Oral nutritional supplements – a packaging minefield

31 Aug 2023
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Ruth Chalke, a specialist prescribing support dietitian in London, explains the challenges in improving sustainability in packaging for oral nutritional supplements, in this month’s Dietetics Today.

As we continue our Sustainable September campaign, we explore some of her findings and what they mean for dietitians and manufacturers. You can read her full article, with all her findings in Dietetics Today here.

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Of the numerous environmental factors impacting climate change, plastic pollution is one of the most pressing issues. But it can all feel cripplingly overwhelming.

Having worked in upper GI surgery for five years, I made the move into prescribing support in early 2022. Working across London, I quickly realised the scale of oral nutritional supplement (ONS) prescribing, not only in terms of cost to the NHS, but also in terms of environmental impact.

Recognising the role these products play in improving nutritional status for some patients, I wanted to get a handle on the impact they might be having on the planet. As a whole, ONS includes both the powder or liquid component, and the packaging. While the content of these products needs addressing with the medical nutrition companies and through further research, I started by setting out to understand both how to recycle ONS packaging and how to educate others to do the same.

The materials used to produce bottles, pots, cups and sachets and the correlating hard lids, peelable lids or seals often vary between manufacturers. This is reflected in the plastic resin IDs, which you will sometimes notice on packaging and which categorise plastic into ‘types’ to ensure consistency in manufacturing and recycling ability.

While users and prescribers of ONS may presume the vital information to consider is whether a product is recyclable or not, to take a holistic approach, we must consider the life cycle analysis (LCA) of products. This standardised approach tracks a product from production through to end-of-life, and measures every stage of the journey from extraction and processing of raw materials, designing and producing the product, packaging and distributing it, its use and re-use, through to disposal (recycling vs. incineration or landfill).

Every product, regardless of material composition, has an effect on the environment. The responsible thing to do, and what all manufacturers have an obligation to do, is carefully consider all the steps that lead from raw materials through manufacture, distribution and usage, to final disposal.

An example of where the sustainability of a material is perhaps not what it first seems is the use of plastic bottles vs. liquid cartons.

A number of medical nutrition companies are making the move away from plastic bottles made from high density polyethylene (HDPE) or polyethylene terephthalate (PET), towards cartons made from card but with a plastic polythene laminate and sometimes aluminium layer to provide an oxygen barrier (to make it suitable for storing liquids). These cartons are promoted as more environmentally friendly, but currently only 68% of Local Authorities (LA) will collect them, and there are subsequently significant challenges due to the collection methods of the LA.

Conversely, food-grade plastic bottles (HDPE/PET) of which most ONS bottles are made, are collected by 100% of LAs and can easily be sorted for recycling, regardless of the collection method used. Further, the demand for food grade recyclate (to produce more bottles/products) is high, making the recycling of HDPE/PET more effective.

Infrastructure to support the recyclability of liquid cartons is paramount as it would provide a recycling stream for this commonly, and increasingly frequently, used packaging, but when (and if) this will become available is unknown.

What does this mean in terms of our daily practice, the choices we make regarding recommending ONS products, and the advice we give our patients?

As dietitians, we are uniquely placed to provide nutritional advice that is not only scientifically-grounded and patient-centric, but also planet-protective.

For our community-based patients, as well as inpatients and staff at ward level, we should be educating on the correct disposal of ONS products:

  • Discard the seals under the lids of plastic ONS bottles
  • Wash out the ONS bottles, squash the bottle and screw the lid back on - this helps the recycling processing machines detect and sort the bottles into the correct stream
  • Remove the labels from bottles and collect with other ‘soft plastics’, to be taken to a front-of-store supermarket collection points. Also included here would be any recyclable ONS sachets (check the packaging).

It is worth keeping abreast of developments with regards to recyclability of sachets for powdered supplements, as some of the key medical nutrition companies for these products are already seeking recyclable options, which would further enhance their LCA.

A call to action

The BDA Sustainable Diets Group Committee has written to all the medical nutrition companies concerned to request that they commit to the following six standards:

  1. Subscribe to on-packet recycling labels (OPRL.org.uk) in order to join the majority of retailers in providing simple guidance to patients, carers and staff
  2. Promote the recyclability and correct disposal of their products
  3. Become members of The UK Plastics Pact, to ensure they are part of the movement to generate a fundamental change in the way we design, produce, use, re-use, dispose of and reprocess plastics, thereby creating a circular economy for plastics.
  4. Introduce recycled content into their packaging, and promote closed-loop recycling, which reduces the overall climate impact
  5. Educate staff on the materials and recyclability of their product (it took months of emails between myself, the companies and their suppliers just to clarify which elements of their products are recyclable, and with what degree of ease. This information was not widely known or understood, and it should be paramount that employees are knowledgeable about their products that have an impact on planetary health)
  6. Declare their company’s sustainability policy and roadmap to net zero along with the full LCA of their products, and educate dietitians on them

Together we have huge potential to have a positive environmental impact through the choices we make, the advice we give, and the determination with which we call the manufacturers of ONS (and enteral) products to account.

The BDA Sustainable Diets Group's new mission is ‘to help all dietitians to embed sustainability across nutrition and dietetic practice’. They are keen to hear from anyone who is embedding sustainability into their practice. If you are active, I encourage you to be in touch and share your experience with the committee at [email protected].