Equipping nutrition graduates for the complex realities of practice: Using practitioner perspectives and experiences to inform authentic sustainability curriculum (2023)

Maher, J, Ashford, T, Verdonck, M, English, E, Burkhart, S. Equipping nutrition graduates for the complex realities of practice: Using practitioner perspectives and experiences to inform authentic sustainability curriculum. J Hum Nutr Diet. 2023; 1– 11. https://doi.org/10.1111/jhn.13159

Open access link to article:

https://onlinelibrary.wiley.com/doi/10.1111/jhn.13159

Relevant to:

Dietitians, Practitioners, Nutrition students, Nutrition graduates

Questions the research focuses on:

How do a cohort of Australian N&D professionals perceive opportunities for integrating sustainability into practice? What are the challenges or barriers to realizing these?

Bottom line for nutrition practice:

We recognize practitioners as a source of experience, anticipating where sustainability discourse and nutrition practice intersect.

Abstract:

Background: Nutrition professionals’ function at the nexus of food, nutrition status and the myriad of determinants influencing these. However, defining our role in food system transformation requires a multifaceted and deep understanding of sustainability in the context of nutrition and dietetics (N&D). Practitioner perspectives and experiences provide a rich source of practice wisdom that can inform authentic curriculum to equip students for the complex realities of practice; however, there is limited understanding of these in the Australian higher education setting.

Methods: Qualitative methodology using semi structured interviews with 10 Australian N&D professionals. Thematic analysis was used to understand how they perceive opportunities and barriers for integrating sustainability into practice.

Results: Practitioners’ experience in sustainability practice varied. Themes were identified in two categories: opportunities and barriers. Themes that reflected future practice opportunities included “Preparing the workforce” (for academics and practitioners interfacing with students), “Practical individual level work” and “System level and policy interests”. Themes that were considered barriers to integrating sustainability in practice included “lack of contextual evidence” and “complexity and competing priorities”.

Conclusions: Our findings make a novel contribution to the current literature as we recognise practitioners as a source of experience anticipating where sustainability and nutrition practice intersect. Our work provides practice-informed content and context that may assist educators to create authentic sustainability-focused curriculum and assessment to replicate the complexity of practice.

Details of results:

  • Practitioners found it difficult to name specific examples of sustainability in practice, possibly because of the current landscape where there is a lack of consensus on what sustainability in nutrition and dietetic practice is.
  • Integrating sustainability into nutrition practice was associated with two themes categorized as barriers. These were: a lack of contextual evidence, complexity and competing priorities.
  • Integrating sustainability into nutrition practice was also associated with three themes for opportunities: learning and teaching practice to prepare the workforce; individual-level practice and application; and broader system/policy-level practice.
  • The results show that opportunities and barriers are interconnected, and it is likely that the perceived opportunities can be realized if sectorial, institutional, and government policies change and the profession advances and adapts.
  • Preparing students for practicing with a sustainability lens requires integration of sustainability in its various forms into N&D curriculum and equipping them with the skills and capabilities to contribute meaningfully to N&D practice from an individual to food system level.
  • Knowledge alone may not equip graduates to effectively practice for human and planetary health. Moving forward, practice insights provide a productive platform for curriculum development, both situating practice within the current complex contexts or “realities” at the same time as also considering a future that integrates sustainability and nutrition more closely.
  • There is a predominant environmental focus that may limit the effectiveness of student training, particularly in addressing more challenging and complex situations or settings where environmental concerns must also be balanced with social and economic realities.
  • If governments or institutions have not yet included sustainability within their policies, curriculum developers can. This will then shift the expectation of N&D graduates who may be able to advocate for change from inside government and institutions.

Of additional interest:

ICDA Learning Modules – These three learning modules are structured to support your knowledge in:

  1. understanding foundational concepts of sustainability and food systems,
  2. understanding the relevance of SFS to nutrition and dietetic practice, and
  3. being able to apply SFS concepts in your practice.

NDA SFS Position Papers – Several nutrition and dietetics associations are officially recognising the relevance of Sustainable Food Systems (SFS) and/or sustainable diets to nutrition and dietetics practice.

SFS Education in Nutrition & Dietetics degrees: Global Case Studies – International Dietetic educators integrating sustainability into their curricula. The is an online platform for sharing examples serves as a series of mini case studies

Teaching Food Systems and Sustainability in Nutrition Education and Dietetic Training: Lessons for Educators (2013) – This is a PDF compilation of research and experiential lesson plans from food, nutrition and dietetic educators in the US and Canada.

