Public health nutrition and sustainability

Consideration of nutrition and sustainability in public definitions of 'healthy' food: an analysis of submissions to the US FDA

OBJECTIVE

To better understand how the public defines 'healthy' foods and to determine whether the public considers sustainability, implicitly and explicitly, in the context of healthy eating.

DESIGN

We conducted a content analysis of public comments submitted to the US FDA in 2016 and 2017 in response to an invitation for feedback on use of the term 'healthy' on food labels. The analysis explored the ways in which commenters' definitions of 'healthy' aligned with the 2015-2020 Dietary Guidelines for Americans and whether their definitions considered sustainability.

SETTING

The US Government's Regulations.gov website.

PARTICIPANTS

All 1125 unique comments from individuals and organisations.

RESULTS

Commenters' definitions of 'healthy' generally mirrored the recommendations that the Dietary Guidelines for Americans put forth to promote a 'healthy eating pattern'. Commenters emphasised the healthfulness of fruit, vegetables, whole grains, fish and other minimally processed foods and the need to limit added sugars, sodium, saturated and trans fats and other ingredients sometimes added during processing. One-third of comments (n 374) incorporated at least one dimension of sustainability, mainly the environmental dimension. Commenters who mentioned environmental considerations primarily expressed concerns about synthetic chemicals and genetic modification. Less than 20 % of comments discussed social or economic dimensions of sustainability, and less than 3 % of comments (n 30) used the word 'sustainability' explicitly.

CONCLUSIONS

This novel analysis provides new information about the public's perceptions of 'healthy' foods relative to nutrition and sustainability considerations. The findings can be used to advance policy discussions regarding nutrition labelling and guidance.

Engaging with 'less affluent' communities for food system transformation: a community food researcher model (FoodSEqual project)

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with socio-demographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet are often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project is a research consortium that aims to 'co-produce healthy and sustainable food systems for disadvantaged communities'. The project focusses on innovating food products, supply chains and policies, placing communities at the centre of the change. Tackling the above issues requires new ways of working. Creative approaches in food research are known to empower a wider range of individuals to share their 'lived food experience' narratives, building relationships and corroborating co-production philosophies, thus promoting social justice, and challenging more traditional positivist/reductionist 'biomedical' approaches for nutrition and food studies. This review paper critiques the use of community-centric approaches for food system transformation, focusing on one, a community food researcher model() as an exemplar, to highlight their utility in advocating with rather than for less affluent communities. The potential for creative methods to lead to more equitable and lasting solutions for food system transformation is appraised, consolidating the need for community-driven systemic change to foster more progressive and inclusive approaches to strengthen social capital. The paper closes with practice insights and critical considerations offering recommendations for readers, researchers, and practitioners, enabling them to better understand and apply similar approaches.

Climate Change and Infant Nutrition: Estimates of Greenhouse Gas Emissions From Milk Formula Sold in Selected Asia Pacific Countries

BACKGROUND

There is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations.

RESEARCH AIMS

To (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region.

METHOD

We used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO₂ eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012-2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines.

RESULTS

Annual emissions for milk formula products ranged from 3.95-4.04 kg CO₂ eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO₂ eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO₂ eq.

CONCLUSIONS

Policies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are "Triple Duty Actions" that help improve dietary quality and population health and improve the sustainability of the global food system.

Knowledge and Perceptions of Plant-Based Diets among Competitive and Recreational Athletes

Little is known about athletes' perceptions of emerging dietary guidance on plant-based diets (PBD). To explore knowledge and perceptions of PBD among competitive and recreational athletes, an online survey was developed, pilot tested, and sent via email to athletes recruited from 2 Canadian post-secondary institutions. Survey questions explored athletes' understanding and views of the proposed Canadian dietary guidelines emphasizing plant-based proteins. Data were analyzed using grounded theory approaches. Forty-eight athletes participated in the survey. Two major themes emerged: (i) athletes had mixed perceptions of plant-based eating (PBE) and (ii) athletes associated PBE with broader food system concerns. Athletes have the potential to be important advocates of healthy and sustainable eating among peer groups and the general public. For effective promotion of PBE, the unique nutrient requirements and performance goals of athletes should be considered. Messaging to encourage a flexible rather than strict view of PBD may be a more feasible and acceptable approach when working with athletes.

