The Promotion of Sustainable Diets in the Healthcare System and Implications for Health Professionals: A Scoping Review (2021 Feb)

Citation: Alberdi G, Begiristain-Zubillaga M. The Promotion of Sustainable Diets in the Healthcare System and Implications for Health Professionals: A Scoping Review. Nutrients. 2021;13(3):747. 

Relevant to: 

Dietitians-Nutritionists in the health care and education sectors.     


This study investigated the size and scope of literature, and the processes and roles related to sustainable diet promotion within health care systems. Twelve appropriate studies were identified, and the data was used to develop a framework of the key elements needed to advance the promotion of sustainable diets within health services. 

Bottom line for nutrition practice:

The findings underscore the importance of a systems approach to integrating sustainable diets within health care systems. A theoretical framework developed by the researchers based on the analysis identifies the following processes, circumstances and roles for advancing sustainable diets: “higher education in dietetics and allied professions”; “peer knowledge share”; “continuous professional development competence”; “standard operating procedures (SOP) in dietetics and allied professions”; “clinical and community health service”; “community engagement”; “policy advocacy on sustainable food systems”; “organizational policy”; “institutional policy advocacy” (p.7).    

The authors suggest that while the evidence shows that health professionals have the potential to advance a paradigm shift toward sustainable diets, their current role and potential impact is underestimated.  


The impacts of the current global food system are already visible in the environment and in the health of the population. The promotion of sustainable diets is key to counter the negative consequences. The healthcare system could be a powerful tool to educate patients by guiding their diets towards sustainability. This study aimed to assess the size and scope of the available literature regarding the promotion of sustainable diets in the healthcare system and to obtain a reliable ap- proximation of the processes and roles related to sustainable diet promotion within healthcare systems. A scoping review where online databases were used to identify English written scientific and grey literature published between 2000–2019 was carried out. The analytical–synthetic approach was used for data charting. Twelve studies were included that were published between 2007–2020. The data highlight education, community and clinical health services, community engagement and policy advocacy, and governance as main action areas along with two transversal aspects, social support, and gender. A systemic approach to the food system is emphasized. Evidence suggests that health professionals have the potential to drive a paradigm shift in food–health environments. Currently, however, their role and potential impact is underestimated within healthcare systems. This review has identified a framework with key areas where processes need to be developed to guarantee sustainable diet promotion in healthcare services.  

Details of results: 

The review found a scarcity of data regarding the potential role of health professionals in advancing sustainable diets within health care services, and stress that it is an emerging field. The 12 articles reviewed came from 2007 onwards, eight of which were published in the last two years. The majority of the articles came from the United States and Canada, and to a lesser extent, the UK. Research articles, research reviews and grey literature such as position papers were included.  

Half of the articles focus on the need to have a systems vision within the job responsibilities of health professionals. This would necessitate the development of new rules and responsibilities at various levels, highlighting the need for organizational policy development and involvement of key stakeholders in institutions related to sustainable diets. For example, food procurement policy within healthcare organizations can both increase sustainability and act as an example of leadership in sustainable diets. Again, half of the articles highlighted the need to complete higher education, training and professional development requirements specific to sustainable food systems – both within the profession, and at the University training level. Four articles identified the need for consensus on sustainable food system related definitions. Issues of governance, policy advocacy, education, leadership and community were identified often; the authors suggest that a systems perspective imply that these are interdependent, and all at the same level of importance.  

Figure 2 (p.7) illustrates the theoretical framework completed by the researchers that organizes and defines principal elements identified through the review. The Figure categorizes standard operating procedures (SOP) of central importance, including concepts such as a shared understanding of sustainable food systems, having a systems perspective, as well as monitoring the advancement of sustainable diets. The authors present two foci from this central element of SOP. First, in higher education and continuous professional development, and second, in roles and practices within health services, the community and in public policy. Further details within these elements can be found in Figure 2 and in the discussion section of this open access paper. 

One gap identified when looking specifically at dietitians, is the low self-efficacy of dietitians related to their low knowledge level on sustainability. Articles recommended innovative changes to teach professionals about food systems, such as agricultural production, environmental sciences, economics, policy advocacy and analysis, etc. Further, as some studies have observed that the advancement of sustainable diets is reliant on self- efficacy and individual beliefs, low self-efficacy is of particular concern, and underscores the importance of a systems approach. The articles also identify a need for consensus on sustainable diets within the health professions, and the adoption of related professional standards and protocols.  

In looking to systems change, the researchers suggest that health professionals need to be engaged with the community in creating food environments that will support the advancement of a sustainable food system. For example, if the food environment can provide norms, opportunities and incentives to change behavior, consumers are more likely to change their consumption habits. Finally, the results stressed that the transformation to sustainable diets requires participation from a wide scope of key stakeholders.    

Of additional interest:

The authors refer to the following discussion paper which outlines ten recommendations for health professionals to support and advocate for sustainable food systems in the UK: 

Bash, K.; Donnelly, A. Sustainable Food Systems for a Healthier UK: A Discussion Paper. 2019. Available online: 

Editor’s comment:

The editor found it interesting that a challenge or barrier not identified in promoting sustainable diets in the health care system was the need to work closely with Dietitians/health professionals working in food industry.  

Open access link to article: 

Conflict of interest/ Funding: 


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