A pathway to personal, population and planetary health for dietitians and nutrition professionals (2023 Nov)

MacKenzie-Shalders, K. L., Barbour, L., Charlton, K., Cox, G. R., Lawrence, M., Murray, S., Newberry, K., Senior, N. M., Stanton, R., & Tagtow, A. M. (2023). A pathway to personal, population and planetary health for dietitians and nutrition professionals. Public Health Nutrition, Advance online publication. https://doi.org/10.1002/puh2.137



Earth and all its inhabitants are threatened by a planetary crisis; including climate change, deforestation, biodiversity loss and pollution. Dietitians and nutrition professionals have a responsibility to lead transformational change in contemporary food and health systems to help mitigate this crisis. The study aims to develop a conceptual framework to support dietitians towards personal, population and planetary health.


Non-empirical methods were used by the co-researchers to explore and explain the application of an international framework ‘Next-Generation Solutions to Address Adaptive Challenges in Dietetics Practice: The I + PSE Conceptual Framework for Action’. (I+PSE = Individual plus Policy, System, and Environmental)


A non-sequential pathway guide to personal, population and planetary health for nutrition professionals was developed including several key guiding principles of Agency, Action, Ascension, Alignment, Alliance and Allyship, and Advocacy and Activism. Each guiding principle features descriptors and descriptions to enhance dietitian and nutrition professional

  • Agency (i.e. vision, self-belief, confidence, strength and responsibility),
  • Action (i.e. start, shift, translate, achieve and commit),
  • Ascension (i.e. build, overcome, manage, challenge and progress),
  • Alignment (i.e. leadership, transparency, diplomacy, values and systems),
  • Alliance and Allyship (i.e. support, collaborate, represent, community and citizenship) and
  • Advocacy and Activism (i.e. disrupt, co-design, transform, empower and urgency).

The framework and its descriptors support enhanced understanding and are modifiable and flexible in their application to guide the participation of dietitians and nutrition professionals in transformational change in personal, population and planetary health. This guide acknowledges that First Nations knowledge and customs are important to current and future work within this field.


Alongside the international body of work progressing in this field, this framework and visual guide will support dietitians and nutrition professionals to achieve urgent, transformational change in personal, population and planetary health.

JHND Special Issue: Sustainable Food Systems and Dietary Patterns in Nutrition and Dietetic Practice (2023 Dec)

The British Dietetic Association’s Journal of Human Nutrition and Dietetics (JHND) published a Special Issue on Sustainable Food Systems and Dietary Patterns in Nutrition and Dietetic Practice edited by: Liesel Carlsson, Angela Madden, and Kalliopi-Anna Poulia (Volume 36, Issue 6, Pages: 2121-2350, December 2023).

Twelve of the sixteen articles are open access and cover a wide range of practice settings.

  • Open Access – Conceptualising sustainability in Canadian dietetic practice: A scoping review – Dietitians are well-positioned to promote sustainable food systems and diets. This research identifies practice activities described in the Canadian published literature and compares these with dietetic competency standards. Increasing practitioners’ ability to analyse issues using systems thinking will help address complex challenges. Updates to competency standards and curricular supports are needed to support this area of practice.
  • Open Access – Local food procurement by hospitals: a scoping review – There is a paucity of peer-reviewed studies describing local food procurement by hospitals. Details of local food procurement models were generally lacking: categorisable as either purchases made ‘on-contract’ via conventional means or ‘off-contract’. If hospital foodservices are to increase their local food procurement, they require access to a suitable, reliable and traceable supply, that acknowledges their complexity and budgetary constraints.

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: 


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.


  • 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

Impacto ecológico de la alimentación en España (2022)

Presentamos la nueva edición (31) de Cuadernos de las Cooperativas de Consumidores con un monográfico sobre el «Impacto ecológico de la alimentación en España». Nuestros hábitos de alimentación y el sistema actual de producción y consumo de alimentos tienen un indudable impacto en la salud del planeta, de manera que las decisiones de compra y consumo deberían ser tomadas con la mayor información posible.

Como sociedad, es necesario avanzar hacia modelos más sostenibles y todos los eslabones de la cadena alimentaria deben contribuir a mitigar el impacto ambiental de nuestras prácticas y actividades. Analizado en términos de oportunidad, el camino hacia la sostenibilidad se presenta como un buen momento para transformar nuestro sistema alimentario.

En este trabajo se aborda, desde el punto de vista del sector de la alimentación, cómo nuestros comportamientos y decisiones de consumo generan considerables impactos ambientales y qué se necesita para minimizar los efectos de nuestros hábitos cotidianos con respecto a los alimentos. Esta publicación forma parte del Proyecto “Impacto ecológico de la alimentación”, subvencionado por Ministerio de Consumo, y cuenta con el apoyo y colaboración del Ministerio de Agricultura, Pesca y Alimentación.