Grape Pomace: A Potential Ingredient for the Human Diet

The industrial production of wine generates annually tons of waste that can and must be properly reused to reduce its polluting load ad increase the availability of passive ingredients to be used in human nutrition. Grape pomace, a by-product of winemaking, beyond being of nutritional value is a bioactive source with high potential value and benefits for human health. Having as main goal the preliminary perception of the potential use of this by-product, the aim of this study was the characterization of eight different grape pomaces. In this sense, ash content, relative ash, moisture, pH, microorganisms, metals (Al, Cd, Cr, Cu, Fe, Hg, Li, Mn, Ni, Pb, and Zn), and semi-metal (As) were reported. The parameter that limits the daily amount ingested of this product is its arsenic content, a non-essential element that belongs to the group of semi-metal. Considering the obtained results and in the light of the restrictions imposed through the legislation in regulations set by the European Commission, the inclusion of grape pomace in the industrial production of foodstuffs could be a step towards the future of human nutrition and health.

Demand-Side Food Policies for Public and Planetary Health

Background: The current food system has major consequences for the environment and for human health. Alignment of the food policy areas of mitigating climate change and public health will ensure coherent and effective policy interventions for sustaining human health and the environment. This paper explores literature on demand-side policies that aim to reduce consumption of animal-based foods, increase plant-based foods, and reduce overconsumption. Methods: We searched for publications, published between January 2000 and December 2019, considering the above policy domains. Articles were distinguished for type of policy instrument, for topic via keywords and examples were given. Results: The majority of demand-side policies focus on preventing overweight and obesity, using all types of policy instruments including more forceful market-based policies. Hardly any examples of public policies explicitly aiming to lower animal-based foods consumption were found. Policies combining health and sustainability objectives are few and mainly of the information type. Discussion: Moving towards environmentally sustainable and healthy diets is challenging as the implemented demand-side policies focus largely on human health, and not yet on environmental outcomes, or on win-wins. Policies targeting foods from the health perspective can contribute to lower environmental impacts, by indicating suitable animal-based food replacers, and aiming at avoiding overconsumption of energy dense-nutrient poor foods. Preferred policies include a variety of instruments, including strong measures. Conclusions: Working solutions are available to ensure coherent and effective demand side food policies aligning public health and environmental aims. Implementation of aligned and effective policy packages is urgent and needed.

Healthy and Sustainable Diets and Food Systems: the Key to Achieving Sustainable Development Goal 2?

The Sustainable Development Goals (SDGs) are considered a unifying global goal setting agenda that every country is meant to achieve. One of those goals, SDG2, promises to ensure food security and nutrition within sustainable food systems. However, achieving that goal is riddled with uncertainty because of the way in which the world currently produces and consumes foods. The global trends of diets and the food systems that produce those diets suggest that they are neither healthy nor sustainable, which has implications for achieving SDG2. This paper characterizes the current state of global diets and food systems, the concept of “healthy and sustainable diets,” and the ethical considerations to achieving healthy and sustainable diets for sustainable development.

The Nature and Quality of Australian Supermarkets' Policies that can Impact Public Health Nutrition, and Evidence of their Practical Application: A Cross-Sectional Study

Improving population diets is a public health priority, and calls have been made for corporations such as supermarkets to contribute. Supermarkets hold a powerful position within the food system, and one source of power is supermarket own brand foods (SOBFs). Many of the world’s largest supermarkets have corporate social responsibility (CSR) policies that can impact public health, but little is known about their quality or practical application. This study examines the nature and quality of Australian supermarkets’ CSR policies that can impact public health nutrition, and provides evidence of practical applications for SOBFs. A content analysis of CSR policies was conducted. Evidence of supermarkets putting CSR policies into practice was derived from observational audits of 3940 SOBFs in three large exemplar supermarkets (Coles, Woolworths, IGA) in Perth, Western Australia (WA). All supermarkets had some CSR policies that could impact public health nutrition; however, over half related to sustainability, and many lacked specificity. All supermarkets sold some nutritious SOBFs, using marketing techniques that made them visible. Findings suggest Australian supermarket CSR policies are not likely to adequately contribute to improving population diets or sustainability of food systems. Setting robust and meaningful targets, and improving transparency and specificity of CSR policies, would improve the nature and quality of supermarket CSR policies and increase the likelihood of a public health benefit.

