Abstract
Objectives Sustainable nutrition is increasingly important, as the food system contributes one third of greenhouse gas emissions. Sustainable nutrition, or sustainable diet, refers to diets with low environmental impacts that contribute to food security and health. This systematic review aimed to identify factors that influence whether professionals in health-related institutions integrate sustainable nutrition into their practice. Methods A mixed-methods systematic review was conducted using the MEDLINE, Embase, PsycINFO, and CINAHL databases. To be included, the studies had to document perspectives on sustainable nutrition from health professionals, including dietitians, students and educators in health sciences, public health officers, and hospital food service managers. Data extraction focused on perceived barriers, facilitating factors, and top recommendations for promoting sustainable nutrition. Synthesis Twenty studies were included, most of which focused on dietitians. Data analysis revealed that 25 factors influenced the integration of sustainable nutrition into professional practice. The factors most reported in the included studies were perceived knowledge of sustainable nutrition, self-efficacy, awareness of environmental issues, and perceiving the promotion of sustainable nutrition to be part of one’s professional role. Increasing societal support through awareness campaigns and increasing institutional support through guidelines, information tools, and financial support were also frequently mentioned. Conclusion Sustainable nutrition is a multifaceted concept; integrating it into already complex professional practices is therefore challenging. At the present time, dietitians seem to be the health professionals predominantly researched regarding their views on sustainable nutrition. Many concrete avenues to promote sustainable nutrition were identified through this review.
Generated Summary
This mixed-methods systematic review explored factors influencing health professionals, public health officers, and hospital food service managers in integrating sustainable nutrition into their professional practice. The review aimed to identify avenues to develop an action plan to promote sustainable nutrition in health-related organizations. Studies included in this review were conducted in Western countries and mostly published after 2000. The study used a mixed-methods approach to analyze qualitative and quantitative data from studies that investigated the views of health professionals. The researchers extracted data, categorized it, and conducted a thematic analysis to identify barriers, facilitators, and recommendations for integrating sustainable nutrition. The research questions addressed the main characteristics of the studies, the perceived barriers and facilitators, and recommendations for advancing the integration of sustainable nutrition.
Key Findings & Statistics
- The food system is estimated to contribute up to 30% of global greenhouse gas emissions (GHGEs).
- Meat and dairy production alone account for 14.5% of all GHGEs globally.
- Agriculture is responsible for 70–80% of all human water use.
- Climate change is expected to result in a loss of up to 25% of world food production over the twenty-first century.
- The FAO estimates that the GHGEs associated with meat and dairy production alone account for 14.5% of all GHGEs globally.
- Over 2 billion people worldwide suffer from micronutrient deficiencies, and approximately 860 million people suffer from hunger.
- Nearly 2 billion people in the world are overweight or obese.
- The world’s population is expected to grow by 2.2 billion by 2050.
- Ultra-processed foods account for half of total energy intake in Canada.
- Most of the population consumes an inadequate amount of fruits and vegetables.
- One in eight households experience food insecurity.
- Twenty studies were included in the review.
- Twelve studies (60%) were quantitative, six were qualitative, and two were mixed methods.
- Seventy percent (14 out of 20) of the studies were conducted among dietitians.
- Plant-based protein consumption relative to animal protein should increase.
- Consumption of fruits and vegetables from various sources should increase.
- Animal-based protein consumption should be reduced.
- Purchase fish from sustainable fisheries.
- Choose fresh, whole, or less-processed foods.
- Choose unpackaged or less packaged foods, or foods with recyclable packaging.
- Choose seasonally available, local foods.
- Eat in moderation and avoid waste.
- Choose pesticide-free, organic, and fair trade food.
- The level of knowledge was the most frequently mentioned factor in 16 studies.
- Perceiving environmental issues to be part of one’s professional role was mentioned in 13 studies.
- Awareness of environmental issues was mentioned in 11 studies.
