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

A conceptual framework for understanding the environmental impacts of ultra-processed foods and implications for sustainable food systems (2022)

K. Anastasiou, P. Baker, M. Hadjikakou, G.A. Hendrie, M. Lawrence. A conceptual framework for understanding the environmental impacts of ultra-processed foods and implications for sustainable food systems. Journal of Cleaner Production. Volume 368, 2022, 133155, ISSN 0959-6526, https://doi.org/10.1016/j.jclepro.2022.133155 (paywall).

Relevant to: 

Dietitians interested in understanding the environmental impacts of UPFs.

Question: 

Research aim: to determine the types of environmental impacts resulting from each stage of UPF production, and the magnitude of these impacts in the context of dietary consumption patterns

Bottom line for nutrition practice: 

  • The findings highlight that environmental degradation associated with UPFs is of significant concern due to the substantial resources used in the production and processing of such products, and also because UPFs are superfluous to basic human needs.

Abstract: 

  • Minimising environmental impacts and prioritising the production of nutritious foods are essential qualities of a sustainable food system. Ultra-processed foods (UFPs) are potentially counterproductive to these objectives.
  • This review aims to summarise the magnitude and types of environmental impacts resulting from each stage of the UPF supply chain and to develop a conceptual framework to display these impacts. It also aims to identify the terms used to describe UPFs in the sustainability literature, and the methods used to measure the associated environmental impacts.
  • A narrative review approach with a systematic search strategy was used. Fifty-two studies were included that either described or quantified the environmental impacts of UPFs.
  • This review found that UPFs are responsible for significant diet-related environmental impacts.
    • Included studies reported that UPFs accounted for between 17 and 39% of total diet-related energy use, 36–45% of total diet-related biodiversity loss, up to one-third of total diet-related greenhouse gas emissions, land use and food waste and up to one-quarter of total diet-related water-use among adults in a range of high-income countries.
    • These results varied depending on the scope of the term used to describe UPFs, stages of the lifecycle included in the analyses and country.
    • Studies also identified that UPF production and consumption has impacts on land degradation, herbicide use, eutrophication and packaging use, although these impacts were not quantified in relation to dietary contribution.
  • The findings highlight that environmental degradation associated with UPFs is of significant concern due to the substantial resources used in the production and processing of such products, and also because UPFs are superfluous to basic human needs.
  • The conceptual framework and findings presented can be used to inform food policy and dietary guideline development, as well as provide recommendations for future research.

Details of results: 

From a resource-use perspective, UPFs are not a necessary component of diets and therefore environmental impacts are avoidable. Environmental impacts from UPFs occur across the entire supply chain. These impacts range in magnitude, but research on Australian discretionary food consumption indicates that they are significant; approximately one-third of diet-related energy, greenhouse gas emissions, land use, and water use was driven by the production of discretionary foods in Australia.

UPFs reliance on low-cost, high-yield commodities is a driver of diet-related greenhouse gas emissions and biodiversity loss, intensive processing technologies is a driver of diet-related energy use and reliance on packaging drives plastic pollution.

Meat-based UPFs appear to be significant drivers of UPF-related greenhouse gas emissions. Plant-based UPFs also contribute to greenhouse gas emissions but their impacts on biodiversity and deforestation are perhaps more concerning.

Of additional interest: 

The ways in which foods were classified in the original research articles influenced study findings. This highlights the importance of considering the most relevant food classification system, and the potential impacts of the classification on the findings. Specifically, some outcomes, such as greenhouse gas emissions and land use, appeared to be driven by whether or not studies included processed meats in their ‘unhealthy food’ category.None

Conflict of interest/ Funding:  

none

External relevant links:  

Ultra-processed foods should be central to global food systems dialogue and action on biodiversity (2022) – The contribution of ultra-processed foods to agrobiodiversity loss is significant, but so far has been overlooked in global food systems summits, biodiversity conventions and climate change conferences. Ultra-processed foods need to be given urgent and high priority in the agendas of such meetings, and policies and action agreed. 

Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation (2020) – This study assessed the intake of ultra-processed foods (UPFs) and unprocessed foods within a group of meat eaters and vegetarians (pesco-vegetarians, vegetarians, and vegans) in France.

Corresponding author: 

Kim Anastasiou, Ms, kim.anastasiou@adelaide.edu.au

Conceptualising the drivers of ultra-processed food production and consumption and their environmental impacts: A group model-building exercise (2023)

Kim Anastasiou, Phillip Baker, Gilly A. Hendrie, Michalis Hadjikakou, Sinead Boylan, Abhishek Chaudhary, Michael Clark, Fabrice A.J. DeClerck, Jessica Fanzo, Anthony Fardet, Fernanda Helena Marrocos Leite, Daniel Mason-D’Croz, Rob Percival, Christian Reynolds, Mark Lawrence. Conceptualising the drivers of ultra-processed food production and consumption and their environmental impacts: A group model-building exercise. Global Food Security, Volume 37, 2023, 100688, ISSN 2211-9124. https://doi.org/10.1016/j.gfs.2023.100688 (paywall)

Relevant to: 

Policy makers and dietitians interested in system-wide policy change.

Question: 

This study aimed to develop and validate a conceptual model of the known and potential environmental impacts across ultra-processed food (UPF) systems.

Bottom line for nutrition practice: 

  • UPFs are associated with a wide range of environmental harms, driven by a profit-based, corporatized food system and enforced by product design and a food environment structured to encourage UPF consumption. Effectively reducing UPF production and consumption would require a suite of policies acting on the political economy, food environment and production system.

Abstract: 

  • Using group model building we developed a series of causal loop diagrams identifying the environmental impacts of ultra-processed food (UPF) systems, and underlying system drivers, which was subsequently validated against the peer-reviewed literature.
  • The final conceptual model displays the commercial, biological and social drivers of the UPF system, and the impacts on environmental sub-systems including climate, land, water and waste. It displays complex interactions between various environmental impacts, demonstrating how changes to one component of the system could have flow-on effects on other components. Trade-offs and uncertainties are discussed.
  • The model has a wide range of applications including informing the design of quantitative analyses, identifying research gaps and potential policy trade-offs resulting from a reduction of ultra-processed food production and consumption.

Details of results: 

There are a range of mechanisms by which UPFs harm the environment. Impacts do not occur in isolation and many are cumulative, whereby one type of environmental damage acts to further degrade other forms of environmental damage. Impacts include climate change, land and soil degradation, water scarcity, biodiversity and agrobiodiversity loss, eutrophication, food loss and waste, plastic waste and air pollution.

Drivers of environmental degradation include a political economy system which acts to reinforce profits of UPF corporations, drive corporate political power and ultimately weaken protective food policies. Other drivers include product design, whereby UPFs are designed to be as palatable as possible and a food environment which enables access to inexpensive UPFs around the globe.

Ultimately a shift in production is required to meet the goals of healthy, sustainable and equitable food systems. However, policies which encourage a shift away from UPF production towards unprocessed, minimally processed and processed foods, need to account for trade-offs. Trade-offs relate to production efficiency, time pressures, food loss and waste, land use, cost and convenience (see Table 1).

Of additional interest: 

The model highlights research gaps which could be used by future researchers to determine UPF-related research studies. Furthermore, the model can be used to guide researchers on designing quantitative environmental impact assessments, as well as to provide a guide for interpreting quantitative findings in the context of complex and dynamic food systems.

Conflict of interest/ Funding:  

This research received no specific grant from any funding agency, commercial or not-for-profit sectors. KA was funded by a Deakin University Postgraduate Research Scholarship.

