Exploring the barriers and facilitators for following a sustainable diet: A holistic and contextual scoping review (Barcelona, Spain, 2024)

Muñoz-Martínez, J., Cussó-Parcerisas, I., Carrillo-Álvarez, E. Exploring the barriers and facilitators for following a sustainable diet: A holistic and contextual scoping review. Sustainable Production and Consumption (2024). 46, 476-490. https://doi.org/10.1016/j.spc.2024.03.002 (pay wall)

Relevant to: 

Dietitians, nutritionists, and public health professionals aiming to promote a shift towards sustainable and healthy diets.

Question: 

Identifying the barriers and facilitators people experience when following a sustainable and healthy diet.

Bottom line for nutrition practice: 

This research recognises the intricate net of factors that influence individuals to adopt a sustainable and healthy diet. Such influences vary significantly in magnitude and direction among different individuals. The complexity surrounding food decisions demands that interventions and actions targeting food behaviour are tailored to the characteristics and needs of the target population.

Abstract: 

  • Changing current dietary patterns to more sustainable ones is paramount to decrease the pressure food systems are putting onto the planet and people’s health and wellbeing. However, modifying consumers’ behaviour is extremely challenging since multiple factors of variable nature (i.e., personal, socioeconomic, cultural, external…) influence food choices.
  • For this reason, we aim to identify consumers’ barriers and facilitators for following a sustainable and healthy diet, and explore how these are perceived among people from different socioeconomic backgrounds.
  • To do so, we conducted a scoping review of the literature with a consultation phase with citizens from Barcelona with different socioeconomic backgrounds.
  • Results revealed one hundred intricate factors that influence people’s food behaviour, which were grouped into internal, and external factors. Although the literature generally agreed on the direction of influence from the identified factors, the consultation phase generated substantial disagreements given the participants’ diverse perspectives and motivations. However, some limiting factors were commonly mentioned across groups which corresponded to feelings of distrust towards the food industry, lack of time, disgust towards specific foods, and the high cost of foods. Differences across socioeconomic groups were not observed except for the latter. All participants agreed that cost acted as a barrier, although participants from higher socioeconomic backgrounds were more capable to find arguments to overcome the price barrier.
  • Results are necessary to acknowledge the particularities embedded in each person and the need to design context-based interventions to effectively overcome people’s barriers and enhance their facilitators.

Details of results: 

  • The scoping review revealed 100 intricate factors influencing consumers in following a sustainable and healthy diet.
  • The consultation phase allowed to identify the nuances surrounding the findings from the literature review.
  • Significant differences across socioeconomic groups were not observed except for how cost was considered as a barrier. For individuals from low socioeconomic backgrounds, the high cost of food is a decisive factor for not purchasing sustainable food, whereas for those from high socioeconomic backgrounds, the cost barrier can be dissipated by factors linked with knowledge and consciousness.
  • Additional commonly identified decisive limiting factors were the distrust towards the food industry, lack of time, and disgust towards specific foods.
  • Newly recognised determining factors included knowledge of ethical aspects of food production, trust in small producers and food sellers, emotional involvement with producers, food addiction, lack of interest, selfishness, the belief that legumes put on weight, being a time-oriented individual, access to culture, food safety, social media, and perceived lack of time.

Of additional interest: 

The results from the literature review barely covered the socioeconomic and cultural dimensions of sustainable diets. Although efforts were made to address this limitation by purposely covering this dimension during the consultation phase, future research should take these aspects into account to address sustainable diets in their broadest understanding.

