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

🍎 Papers highlighting the role of Dietitians/Nutrition Professionals/Healthcare Providers in food system transformation

 

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.  There are also papers below regarding consumer behavior and ways to better market and implement sustainable diets with patient population and brands. The papers with the *** are, in my opinion, extremely helpful and relevant.

Please note: These articles have been update through January, 2024

  • 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. 
    • There have been calls to promote SD to consumers  in part through nutrition education. Nutrition education has been defined as “any combination of educational strategies, accompanied by environmental supports, designed to facilitate voluntary adoption of food choices and other food- and nutrition-related behaviors conducive to health and well-being”, and has been conducted in a broad array of settings, including schools, colleges and universities, community sites, and clinical sites, to both youth and adults . Of note, the counseling done by dietitians with their patients (typically at clinical sites) should also be considered as “nutrition education” for the purposes of this paper, as this work presents an equally viable opportunity for the incorporation of SD messages in such a setting. 

  • 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.
  • Cole A, Pethan J, Evans J. The Role of Agricultural Systems in Teaching Kitchens: An Integrative Review and Thoughts for the Future. Nutrients. 2023; 15(18):4045.
    • Operating teaching kitchens in collaboration with local agriculture, including farms, community gardens, vertical farms, and urban agriculture, has the potential to catalyze a movement that emphasizes the role of the food system in promoting human and planetary health, building resilient communities, and encouraging cross-disciplinary collaboration.
  • Eisenberg DM, Pacheco LS, McClure AC, McWhorter JW, Janisch K, Massa J. Perspective: Teaching Kitchens: Conceptual Origins, Applications and Potential for Impact within Food Is Medicine Research. Nutrients. 2023; 15(13):2859. https://doi.org/10.3390/nu15132859
    • There is a need to identify innovative strategies whereby individuals, families, and communities can learn to access and prepare affordable and nutritious foods, in combination with evidence-based guidance about diet and lifestyle. These approaches also need to address issues of equity and sustainability.
    • Teaching Kitchens (TKs) are being created as educational classrooms and translational research laboratories to advance such strategies. Moreover, TKs can be used as revenue-generating research sites in universities and hospitals performing sponsored research, and, potentially, as instruments of cost containment when placed in accountable care settings and self-insured companies.
  • 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.
  • Global Alliance for the Future of Food.Creating Better Health for People, Animals, & the Planet: Food Systems Insights for Health Professionals. n.p.: Global Alliance for the Future of Food, 2022.
    • The report showcases 10 food-focused initiatives that have taken action to promote human, ecological, and animal health and well-being.
    • Food is at the heart of human, animal, and ecological health and well-being; however, our present-day food systems put all three at  risk. Industrialized food systems and unhealthy diets significantly  contribute to climate change, undermine the integrity of ecosystems, and are responsible for the escalating rates of disease.  
    • THE IMPACT OF FOOD SYSTEMS ON HUMAN HEALTH Food systems impact our health in a multitude of ways. The World Health Organization estimates that non-communicable diseases (NCDs) such as diabetes, heart attack, stroke, chronic respiratory disease, and cancer are responsible for 41 million deaths each year —  71% of all mortality globally. Diet is a leading risk factor for NCDs. Other hazards associated with our food systems include food-borne disease and exposure to pesticides and toxins among farm workers and eaters alike. The resistance of people and livestock to antibiotics and other antimicrobials is creating an emerging public health crisis. And then there’s zoonoses — pathogens that cross from animals to humans, most recently illustrated by the novel coronavirus, or COVID-19, pandemic. The primary pathways through which food systems impact health were identified in a 2021 WHO report, Food Systems Delivering Better Health.
  • Gonzalez Fischer C, Garnett T. Plates, Pyramids, Planet: Developments in National Healthy and Sustainable Dietary Guidelines: A State of Play Assessment. FAO; 2016. https://www.fao.org/documents/card/en?details=d8dfeaf1-f859-4191-954f-e8e1388cd0b7
    • RE: Dietary Guidelines Adopting food-based dietary guidelines that include sustainability criteria is crucial. Food based dietary guidelines that include sustainability criteria are key to changing dietary patterns towards more sustainable, healthier diets.
  • 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
  • Kenny,  T, et al. Consumer attitudes and behaviors toward more sustainable diets: a scoping review, Nutrition Reviews, Volume 81, Issue 12, December 2023, Pages 1665–1679, ***
    •  The findings suggest that consumers, insofar as they are interested in sustainability and have the capacity to engage with the concept, primarily approach the concept of sustainable diet from a human health perspective.
    •  This highlights the need for (1) sustained efforts from public health professionals to encourage a realignment of the term sustainable diet…by championing an ecological public health approach in all efforts aimed at promoting more sustainable consumption, from awareness raising to policy development;… (3) the development of multidisciplinary, clear, and evidence-based sustainable-eating messages, including holistic sustainable dietary guidance, to address knowledge gaps, minimize conflicting narratives, and build consumer agency. 
  • 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
  • Pastorino, Silvia; Springmann, Marco; Backlund, Ulrika; Kaljonen, Minna; Singh, Samrat; Hunter, Danny; Vargas, Melissa; Milani, Peiman; Bellanca, Raffaella; Eustachio Colombo, Patricia, et al. (2023) School meals and food systems: Rethinking the consequences for climate, environment, biodiversity, and food sovereignty. Discussion Paper. London School of Hygiene & Tropical Medicine, London.