External relevant links:  

Ultra-processed foods should be central to global food systems dialogue and action on biodiversity (2022) – The contribution of ultra-processed foods to agrobiodiversity loss is significant, but so far has been overlooked in global food systems summits, biodiversity conventions and climate change conferences. Ultra-processed foods need to be given urgent and high priority in the agendas of such meetings, and policies and action agreed.

Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation (2020) – This study assessed the intake of ultra-processed foods (UPFs) and unprocessed foods within a group of meat eaters and vegetarians (pesco-vegetarians, vegetarians, and vegans) in France.

Corresponding author: 

Kim Anastasiou, Ms – kim.anastasiou@adelaide.edu.au

Food environment framework in low- and middle-income countries – An integrative review (2023 Dec)

Neha Gupta, Vaishali Deshmukh, Sonika Verma, Seema Puri, Nikhil Tandon, Narendra K. Arora. Food environment framework in low- and middle-income countries – An integrative review. Global Food Security. Volume 39. 2023. 100716. ISSN 2211-9124. https://doi.org/10.1016/j.gfs.2023.100716. (pay wall)

Relevant to: 

Researchers from multidisciplinary domains, policy makers, program managers

Question: 

The integrative review addressed the following objectives: (1) to develop a multi-level framework of Food Environments (FE) for low- and middle-income countries (LMICs) based on McLeroy socio ecological theory and Penchansky and Thomas’s theory of access; (2) to identify the factors operating at different levels of the FE framework; and (3) to understand the relationship between factors operating at different levels of FE framework and dietary behaviors in LMICs.

Bottom line for nutrition practice: 

  • Food environment embedded in the food systems is a key consideration in sustainability. This study finds that the food environments in LMICs are in a dynamic state and have context specific mix of traditional systems and emerging modern supply chain-based markets.
  • The proposed socio-ecological model of the food environment in the context of LMICs should lay the foundation for an operational and analytical tool for surveillance, capturing dynamicity and its determinants.

Abstract: 

  • There are major gaps in our understanding of food environments (FE) in low-and middle-income countries (LMICs) witnessing differential and complex social and economic transition. The present integrative review was conducted to develop a conceptual framework of FE for LMICs using socio-ecological and access theory. The FE framework has four layers: public policy, community/neighborhood (including organizational e.g., markets, schools), household, and individual. Availability, accessibility, and affordability with built-in socio-cultural and contextual factors were the major domains in every layer. The following additional domains emerged: global influences, marketing and regulation, nutrition programs, time-constrained family members, and food behavior. Wet and informal markets are important components of FE. The next step is determining the model’s resilience to accommodate and capture nuances across LMICs.

Details of results: 

  • The integrative review included evidence from 28 studies about food environment in low and middle-income countries in the last two decades.
  • The review used McLeroy’s socio-ecological model and Penchansky’s access theory as the basis for identifying the socio-economic and ecological factors operating at multiple levels in the LMIC food environment that influence dietary outcomes.
  • The factors were operating at (i) policy, (ii) community, (iii) household, and (iv) individual levels under the availability, affordability, and accessibility domains at each level are interwoven among themselves
  • The review identified that context and neighborhood characteristics characterise the food environment. In addition, the unorganized markets comprise of the major component of food environment
  • The evidence synthesis identified the following additional domains at multiple levels: Nutrition programs and global influences (Policy level); marketing and regulations (policy and neighborhood level); and time constraint and food behavior (household level).

Of additional interest: 

n/a

Conflict of interest/ Funding:  

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

External relevant links:  

n/a

Corresponding author: 

Seema Puri, Department of Food and Nutrition, Institute of Home Economics, University of Delhi, New Delhi, India, dr.seemapuri@gmail.com

Environmental imprints of agricultural and livestock produce: a scoping review from South Asian countries (2023 Dec)

Sachdeva B, Puri S, Aeri BT. Environmental imprints of agricultural and livestock produce: a scoping review from South Asian countries. J Hum Nutr Diet. 2023: 1–13. https://doi.org/10.1111/jhn.1323 (pay wall)

Relevant to: 

Medical professionals, nutrition experts, chefs, foodservice procurement

Question: 

The present study explored the role of South Asian food crops and livestock in environmental degradation.