The Food Sustainability Index (FSI) as an Educational Tool (2016) – The FSI has an intended audience of university students and graduate students, by can be used for anyone who interested in learning more about the connection of food and nutrition to sustainable food systems and the Sustainable Development Goals.

Sustainability: nutrition and dietetic students’ perceptions (2020) – This Australian study explored nutrition and dietetic undergraduate students’ self-reported views and actions related to sustainability, with a view to building a holistic curriculum that includes content and competencies required to address UN Sustainable Development Goals.

Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education (2021) – A multidisciplinary group of educators, learners, and food systems experts representing eight different institutions across the US worked together over one year to develop, pilot test, and evaluate two interactive webinar series. The series was provided for dietetics interns and graduate students at four university sites in the United States between March and May 2019.

Summary: How do dietetics students learn about sustainability? A scoping review (2023) – Despite increasing discussion about the role of dietitians in supporting sustainable food systems, effective integration into dietetics curricula is understudied. Some evidence points to the importance of experiential learning, and scaffolded learning about SFS through integration into a number of different courses.

Conflict of interest/funding:

The authors declare that there are no conflicts of interest.

Corresponding author:

Judith Maher, Doctor of Philosophy (Nutrition and Dietetics), jmaher@usc.edu.au

Food and food-related waste management strategies in hospital food services: A systematic review (2022)

Cook N, Goodwin D, Porter J, Collins J. Food and food-related waste management strategies in hospital food services: A systematic review. Nutrition & Dietetics. 2022;1‐27. doi:10.1111/1747-0080.12768COOKET AL.27

Open access link to article: 

https://onlinelibrary.wiley.com/doi/full/10.1111/1747-0080.12768

Relevant to: 

Foodservice dietitians, sustainability dietitians, foodservice manager and workers

Question: 

  • What are hospital foodservices around the world currently doing to manage their food waste more sustainably?
  • What are the financial, environmental and staffing outcomes associated with these activities?
  • And what were the barriers and enablers to implementing these strategies?

Bottom line for nutrition practice: 

  • Divert surplus edible food and inedible food waste from landfill by using the most appropriate management strategy available.

Abstract: 

  • Aim – This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings; their financial, environmental and staffing outcomes; and the barriers and enablers associated with their implementation.
  • Methods – Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively.
  • Results – Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes.
  • Conclusion – This review summarises the waste management strategies used by hospitals worldwide that divert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.

Details of results: 

  • 85 examples of hospital foodservices were found to be diverting their food waste from landfill more sustainably.
  • When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17).
  • The location of these strategies diverting waste were in hospital foodservices (n = 41), cafeteria (n = 7), CPK (n = 2), catering unit (n = 1) or combination of these settings (n = 18).
  • Financial savings ranged from AUD $400-50,000 from waste disposal, equipment changes and labour use whereas costs ranged from AUD $1200-260,500 from food waste collection and installing procured equipment.
  • Landfill savings occurred in every case but notably the highest examples were annually: 18,1444 kgs being donated, 200 tons composted and 360 digested.
  • Other environmental outcomes included reduced carbon emissions, water savings, energy creation and less transport.
  • Staffing outcomes were less waste handling and less time cleaning, however also involved giving staff more responsibility to separate, transport waste and operate equipment.
  • The major reported barriers were contamination, times demands, equipment problems, stakeholder coordination and staff resistance, whereas enablers were leadership, no increase in time, easy equipment use, data and a return on investments.

Of additional interest: 

Collection of research on food waste measurement by this group on Google Scholar

Conflict of interest/ Funding:  

Prof. Judi Porter is Editor-in-Chief of Nutrition & Dietetics. She was excluded from the peer-review process and all decision making regarding this article. This manuscript has been managed throughout the review process by the Journal’s Editor. The Journal operates a blinded peer review process and the peer reviewers for this manuscript were unaware of the authors of the manuscript. This process prevents authors who also hold an editorial role to influence the editorial decisions made. All authors are in agreement with the manuscript and declare that the content has not been published elsewhere. Other authors declare no conflicts of interest. NC received a departmental scholarship for his Ph.D. from Monash University’s Department of Nutrition, Dietetics and Food, and a King and Amy O’Malley Trust Scholarship during this study.

External relevant links:  

USA EPA Food recovery hierarchy.

