Position of the academy of nutrition and dietetics: nutrition security in developing nations: sustainable food, water, and health

Systems Thinking and Sustainable Food Systems in Dietetics Education: A Survey of Directors

BACKGROUND

Systems thinking is recommended, but not required, for teaching food and water system sustainability in nutrition and dietetics education.

OBJECTIVE

This study investigated systems thinking and sustainable, resilient, and healthy food and water systems (SRHFWS) in nutrition and dietetics programs. It examined program directors' practices, values, attitudes, confidence levels, and the relationships between systems thinking, teaching SRHFWS topics, confidence levels, and years of experience as a dietitian and program director.

DESIGN

Conducted in September 2022, the study used a descriptive design with a validated 20-item Systems Thinking Scale and a researcher-designed survey with 1-5 Likert-type scales.

PARTICIPANTS AND SETTING

The online survey was distributed to 611 Accreditation Council for Education in Nutrition and Dietetics program directors, with a 27% (N = 163) response.

STATISTICAL ANALYSIS

Descriptive statistics (frequency or mean ± SD) were calculated using Excel. Inferential statistics were examined using R. Analysis of variance was used to compare experience as a registered dietitian nutritionist and experience as a program director to confidence levels in teaching each SRHFWS topic. Linear regression was used determine the relationship between total Systems Thinking Scale score and demographic and programmatic variables.

RESULTS

Seventy-seven percent of program directors scored high on the Systems Thinking Scale (mean score = 65.2 ± 8.4 on a 0 to 80 scale), and more than 85% of directors agreed that including systems thinking in dietetics was important. However, only 32.1% reported teaching systems thinking. Less than half of program directors agreed that systems thinking was adequately addressed in Accreditation Council for Education in Nutrition and Dietetics standards, and nearly 80% of program directors agreed there was room to strengthen systems thinking content. Directors neither agreed nor disagreed there are adequate Accreditation Council for Education in Nutrition and Dietetics standards addressing SRHFWS and reported SRHFWS topics were inconsistently taught. Confidence levels were lowest for teaching economic and environmental topics. Awareness and use of resources developed by the Academy of Nutrition and Dietetics Foundation was low.

CONCLUSIONS

Integration of systems thinking in nutrition and dietetics education presents promising opportunities to address complexity in the field. Applying systems thinking to teach SRHFWS may narrow the disparity between educators' perceived importance and program coverage. Enhancing program directors' awareness and utilization of Academy of Nutrition and Dietetics Foundation resources and improved alignment between practice standards and accreditation standards may empower program directors to use systems thinking to teach sustainability-related challenges in nutrition and dietetics.

Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Using preschoolers to improve caregivers' knowledge, attitude, and practices relating to biofortified crops: Evidence from a randomized nutrition education trial in Kenya

This 2018 randomized controlled trial examined the role behavioral nudges can play in improving caregivers' knowledge, attitude, and practices (KAP) relating to biofortified orange‐fleshed sweetpotato (OFSP). The experiment involved 431 preschooler–caregiver pairs in 15 villages. The preschoolers were enrolled in public‐run Early Childhood Development and Education (ECDE) centers in the respective villages. Caregivers were first exposed to the routine OFSP promotion activities in the area – invited to cooking demonstration workshops and issued with free OFSP vines to plant. A baseline survey followed. Next, the 15 villages were randomized into four study groups (a control and three treatments). The interventions were deployed for 30 days as follows: Treatment 1 – preschoolers issued OFSP‐branded exercise books, class posters, and poems; Treatment 2 – caregivers received phone‐mediated text messages; and Treatment 3 – received the full suite of interventions. This study analyzed the endline and baseline data and finds that, in general, changes in KAP scores were negatively associated with control group (p = .005) and positively associated with Treatment 3 (p = .02). Specifically, Treatment 3 significantly increased caregivers' knowledge of OFSP production, consumption, and vitamin A. Treatment 2 significantly improved their attitude too. It concludes that an integrated complementary nutrition education approach targeting preschooler–caregiver pairs is more effective in increasing knowledge of cultivation and consumption of OFSP. It discusses the implications for the design of more effective nutrition programs targeting households with preschoolers to accelerate the fight against vitamin A deficiency (VAD).

Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education

Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the opportunities and challenges of using online platforms for this experience. As online learning opportunities become more common, it will become increasingly important for educators to prioritize strategies that effectively equip students with the higher-order thinking skills, such as systems thinking, needed to address the complexities of sustainable food systems. The interactive webinar series format described here provides an opportunity to leverage didactic webinars in combination with interactive experiences that enable learners to deepen their knowledge through practice with peers and subject matter experts. Though this format was piloted within dietetics education programs, many of the lessons learned are transferable to other food systems educational contexts.

