Sustainable eating: how Allied Health Professionals can reduce the environmental impact of food and diet

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“What, and how much we eat directly affects what, and how much is produced. We therefore need to consume more ‘sustainable diets’ – diets that have lower environmental impacts and are healthier” (Garnett, 2014)

As a dietitian, one of my main roles is to utilise the most up to date scientific evidence on food, health and disease and translate this in to practical guidance to enable people to make appropriate lifestyle and food choices. I firmly believe that this needs to be done with both human and planetary health in mind. I have been working for a number of years as a passionate ‘sustainable diets’ advocate, supporting this agenda and the vital role dietitians can play to promote environmentally sustainable diets in their practice (see BDA 2018; BDA 2021).

But it is not just dietitians that have a role to play in this agenda! All Allied Health Professionals (AHPs) need to be prepared for a future where many aspects of healthcare practice are likely to be affected by climate change, water and land shortage, as well as other pressing food system challenges. With our diverse skillset and competencies, AHPs are very well positioned to contribute to this agenda at multiple levels – by altering our individual behaviours and professional practice; by influencing our workplace and community; by role modelling, collaborating and catalysing change; by amplifying our voices to spearhead system and policy level transformation.

I have been privileged to be involved with the development of the Greener AHP hub as a member of the inter-disciplinary steering sub-group who worked on the ‘food and nutrition’ section of the ‘Guide to being a Greener AHP’ with a team of inspiring AHPs. This blog is intended to provide you with some insight into the very complex arena that is ‘Sustainable eating’. I am unable to cover everything in detail here, but will touch on some of the basics and provide signposting to you for further reading and research.

Our broken food (and health) systems

The current food system is unsustainable and ‘distorted by inequalities of access’. More than enough food is generated for the 7 billion population, yet half the global population is malnourished and about 2 billion are deficient in key micronutrients (see Pettinger, 2018). In October 2018, The Lancet published the latest findings from the Global Burden of Disease study, which estimated that 15% of deaths in the UK were attributed to poor dietary habits alone, [i.e. excluding disease states and other disease risk factors] (Lancet, 2019). What we eat costs us twice as much as appears on our shopping bills! For every £1 consumers spend on food additional costs of 97p are incurred*. The resulting ill health (i.e. higher prevalence of chronic non-communicable disease) costs the NHS £6 billion each year (BMA 2016). If unchecked, it is predicted, by 2050, that current dietary trends will cause further significant damage to the environment (e.g. biodiversity loss, increased water footprint and pollution). The implementation of solutions to address the tightly linked ‘diet–environment–health’ trilemma is, therefore, a pressing challenge (Tilman & Clark 2014).

*In total, production-related costs account for an extra 48p for every £1 spent on food, while the costs of diet-related disease account for an extra 39p (Fitzpatrick et al 2019)

‘Sustainable eating’ is a broad and complex issue, which lies at the intersection of public health, environmental health and the business of food (Lang & Barling 2013). Food is a massive industry and the many key players involved have differing interests (Tansey 2015). There is a call for stronger multi-sector leadership in championing a more sustainable and ecological approach to the food system – this presents massive opportunities for AHPs.

The recently published UK National Food Strategy (Dimbleby et al 2021) has stated that the food system of the future must meet the following goals:

Make us well instead of sick
Be resilient enough to withstand global shocks
Help to restore nature and halt climate change so that we hand on a healthier planet to our children
Meet the standards the public expect, on health, environment, and animal welfare

The objectives of the strategy are: (1) to escape the junk food cycle to protect the NHS; (2) to reduce diet-related inequality; (3) to make the best use of our land; (4) to create a long-term shift in our food culture.

The healthcare system in England is responsible for an estimated 4-5% of the country’s carbon footprint (NHS, 2020). A ‘Net Zero NHS’ aims to reduce this, and ensure that our health system contributes towards the national ambition to be carbon neutral by 2050 (DBEI, 2019). The food system of the NHS and the wider health and care systems will be key means of meeting that aim. AHPs, including Dietitians, Occupational Therapists and Speech and Language Therapists, will interact with these systems directly. Other AHPs will interact with different segments of the wider food system. But we all have a role to play...