Conflict of interest/ Funding:  

None

Corresponding author: 

Irene Cussó-Parcerisas, PhD
irenecp2@blanquerna.url.edu

Responding to urgent calls for fit-for-purpose planetary health curricula: an examination of nutrition and dietetics tertiary education (2025)

Barbour L, McCartan J (2025), “Responding to urgent calls for fit-for-purpose planetary health curricula: an examination of nutrition and dietetics tertiary education”. International Journal of Sustainability in Higher Education, Vol. 26 No. 9 pp. 112–130, doi: https://doi.org/10.1108/IJSHE-07-2024-0465

Purpose
Health professionals play a crucial role in addressing the climate crisis and contributing to sustainable development. However, despite urgent calls from experts and health professions students, tertiary education currently lacks fit-for-purpose planetary health curricula. This study aims to provide a comprehensive, Australia-wide examination of planetary health curricula offered within two health professions: nutrition and dietetics.

Figure 4: Curriculum concepts, as described in relevant learning outcomes of eligible units

Design/methodology/approach
This mixed-method study involved two phases. Firstly, content analysis of publicly available unit titles and descriptions to determine the frequency and distribution of relevant curricula. Secondly, content and inductive thematic analysis of relevant learning outcomes, guided by Bloom’s Revised Taxonomy to assess the level of cognitive learning and the subject matter being prioritised.

Findings
Examination of 104 degrees offered by 41 Australian universities identified relevant curricula in 71 nutrition degrees (84%) and 18 dietetics degrees (95%). Majority of relevant learning outcomes (n = 137) focus on lower-order cognitive learning, with 11 themes of subject matter identified; planetary health, critiquing the status quo, innovation and disruption, equity, values-based practice and evidence-based practice, (dietary modification, food service in health-care settings, food and nutrition policy, food system drivers and elements of the food supply chain.

Originality/value
This study identified an increase in coverage of planetary health curricula in Australian nutrition and dietetics degrees compared to previous examinations and the need for higher-order learning to adequately equip the future health workforce.

Sustainable food systems education in nutrition and dietetics: an appraisal of the tertiary landscape in multiple countries (2025)

Wegener J, Carlsson L, Barbour L, Everitt T, Pettinger C, Reguant-Closa A, Meyer N, Svette S, Hassan D, Platnar J (2025), “Sustainable food systems education in nutrition and dietetics: an appraisal of the tertiary landscape in multiple countries”. International Journal of Sustainability in Higher Education, Vol. 26 No. 3 pp. 558–574, doi: https://doi.org/10.1108/IJSHE-09-2023-0449 (Pay Wall)

Purpose
Despite a growing awareness of the gap between professional expectations and competence, there has been no comprehensive appraisal of sustainable food systems (SFS) education within dietetics and nutrition programs to date. Dietitians and nutritionists play important roles in promoting sustainability yet many perceive themselves to be inadequately trained. The purpose of this study was to explore how, and to what degree, SFS education is incorporated into accredited nutrition and dietetics programs in the United Kingdom, Australia and Canada.

V. Supplementary Figure 3: Word Cloud of Courses Identified with Full SFS Content Integration in the United Kingdom/Ireland, Australia, and Canada (top 150 words)
Source: Authors’ own creation/work

Design/methodology/approach
A content analysis of course descriptions from program websites was conducted between 2021 and 2022. Courses were reviewed, analyzed and evaluated using a novel sustainability metric.

Findings
SFS is integrated into the education environment of some, but not all, dietetics and nutrition programs to varying degrees (no, partial and full). Partial and full integration was present in a small percentage of courses, with a larger percentage in nutrition programs. SFS education was offered more often through a single unit than a dedicated course. Twelve best practice examples of courses dedicated to SFS were identified. In the UK, their focus was nutrition and diet, contrasting food and food systems in Australia and Canada.

Originality/value
These findings provide insight into SFS education for professional societies, instructors and program directors. Through intentional curricular design considerations supported by this study, program leads can take small conscious reorganizational steps to integrate SFS. This study offers a sound methodology to initiate and benchmark further assessment and a novel approach for other professions looking to equip their future workforce through SFS education.