Corresponding author: 

Mr. Nathan Cook, Nathan.cook@monash.edu

Factors influencing implementation of food and food-related waste audits in hospital foodservices (2022)

Cook N, Collins J, Goodwin D and Porter J (2022) Factors influencing implementation of food and food-related waste audits in hospital foodservices. Front. Nutr. 9:1062619. doi: 10.3389/fnut.2022.1062619

Open access link to article: 

https://www.frontiersin.org/articles/10.3389/fnut.2022.1062619/full

Relevant to: 

  • Foodservice dietitians, sustainability dietitians, foodservice manager and workers

Bottom line for nutrition practice: 

  • What are the perspectives of individuals working close or within hospital foodservices on a previous developed food waste audit tool and what do they perceive to be the major factors supporting and or blocking the completion of a food waste audit?
  • Consider the barriers and enablers to the completion of a food waste audit in your facility before pursuing one including the design, completion and analysis of an audit.

Abstract: 

  • Background: Designing a food waste audit tool for novel hospital foodservice practice does not guarantee uptake. Intended users must be consulted to understand the tool’s feasibility and face validity. This study aimed to identify the perspectives of staff involved in the operation of hospital foodservices on (1) how an evidenced based consensus pathway food waste audit tool is perceived to translate into practice, and (2) to determine the factors that influence the completion of food and food-related waste audits within this setting.
  • Materials and methods: Purposeful sampling was used to recruit staff with knowledge on the operation/governance of foodservices within hospitals in Victoria, Australia. Semi-structured interviews (n = 20) were conducted via Zoom to explore barriers and enablers to completing food and food-related waste audits and a previously published food waste audit tool. NVivo was used for inductive thematic analysis.
  • Results: Three factors determined the completion of food and food-related waste audits in hospital foodservices, and each factor could be a barrier or an enabler; (1) capacity: the availability of time, labour and materials to complete an audit (2) change: staff resistance to audit procedures and how to gain their buy-in (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present. The consensus tool appeared to have face validity. Planning audit operations, conducting stakeholder meetings, providing education/training to foodservice team members, and facilitating communication between managers and staff were described to support consensus tool use and audit completion.
  • Conclusion: The consensus tool can be used to support hospital foodservices to complete food and food-related waste audits, although it may need to be customised to be fit for purpose. Optimising the capacity, change management and processes, governance and leadership of the foodservice department may improve the experience and success of a food and food-related waste audit.

Details of results: 

  • The two major perspectives participants shared for a food waste audit to come to fruition were appropriate preparation and implementation. Other recommendations included adequate support, having a clear goal in mind, planning, organising logistics and having clear communication between all levels of staff delivered through meetings and education sessions.
  • Most of participants believed the tool was: detailed, supportive to their practice, helpful for decision making and ready to use. However others viewed it as busy, confusing and that it requires extra knowledge to understand and use. Future iterations of the tool were suggested to be customisable to participants facilities, demonstrate solutions to reduce food waste and have separate sections compared to the one page only.
  • The three factors relating to food waste audit completion were –
    • (1) capacity: the availability of time, labour and materials to complete an audit.
    • (2) change: staff resistance to audit procedures and how to gain their buy-in.
    • (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present.
  • A key finding related to the factors which may support or hinder a food waste audits completion were that the enablers suggested would solve the barriers discussed. This demonstrates individuals who work close or within hospital foodservices already know what to do for a food waste audit if this task was asked of them to complete.

Of additional interest: 

Collection of research on food waste measurement by this group on Google Scholar.

Conflict of interest/ Funding:  

No conflict of interest. NC received a departmental scholarship for his Ph.D. from Monash University’s Department of Nutrition, Dietetics and Food, and a King and Amy O’Malley Trust Scholarship during this study

External relevant links:  

Corresponding author: 

Mr. Nathan Cook Nathan.cook@monash.edu

‘It’s a constant changing environment, and we’re just playing catch up’: Hospital food services, food waste, and COVID-19 (2022 Jun)

(available for download at the bottom)

Cook N, Goodwin D,Collins J, Porter J.‘It’s a constant changingenvironment, and we’re just playing catch up’:Hospital food services, food waste, and COVID-19.Nutrition & Dietetics. 2022;1‐10. doi:10.1111/1747-0080.12762

Open access link to article: 

https://onlinelibrary.wiley.com/doi/epdf/10.1111/1747-0080.12762

Relevant to: 

Foodservice dietitians

Question: 

The research wanted to understand the impacts of COVID-19 on hospital foodservice practices. Specifically, how COVID-19 impacted the completion of food waste audits and the generation of food waste in hospital foodservice.