The environmental impact of food

Production/transportation

There is increasing food demand for the growing human population, from an already challenged food system that is stressed by the degradation of global ecosystems. At a national scale, food and agriculture (including transportation) are estimated to be responsible for between 15 and 30% of UK greenhouse gas emissions (GHGe) (FSA, 2010). The majority of these result from the rearing of livestock for meat, dairy and eggs, which generate 18%-20% of total GHGe (Green et al. 2015). The environmental impact is much greater than that, however (Figure 1), with agriculture a key source of soil degradation, water usage and biodiversity loss across the globe (Garnett et al, 2018). It is therefore widely recognised that we need to transform our food systems at a local, national and (inter)national levels if we are to address the challenge of climate change and meet our targets for Net Zero carbon.

Figure 1 The environmental impact of our UK Food system (BDA, 2018)

We know that different foods have different degrees of environmental impact, with red meat (especially beef), dairy, air-freighted foods, soft drinks and processed foods (ie those high fat, sugar and salt foods) likely to have a greater impact on GHGe than others (Murakami and Livingstone, 2018). We also know (from modelling studies) that if UK diets conformed to healthy eating recommendations, massive GHGe savings could be achieved simply by making realistic modifications to diet with fewer animal proteins and processed snacks and more plant based foods, such as fruit, vegetables, cereals and wholegrains (Green et al, 2015).

Optimising land use for food production, such as reducing the amount of land required for the rearing of meat, would reduce environmental impacts in a range of ways. In order to achieve climate-related targets, and mitigate the harsh effects of climate change, agriculture and food production methods need to change, as well as our dietary intake patterns (Bajzelj et al. 2014; MacDiarmid et al. 2012).

Hospital food waste

According to WRAP (2020) the UK produced around 9.5 million tonnes of food waste in 2018. It is estimated that 70% of this total was intended to be consumed by people (households), the rest classified as ‘inedible parts’. WRAP reported that this waste had a value of over £19 billion a year and would be associated with more than 25 million tonnes of greenhouse gas emissions. It has said that of this waste, 6.4 million tonnes could have been eaten—the equivalent of over 15 billion meals.

In 2013, the UK health system was calculated to have produced 121,000 tonnes of food waste and 49,300 of associated packaging waste. Most of this waste (93%) gets sent to landfill or is disposed of down the drain using macerators. This comes in at a cost of £230 million a year (WRAP 2021). This is likely to be a significant underestimate, however, based on more detailed studies which explore individual geographical locations (e.g. Sonnino and McWilliam, 2011).

All the energy that goes into growing, transporting and preparing a meal is wasted when food is thrown away. Food waste has a detrimental impact on the environment, decomposing food gives off methane (GHGe), which is much more potent than carbon dioxide. Aside from the social, economic and moral implications of food waste - in a the UK over 8 million people struggle to afford to put food on the table, (Taylor and Loopstra, 2016) - the environmental cost of producing all of this food for nothing is staggering. Food that is not eaten also has no nutritional value and is not supporting a patient’s recovery (in the healthcare context). Research has shown that reducing food waste is a key means of addressing the environmental impact of food in health and care settings (Carino et al 2020).

Initiatives to reduce food waste include UK Food Waste Roadmap (a series of milestones for retailers, producers and manufacturers); FareShare (redistributing surplus food to charities) and other local endeavours (eg Love food hate waste).

Food Packaging

Single-use (disposable) plastics are used only once, before being thrown away or recycled. These items include plastic bags, straws, coffee stirrers, and most food packaging. Plastic packaging in the UK accounts for nearly 70% of our plastic waste (WRAP, 2018) much of which relates to the food and drink industries. Food packaging is directly responsible for a range of environmental issues, including overcrowded landfills, greenhouse gas emissions and litter-pollution (on land and in sea). Public awareness is increasing around these associated detrimental issues.

Within the health service, prescribed food or nutrition products (such as Oral Nutrition Supplements) are a significant source of waste, both in terms of packaging and money for health services, when they are inappropriately prescribed. These products are used widely in hospitals, often as a cheap and easy alternative to meeting a patient’s nutritional requirements when malnourished. Furthermore, ‘food contact materials’ (FCMs) play an important role in food services in healthcare to ensure the safe delivery of food to patients and staff. Some harmful substances present in FCM, however, are thought to be toxic and can lead to negative health effects (eg to nervous and endocrine systems) so their use need to be minimised (HCWH, 2021).