Collaborative co-design for local blue food system transformation: the practicalities and challenges of the UK’s (FoodSEqual) ‘Plymouth Fish Finger’ pilot study (2025, Accepted Manuscript)

Hunt, L., Pettinger, C., Tsikritzi, R., & Wagstaff, C. (2025). Collaborative co-design for local blue food system transformation: The practicalities and challenges of the UK’s (FoodSEqual) “Plymouth Fish Finger” pilot study. Environmental Research: Food Systemshttps://doi.org/10.1088/2976-601X/ae1f1c (Open Access, Accepted Manuscript)

Abstract

Purpose: UK food system transformation is urgently needed but blue foods (e.g. fish) have been only minimally part of this discourse. Informed by community action research in a UK southwest coastal city, fish was identified as a food commodity for food system innovation, leading to local collaborative ‘co-design’ of an iconic British food. The ‘Plymouth Fish Finger’ pilot assessed the practicalities and challenges of this social innovation and its provision into the school meal system.

Design: Exploratory creative mixed methods mapped the journey of the Fish Finger as a social innovation. Methods drew on ‘co-production’ approaches, involving Community Food Researchers (CFR), co-design with secondary school students, expert fish/school stakeholder consultations, educational pop-up taste tests in primary schools, processual observations and fieldnote reflections. Descriptive statistics and participatory analyses provided quantitative and qualitative insights respectively.

Findings: Taste testing with schools and communities showed positive sensory and educational attributes. Participatory analyses resulted in five core themes:
i) ‘Supply’ – disrupting traditional supply chains;
ii) ‘Environmental benefits’ – reduced impact of small vessels;
iii) ‘Processing’ – making an appealing product;
iv) ‘Education’ – the value of educational input; and
v) ‘Upscaling and legacy’ – routes to possible future expansion.
An underpinning category was also constructed – ‘Pride and identity meets reality’, which illuminates pride in the product and the imperative of its economic viability.

Originality: This small-scale exploratory pilot study forged relationships between academics, communities, fishing industry stakeholders, schools, and school meal providers. It successfully built the concept of a community-led fish finger social innovation, advocating for collaborative action towards (blue) food system transformation. This paper offers insights and recommendations for research, policy, and practice, which exemplify the complex interplay between factors driving distortions in access to and availability of fish within the local food system

2025 December: When the Accepted Manuscript is finalized this figure will be updated.

updated 2025 December

Mainstreaming agrobiodiversity in planet-friendly school meals for children: a scoping review (2025 Nov)

Distribution of evidence from the 124 articles on home grown school meals or school garden interventions, or both, with labels showing the number of articles per country.

Estrada-Carmona, N., Hunter, D., Samrat, S., & Research Consortium for School Health and Nutrition. (2025). Mainstreaming agrobiodiversity in planet-friendly school meals for children: A scoping review. The Lancet Planetary Health, 9(11), 101374. https://doi.org/10.1016/S2542-5196(25)00252-9[1]

The global shift away from healthy, diverse, and sustainable diets threatens children’s health and futures. Although school gardens and home-grown school meals can reconnect children with nutritious, sustainably produced food, these interventions are often implemented separately and with little attention to agrobiodiversity, which is a cornerstone for sustainability and healthy diets.

Via a scoping review of 124 articles from 35 countries, we identified wide-ranging and complementary benefits of these interventions beyond health and education. The benchmark of the species used in these interventions against cultivated, predicted, and listed edible plants shows that agrobiodiversity is underused.

Despite fragmented and incomplete evidence, our research shows that these interventions can jointly drive profound transformation. Realising this potential demands systemic shifts toward holistic, rights-based approaches that overcome surmountable barriers and build objective, sustainable, and resilient food systems delivering planet-friendly school meals.