Bottom line for nutrition practice: 

  • A prerequisite for achieving the Sustainable Development Goals is the sustainable food production. Many foods that are healthy for people are healthy for the environment, too. Trained medical professionals and nutrition experts encourage healthy eating. According to the research, nutrition experts in South Asian nations do possess enough understanding about sustainable food systems. Thus, in addition to nutrition education, they can spread the knowledge about food sustainability as well.
  • At the public level, concept of food sustainability can be promoted by chefs or nutritionists who oversee large food establishments and serve maximum population. Providing plant-based, seasonal, varied, and traditional menus, along with reduced portion sizes, could be easy yet effective ways to encourage sustainable diets and decrease food waste.

Abstract: 

  • Background: Global agricultural activities in 2020 produced 5.5 billion tonnes of CO2 equivalent, and this amount is projected to increase since 70% more food would need to be produced in 2050 to feed the world’s population. Food security in South Asian countries is expected to rise due to increased agricultural output, yet it is unclear how their livestock and food crops will affect the environment. The purpose of this review was to evaluate the environmental effects of agricultural activities (pre and post-production) associated with edible food crops and livestock products consumed in eight South Asian nations.
  • Methods: Three databases—PubMed, Google Scholar, and Science Direct—were used to find the studies between 2011 and 2022. There was no registered protocol for this scoping review.
  • Results: The criteria for inclusion were met by twenty-seven studies. Most of the research was done in India. The assessment of greenhouse gas emissions was reported in twenty-four papers followed by water footprints (n = 5), emissions of nitrogen and phosphorus (n = 4), and land requirements (n = 4).A major source of greenhouse gas emissions has been found to be the cultivation of wheat and rice. It has been reported that the production of livestock (meat, dairy, prawns, and bovine) in Bangladesh, India, and Sri Lanka has also a negative impact on the environmental. For other environment variables, inconclusive data were obtained.
  • Conclusions: Growing more coarse cereals (millets) and diversifying the food production are the requisite steps to reduce the GHG emissions. However, to corroborate the current analysis, further long-term studies for South Asian nations are necessary.

Details of results: 

  • A total of twenty-seven screened studies met the scoping review’s eligibility and were included in the final analysis. Selected research articles discussed the impact of livestock and/or food production on various environmental parameters.
  • With the help of this review, information about various environmental effects of pre- and post-production activities pertaining to food crops and livestock products in South Asian nations was gathered. In accordance with the World Bank’s classification, eight South Asian nations—India, Afghanistan, Sri Lanka, Bangladesh, Nepal, Bhutan, and Pakistan—were taken into consideration.
  • It was observed that greenhouse gas emissions were the most often researched environmental impact worldwide. Retrieved data on land requirements, water footprints, and nitrogen.
  • Understanding a nation’s food production and consumption pattern is essential to ensure food sustainability. Research indicates that due to globalisation there has been a nutrition transition in South Asian countries.
  • Refined products, high fat, high sugar and animal-based food which are consumed more frequently are considered harmful for the environment. Diversifying one’s diet is recommended at the individual level in all six countries. This includes consuming a range of grains and substituting millets (bajra, ragi, and sorghum) for rice/wheat and plant based milk (almond milk for dairy or animal products.

Of additional interest: 

Conflict of interest/ Funding:  

The authors declare that there are no conflicts of interest.