Initiatives to tackle the single use plastics agenda include the UK Plastics pact which was launched in the UK in 2018 (with the Ellen MacArthur Foundation). This world leading initiative has been the trailblaizer for a network of global pacts all working towards a circular economy for plastics (WRAP 2018). Similarly, the NHS launched a ‘single-use plastics reduction’ pledge in 2019 to tackle this agenda (NHS 2019; Shelley et al, 2020).

What is a ‘sustainable diet’?

“Eat food, not too much, mostly plants” (Michael Pollan)

There are complexities surrounding definitional aspects of sustainable diets. The FAO/WHO agreed a definition in 2010 that recognised the breadth of considerations to account for these complexities:

“Sustainable Diets are those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy while optimizing natural and human resources.”*

*We must always recorgnise and prioritise health and care needs first. Many AHPs will work with vulnerable patients and a range of communities, and not every approach to sustainability will be appropriate or applicable.

For more detailed information, read the FAO/WHO 2019 Sustainable Healthy Diets Guiding Principles (FAO, 2019).

A sustainable diet can be achieved by reducing meat (red and processed meat in particular) and dairy products in the diet and replacing these with appropriate plant-based proteins, such as beans and pulses, and plant-based dairy alternatives (Green et al 2015). Such sustainable eating habits align with recommendations in the UK’s Eatwell Guide (PHE 2016) and are actively promoted within the British Dietetic Association’s ‘One Blue Dot’ toolkit (BDA 2018) – see figure 2 for One Blue Dot’s healthy and sustainable eating guidelines.

Figure 2. One Blue Dot – healthy and sustainable eating guidelines (BDA, 2018)

How can AHP’s encourage more sustainable practices and food choices?

As AHPs, we are very well positioned to support the sustainable food agenda. There is an inextricable link between our ambitions to improve the public’s health and reduce our carbon impact. By 'making every contact count’, we can carry out positive conversations to promote healthy and sustainable diets*, which can prevent illness and protect health and wellbeing at the same time as supporting our carbon footprint. We can work closely with individuals, families and communities to enable them to make informed food choices.

*We must always recognise and prioritise health and care needs first. Many AHPs will work with vulnerable patients and a range of communities, and not every approach to sustainability will be appropriate or applicable

We might consider the following examples to become more pro-active in this space:

Educating ourselves to improve ‘sustainability literacy’ through attending (and/or delivering) CPD training courses
(Co)delivering education sessions on healthy and sustainable diets – there are many examples available (eg One Blue Dot). Dietitians are perfectly placed to support such sessions.
Cooking (and/or budgeting) groups – to support healthy and sustainable eating. Dietitians, OTs and other creative practitioners can engage with such activities. Good ‘case study’ examples are Let’s Get Cooking; The Joy of Food; Cook and Eat
Protected/assisted meal times for patients - support patients to eat sustainably in order to reduce food waste and improve nutritional status. How about setting up a multidisciplinary group to support a new policy in your healthcare setting
Seasonal produce guides – Many examples are available - why not check out the BDA’s handy seasonal Fruit and veg guide
Meat free Mondays – why not go ‘plant based’ for a day a week? A fun and easy way to do something good for the planet – encourage your catering team to consider this as a menu option
Advocacy for menu re-design, to include locally sourced sustainable food, and review of portion sizes. Menu planning is known to reduce food waste. Dietitians (and other AHPs) can play a role to work with caterers to improve outcomes for nutrition and hydration, which supports sustainable practices. Digital menus are becoming more common place
Sorting food waste - advocate for your local trust to put systems in place (if they do not already) for recycling and composting. Wards have appropriately marked bins for staff and patients to use (compost/plastic recycling/glass recycling etc)
Alternatives to plastic packaging – consider lobbying for alternative supply chains to be used for sourcing products, supplements etc
Growing and gardening activities – Setting up an active green space within healthcare facilities can improve physical activity, mental wellbeing, social interaction, meaningful occupation. These can be a means of acquiring knowledge and skills and seasonal produce. They can also support mindful eating through interactive experiences tasting freshly picked produce, which links to cooking group (1 above). Can also encourage patients to create their own growing area at home (even if only small scale – herbs, salad etc)
BECOME AN ACTIVE SUSTAINABILITY CHAMPION – See links to useful resources below

"If you think you are too small to make a difference, try sleeping in the same room as a mosquito (The Dalai Lama)"

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