a powerful tool to educate patients by guiding their diets towards sustainability. 
  • This review has identified a framework with key areas where processes need to be developed to guarantee sustainable diet promotion in healthcare services.
• Bastian GE, Buro D, Palmer-Keenan DM. Recommendations for Integrating Evidence-Based, Sustainable Diet Information into Nutrition Education. Nutrients. 2021; 13(11):4170. ***
  • The results of a thorough, narrative review of the literature performed in 2021 suggest there are five well-supported recommendations nutrition educators should consider incorporating in their work.
  • They are
    • (1) shift towards a plant-based diet
    • (2) mitigate food waste
    • (3) limit consumption of ultra-processed foods (UPF)
    • (4) engage in local food systems
    • (5) choose sustainable seafood. 
• Burke, J. 2012. Bridging the sustainability gap URL:
• Carlsson, L., Callaghan, E., & Broman, G. (2019). How Can Dietitians Leverage Change for Sustainable Food Systems in Canada? Canadian Journal of Dietetic Practice and Research, 80(4): p. 164-171.
• Craig WJ, Mangels AR, Fresán U, et al. The safe and effective use of plant-based diets with guidelines for health professionals. Nutrients. 2021;13(11):4144.
• Fanzo, J., Bellows, A., Spiker, M., Thorne-Lyman, A., & Bloem, M., 2021. The importance of food systems and the environment for nutrition ***
  • Food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability.
  • In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation
• Garnett, T et al  Dietary Guidelines and Sustainability from FAO: Plates, Pyramids and Planets (read “Executive Summary p. 1-7)  2016 ***
  • One important step that governments can take to signal their commitment to a more sustainable and healthy future, is to develop and disseminate food based dietary guidelines (FBDG) that embed health and sustainability objectives. These can then form the basis of policies seeking to foster such patterns
  • “Recommendations include for example: having a mostly plant-based diet, focus on seasonal and local foods, reduction of food waste, consumption of fish from sustainable stocks only and reduction of red and processed meat, highly-processed foods and sugar-sweetened beverages.”
• Garnett, T et al: Policies and actions to shift eating patterns: What works?. Food Climate Research Network
  Environmental Change Institute & The Oxford Martin Programme on the Future of Food, The University of Oxford 2015 ***
  • There are also striking inequalities in how the economic benefits of food provisioning are distributed: while the top ten food companies collectively generate daily revenues  of more than $1.1bn,3 over a billion people who rely upon agriculture for their livelihoods live below the poverty line of US$1.25 a day 
  • There is also recognition of the need to go beyond a simple emphasis on producing more food to take into
    account factors such as the nutritional quality and diversity of foods produced as well as non-food environmental and social goods and services that contribute to the livelihoods of producers and local consumers.
  • We need to address systemic inequities that are important determinants of food security -increases in supply do not automatically lead to increases in access nor to improvements in food quality – and to tackle the growth in obesity and diet-related non communicable diseases while continuing to reduce hunger and malnutrition.
  • The lower the meat, fish and dairy content, the lower the environmental impact – and the more important it is that reduced meat intakes are compensated for, nutritionally speaking, with increases in the quantity and diversity of whole grains, fruits and vegetables, and legumes
• Geagan, K.  Navigating Sustainability With Confidence. Today’s Dietitian Magazine.  Vol. 25 No. 1 P. 22 Published January 2022.  Accessed January 2022. ***
• Gibbs J, Cappuccio FP. Plant-Based Dietary Patterns for Human and Planetary Health. Nutrients. 2022; 14(8):1614.
• Hawkins IW, Mangels AR. Resources used and innovations in teaching vegetarian and vegan nutrition in accredited dietetics programs in the United States. International Journal of Disease Reversal and Prevention 2021;3(2): d
  Jones, R., Vogliano, C., & Burlingame, B. (2018) Sustainable Diets: Linking Nutrition and Food Systems. Sustainable Diets and Food-based Dietary Guidelines, p 158
• Kowalsky TO, Morilla Romero de la Osa R, Cerrillo I. Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review. Nutrients. 2022; 14(5):928. ***
  • Healthcare workers, as nutrition counselors, have an essential role in the nutritional education of patients (therapeutic objectives) and communities (preventive objectives), which positions them as a social speaker for the promotion of a healthy and sustainable diet. However, the way of eating not only has an impact on population health but also has an important environmental impact.