- Educating patients on sustainable nutrition was perceived as very important and that their personal values and beliefs on pre-serving the environment had a positive influence on their practice (n = 5).
- Perceived skills and self-efficacy was found in 9 studies.
- Dietitians reported needing tools to make efficient use of client education time and recommended establishing a uniform message on sustainable nutrition.
- The low priority given to climate change in the practice setting was described as a barrier.
- Some dietitians reported that they currently advocate for sustainable nutrition in their practice; most of these dietitians were also personally making the shift to a more sustainable diet.
- Dietitians mainly leaned toward buying organic and locally grown food.
Other Important Findings
- The concept of sustainable nutrition was introduced by Gussow and Clancy (1986), who argued that sustainability is vitally important to a healthy diet.
- The FAO developed a consensus definition for “sustainable diets” as “diets with low environmental impacts that contribute to food and nutrition security and to healthy lives for present and future generations.”
- Various efforts have also focused on evidence-based food system action goals that could significantly reduce global warming, improve global nutritional health, and maintain food resources for future generations (Harmon et al. 2011).
- Being vegetarian or vegan appeared to strongly influence motivation and commitment to applying sustainable nutrition principles.
- The years of professional experience as a dietitian also appeared to play a role, as dietitians who had been practicing longer reported a lower intention to incorporate sustainable nutrition into their practice.
- Participants’ age appeared to be an influencing factor.
- Increasing professionals’ knowledge was the most frequently mentioned factor in 16 studies.
- Perceiving environmental issues to be part of one’s professional role and professionals’ awareness of environmental issues were also frequently mentioned.
- Participants also indicated that they perceived educating patients on sustainable nutrition to be very important and that their personal values and beliefs on pre-serving the environment had a positive influence on their practice.
- Chief among the factors was a perceived lack of skills needed to integrate sustainable nutrition into practice.
- The need for official guidelines on sustainable nutrition and purchasing practices and improved labeling laws that would facilitate choices for the general population and hospital food service managers (n = 10).
- Factors influencing food managers and public health officers was assessed.
- Hospital food service managers reported a lack of consumer awareness about sustainable nutrition and that, in comparison, much more attention was given to the impacts of food on human health.
- The need for tools to systematically measure and track changes at the local food system level.
- The need to use common metrics such as the percentage of locally or sustainably sourced foods.
Limitations Noted in the Document
- The review focused on the views of various stakeholders in the health system and excluded interventional studies.
- Only articles written in English or French were considered, which may have biased the results.
- The results were not systematically provided based on the categories of the workplace.
- Six studies came from just two research programs, potentially leading to overestimating some results.
Conclusion
The integration of sustainable nutrition into professional practices is a complex, multidimensional phenomenon influenced by a wide range of factors at societal, political, industrial, organizational, and educational levels. The main findings of the review suggest that greater institutional support is needed to enable health professionals to integrate sustainable nutrition into their practices. This support may take the form of updated practice guidelines, action plans, common definitions, principles, monitoring tools, and training programs. Promoting sustainable nutrition among the general population was strongly recommended to support broad social change, which in turn would support specific improvements, such as sustainable nutrition guidelines for professionals, improving purchasing practices, and improving nutrition labeling information rules. It is important to recognize that the successful integration of sustainable nutrition requires a multi-faceted approach that considers the different levels of influence and the specific factors impacting different groups of professionals. The need for stronger partnerships across sectors and the involvement of public organizations in promoting sustainable nutrition are also important. The authors emphasize that there is a need for health systems and practice settings to prioritize climate change and sustainable diets. Also, there is an increasing need for official guidelines on sustainable nutrition and purchasing practices, as well as improved labeling laws, which would aid the general population in making eco-friendly choices. The focus on a few dimensions of sustainable nutrition (organic, locally grown food, or animal protein replacement) indicates a need for a more comprehensive approach, encompassing all facets of sustainable nutrition. This review provides evidence that the efforts to promote sustainable nutrition are multi-faceted and require a comprehensive approach.