Searching for a Measure Integrating Sustainable and Healthy Eating Behaviors

Sustainable and healthy food-related behavior is high on the public policy and research agenda due to its potential to cope with negative environmental and health outcomes. There are several measures related to sustainability in food choices but there have not been many attempts to integrate sustainable and healthy eating (SHE) behaviors into one measurement instrument so far. Therefore, the main aim of this study was to identify how young adults interpret the SHE concept and to develop an instrument that measures a self-reported consumer's SHE behavior. The process of scale development involved an exploratory qualitative study and two quantitative studies. As a result of 20 individual in depth interviews with Polish young adults, 50 items were generated reflecting their perspective on principles of SHE (Study 1). Two samples were used in the scale validation process: n = 217 (Study 2) and n = 220 (Study 3). Via principal component analysis, reliability analysis, and confirmatory factor analysis, the final form of the scale was derived. The proposed 34-item scale offers insights into the most relevant aspects of SHE behaviors, grouped in eight factors: "healthy and balanced diet", "certification and quality labels", "meat reduction", "selection of local food", "choice of low fat food products", "avoidance of food waste" and purchase and consumption of food products that are respecting "animal welfare" and finally choice of "seasonal food". Although the developed scale can benefit from further refinement and validity testing in different cultural and social background, it is clear that the scale, as developed, can be a useful tool for researchers who are interested in the study of SHE behaviors.

Evolution not Revolution: Nutrition and Obesity

The increasing prevalence of obesity over the course of life is a global health challenge because of its strong and positive association with significant health problems such as type 2 diabetes, cardiovascular disease, stroke, and some cancers. The complex causes and drivers of obesity include genetic factors, social, ecological and political influences, food production and supply, and dietary patterns. Public health messages and government food and activity guidelines have little impact; the retail food environment has many low-priced, nutrient-poor, but energy-dense products and there is a gap between what an individual knows and what they do. Public health and education services need legislation to mandate supportive environments and promote food literacy. Two New Zealand case studies of proof-of-principle of positive change are described: Project Energize and Under 5 Energize as exemplars of school environment change, and the development of the Nothing Else™ healthier snack bar as an example of working with the food industry. Changes in food literacy alongside food supply will contribute in the long term to positive effects on the future prevalence of obesity and the onset of non-communicable disease. More cross-disciplinary translational research to inform how to improve the food supply and food literacy will improve the health and wellbeing of the economy and the population.

A Food Systems Approach To Healthy Food And Agriculture Policy

Food has become a prominent focus of US public health policy. The emphasis has been almost exclusively on what Americans eat, not what is grown or how it is grown. A field of research, policy, and practice activities addresses the food-health-agriculture nexus, yet the work is still often considered "alternative" to the mainstream. This article outlines the diverse ways in which agriculture affects public health. It then describes three policy issues: farm-to-school programming, sustainability recommendations in the Dietary Guidelines for Americans, and antibiotic use in animal agriculture. These issues illustrate the progress, challenges, and public health benefits of taking a food systems approach that brings together the food, agriculture, and public health fields.

Med Diet 4.0: the Mediterranean diet with four sustainable benefits

OBJECTIVE

To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns.

DESIGN

A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined.

RESULTS

The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet.

CONCLUSIONS

By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

Sustainable healthy eating behaviour of young adults: towards a novel methodological approach

Background

Food, nutrition and health policy makers are poised with two pertinent issues more than any other: obesity and climate change. Consumer research has focused primarily on specific areas of sustainable food, such as organic food, local or traditional food, meat substitution and/or reduction. More holistic view of sustainable healthy eating behaviour has received less attention, albeit that more research is emerging in this area.

Methods/design

This study protocol that aims to investigate young consumers’ attitudes and behaviour towards sustainable and healthy eating by applying a multidisciplinary approach, taking into account economical, marketing, public health and environmental related issues. In order to achieve this goal, consumers’ reactions on interactive tailored informational messages about sustainable from social, environmental and economical point of view, as well as healthy eating behaviour in a group of young adults will be investigated using randomized controlled trial.

To undertake the objective, the empirical research is divided into three studies: 1) Qualitative longitudinal research to explore openness to adopting sustainable healthy eating behaviour; 2) Qualitative research with the objective to develop a sustainable healthy eating behaviour index; and 3) Randomised controlled trial to describe consumers’ reactions on interactive tailored messages about sustainable healthy eating in young consumers.

Discussion

To our knowledge, this is the first randomised controlled trial to test the young adults reactions to interactive tailor made messages on sustainable healthy eating using mobile smartphone app. Mobile applications designed to deliver intervention offer new possibilities to influence young adults behaviour in relation to diet and sustainability. Therefore, the study will provide valuable insights into drivers of change towards more environmentally sustainable and healthy eating behaviours.

Trial registration

NCT02776410 registered May 16, 2016.