Growing Progress in the Evolving Science, Business, and Policy of Sustainable Nutrition

A session was convened at the ASN Nutrition 2018 annual meeting to discuss the scientific evidence on what makes individual foods and dietary patterns both sustainable and nutritious, and the role of various stakeholders in the actions needed to implement food systems that deliver "sustainable nutrition." This commentary is a structured synthesis of the primary themes of the session, and concludes with a set of implications and research recommendations. Consumers are becoming increasingly aware of the environmental implications of what they eat, and there is growing momentum toward changes in the food system. However, ecological challenges persist, and although the literature is evolving, methodologic improvements are needed in the scientific approaches to address dietary patterns that meet nutrition needs in more holistically sustainable ways. The session concluded with encouraging evidence that consumers, businesses, scientists, and policy-makers are collectively "rising to the occasion," with cross-sectoral partnerships to address these issues.

Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Food security and sustainability: can one exist without the other?

OBJECTIVE

To position the concept of sustainability within the context of food security.

DESIGN

An overview of the interrelationships between food security and sustainability based on a non-systematic literature review and informed discussions based principally on a quasi-historical approach from meetings and reports.

SETTING

International and global food security and nutrition.

RESULTS

The Rome Declaration on World Food Security in 1996 defined its three basic dimensions as: availability, accessibility and utilization, with a focus on nutritional well-being. It also stressed the importance of sustainable management of natural resources and the elimination of unsustainable patterns of food consumption and production. In 2009, at the World Summit on Food Security, the concept of stability/vulnerability was added as the short-term time indicator of the ability of food systems to withstand shocks, whether natural or man-made, as part of the Five Rome Principles for Sustainable Global Food Security. More recently, intergovernmental processes have emphasized the importance of sustainability to preserve the environment, natural resources and agro-ecosystems (and thus the overlying social system), as well as the importance of food security as part of sustainability and vice versa.

CONCLUSIONS

Sustainability should be considered as part of the long-term time dimension in the assessment of food security. From such a perspective the concept of sustainable diets can play a key role as a goal and a way of maintaining nutritional well-being and health, while ensuring the sustainability for future food security. Without integrating sustainability as an explicit (fifth?) dimension of food security, today's policies and programmes could become the very cause of increased food insecurity in the future.

Sustainable diets: The interaction between food industry, nutrition, health and the environment

Everyday great amounts of food are produced, processed, transported by the food industry and consumed by us and these activities have direct impact on our health and the environment. The current food system has started causing strain on the Earth's natural resources and that is why sustainable food production systems are needed. This review article discusses the need for sustainable diets by exploring the interactions between the food industry, nutrition, health and the environment, which are strongly interconnected. The most common environmental issues in the food industry are related to food processing loss, food wastage and packaging; energy efficiency; transportation of foods; water consumption and waste management. Among the foods produced and processed, meat and meat products have the greatest environmental impact followed by the dairy products. Our eating patterns impact the environment, but the environment can impact dietary choices as well. The foods and drinks we consume may also affect our health. A healthy and sustainable diet would minimise the consumption of energy-dense and highly processed and packaged foods, include less animal-derived foods and more plant-based foods and encourage people not to exceed the recommended daily energy intake. Sustainable diets contribute to food and nutrition security, have low environmental impacts and promote healthy life for present and future generations. There is an urgent need to develop and promote strategies for sustainable diets; and governments, United Nations agencies, civil society, research organisations and the food industry should work together in achieving this.

Food insufficiency in the households of reproductive-age Ecuadorian women: association with food and nutritional status indicators

Data from a nationally representative survey of Ecuadorian households with reproductive-aged women (n = 10,784) were used to analyze the prevalence of household food insufficiency (HFI) and its association with sociodemographic characteristics, food acquisition and expenditure patterns, dietary diversity, and anthropometric indicators. Fifteen percent of households had food insufficiency and 15% had marginal food sufficiency. HFI was associated with poverty-linked indicators. Marginally food sufficient households reported social and economic capital than food which appeared protective against HFI. Food insufficiency was associated with reduced household acquisition/expenditures on high quality protein and micronutrient-rich food sources. HFI was not associated with adult or adolescent female overweight/obesity but was associated with short adult stature (< 1.45 m). The ongoing nutrition transition in Ecuador is expected to continue to modify population food security, diet, and nutrition. Systematic surveillance of household level food security is needed to inform recent food-related policies and programs implemented by the Ecuadorian government.

Academy of Nutrition and Dietetics: Standards of professional performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sustainable, Resilient, and Healthy Food and Water Systems

Sustainability is the ability of a system to be maintained over the long term. Resilience is the ability of a system to withstand disturbances and continue to function in a sustainable manner. Issues of sustainability and resilience apply to all aspects of nutrition and dietetics practice, can be practiced at both the program and systems level, and are broader than any one specific practice setting or individual intervention. Given an increasing need to apply principles of sustainability and resilience to nutrition and dietetics practice, as well as growing interest among the public and by Registered Dietitian Nutritionists of health issues related to food and water systems, the Hunger and Environmental Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Standards of Professional Performance as a tool for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems to assess their current skill levels and to identify areas for further professional development in this emerging practice area. This Standards of Professional Performance document covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how sustainable, resilient, and healthy food and water systems principles can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems.