Studies and Reports of the Month: June 2026

This quasi-experimental study evaluated the first large-scale implementation of MTMs within a US state Medicaid program. Researchers linked Medicaid claims data with program records from 11 Accountable Care Organizations in Massachusetts, comparing 1,866 adult MTM recipients, enrolled for more than 90 days, to 1,372 eligible but non-enrolled comparators from 2020 to 2023. Meals were fully prepared and home delivered by a nonprofit provider adhering to Food is Medicine Coalition standards. Fifteen meal plans were tailored by registered dietitians across five core diets (Renal, Diabetic, Cardiac, Maternal Health, General Wellness). The sample diabetic menu shows mixed-protein meals, with hard caps on sodium and saturated fat. Findings were tested against four sensitivity analyses, an alternate comparison group, and a negative control time period. The senior author discloses advisory roles across a long list of food and health companies; the first author reports consulting with the Food is Medicine Coalition.

• Utilization dropped substantially. MTM recipients experienced 31% fewer hospitalizations and 20% fewer emergency department visits over an average enrollment of 6.7 months. Primary care visits did not change, indicating continued clinical engagement rather than general disengagement from healthcare.
• Costs largely paid themselves back. Total per-person healthcare costs fell by $3,433 during enrollment. This offset 98% of MTM program costs of $3,512 per person, producing a net cost of just $14.90 per person per month.
• Savings were largest for the sickest patients. Stratified analyses showed net cost savings among participants with cardiovascular disease ($10,450 saved per person), chronic kidney disease ($12,312 saved), depression or anxiety disorders ($5,597 saved), and diabetes ($4,123 saved). Patients in the highest tertile of medical comorbidity accounted for the bulk of cost reductions.
• The meals, not the counseling, appear to be doing the work. Only 5% of enrolled participants attended all three optional nutrition counseling sessions, and 62% attended none, yet healthcare utilization and cost reductions still occurred. The authors note prior evidence that supplemental counseling within food-as-medicine programs adds little marginal benefit.

Thirteen US states have approved Medicaid Section 1115 waivers to fund food-as-medicine programs, and three more are pending federal approval. This is the first large-scale, peer-reviewed policy evaluation to test whether the intervention pays for itself in a real Medicaid setting. The answer is: yes.

The results strengthen the case for expansion across state Medicaid programs, private insurers, and healthcare systems in other countries with similar structures. It also carries a design lesson worth making explicit: the effects observed here came from an accredited nonprofit adhering to Food is Medicine Coalition standards, including registered dietitian staffing floors and aligned nutrition specifications.

Note: replication programs that treat ‘medically tailored’ as marketing rather than a specification, that use non-accredited or for-profit providers, or that rely on nutritional advice without changing food access, cannot expect the same results.

Participants were not randomly assigned, so selection bias remains possible, though the authors address it through propensity weighting and a secondary comparison group of members never referred to the program, with converging results. Dietary intake was not measured, so meal adherence is inferred from the fact that meals were home delivered rather than offered for pickup. The paper does not report how many patients selected the plant-forward modifiers, so the relative contribution of specific compositional choices cannot be isolated. Follow-up ends when the program ends, leaving open whether cost reductions persist afterward. The program was run by a well-resourced accredited nonprofit in a state with strong safety-net infrastructure; less well-designed programs, or those in states with weaker infrastructure, may not produce the same effects.

Trials in Australia and China are testing whether these findings travel to different national contexts. An intervention increasing the plant-protein content of the meal types would be a powerful next step to determine if outcomes can be further improved, especially for patients with conditions (e.g., cardiovascular disease and Type 2 diabetes) that have the strongest evidence base for plant-forward dietary patterns.

This Science study builds sustainable landscape efficiency frontiers for 146 countries: the best achievable combinations of biodiversity conservation, land-based climate mitigation, and net economic value from crops, livestock, and forestry, three goals usually treated as competing. Using high-resolution land-cover and economic data, the team optimized across 13 land-use and land-management options per location, counting the cost of switching land use, to find points where no goal could improve without another getting worse.

• Most countries can gain on all three goals at once. Almost every country sits well inside its frontier, meaning simultaneous improvements in biodiversity, climate, and economic value are possible even after accounting for transition costs.
• Climate mitigation could rise 23% or economic value could rise 83%. From 1035 to 1268 billion metric tons of CO2 equivalents with no loss to economic value or biodiversity in any country – enough to offset roughly four years of total global emissions at 2019 levels. Economic value could rise from ~$444 billion to ~$812 billion annually without sacrificing biodiversity or climate, mainly by closing crop yield gaps in lower-income countries alongside selective restoration.
• Concentrated action captures most of the benefit. In Paraguay, the top 30% of land-use changes delivered 65% of the economic gain and 61% of the climate gain, so a focused set of well-chosen changes does most of the work.

The finding undercuts the most common objection to ambitious land and food policy, that protecting nature and growing the economy are a zero-sum trade, giving agriculture ministries, development banks, and finance institutions a quantified case for redirecting land-use decisions rather than defending the status quo. The authors point to payments for ecosystem services, already used in Costa Rica, China, and the US Conservation Reserve Program, as a practical way to reward landowners for public benefits the market ignores, and reframe the land-sparing versus land-sharing debate as a false choice in which the largest gains come from combining restoration with higher yields on the most suitable land.

The economic figures are a ceiling, not a forecast: prices are held fixed, so the authors note real-world price responses would shrink the win-win zone, and harms such as water-quality damage from intensification go uncounted. The model covers crop, livestock, and forestry but not human nutrition, food security, or dietary demand, all flagged as future work, so it speaks to how land is allocated rather than what is produced and for whom.

This study puts a monetary value on the environmental damage caused by the world’s top 10% of consumers, across four of the nine planetary boundaries: climate change, biosphere integrity, biogeochemical cycles (nitrogen and phosphorus), and freshwater use. It applies willingness-to-pay-based prices from the Environmental Prices Handbook 2024 to consumption-based footprints drawn from Tian et al. (2024, Nature), , and reports results globally and for six major economies (Brazil, China, Egypt, Germany, India, and the U.S.). All figures are in 2017 dollars. It was published with funding from the EU-supported WISE Horizons project.

• The damage exceeds the funding the world says it lacks. The top 10% cause $1.7 to $5.7 trillion in annual environmental damage, or $2,300 to $7,500 per person. Both the lower United States and the lower Chinese estimates each cover the $675 billion biodiversity financing gap identified for 2030, and the central United States estimate surpasses the $993 billion a year for climate action by 2035 agreed at COP30.
• Biodiversity dominates the bill. Biodiversity loss accounts for 47 to 56% of the total and climate change 36 to 45%, with nitrogen at 6 to 8% and water and phosphorus each under 2%. Climate is not the largest priced harm.
• The burden is steeply unequal and geographically concentrated. The United States top 10% owe $19,000 to $63,000 per person, equal to 6 to 20% of income or 0.8 to 3% of wealth. India’s top 10% owe $410 to $1,400, equal to 0.8 to 2.8% of income. More than 60% of the global top 10% live in the United States and the EU; roughly 2% are in India.
• The estimate is a floor. Five planetary boundaries could not be priced, including land-system change, and investment-linked emissions are excluded. The authors note that environmental taxation aimed at luxury consumption rather than basic goods tends to be both more progressive and more effective at reducing emissions.

Tian et al., the source of the underlying footprints, analysed 201 consumption groups across 168 countries and attributed 31-67% of planetary boundary breaching responsibility to the global top 10%. Their sectoral analysis finds food and services to be the leading sectors across the land, nitrogen, phosphorus, freshwater and biosphere integrity footprints, and the two that deliver most of the reduction under its mitigation scenarios.

Monetisation reframes elite consumption damage as a priced, taxable liability, and the resulting figure exceeds the very financing gaps governments cite as the reason for delay. That matters for food systems because the affordability objection is the most durable barrier to demand-side food policy: environmental taxes, procurement standards, and subsidy reallocation are routinely argued down on cost grounds. A credible price on the harm changes what “too expensive” means, and gives finance and treasury audiences a number to work with rather than a moral claim to defer.

Biodiversity loss dominating the bill is the finding with the longest reach. Climate has absorbed most environmental fiscal attention, yet the largest priced harm sits in biosphere integrity, where agriculture is the principal driver. That points environmental taxation toward land and nature impacts rather than carbon alone, a shift that would fall differently across food production systems than a carbon price does.

The figures rest on willingness-to-pay-based environmental prices, which carry wide uncertainty, particularly for biodiversity, where the authors flag that valuations converted from European ecosystems do not transfer cleanly to other regions. Two next steps that would sharpen the analysis: (a) a sectoral breakdown or estimate of the damage bill and (b) deeper work on the polluter-pays mechanism itself – which fiscal instruments actually recover priced harm of this kind, at what rate, and with what distributional effect across income groups.

Researchers used grocery loyalty-card records to measure how actual purchasing responds to price, rather than relying on surveys or stated intentions. The main analysis tracked 29,131 Finnish shoppers across 2017 and 2018, with a separate robustness check on 58,267 Canadian shoppers in Quebec. Using mixed-effects regression, they estimated price sensitivity for seven plant-based and fourteen animal-based protein subcategories, and tested whether socioeconomic status, measured both from individual surveys and from neighbourhood census data, changed the picture.

• Plant-based proteins were less price-sensitive than animal proteins. The pattern held in both countries. Demand for nearly every category still fell when prices rose, so price remains a real barrier across the board; the difference is one of degree, not direction.
• Socioeconomic gaps were over three times wider for animal proteins. The difference in price sensitivity between lower- and higher-income shoppers was much larger for meat and dairy than for plant-based foods, where the gap, though present, was small.
• Price was not the only barrier. Consistent availability, clear placement, and stable prices were critical retail conditions, and variety expansion and promotions drove plant-based demand more than relative price alone.
• Income did most of the work. Income, more than education, drove differences in price sensitivity, while education played a larger role specifically for animal products. Lower-income shoppers were the most price-sensitive group overall.

Because plant-based price sensitivity is broadly consistent across income groups, price interventions that lower plant-based costs, such as price-parity trials, targeted discounts, or subsidies, can lift purchasing across the population while narrowing rather than widening equity gaps. The shoppers who currently buy the least stand to gain the most. The study also shows that neighbourhood-level census data can stand in for harder-to-collect individual data, opening a practical route to monitoring dietary transitions where detailed survey data are scarce.

These findings, together with Lemken et al. (Entry 7 in this issue), highlight that price interventions do not widen income gaps and that defaults do not skew by age, gender or education.

The analysis is observational and cannot establish cause and effect, and it draws on data from 2017 to 2018 (and 2015-2017 for Quebec), predating the more crowded plant-based market of today. It covers two high-income countries, one retailer each, and captures only in-store grocery purchases, not eating out. The authors also caution that their elasticity magnitudes should be read as comparisons between categories rather than precise figures, because purchasing was measured by weight. Updated data, supply-side dynamics, and lower- and middle-income settings are the clear priorities for future work.

This institutional case study examines a mentorship programme for early-career climate researchers funded by the Canadian Beef Cattle Research Council (BCRC), a body financed by mandatory levies on all cattle sales in Canada. The programme pairs researchers studying greenhouse gas emissions from cattle farming with operators of large-scale industrial feedlots and industry consultants. Drawing on publicly available programme materials, cohort descriptions, and researcher outputs spanning 2014 to 2023, the author documents how the programme shapes the research landscape not by directing individual findings but by determining which researchers gain resources and which questions prove professionally viable.

• Reversed mentorship structure: Industry operators mentor scientists on research questions and methodological framing, not the reverse. The BCRC states openly on its programme website that the goal is to “align research interests with those that are practical and beneficial to Canada’s beef industry.”
• Documented outputs depart from scientific consensus: Across three detailed case studies from cohorts between 2016 and 2021, post-mentorship publications and public communications consistently omit demand reduction and dietary transition as mitigation strategies, frame declining emissions per kilogram of beef as evidence of sustainability while total emissions from Canadian cattle production rose approximately 28% between 1981 and 2011 (Legesse et al., Animal Production Science, 2016), and in several cases advance claims that large-scale feedlots are environmentally sustainable or that Canada should increase cattle production.
• No mentored researcher questioned herd size: Across all cohorts identified, not one researcher produced work arguing that Canada’s total farmed cattle population is inherently unsustainable or should be limited, despite a body of peer-reviewed Canadian literature making precisely this claim.
• Career capture, not content capture: The programme’s mechanism operates through competitive advantage. Researchers who already work in directions the industry prefers receive funding, facility access, conference participation, and informal professional connections that improve their CVs and hiring prospects. The programme’s executive director has stated that participants get “a really big leg up” and that “when they are applying we see it in their proposals.”

This case illustrates how greenwashing in animal agriculture operates at the level of research infrastructure, not only in public communications. The industry does not need to suppress unfavorable findings; it funds the conditions under which unfavorable questions are less likely to be asked. The emissions-intensity framing documented here (declining greenhouse gases per kilogram of beef, rising total emissions) is not unique to Canada: analyzing 1,233 environmental claims across 33 of the world’s largest meat and dairy companies, Bach et al. (2026; April’s digest) identified the same underlying mechanism at the level of corporate sustainability reporting, finding that companies “emphasize marginal efficiency” while producing “substantial absolute GHG emissions,” with 98% of claims meeting established criteria for greenwashing. The case also highlights the role of checkoff programmes, government-mandated levies directed to private industry bodies, as a channel through which public resources subsidize research agenda capture. For science policy and research ethics, the question this programme raises is whether the same institutional safeguards applied to pharmaceutical or fossil fuel industry engagement with researchers should apply to animal agriculture.

This is a qualitative case study based on publicly available materials from a single programme in one country; the three researcher cases analyzed are not a random sample and cannot support claims about the scale of the effect on the Canadian research literature as a whole. The author cannot rule out that individual research projects were unaffected by mentorship, and the causal argument runs through career incentives and landscape effects rather than documented interference with findings. Future work should examine analogous programmes in other major beef-producing countries, assess how industry-aligned research enters agricultural school curricula, and compare the BCRC model against industry engagement programmes in sectors where conflicts of interest are more tightly regulated.

This modeling study quantifies the environmental footprint of following the 2025-2030 Dietary Guidelines for Americans, released in early 2026, which advise avoiding ultra-processed foods while recommending higher protein intake, chiefly from animal sources. The researchers built isocaloric 2,500 kcal diets with all ultra-processed foods removed at three protein levels (0.8, 1.2, and 1.6 grams per kilogram of body weight), plus two high-protein diets contrasting plant and animal sources, and compared each against the current Mean American Diet. Land use, nitrogen fertilizer use, freshwater use, and greenhouse gas emissions were estimated using the published Dietary Impacts on Environmental Measures dataset.

• Removing ultra-processed foods helps, but the protein push cancels it. Ultra-processed foods account for 40-58% of the current diet’s environmental impact, so removing them lowers footprints. Raising protein to the guidelines’ levels reverses that, increasing land use, nitrogen use, and greenhouse gas emissions by up to 32% relative to the current diet.
• Water is the one exception. Freshwater use fell 7-19% across the modeled diets, and the benefit would be larger with lower protein and more plant-sourced protein.
• Protein source decides the outcome. At the same high protein level, the animal-based diet had a greater environmental impact than the plant-based diet across metrics, with the plant-based high-protein diet substantially lower overall.
• Grass-fed is not a way out. Current pastureland grass resource can support only 27% of the current beef supply (27 million cattle), an amount 30% smaller than prior estimates (Hayek & Garrett, 2018), so current or higher intake at that standard is not feasible.

Dietary guidelines are the backbone of US federal food policy, shaping school meals, food assistance, and government, military, and hospital procurement, so their environmental footprint scales far beyond individual plates. This analysis shows that the headline move against ultra-processed foods, sound on its own, is outweighed when paired with a higher-protein recommendation that in practice means more meat. Framing the guidelines as a return to natural, less-processed foods also risks steering consumers toward more red meat, including grass-fed beef that the land base cannot supply at current consumption levels. The finding reframes the question from how much protein to which protein, and the authors conclude that the guidelines should be revised to prioritize plant-based over animal foods to meet health and environmental goals together.

As a modeling study, the results depend on the environmental impact coefficients used and on the assumption that higher protein recommendations translate into higher animal-protein intake, which reflects current US consumption patterns rather than a certainty. The analysis covers four environmental measures and does not model health outcomes, cost, or the biodiversity and land-use-change effects that would further separate plant from animal sources. It is US-specific, tied to the Mean American Diet and domestic production, though the underlying pattern that animal protein carries a heavier footprint per unit is well established across the wider literature. The code is openly available, supporting reproducibility and adaptation to other national contexts.

This systematic data review pairs a preregistered PRISMA search with re-analysis of the raw participant data shared by the original study authors. It pools 12 food-choice experiments (N \= 10,788), from cafeterias and coffee shops to university dining halls and online supermarkets, to test whether the effect of a default option, versus requiring an active choice, varies by age, gender, or education.

• No consistent moderation by demographics. Across 40 interaction tests, the influence of age, gender, and education on default effectiveness was close to zero (pooled Cohen’s d of -0.006 for gender, -0.028 for education, and -0.017 for age). Equivalence testing confirmed the gender and education effects as statistically equivalent to zero.
• Defaults do not widen socio-economic gaps. Because they do not rely on time, attention, or deliberation, defaults avoid the socio-economic skew of information and labelling interventions, which prior research shows tend to benefit already-advantaged groups.
• A caution on harmful defaults. A non-significant trend suggested harmful defaults, such as preselected high-sugar or high-meat options, may affect less-educated consumers more strongly. Based on only three studies it is not robust, but it supports scrutiny of manipulative commercial defaults.

Lemken addresses distributional heterogeneity but not overall magnitude, so this paper strengthens the case for defaults being equitable if they work, without settling whether their real-world dietary impact is large or modest. Where defaults do move behaviour, they can be applied across school meal programmes, public procurement, and institutional catering without disadvantaging specific groups. The authors frame defaults as a complement to, not a substitute for, structural measures on price and availability.

The equity-across-groups finding here sits alongside a live methodological question about the size of default effects themselves. Green, Smith & Mathur (2025) meta-analysed 35 papers (comprising 41 studies and 112 interventions) of interventions to reduce meat and animal-product consumption and found a pooled effect roughly one-third the size of what behavioural scientists conventionally call a “small effect” (SMD 0.07, 95% CI 0.02 to 0.12), once outcomes were measured beyond a single decision point, concluding the problem remains “unsolved”.

The conclusions rest on an absence of detected moderation rather than proof that none exists; a few pooled studies were underpowered, and the age result was the least conclusive of the three. Only one study measured income, leaving financial vulnerability largely untested, and the evidence skews toward higher-income settings such as university canteens. Most studies measured immediate choices rather than sustained consumption, leaving open whether equitable short-term effects translate into durable dietary change.