Hemos conseguido reunir las reflexiones de responsables en la materia y reconocidos especialistas, incluyendo los aspectos normativos y nutricionales, dando voz al sector de la producción y la distribución comercial. Cada artículo se aproxima al problema con un punto de vista diferente, configurando un completo trabajo de lectura recomendada.

Las personas consumidoras quieren reducir su huella ecológica y ya apuestan por las empresas que se comprometen y actúan para reducir tanto sus emisiones como los impactos ambientales. Pero cada día es más patente la gran distancia que existe entre la intención y la acción. A esto se añade el aumento del coste de la vida, que impide tomar decisiones de forma responsable con el planeta. En esta situación, el precio se ha convertido en una barrera para el comportamiento sostenible, por lo que debemos tener en consideración a aquellos colectivos de personas vulnerables para que no se queden fuera en estos momentos y avancen igualmente en el camino hacia la reducción del impacto ambiental de los hábitos de compra y consumo de alimentos. 

En la apuesta por la sostenibilidad, compartida de forma unánime por todos los sectores, hay muchas lagunas y la persona consumidora, como último eslabón de la cadena, reclama más información y un compromiso real y contrastable del sector de la alimentación con el medio ambiente, para que se ofrezcan productos que nos permita seguir unos patrones de alimentación más saludables, a la vez que sostenibles. 

Con este Monográfico también queremos hacer, en nombre de las cooperativas de consumo un llamamiento al compromiso sincero con la sostenibilidad, impulsando innovaciones y nuevas oportunidades empresariales, que permitan avanzar hacia un sistema alimentario más sostenible y respetuoso con el planeta y las personas.

‘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: 


Relevant to: 

Foodservice dietitians


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.


  • 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

EFAD’s Kompass Nutrition & Dietetics journal (2022 Nov)

#SustainableNutrition is the focus for the November 2022 issue of The European Federation of the Associations of Dietitians (EFAD)‘s Kompass Nutrition & Dietetics journal.  It includes 9 articles as well as some shorter pieces and announcements related to:

  • Evidence-Based and Sustainable Food System Innovations for Healthier Diets
  • Sustainability in Hospital Food Catering
  • Association Between Sustainability and Cancer
  • Sports
  • School Meals
  • Is the focus on health eating drowning in the discussion about sustainable food?

Good food for thought, discussion, and action!

Download at: https://www.karger.com/Journal/Issue/281118?fbclid=IwAR058Y_7pKRy63JkTJC6p2f_-117mQJ3clfdNFQQuDflLJvdEnrIWfVObkk

Delivering community benefit: Healthy food playbook (tool)

The “Delivering community benefit: Healthy food playbook” is a suite of resources to support hospital community benefit professionals and community partners in developing community health interventions that promote healthy food access and healthier food environments.

If a facility has identified obesity, food access, or diet-related health conditions among the priority health needs in its community health needs assessment (CHNA), then initiatives to promote healthy food access and increased consumption of fruits and vegetables can be important components of an implementation strategy to address these needs.

The playbook has several sections with resources to support different stages of the community benefit or community health planning process. Each resource provides examples and links to learn more. These resources will inspire and strengthen your efforts to promote healthy and vibrant communities with healthy, sustainable, and equitable community food systems.

Inspired by a commitment to respond to community health needs, Health Care Without Harm’s Healthy Food in Health Care program carried out a national research project to support hospital community benefit professionals and community partners in developing initiatives that promote healthy food access and healthier food environments. The project was supported by a grant from the Robert Wood Johnson Foundation

Healthy Food in Health Care Pledge (Tool)

You can encourage your Health Care institution to sign the Healthy Food in Health Care Pledge below, which is a framework by Health Care Without Harm US & Canada that outlines steps to improve the health of patients, communities, and the environment.

In addition to encouraging your Health Care systems to sign, implement, and report on this pledge, you could adapt this pledge to other situations – schools, churches, or other groups or institutions you are working with to signal to the marketplace about their interest in local, nutritious, sustainable food. Share back with us if you do this, and we will encourage others to sign!

The pledge

As a responsible provider of health care services, we are committed to the health of our patients, our staff and the local and global community. We are aware that food production and distribution methods can have adverse impacts on public environmental health. As a result, we recognize that for the consumers who eat it, the workers who produce it and the ecosystems that sustain us, healthy food must be defined not only by nutritional quality, but equally by a food system that is economically viable, environmentally sustainable, and supportive of human dignity and justice. We are committed to the goal of providing local, nutritious and sustainable food. This Healthy Food in Health Care Pledge is a framework that outlines steps to be taken by the health care industry to improve the health of patients, communities and the environment.

Specifically, we are committed to the following healthy food in health care measures for our institution.