Bottom line for nutrition practice: 

  • Foodservice staff are a resilient workforce group
  • Forced changes in resource allocation and usage allowed foodservices to adapt and learn to work with COVID-19 restrictions, potentially beginning the path to post-pandemic services.
  • This stage of the ‘green recovery’ can be led by dietitians and may incorporate food waste audits as a higher priority.
  • The success of electronic menu management tools during this period to combat contact restrictions may see them remain as ‘standard procedure’ for food waste data collection and be selected for uptake in additional hospitals who do not have this technology currently.

Abstract: 

  • Aims: Hospital food service operations have been affected by the COVID-19pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID-19 pandemic on hospital food ser-vices, particularly on food waste and the completion of food waste audits.
  • Methods: A qualitative interview research design was used. Semi-structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty-one participants were interviewed from 12 hospitals. No questions were related o the COVID-19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis.
  • Results: Five themes were generated from the interviews related to COVID-19and hospital food services; impacts on practice, labour, change, technology and post-pandemic expectations. Participants reported COVID-19 negatively affected food service operations. Changes included increased food waste, con-tact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID-19 restrictions.
  • Conclusions: Despite the impact COVID-19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post-pandemic, and may be facilitated through the operational changes forced by COVID-19.

Details of results: 

Five themes were generated from the data after inductive coding was completed: these are below in dot point format with some of the dominant responses presented.

  1. Impacts on practice
    • Infection prevention led to increased pre-packaged single serve food, utensils, crockery and their waste
    • The re-use, storage, or donation of used items was prohibited
    • Waste disposed of in patient rooms
    • Forecasting was impacted by COVID peaks
  2. Change
    • Some changes occurred immediately, others took time
    • Reduction in hospital catering services
    • COVID-19 as an excuse to trialing new practice
    • Ingredients inaccessible and out of stock
  3. Technology
    • Room service was recommended to forecast meal numbers and support food service delivery
    • Electronic menu management systems with waste measurement capabilities were supportive in plate waste data collection but not available at all sites due to cost, equipment, and manual data collection still being part of standard practice
  4. Labour
    • Higher than usual sick leave
    • Failure to hire new staff (>300 interviews completed at one site)
    • Individuals forced to step in to new and unfamiliar roles (e.g. manager to chef)
    • Cumulative pressure on staff throughout COVID including vaccine mandate in Victoria which resulted in loss of staff
    • Nutrition students unavailable to hospitals for placement
  5. Post Pandemic expectations
    • Hope for practice to return to normal as soon as possible or when the pandemic is ‘over’
    • Planning for future emergencies already to counteract drastic changes in service and practice

Of additional interest: 

Editor’s comment:  

@nathan_cook includes the audit tool with descriptions for you available at this link in the side bar.

Conflict of interest/ Funding:  

One author of the research is an editor at the journal, however the journal undergoes a blinded peer review process. Funding was received by Nathan Cook in the form of a scholarship from the King and Amy O’Malley Trust Scholarship and the Department of Nutrition, Dietetics and Food at Monash University as part of his PhD.

External relevant links:  

A blog describing the research article – http://monashnutrition.blogspot.com/2022/09/hospitals-covid-food-waste-dilemma.html

Corresponding author: 

Nathan Cook, @nathan_cook, PhD candidate, nathan.cook@monash.edu

Exploring young Australians’ understanding of sustainable and healthy diets: A qualitative study (2022 Jul)

Ronto, R., Saberi, G., Carins, J., Papier, K., & Fox, E. (2022). Exploring young Australians’ understanding of sustainable and healthy diets: A qualitative study. Public Health Nutrition, 1-13. doi:10.1017/S1368980022001513

Open access link to article: 

https://www.cambridge.org/core/journals/public-health-nutrition/article/exploring-young-australians-understanding-of-sustainable-and-healthy-diets-a-qualitative-study/4B88F9E0ED4A61EFF37E10CE6AACA0FE

Relevant to: 

Public health nutrition, sustainability

Question: 

Understanding of and motivators of achieving sustainable and healthy diets among young adults

Bottom line for nutrition practice: 

There is a need for the development and evaluation of individual and micro-environmental-based interventions promote sustainable and healthy diets more comprehensively.

