Sustainable Diets – a toolkit for dietitians

by BDA Partnerships Officer, Jo Lewis.

Sustainable diets have been considered in most national dietary guidelines globally, including the UK (1-6 see references below). The dietary recommendations demand a shift in consumer behaviour to include significantly more healthy plant foods whilst reducing the consumption of meat and animal products (7,8).

The BDA wants to ensure that dietitians lead on UK dietary changes. It has a specialist Plant-based Nutrition Group within the BDA Public Health Specialist Group and recently published its Policy Statement on Sustainable Diets with a clear call to action to all dietitians to become involved (9). To support this, the BDA is developing a Sustainable Diets Toolkit for members. This article reports on findings from recent quantitative and qualitative surveys undertaken with dietitians which will feed into its content.

Why Sustainability Matters

• There is a high environmental cost of our current food system (production, distribution, delivery and waste) – contributes 20-30% of greenhouse gas emissions; is the leading cause of deforestation and biodiversity loss; pollutes soils and water; and accounts for 70% of all human water use.
• 30–50% of all food produced is spoiled or wasted – representing a waste of land, water and other inputs, ‘unnecessary’ emissions, and contributing to food insecurity.
• Despite current food production being adequate to meet the needs of the seven billion global population, two billion exceed their needs whilst 800 million suffer hunger.

The Role of The Eatwell Guide

Despite lack of consensus or formal definition, a ‘sustainable diet’ focuses on a dietary pattern that is predominantly based on (healthy) plant foods whilst consumption of meat and animal produce is reduced (7-9). The predominantly plant-based Eatwell Guide (over 80% food weight from plant foods) has the potential to reduce our environmental footprint by almost a third (11-12). Concerns have arisen with regard to the practicality and micronutrient adequacy of such a dietary regimen, however, extensive reviews of the literature confirms that a sustainable diet does not need to be devoid of animal foods and is nutritionally replete (4, 8, 11).

Motivating the UK Popluation

So, how do we motivate 99% of the UK population to adopt the Eatwell Guide? A review of the National Diet and Nutrition Survey data identified that only 1% of the population managed to adhere to the previous UK dietary guidelines, the Eatwell Guide (13). This leaves dietitians with a significant challenge to help drive the majority of the population towards a healthier, more sustainable eating pattern.

Dietitians’ Thoughts on Sustainable Diets

The BDA toolkit will provide dietitians with the scientific knowledge – as well as the practical tools – to empower themselves and consumers to adopt a sustainable eating pattern. To gain insights from members, the BDA undertook an online survey with corporate member Alpro (319 dietitians), a workshop at the recent March BDA Live event (70 dietitians), and a focus group – again with Alpro (8 dietitians). From this, the BDA compiled a list of top barriers and key motivators.

Dietitians’ Top Barriers

1. Lack of practical ‘how to’ knowledge/resources – this was top of the list, noted as a lack, in particular, of training for dietitians and other health professionals and in the curriculum as well as consumers’ lack of practical skills such as meal planning, budgeting and cooking. Equally important from all of these focus groups/surveys was placing this on the school curriculum.
2.  Time constraints, convenience and taste perceptions – these were additional consumer barriers. 3. Environment – the imbalance of predominantly plant-foods to predominantly animal food availability from retailers, restaurants, take-aways etc.
3. Relevancy – for different population groups and tone of voice used. Teenagers were seen as a challenging but key population group to influence.
4. Additionally, cultural differences needed to be accommodated. Many felt the current tone of voice was relevant to the affluent groups.
5. Lack of clarity and consensus – the lack of consensus on what a ‘sustainable diet’ actually means, its association with vegan or vegetarian diets and the mixed messaging for consumers. Dietitians were particularly perplexed by the discrepancy between sustainable and healthy eating recommendations with regard to:

Fish recommendations – our fishing practices are unsustainable and need to be reduced, our healthy eating messages are to consume more fish and our current intakes are negligible (less than one serving of fish a week), so what should the recommendation be? And what will be the consequences for long-chain omega-3 intakes and heart health?

Processed foods – most definitions of sustainable diets recommend avoidance of processed foods to the same extent as high fat, salt and/or sugary foods. We will need to carefully discuss this as there are healthy processed foods which can support positive dietary change (e.g. tinned pulses). 6. Concerns about nutritional adequacy – many dietitians and consumers are concerned that a sustainable (plant-based) diet places individuals at risk of deficiency for some key micronutrients and protein. The evidence-based Eatwell Guide and international recommendations demonstrate that a healthy sustainable diet that is predominantly based on plant foods is not only nutritionally complete, but produces significantly better health outcomes ( 4, 8, 11, 14, 15, 16, 17)

Dietitians’ Key Motivators

1. Changing the environment and multi-organisation involvement – improving the availability of sustainable and healthier foods by developing integrated multi-organisation sustainable polices with government, local authorities, farmers, local producers as well as NGOs such as food banks and commercial companies.