Corresponding author: 

Seema Puri, Department of Food and Nutrition, Institute of Home Economics, University of Delhi, New Delhi, India, dr.seemapuri@gmail.com

Optimizing sustainable, affordable, and healthy diets and estimating the impact of plant-based substitutes to milk and meat: A case study in Spain (2023 Sep)

Muñoz-Martínez, J., Abejón Elías R., Batlle-Bayer, L., Cussó-Parcerisas, I., Carrillo-Álvarez, E. (2023) Optimizing sustainable, affordable and healthy diets and estimating the impact of plant-based substitutes to milk and meat: A case study in Spain. Journal of Cleaner Production. Volume 424. https://doi.org/10.1016/j.jclepro.2023.138775. (paid access)

Relevant to: 

Dietitians and public health nutritionists, Health care professionals, Policy makers

Question: 

How is an environmentally sustainable, affordable, culturally acceptable, and nutritious diet determined in Spain? What is the sustainability of current Food-Based Dietary Guidelines (FBDG)? How much can we rely on plant-based milk and plant-based meat from a sustainability perspective ?

Bottom line for nutrition practice: 

  • It is paramount to evaluate the sustainability of diets from a holistic and context-based perspective. Our analysis revealed that although the Spanish FBDG have lower Greenhouse Gas emissions (GHGe) than current diets, they are more blue-water demanding and also more expensive due to the high content in plant-based foods.
  • We were able to determine a nutritious diet with the lowest environmental impact and lowest cost, but results revealed the need to apply actions at systems level to enable more environmentally respectful production practices, and make healthy foods more affordable.
  • Processed plant-based meat alternatives are not required to achieve a sustainable and healthy diet.

Abstract: 

  • The global food system is failing to appropriately nourish the population and has been identified as a driving force for environmental degradation. Changing current diets to healthier and more sustainable ones is key to decrease the incidence of non-communicable diseases and force changes at the production stage that will release environmental pressure. The determination of such diets is a challenge since it should be context specific, culturally acceptable, affordable, nutritionally adequate, and environmentally friendly.
  • Through multiobjective optimization we aimed to determine a sustainable and healthy diet (SHD) in Spain with the minimum cost and environmental impact (assessed through GHGe, land use and blue-water use) that deviate the least from current consumption. Additionally, this research also compares the optimised diet with the Spanish food-based dietary guidelines (FBDG), and explores the potential benefits of reducing animal meat and milk while replacing them with plant-based alternatives. Compared to current consumption, a SHD in Spain can be more nutritious and reduce cost, GHGe, land and blue-water use by 32%, 46%, 27%, and 41%, respectively.
  • The Spanish intake displayed the worst nutritional assessment and the highest values for GHGe and land use. The Spanish FBDG showed the highest cost and blue-water usage. Further analysis revealed that plant-based meat alternatives are not necessary to achieve a nutritionally adequate diet at the minimum cost and environmental impact. Shifting to fortified plant-based milk alternatives may add additional environmental benefits.
  • This work emphasizes the potentiality of using optimization to determine a SHD and identifies important gaps to be fulfilled in future research.

Details of results: 

  • Compared to the Spanish intake, a nutritionally adequate sustainable and healthy diet can be 1.61 € cheaper, reduce GHGe by 2.33 kgCO2eq, land use by 1.5 m2, and blue water use by 156 L. 
  • The Spanish FBDG basket was the most expensive and blue water demanding, mainly explained by the high content of fruits and vegetables. 
  • The Spanish intake showed the lowest nutritional index and the highest GHG and land footprint due to the high content of animal protein.

Of additional interest: 

Conflict of interest/ Funding:  

None

Corresponding author: 

Júlia Muñoz Martínez, juliamm1@blanquerna.url.edu

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

How do dietetics students learn about sustainability? A scoping review (2023)

McCormack, J., Rutherford, S., Ross, L. J., Noble, C., & Bialocerkowski, A. (2023). How do dietetics students learn about sustainability? A scoping review. Nutrition & Dietetics. https://doi.org/10.1111/1747-0080.12795

Link to the article

Open Access: https://onlinelibrary.wiley.com/doi/epdf/10.1111/1747-0080.12795

Relevant to:

Dietetic Educators, Dietitians, Dietetic Students

Questions the research focuses on:

  1. What teaching approaches and evaluation strategies have been used to underpin the learning activities focused on sustainability in dietetics entry-level curricula?
  2. What are the learning outcomes of these activities based on the Kirkpatrick-Barr framework?
  3. Have the UNESCO and Commonwealth Secretariat recommendations translated into the delivery of sustainability content in nutrition and dietetics entry-level curricula based on articles published since their development?