Abstract: 

  • Objective: This qualitative study aimed to explore young Australians’ perspectives, motivators and current practices in achieving a sustainable and healthy diet.
  • Design: Semi-structured online interviews were conducted with young Australians. Interviews were audio-recorded using the online Zoom platform, transcribed and analysed using a deductive analysis method by applying the Theoretical Domains Framework and inductive thematic data analysis.
  • Setting: Young Australians recruited via social media platforms, noticeboard announcements and flyers.
  • Subjects: Twenty-two Australians aged 18 to 25 years.
  • Results: The majority of participants were aware of some aspects of a sustainable and healthy diet and indicated the need to reduce meat intake, increase intake of plant-based foods, reduce food wastage and packaging and reduce food miles. Young adults were motivated to adopt more sustainable dietary practices but reported that individual and environmental factors such as low food literacy, limited food preparation and cooking skills, lack of availability and accessibility of environmentally friendly food options and costs associated with sustainable and healthy diets hindered their ability to do so.
  • Conclusions: Given the barriers faced by many of our participants, there is a need for interventions aimed at improving food literacy and food preparation and cooking skills as well as those that create food environments that make it easy to select sustainable and healthy diets. Future research is needed for longitudinal larger scale quantitative studies to confirm our qualitative findings. In addition, the development and evaluation of individual and micro-environmental-based interventions promote sustainable and healthy diets more comprehensively.

Details of results: 

  • Table 2. Themes, subthemes and illustrative quotes fills two and a half pages of the report with useful insights into the population studied.

Of additional interest: 

n/a

Editor’s comment:  

This is not an audience that has a lot of space within this SFS Toolkit. I hope we can change this and get a lot more adolescent and young adult resources.

Conflict of interest/ Funding:  

Macquarie University New Staff Grant (Grant reference number: PURE 109740183) and the Wellcome Trust, Our Planet Our Health (Livestock, Environment and People – LEAP) (Grant number: 205212/Z/16/Z]

External relevant links:  

n/a

Corresponding author: 

Dr Rimante Ronto
Department of Health Sciences, Macquarie University, Australia
Rimante.ronto@mq.edu.au

Climate and Health Alliance (website) 

The Climate and Health Alliance (CAHA) is an Australian coalition of health care stakeholders who work together to see the threat to human health from climate change and ecological degradation addressed. Together they are driving the sector-wide “Our Climate Our Health” campaign, including spearheading a national consultation to develop the world-leading “Framework for a National Strategy on Climate, Health and Well-being”, endorsed by over 50 health, social welfare and conservation groups. They have established a pacific network of “Global Green and Healthy Hospitals”, supporting members representing more than 1,700 hospitals and healthcare providers across Australia & NZ to reduce emissions and environmental footprint. 

Environmentally sustainable hospital foodservices: Drawing on staff perspectives to guide change (2021 January)

Citation: Carino S, Collins J, Malekpour S, Porter J. Environmentally sustainable hospital foodservices: Drawing on staff perspectives to guide change. Sustainable Production and Consumption. 2021/01/01/;25:152-61. https://doi.org/10.1016/j.spc.2020.08.003 (note: there is a paywall to access the full study)

Relevant to: 

Dietitians-Nutritionists working in hospitals or in food services.

Question: 

Forty-six stakeholders working across the hospital supply chain in three Australian hospitals were interviewed regarding their perspectives on: (1) sustainable and unsustainable practices in hospital food provision; (2) barriers and enablers of sustainable practices; and (3) future recommendations for implementing sustainable foodservice practices.

Bottom line for nutrition practice: 

This paper identifies specific sustainable and unsustainable practices across the hospital food chain under the following categories:

  • procurement;
  • food processing (central production kitchen);
  • food service model/ menu design;
  • meal ordering and selection;
  • food preparation;
  • patient consumption;
  • food waste;
  • waste management.

The abstract below summarizes current sustainable and unsustainable practices as well as barriers and enablers to improving sustainability. Future recommendations were generated under 3 themes:

  • (1) practice recommendations;
  • (2) knowledge generation/ sharing recommendations and
  • (3) leadership and policy recommendations. 

The authors emphasize the importance of involving staff in making changes, and suggest that creating best practice guidelines for sustainability within food services could address one of the key barriers identified.