2. Improving education and knowledge for health professionals/consumers – a strong focus for under and postgraduate dietetic training on sustainable diets as well as placing sustainable diets on the school curriculum, practical skills as well as education.

3. Clear and simple language – making sustainable diets easier to understand and gaining a consensus.

4. Relevancy – ensuring that messages are relevant for different population groups especially teenagers and accommodating different cultures. Use of social media was highlighted.

What Dietitians Would Like from The BDA Toolkit

• Keep it visual and keep it simple – popular everyday meal swaps were, by far, the top practical tip of choice for dietitians (prompted and unprompted).
•  Keep it real and adapt the tone of voice – using every-day foods and meals.
• Top practical skills to accommodate were cooking skills as well as: menu and cost/budgeting planners (demonstrating that sustainable diets are cost effective and providing weekly/monthly meal plans to accommodate different budgets); recipes/recipe cards; tips for vulnerable groups (e.g. under fives, pregnant women, elderly etc.); healthy options when eating out of home; convenience foods e.g. ready meals.
• Clear messaging that sustainable/plant-based diets do not necessarily mean veganism or vegetarianism – also stating the benefits for individuals; how plant foods can provide key micronutrients (various plant food options for key micronutrients such as iron and iodine); strategies for animal to plant-based nutritionally equivalent food swaps to offer choice to the public.
•  The Eatwell Guide – should be used as this has been extensively researched to be both a sustainable eating regimen as well as meeting all nutritional needs.
• Community led.
• Single, trusted point of access for all material.
• Teaching materials/online could include the above as well as other themes such as animal welfare; waste; seasonality; local produce.

What Sort of Information Should the Toolkit Provide?

Using these insights, the BDA is now working towards formulating the toolkit, which should be ready in the last quarter of this year.

References:

1. FAO. Food-based dietary guidelines - Belgium. FAO. Accessed January 18, 2018.

2. Government of Canada. Food guide consultation - Guiding principles. Government of Canada. April 5, 2017. Accessed January 18, 2018.

3. Kromhout D, Spaaij C, de Goede J, Weggemans R. The 2015 Dutch foodbased dietary guidelines. Eur J Clin Nutr. August 2016;70(8):869-878.

4. PHE. Guidance: The Eatwell Guide. Gov. UK. March 17, 2016. Accessed March 2017.

5. WCRF International. Cancer Prevention and Survival. Summary of global evidence on diet, weight, physical activity and what increases or decreases your risk of cancer. London: WCRF International; 2016. Continuous Update Project.

6. WHO Europe. Health Topics - Disease Prevention - Nutrition - A Healthy Lifestyle. WHO Europe. Accessed January 18, 2018.

7. Burlingame B, Dernini S, Nutrition and Consumer Protection Division, FAO. Sustainable diets and biodiversity directions and solutions for policy, research and action. Proceedings of the International Scientific Symposium Biodiversity & Sustainable Diets United Against Hunger Nov 2010. Rome: FAO; 2012. Sustainable diets and biodiversity directions and solutions for policy, research and action.

8. Garnett T. What is a sustainable healthy diet? A discussion paper: Food Climate Research Network; 2014.

9. British Dietetic Association (BDA). Policy statement: sustainable diets. British Dietetic Association. November 2017. Accessed March 23, 2018.

10. FCRN. Why food and climate? FCRN (The Food Climate Research Network). Accessed March 22, 2018.

11. Scarborough P, Allender S, Clarke D, et. al. Modelling the health impact of environmentally sustainable dietary scenarios in the UK. Eur J Clin Nutri. 2012;66:710-715.

12. Carbon Trust. The Eatwell Guide: a more sustainable diet: methodology and results summary. 2016. Accessed March 22, 2018.

13. Harland J, Buttriss J, Gibson S. Achieving eatwell plate recommendations: is this a route to improving both sustainability and healthy eating? 2012;37(4):324–343.

14. Barnard N, Levin S, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. 2015;115(6):954-69.

15. Sabaté J, Wien M. Vegetarian diets and childhood obesity prevention. Am J Clin Nutr. 2010;91(5):1525S-1529S.

16. Satija A, Bhupathiraju S, Spiegelman D. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. J Am Coll Cardiol. 2017; 70:411–22.

17. Sacks F, Lichtenstein A, Wu J. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. July 2017; 136(3):e1-e23