We pledge to:

  • Work with local farmers, community-based organizations and food suppliers to increase the availability of locally-sourced food.
  • Encourage our vendors and/or food-management companies to supply us with food that is, among other attributes, produced without synthetic pesticides and hormones or antibiotics given to animals in the absence of diagnosed disease and which supports farmer health and welfare, and ecologically protective and restorative agriculture.
  • Increase our offering of fruit and vegetables, nutritionally-dense and minimally processed, unrefined foods and reduce unhealthy (trans and saturated) fats and sweetened foods.
  • Implement a stepwise program to identify and adopt sustainable food procurement. Begin where fewer barriers exist and immediate steps can be taken. For example, the adoption of rBGH free milk, fair trade coffee, or the introduction of organic fresh produce in the cafeteria.
  • Communicate to our Group Purchasing Organizations our interest in foods that are identified as local and/or third-party certified.
  • Educate and communicate within our system and to our patients and community about our nutritious, socially just and ecological sustainable food healthy food practices and procedures.
  • Minimize or beneficially reuse food waste and support the use of food packaging and products which are ecologically protective.
  • Develop a program to promote and source from producers and processors which uphold the dignity of family, farmers, workers and their communities and support sustainable and humane agriculture systems.
  • Report annually on the implementation of this pledge. 

UN Food Systems Coordination Hub (2021-present)(website)

2023: The UN Food Systems Summit +2 Stocktaking Moment took place in Rome, Italy from 24 – 26 July 2023, on the premises of the Food and Agriculture Organization of the United Nations (FAO). It was hosted by Italy, in collaboration with the Rome-based UN Agencies (FAO, IFAD, WFP), the UN Food Systems Coordination Hub and the wider UN system. The purpose of the UN Food Systems Summit +2 Stocktaking Moment was to build on the momentum of the 2021 Food Systems Summit and create a conducive space for countries to review progress on the commitments to action and identify successes, enduring bottlenecks and priorities in order to close the implementation gap by effectively and efficiently utilizing the Means of Implementation for food systems transformation. It was also an opportunity to further socialize the powerful role of sustainable, equitable, healthy and resilient food systems as critical SDG accelerators and advocate for urgent action at scale, building on the latest evidence that sustainable food systems contribute to better and more sustainable outcomes for people, planet and prosperity leaving no one behind.

2022: Food Systems Coordination Hub is hosted by FAO on behalf of the UN system. The Chair of the UN Task Force will rotate among interested UN agencies with strong connections to the work of the Hub. Taking over from the Food Systems Summit Secretariat, the Coordination Hub will help draw on the best of the UN System and all constituencies to build on the momentum and deliverables that emerged through the Summit process to achieve the 2030 Agenda and sustainable food systems for all. The vision is to stimulate and support action for SDGs-based food systems transformations towards the acceleration of the 2030 Agenda. The mission is to serve countries through systemic, country-driven, customized support in translating their commitments into effective actions to reach sustainable food systems by 2030, leveraging the wider UN system’s capacities. To achieve this, the Hub acts as a catalyst and connector inside the UN system in relation to food systems transformations’ contribution to the 2030 Agenda. To accelerate food systems transformations, the Hub takes on an essential coordination role to bring together relevant UN agencies, coalitions, international financial institutions, the private sector and other actors of support to galvanize food systems knowledge and expertise in support of countries’ action.

2021: Convened by the UN Secretary-General, over 160 Member States, representatives of partners and stakeholder groups, came together at the UN Food Systems Summit (UNFSS) on 23-24 September 2021 where they articulated hundreds of individual and collective solutions and commitments to transform food systems to achieve the 2030 Agenda. The UNFSS Action Tracks offer stakeholders from a wide range of backgrounds a space to share and learn, with a view to fostering new actions and partnerships and amplifying existing initiatives. The Action Tracks are aligned with the Summit’s five objectives. Importantly, the Action Tracks are not separate, nor do they sit in siloes. Each Action Track is designed to address possible trade-offs with other tracks, and to identify solutions that can deliver wide-reaching benefits. Together, they explore how key cross-cutting levers of change such as human rights, finance, innovation, and the empowerment of women and young people can be mobilized to meet the Summit’s objectives.

Food is Medicine Research Action Plan (2022 Jan)

The research on Food is Medicine builds upon a large and robust body of evidence that links food insecurity to poor health outcomes, both physical and mental. Research repeatedly demonstrates that food insecurity is associated with increased health care use and spending.

The Action Plan provides a comprehensive analysis to date of research on medically tailored meals, medically tailored groceries, and produce prescriptions. The greatest challenge—and starting point for this Action Plan—is how to propel rigorous, high-impact, translatable research that can quickly bring necessary reforms to our health care and food systems. The Action Plan is written for: Researchers; Funders; Food is Medicine program implementers; Advocates for increasing access to Food is Medicine interventions. It is focused on the USA but could be useful to anyone in the world to consider their own Food is Medicine Action Plan.

The research included in this report was made possible through funding by the Walmart Foundation. The findings, conclusions, and recommendations presented in this report are those of Food & Society at the Aspen Institute and the Center for Health Law Policy Innovation (CHLPI) alone, and do not necessarily reflect the opinions of the Walmart Foundation.

Downer S, Clippinger E, Kummer C. Food is Medicine Research Action Plan. Published Jan. 27, 2022.