Abstract:

Foodservice is a key contributor to environmental impacts of the healthcare sector, in particular hospitals. Driving towards sustainable solutions in foodservices can bring financial and social benefits, whilst allowing hospitals to position themselves as leaders towards a sustainable food system and healthcare sector. Such a change depends on those working directly or indirectly with foodservices. Staff possess valuable knowledge, ideas, motivation and responsibility for improving the environmental sustainability of the foodservice system.

The aim of this study was to explore the perspectives of staff working across the hospital food supply chain towards: (1) sustainable practices in hospital food provision; (2) existing barriers and enablers; and (3) recommendations for implementing sustainable foodservice practices in the future.

Through qualitative inquiry, semi-structured interviews were conducted with individuals at operational and management levels responsible for policy, purchasing, production, onsite plating and delivery and waste disposal at three hospitals in Australia. Framework analysis was used to synthesise transcribed data into practices, barriers and enablers, and recommendations. Interviews (n=46 participants) identified current sustainable practices including those related to recyclable packaging, effective equipment and technology and efficient processes.

  • Unsustainable practices included restrictions on sourcing food, packaging that cannot be separated or recycled, rigid foodservice models and menu, waste production and processes.
  • Enablers to improve sustainability included the power of individuals to influence change, education on recycling, knowledge generation, audits and grants for innovative research, rebates and quality improvement processes.
  • Barriers included competing priorities, poor communication, lack of training opportunities and knowledge, infection control restrictions, lack of policy, funding, and time between meal ordering and delivery.
  • Participants proposed practice changes across the food supply chain and recommended generation and sharing of knowledge, leadership and policy support.
  • Perspectives of individuals within foodservice reveal shared motivation and desire for sustainable foodservices, with support needed from leaders and policy.
  • Future research should use a co-design approach involving staff to create and implement sustainable strategies within hospitals. To see widespread and timely change, action is needed towards effective and meaningful policy.

Details of results: 

In providing a background to the study, the authors note that the health care supply chain accounts for 71% of health care greenhouse gas emissions, and food is part of the supply chain. In addition to emissions, food also accounts for freshwater and land use, among other environmental impacts, so it is an important consideration for sustainability. The authors stress that examining the way food is managed in hospitals, including studying decisions points at each part of the hospital food supply chain, is important to effectively mitigating environmental impacts. They also suggest that there is a lack of research examining this issue from a systems perspective.

Interviewees included: policy makers; group purchasers; health service managers; central production kitchen staff; food preparation (food services staff, managers and supervisors); nurses; dietitians and waste management staff.

Some specific sustainable practices identified but not listed in the abstract include: “use of water technology to prevent the need for chemical cleaning products”; “use of metal trays”; “electronic menus”; decreasing time between ordering and delivery; “chemical free kitchen”; “patient meal time assistance”; “food waste audit and research”; waste management innovation (p. 155). Other unsustainable practices identified include: lack of organic meat or cage free alternatives; not following standardized recipes; relying on meat and dairy for protein; plastic packaging for individual pre portioned meals; patient difficulty to open items (leading to food waste); food waste technology not provided or working. 

Key barriers and enablers were categorized under several themes. First, under “people and their power and motivation” (p.156), individuals who advocated for change as well as the power of a sustainability team were identified as enablers; it was also noted that patient feedback on food quality enables change, as this is required to meet performance indicators. Second, “competing priorities for action” (p.156) was noted as a barrier, such as infection control requirements which restricted the reuse of unopened, individually pre-packaged foods. Third, while “education training and knowledge generation/ sharing” (p.156) can be an enabler (noting the powerful influence of data), gaps exist (e.g., in orientation training; lack of awareness of best practices). Next, many gaps exist under “policy influence”, including lack of best practice standards. Sustainable procurement can also be difficult as a result of supply contracts. Interviewees also noted that sustainability should be legislated if governments consider it a priority. Finally, foodservice systems can present opportunities (e.g., opening a new kitchen), but gaps were also identified (e.g., food waste resulting from delays between meal ordering and delivery, and as a result of offering a wide range of meal options).

Future recommendations were generated under three themes. First, “practice recommendations” (p. 158) included strategies such as reducing the frequency of meat on the menu and including more plant based options; reducing time between ordering and meal delivery; soliciting patient feedback; reducing food packaging; creating a vegetable garden on site and using generated compost on it. Second “knowledge generation/ sharing recommendations” (p. 158) included recommendations such as the creation of best practice guidelines, increased communication about effective strategies, using business cases to support practices, learning from other institutions, and including sustainability information in orientation sessions. Third, “leadership and policy recommendations” (p. 158) included actions such as funding a sustainability officer and creating a hospital sustainability policy which includes food.