Contributed by Christine McCullum-Gomez, PhD, RDN

updated 2025 December

Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort (2025)

Citation: Berthy, F., Toujgani, H., Duquenne, P., Fezeu, L. K., Lairon, D., Pointereau, P., Touvier, M., Hercberg, S., Galan, P., Alles, B., Baudry, J., & Kesse-Guyot, E. (2025). Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort. The American Journal of Clinical Nutrition, 122(3), 450–459. https://doi.org/10.1093/ajcn/nqaa123

Abstract

Background: Obesity has emerged as a significant public health issue globally. In response to the dual health and environmental challenges posed by dietary patterns, the EAT-Lancet Commission recommended a planetary health diet that promotes well-being.

Objectives: This study aimed to investigate the association of the EAT-Lancet reference diet with body weight (BW) changes, incidences of overweight [body mass index (BMI) 25 kg/m²], and obesity (BMI 30 kg/m²), in a large French cohort.

Methods: The study analyzed data from 51,711 adults who participated in the French NutriNet-Santé cohort between 2009 and 2023. Exposure was measured by the level of adherence to the EAT-Lancet reference diet, evaluated through the EAT-Lancet Diet Index (ELD-I), categorized into sex-specific quintiles (Qs), and as a continuous variable. The relationship between ELD-I and changes in BW was examined using multivariable linear mixed models. For the incidences of overweight and obesity, multivariable Cox proportional hazards models were employed.

Results: During follow-up (median = 8.7 years), 4,250 and 1,604 persons became overweight and obese, respectively. We observed an inverse association between the level of ELD-I and gain in BW (in kg) [βQ5 time = 0.18; 95% confidence interval (CI): 0.20, 0.16; P < 0.0001]. Higher level of ELD-I was associated with lower risks of reaching overweight [hazard ratio (HR) Q5 compared with Q1: 0.60; 95% CI: 0.54, 0.66; P-trend < 0.0001] and obesity status (HR Q5 compared with Q1: 0.54; 95% CI: 0.45, 0.63; P-trend < 0.0001) during follow-up.

Conclusions: This comprehensive prospective observational study revealed that a stronger adherence to the EAT-Lancet reference diet is associated with lower BW and reduced risks of overweight and obesity. Promoting a sustainable plant-based diet seems to be an effective strategy for addressing the global public health challenge of obesity.

updated 2025 November

Planetary health diets: sustainable nutrition transition for obesity epidemic and eco-environmental sustainability in the Anthropocene (2025)

Citation: Li, A. M. L. (2025). Planetary health diets: sustainable nutrition transition for obesity epidemic and eco-environmental sustainability in the Anthropocene. Academia Nutrition and Dietetics, 2(4). https://doi.org/10.20935/AcadNutr7972

Abstract

This paper provides an analytical perspective on the historical evolution of food patterns during periods of transition, with a focus on the arising concerns surrounding the obesity epidemic and eco-environmental sustainability in this new epoch of the Anthropocene.

Dietary risk factors have emerged as the second and third leading causes of global attributable deaths, alongside their significant influence on the actual and potential catastrophic effects on eco-environmental sustainability. These unprecedented challenges call for new perspectives in addressing this evolving nutritional health literacy, aimed at facilitating sustainable nutrition transition in this new era.

Planetary health diets are proposed as a solution-oriented framework for guiding dietary practices during the Anthropocene’s transitional period. This paper explores planetary health diets as a key trend in nutritional health, emphasizing their role in sustaining food systems and eco-environments within the broader concepts of planetary health and ecological public health.

Methodologically, content and thematic analyses were used to identify key issues and critical insights arising from the complex interplay of interrelated dynamics. These include:
(1) diet-induced obesity and its associated health risks,
(2) the historical evolution of food patterns and nutrition transitions,
(3) comparisons between animal-based and plant-based foods in relation to their impacts on greenhouse gas emissions, land use, and water consumption, and
(4) the application of safety limits derived from the scientific indicators of the planetary boundaries framework.