  • 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.
  • Rossi L, Ferrari M, Ghiselli A. The Alignment of Recommendations of Dietary Guidelines with Sustainability Aspects: Lessons Learned from Italy’s Example and Proposals for Future Development. Nutrients. 2023 Jan 20;15(3):542. doi: 10.3390/nu15030542.
    • The IDGs sustainability recommendations were related to the 16 guiding principles of a sustainable healthy diet and their contribution to the achievement of the Sustainable Developing Goals was provided. The inclusion of sustainability in dietary guidelines requires a multidisciplinary approach to cover the wide range of aspects of a sustainable diet.
    •  The main recommendation of the IDGs’ sustainability chapter was the reduction of consumption of red and processed meat, maximizing the quota of plant foods, and the intake of proteins from vegetable sources (e.g., legumes). This recommendation combines human health promotion and environmental protection.
  • Sanjeevi, N; Monsivais, P. . Consumption Trends and Eating Context of Lentils and Dried Peas in the United States: A Nationally Representative Study. Nutrients 2024, 16(2), 277;
    • Shifting to more plant-focused diets could improve nutrition and also reduce the environmental impact of diets [2], yet such healthy diets are often more costly to consumers [3]. The 2020–2025 Dietary Guidelines for Americans (DGAs) emphasizes plant-based and minimally-processed dietary patterns
    • Legumes have been shown to provide the highest nutritional value per penny compared to other vegetables [9]. Legumes, including lentils and dried peas [10] are an excellent source of folate [11,12,13] and soluble fiber, especially resistant starch, which have important prebiotic functions [14,15]. Although lentils and dried peas are an abundant source of dietary protein and fiber [16], they are not consumed in adequate quantities for health [17] and are among the least-consumed legumes in the United States
  • 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
  • Springmann M, Godfray HCJ, Rayner M, Scarborough P. Analysis and valuation of the health and climate change cobenefits of dietary change. Proceedings of the National Academy of Sciences of the United States of America. 2016;113(15):4146-4151. doi:10.1073/pnas.1523119113
    • The food system is responsible for more than a quarter of all greenhouse gas (GHG) emissions (1), of which up to 80% are associated with livestock production (2, 3). The aggregate dietary decisions we make thus have a large influence on climate change. High consumption of red and processed meat and low consumption of fruits and vegetables are important diet-related risk factors contributing to substantial early mortality in most regions while over a billion people are overweight or obese (4). Without targeted dietary changes, the situation is expected to worsen as a growing and more wealthy global population adopts diets resulting in more GHG emissions (5) and that increase the health burden from chronic, noncommunicable diseases (NCDs) associated with high body weight and unhealthy diets (6).
    • Transitioning towards more plant-based diets in line with WHO and other international dietary guidelines could decrease global mortality, shrink the global food gap and substantially reduce diet-related GHG emissions.
  • 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.
  • Wise J, Vennard D. It’s All in a Name: How to Boost the Sales of Plant-Based Menu Items. World Resources Institute. Published February 5, 2019. Accessed Dec 2023 https://www.wri.org/insights/its-all-name-how-boost-sales-plant-based-menu-items
    • . If global consumers shifted 30 percent of their expected consumption of ruminant meat in 2050 to plant-based proteins, the change in diets would close half of agriculture’s GHG mitigation gap to hold global warming well below 2 degrees Celsius – even as the population climbs toward 10 billion by mid-century.
    • 1. DON’T USE “MEAT-FREE” “Meat-free” means less of what meat eaters like
    • 2. DON’T USE “VEGAN” – “Vegan” means “different from me”
    • 3. DON’T USE “VEGETARIAN” – “Vegetarian” means “healthy – but unsatisfying – food”
    • 4. DON’T USE “HEALTHY RESTRICTIVE” LANGUAGE – “Healthy restrictive” language like “low fat” has low appeal
  • World Health Organization: WHO. Healthier diets for our planet: new WHO/Europe data tool to drive innovative country policies. World Health Organzation. Published November 6, 2023.
    • The way we produce and consume food – through our food systems – is tightly interconnected with environment and health. Foods high in salt, added sugars and trans fats can harm our health and lead to early death. At the same time, the production of food products may contribute to soil pollution, greenhouse gas emissions and packaging waste. But there is a way to help understand the impact of food systems on the environment and health: WHO/Europe’s new tool for diet impact assessment (DIA) can help.
    •  The way we produce and consume food worldwide has led us to go beyond what is thought to be a safe limit for Earth’s stability,” 
    • Agriculture is responsible for about a quarter of all greenhouse gas emissions and uses 70% of all freshwater resources. Over-application of fertilizers in some regions has led to the pollution of surface and groundwater, and to dead zones in oceans.
    • If we don’t make changes to how we produce and eat food, like transitioning to healthier and more plant-based diets, we might jeopardize the well-being of our planet and risk not being able to avoid dangerous levels of climate change
    • For each diet scenario, the DIA simultaneously looks at health indicators – such as premature deaths that could be avoided by improving diets; risk factors for cancer, heart disease and diabetes; and bodyweight-related risks – and environmental analyses, such as for greenhouse gas emissions, cropland and freshwater.

Additional Resources to Explore

Saving the Planet with your Fork

Saving the Planet with your Fork

While not everyone always has a choice in what they eat and buy, for those who do, what goes on the menu, plate or shopping cart can make a difference for our environment.   This doesn’t require perfection or a complete 180 in dietary habits.  But since our...

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