Bottom line for nutrition practice:

Despite increasing discussion about the role of dietitians in supporting sustainable food systems, effective integration into dietetics curricula is understudied. Without clear competencies and guidance, educators are doing this ad hoc. More guidance is needed. Some evidence points to the importance of experiential learning, and scaffolded learning about SFS through integration into a number of different courses.

Abstract:

Aim: Globally, sustainability and planetary health are emerging as areas of critical importance. In 2015, the 2030 Agenda for Sustainable Development was adopted by the United Nations member states. Since then, the United Nations Educational, Scientific and Cultural Organization and the Commonwealth Secretariat have published guidelines for educators to embed sustainability content into curricula. This scoping review aims to identify how student dietitians learn about sustainability, how learning opportunities are evaluated, their outcomes, and whether these guidelines have translated into teaching activities contained in dietetic degrees.

Methods: A scoping review was used to address the aims. Eight electronic databases and Google Scholar were searched from inception to March 2022 for articles describing dietetics students’ participation in learning activities focused on sustainability. Data that addressed the research aims were charted independently by two researchers, then narratively synthesized.

Results: Twelve articles met the inclusion criteria. A range of teaching approaches and evaluation methods were used, from passive learning in lectures to experiential learning activities. A change in knowledge or behaviour was found for experiential learning activities (n = 5). For articles published after 2015 (n = 9), two mentioned the Sustainable Development Goals and no articles referenced the published guidelines.

Conclusions: A paucity of evidence exists describing how dietetics students learn about sustainability and their learning outcomes. Of the 12 articles published, varied teaching approaches and evaluation methods have resulted in inconsistencies in the reporting of outcomes. The minimal reference to the Sustainable Development Goals and published guidelines suggests a slow translation of knowledge to practice.

Details of results:

  • The database search yielded 1363 unique items. A total of 12 articles met the inclusion criteria and were therefore included in this scoping review. With 12 articles found, each used a unique method. This variety in both the teaching approach and evaluation makes it difficult for dietetics educators to choose an approach that maximizes the knowledge and skills attained by students.
  • Given the drive to upskill both students and dietitians alike in this critical area of practice, longer-term outcomes should be measured. Arguably, the depth and complexity of the knowledge required to develop dietetics students who are competent in this area cannot be taught in one course and requires the development of knowledge and skills to occur over a longer time period. This aligns with recommendations made by UNESCO and the Commonwealth Secretariate that suggest scaffolding content across multiple courses to develop key competencies. UNESCO recommends that educators embed an action-oriented, transformative pedagogy, that is scaffolded across the curriculum, and not contained in a stand-alone course.
  • Based on this review, only three articles referred to the Sustainable Development Goals, and no articles referred to the UNESCO or Commonwealth Secretariat Guidelines.
  • Without clear competencies from professional bodies and guidance on what to include in the curriculum, academics with an interest in sustainability may add content only when necessary.
  • Based on this review of peer-reviewed and grey literature, there is limited literature to describe how student dietitians are learning about sustainability within their dietetics education programs. The variable teaching approaches and evaluation methods used have resulted in inconsistencies in the reporting of outcomes, and the minimal reference to the Sustainable Development Goals and other published guidelines suggests a slow translation of knowledge to practice in the higher education setting.

Of additional interest: 

Conflict of interest/ funding:

Open access publishing facilitated by Griffith University, as part of the Wiley – Griffith University agreement via the Council of Australian University Librarians. The authors declare no conflicts of interests.

Corresponding author:

Joanna McCormack, Accredited Practising Dietitian (APD) j.mccormack@griffith.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