  • A calorie-balanced diet mainly based on food of plant origin that would allow the attainment of 60% of daily caloric requirements and a low protein intake from animal foods (focusing in fish and poultry) could significantly reduce global morbi-mortality and the dietary environmental impact maintaining a framework of sustainability conditioned by the consumption of fresh, seasonal, locally produced and minimally packaged products.
  • It is essential to be clear on the environmental impact of foods or diets when establishing consumption recommendations. Different environmental-impact indicators have been used that determine in what sense land, water or the atmosphere are affected. Among them, greenhouse gas emissions (GHGe) have been considered a good proxy for this total environmental load, but this is not the only parameter to have in account.
  • Incorporating the dimension of sustainability is essential in nutritional counseling; however, a successful educational intervention requires prior training and conceptual mastery of the subject.
  • There is increasing evidence of the high exposure to environmental contaminants to which we are exposed from birth, since many of them accumulate in breast milk 33]. In addition, environmental pollution is related to the emerging appearance of different types of diseases such as those that have an autoimmune basis
• Plotnikoff  et al. Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions. Nutrients 2023, 15(6), 1387; 
  • For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets.
  • This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions.
• Rifkin ME. Nutrition policy critical to optimize response to climate, public health crises. Front Nutr. 2023;10:1118753. Published 2023 Aug 16. doi:10.3389/fnut.2023.1118753
  • Accordingly, this article proposes four criteria for nutrition policy in the Anthropocene: objective government nutrition recommendations, healthy dietary patterns, adequate nutrition security, and effective nutrition education.
  • Application of such criteria shows strong potential to improve our resiliency despite the climate and public health crises.
• Spiker ML, Knoblock-Hahn A, Brown K, Giddens J, Hege AS, Sauer K, Enos DM, Steiber A. Cultivating Sustainable, Resilient, and Healthy Food and Water Systems: A Nutrition-Focused Framework for Action. J Acad Nutr Diet. 2020 Jun;120(6):1057-1067. ***
• Spiker et al. Revised 2020 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sustainable, Resilient, and Healthy Food and Water Systems, JAND. VOLUME 120, ISSUE 9, P1568-1585.E28, SEPTEMBER 01, 2020
• Stiles G, Collins J, Beck KL. Effectiveness of Strategies to Decrease Animal-Sourced Protein and/or Increase Plant-Sourced Protein in Foodservice Settings: A Systematic Literature Review. J Acad Nutr Diet. 2022 May;122(5):1013-1048.
  • Effective population-based strategies are required to move toward healthy sustainable diets that replace a proportion of animal- with plant-based protein. Food service can support this using a variety of strategies across the food supply chain.
• Stubbendorff A, Sonestedt E, Ramne S, Drake I, Hallström E, Ericson U. Development of an EAT-Lancet index and its relation to mortality in a Swedish population, The American Journal of Clinical Nutrition, 2022;115(3):705–716
  • In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both human health and environmental sustainability.
  • Divided into 5 adherence groups, the highest adherence to the EAT-Lancet diet was associated with lower all-cause mortality cancer mortality  and cardiovascular mortality 
• Tagtow, A.: Next-Generation Solutions to Address Adaptive Challenges in Dietetics Practice: The I+PSE Conceptual Framework for Action, Journal of the Academy of Nutrition and Dietetics, 2021
• Taylor, I., Bull, J.W., Ashton, B. et al. Nature-positive goals for an organization’s food consumption. Nat Food 4, 96–108 (2023). https://doi.org/10.1038/s43016-022-00660-2
  • Here we propose an approach to achieve nature-positive targets with respect to the embodied biodiversity impacts of an organization’s food consumption.
  • Organizations are committing to strategic biodiversity targets aimed at mitigating negative biodiversity impacts, and increasingly to nature-positive outcomes in line with global policy directions
• Thiry, M. 2022. Intersection of human and planet health  Food and Nutrition Magazine. 2022 URL: https://foodandnutrition.org/from-the-magazine/intersection-of-human-and-planet-health/ 
• Vogliano, C., Steiber, A., & Brown, K. (2015). Linking agriculture, nutrition, and health: The role of the registered dietitian nutritionist. Journal of the Academy of Nutrition and Dietetics, 115(10): p. 1710-1714.