The findings underscore that planetary health diets are central to sustainable nutrition transitions, aligning with historical trends during this era of eco-environmental and climate-mediated health risks in the Anthropocene. In light of these global challenges, this paper emphasizes the importance of advancing scientific nutritional knowledge through multidisciplinary approaches, forming part of transformative processes that promote a holistic understanding of global dietary challenges.

Key recommendations include: prioritizing the advocacy of planetary health diets as part of lifestyle medicine interventions in nutrition, alongside curriculum reform to enhance nutritional health literacy and foster sustainable nutrition transitions through ecological public health education. A multifaceted, transdisciplinary approach to ecological public health education, integrated with the planetary boundaries framework, is strongly recommended to address the complex interactions of dietary practices and achieve sustainable nutrition transitions.

These synergies provide actionable solutions to combat the obesity epidemic and promote eco-environmental sustainability. Universities, as global institutions, are uniquely positioned to lead collaborative efforts in advancing these transformative initiatives.

updated 2025 November

Sustainable diets reduce diet-related greenhouse gas emissions and improve diet quality: Results from the MyPlanetDiet randomized controlled trial (2025)

Citation: Davies, K. P., Gibney, E. R., Leonard, U. M., Conway, M. C., McCarthy, S. N., & O’Sullivan, A. M., et al. (2025). Sustainable diets reduce diet-related greenhouse gas emissions and improve diet quality: Results from the MyPlanetDiet randomized controlled trial. The American Journal of Clinical Nutrition. Advance online publication. https://ajcn.nutrition.org/article/S0002-9165(25)00268-0/fulltext

Figure 1: There were 2625 responses to online screening questionnaires between February 2022 and March 2023

Abstract

Background: Diet-related environmental impacts must be reduced to mitigate climate change. Although many sustainable diets have been proposed, the human and planetary impacts of following such diets have not been tested.

Objective: The aim of this study was to assess health and environmental outcomes related to following whole-diet sustainable dietary advice.

Methods: The MyPlanetDiet RCT was a 12-week single-blinded, parallel study testing the impacts of a more sustainable diet. Participants were randomly assigned to receive personalized advice based on a sustainable diet (intervention) or based on current healthy eating guidelines (control). Dietary assessments, fasted anthropometry, and fasted serum samples were collected at baseline and end point. The primary outcome was change in diet-related greenhouse gas emissions (GHGE) measured in kilograms carbon dioxide equivalents per day (kgCO2-eq/d). Secondary outcomes included changes in diet quality, macronutrient and food group intakes, diet-related water footprint, and health biomarkers. Data were analyzed using 2-way mixed analysis of covariance.

Results:

  • Study participants (n = 292) decreased diet-related GHGE over time (P < 0.001) with a significant time × group interaction between control (from 6.5 ± 0.2 to 5.7 ± 0.2 kgCO2-eq/d) and intervention groups (7.1 ± 0.2 to 4.8 ± 0.1 kgCO2-eq/d; P < 0.001).
  • Diet quality increased in control (from 44.2 ± 0.8 to 52.9 ± 0.9) and intervention (from 44.7 ± 0.8 to 53.0 ± 0.9) groups (P < 0.001).
  • Participants decreased red meat intakes (control: from 34.2 ± 2.9 to 25.7 ± 2.4 g/d; intervention: from 42.7 ± 3.4 to 12.8 ± 1.9 g/d; P < 0.001) and increased plant-based food intakes including beans, peas, and lentils (control: from 15.4 ± 1.9 to 18.3 ± 2.1 g/d; intervention: from 18.4 ± 2.1 to 49.2 ± 4.3 g/d; P < 0.001), fruit (control: from 164.8 ± 12.3 to 264.5 ± 13.9 g/d; intervention: from 188.5 ± 14.2 to 233.7 ± 13.5 g/d; P < 0.001), and vegetables (control: from 148.1 ± 6.5 to 163.1 ± 7.3 g/d; intervention: from 161.3 ± 5.9 to 201.9 ± 8.0 g/d; P < 0.001).
  • No changes in anthropometry, serum biochemistry, or diet-related water footprint were observed.