Of additional interest: 

Editor’s comment:  

Interested Dietitians-Nutritionists may want to access the full article, as it identifies many practical actions at various points along the hospital food chain. 

Open access link to article: 

N/A – there is a pay wall to access the article (see citation above)

Conflict of interest/ Funding: 

The authors reported no conflict of interests.   

External relevant links: 

Corresponding author:

Stefanie.carino@monash.edu

Sustainable Institutional Food Procurement Insights, lessons, and recommendations from a Churchill Fellowship (2022)

Governments have few sources of leverage over increasingly globalized food systems – but public procurement is one of them. When sourcing food for schools, hospitals and public administrations, Governments have a rare opportunity to support more nutritious diets and more sustainable food systems in one fell swoop,” – Olivier De Schutter United Nations Special Rapporteur On The Right To Food (2014)

In May and June of 2022, the author of the report on Sustainable Institutional Procurement, Leah Galvin attended meetings and site visits in the USA, Canada, England, Denmark, Sweden, and Finland where the was researching models and approaches that increase the procurement by public institutions of local, healthy and/ or sustainable food. Public food can create public good – economically, environmentally, socially and for our health. Public (government funded) food procurement by institutions can be driven by a range of values: the kind of food purchased, from whom it is purchased and the production method. Institutions include – hospitals, universities, aged care, preschools, schools, prisons, workplace canteens/catering and community meal programs such as meals on wheels.

Author Leah Galvin, recipient of the 2019 Churchill Fellow explains: In writing this report I have had practitioners, government policymakers, food systems advocates, philanthropic investors, and food service and institutional procurement professionals in mind. You can read it all or just cherry-pick parts which are most helpful to you. Much of it is practical, and translatable to the Australian context and I hope affirming for those keen to values-based procurement widely practiced. If you have a sustainability mindset, this report can provide you with a new way to think about how our food system is part of the emissions reduction solution, because sustainable institutional food procurement in Australia, remains the sleeping giant of food systems transformation.

Also see Leah’s infographic on the same topic at this link in this #ICDAsfsToolkit.

Identifying effective interventions to promote consumption of protein-rich foods from lower ecological footprint sources: A systematic literature review (2022)

Ronto R, Saberi G, Leila Robbers GM, Godrich S, Lawrence M, et al. (2022) Identifying effective interventions to promote consumption of protein-rich foods from lower ecological footprint sources: A systematic literature review. PLOS Global Public Health 2(3): e0000209. https://doi.org/10.1371/journal.pgph.0000209

Open access link to article: 

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000209

Relevant to: 

Public health nutrition, sustainability 

Question: 

To identify effective interventions to promote intake of protein-rich foods from lower ecological footprint.

Bottom line for nutrition practice: 

There is a clear gap in the current evidence base for interventions that promote plant-based diet in the general population.

Abstract: 

Addressing overconsumption of protein-rich foods from high ecological footprint sources can have positive impacts on health such as reduction of non-communicable disease risk and protecting the natural environment. With the increased attention towards development of ecologically sustainable diets, this systematic review aimed to critically review literature on effectiveness of those interventions aiming to promote protein-rich foods from lower ecological footprint sources.

Five electronic databases (Medline, Web of Science, Scopus, Embase and Global Health) were searched for articles published up to January 2021. Quantitative studies were eligible for inclusion if they reported on actual or intended consumption of protein-rich animal-derived and/or plant-based foods; purchase, or selection of meat/plant-based diet in real or virtual environments. We assessed 140 full-text articles for eligibility of which 51 were included in this review.

The results were narratively synthesised. Included studies were categorised into individual level behaviour change interventions (n = 33) which included education, counselling and self-monitoring, and micro-environmental/structural behaviour change interventions (n = 18) which included menu manipulation, choice architecture and multicomponent approaches. Half of individual level interventions (52%) aimed to reduce red/processed meat intake among people with current/past chronic conditions which reduced meat intake in the short term. The majority of micro-environmental studies focused on increasing plant-based diet in dining facilities, leading to positive dietary changes. These findings point to a clear gap in the current evidence base for interventions that promote plant-based diet in the general population.