Conclusions: It is clear that the environmental impact of food systems must be reduced to mitigate the effects of climate change and adhere to global climate targets. Meaningful change will require a full-system approach, which means all actors, including consumers, doing their part for a more sustainable food system. Moving individuals toward more sustainable diets is critical, and our findings address an evidence gap to support this transition. We have shown that it is possible at the consumer level to adopt more sustainable diets. Changes to dietary intakes resulted in decreased diet-related GHGE without compromising health status. Further research is warranted in other populations, for longer intervention periods, or with other outcomes measures (ie, nutrient status). However, our findings add to the literature for what the transition to sustainable diets will look like in the real world. It is important for future FBDGs to consider how to appropriately support individuals to make dietary changes. Our findings show that supporting individuals with personalized nutrition led to dietary change for more sustainable and healthy diets without negative health consequences.

updated 2025 November

Johns Hopkins School of Public Health (website)

The Johns Hopkins Bloomberg School of Public Health is the overarching institution that houses various specialized centers, including the Center for a Livable Future (CLF) and the Center for Planetary Health. There are a myriad of resources to aid and support D-Ns in contributing to SFS within their roles.

  • The Center for a Livable Future, founded in 1996 within the Bloomberg School of Public Health, focuses on applying science and systems thinking to build healthy, equitable, and sustainable food systems through research, education, and policy advocacy. It addresses the interconnections among diet, food production, environment, and human health.
  • The Center for Planetary Health, launched in 2024, accelerates cross-university collaboration in addressing the degradation of Earth’s natural systems and its impacts on human health and well-being. JHIPH’s mission is to catalyze scholarship and practice of Planetary Health by bringing together a community of faculty, students, and staff united by their commitment to work across disciplines to address the urgency of the Earth crisis and its impacts on humanity. One of the four cornerstones for action uses the food system as an example:

Revealing the hidden health costs of environmental destruction with transparent accounting to identify efficient changes—for example, transforming the global food system would cost substantially less than current hidden healthcare impacts.
– From the JHIPH’s four cornerstones for Planetary Health

Some useful resources on planetary health include:

  • The Case for Planetary Health: A million years of biological evolution and thousands of years of social evolution have brought us to this question: Can we change? Listen as Samuel Myers, director of the Johns Hopkins Institute for Planetary Health, explores humanity’s impact on the planet and the need for a new path forward before it’s too late.
  • A Special issue of Hopkins Bloomberg Public Health Magazine, “Our Planet, Our Health,” – The Case for Planetary Health by Samuel Myers, on the choices we make today that will determine whether we have a livable future. The issue explores systemic challenges in food systems related to climate change and nutrition, highlighting research on how environmental changes contribute to hidden hunger and affect public health, and discusses innovative approaches to improving food system resilience, reducing food waste, and ensuring equitable access to nutritious food, emphasizing the interdependence of planetary health and human nutrition.
  • Nourishing the Future: Sustainable Food Systems for Nutrition and Dietetic Students (partially done 2026 January) – Together with Food + Planet, they are working on developing a set of learning modules to inspire and equip the next generation of registered dietitian nutritionists to become advocates for sustainable food systems. These modules offer a comprehensive overview of food systems as they relate to sustainability and public health, with a strong emphasis on nutrition. Designed for students in dietetic internships and coordinated programs, these evidence-based modules provide well-rounded training that addresses the complex, interconnected aspects of sustainable diets—including human health, sociocultural factors, and environmental impact. Each module includes a set of slides with notes, case studies, discussion questions, and additional resources.
    • Module 1: Introduction to Sustainable Food Systems
    • Module 2: Food Systems for All (available January 2026)
    • Module 3: Food and our Climate (available February 2026)
    • Module 4: Aquatic Foods, Nutrition, and Sustainability (available March 2026)

updated 2025 December