Details of results: 

Limitations

  • One limitation of this review is that most of the included studies have been conducted in high income countries and only a few studies were conducted in low- and middle-income countries (LMIC). This might be due to the fact that plant-based diet concept in high income countries has received increased attention in the last five years and LMICs have not prioritised it as a significant nutrition and environmental issue due to dealing with other diet related issues such as undernutrition and nutrient deficiencies. Research indicates that meat intake in LMIC has been associated with wealth as the rise in income has resulted in significant animal-derived food consumption in these countries [85].
  • Furthermore, most studies used self-reported measures to measure dietary behaviours which may increase biases [86].
  • Also, this review was limited to the literature published in English language and did not included articles published in grey literature, therefore it may be we missed some important research written in other languages. Finally, the majority of individual level behaviour change interventions included people who may be highly motivated to change their dietary behaviour such as cancer survivors, people at risk of developing chronic conditions, limiting the generalizability of the data to general population.

Results

The present review identified effective individual and micro-environmental behaviour change interventions which showed promising results in reducing protein intake from high ecological footprint sources.

  • The findings suggest that individual behaviour change interventions such as education, counselling and self-monitoring interventions might be useful strategies to educate people to change their dietary behaviours to more sustainable ones. However, there is a need to test these strategies among the general population longitudinally.
  • In addition, our findings showed that altering food environments using nudging and choice architecture approaches can achieve positive dietary changes but there is a need for development and evaluation of interventions in general settings (macro-environments) and explore motivations in sustainable food purchasing behaviours.

Our findings inform future research for development and evaluation of interventions and strategies to encourage greater adoption of sustainable and healthy diets.

Of additional interest: 

  • See the article reference list

Editor’s comment:  

n/a

Conflict of interest/ Funding:  

None to declare

External relevant links:  

n/a

Corresponding author: 

Dr Rimante Ronto
Department of Health Sciences, Macquarie University, Australia
Rimante.ronto@mq.edu.au

Healthy and sustainable diets: Position brief of Dietitians Australia (2022 Mar, revised from 2020)

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that supports the population to adopt healthy and sustainable diet-related practices.

MEDIA RELEASE Monday 28 March 2022 (see full pdf below)

Australia eating its way to a sick planet. Six and a half planet Earths would be needed to produce food by 2050 if the world were to adopt Australia’s eating habits.

A recently published position statement by Dietitians Australia revealed that as the planet’s health continues to decline, so too does the health of Australians, as our country favours quantity over quality when it comes to food. Dietitians Australia is calling on the government for urgent intervention by strategically planning the nation’s food systems in favour of a sustainable, affordable and nutritious way forward. “Australia’s diet causes the highest per capita greenhouse gas emissions of all G20 countries and many of these foods are energy dense and nutrient poor, which are not needed for health,” said Robert Hunt, CEO of Dietitians Australia. “We need to shift away from just focusing on producing more food, and instead concentrate on how we can sustainably produce nutritious food that’s affordable.”

Dietitians Australia believes that Aboriginal and/or Torres Strait Islander knowledge is key to sustainability into the future, and that this should be captured in a National Nutrition Strategy that supports a healthy planet. “As a nation we must work in partnership with First Nations Peoples and respect their knowledge of caring for the land, waters and ecosystems. Capturing this within a National Nutrition Strategy would help lead the way for healthy and sustainable eating patterns to flow through our communities. The strategy could see sustainability incorporated into the Australian Dietary Guidelines and be accounted for in the meals served at hospitals, aged care homes, education centres and correctional facilities. It would also support the evolution of food on our supermarket shelves to meet consumer demand for healthy and sustainable options.”

The report, published in Nutrition & Dietetics, explained how Australia and New Zealand are among the highest in rates of overweight children at 16.9%, compared to a global average of 5.7%. Obesity in adults is also extraordinarily high at 30.7%, compared to a global average of 13.2%. Despite being considered ‘the lucky country’, 12.3% of Australians have trouble affording or accessing food, compared to a 7.6% average amongst other high-income countries. When comparing Australia’s food system scorecard to those in the global arena, the report found that urgent action is required to contribute to global transformative efforts.

Barbour L, Bicknell E, Brimblecombe J, Carino S, Fairweather M, Lawrence M, et al. Dietitians Australia position statement on healthy and sustainable diets. Nutrition & Dietetics. 2022;79(1). 10.1111/1747-0080.12726