A Qualitative Study of the Skills That Enabled the Pro-Environmental Behaviors of Registered Dietitians

Integrating sustainable nutrition into health-related institutions: a systematic review of the literature

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.

Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review

BACKGROUND

Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal).

OBJECTIVE

To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice.

METHODS

Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively.

RESULTS

From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients' intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this.

CONCLUSION

The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.

Sustainability: Nutrition and Dietetic Students’ Perceptions

Opportunities exist for nutrition and dietetic (N&D) professionals to contribute to sustainable development and support actions towards the attainment of the UN’s Sustainable Development Goals (SGD’s). Students undertaking higher education are well-placed to develop skills and capabilities in creative and critical problem solving for sustainability. However, there is limited literature exploring nutrition and dietetic students’ perceptions of sustainability that would help to inform an effective and constructively aligned embedding of sustainability content and active learning opportunities into curriculum. This descriptive cohort study design utilised a 17-question online survey to explore 95 Australian N&D undergraduate students’ self-reported familiarity with and perceived importance of sustainability and related concepts, and view of sustainability for future practice. Participants reported being more familiar with the term environmental sustainability and related concepts than economic or social sustainability. Varying levels of familiarity of 42 sustainability related concepts within economic resilience, environmental integrity, social development and cross-cutting issues were reported. Most participants (82%, n = 78) reported sustainability was very important in general (82%, n = 78), and for professional practice (63%, n = 60). Over half of the participants identified government led initiatives to address the future of society (65%, n = 71). Our study highlights the complexity of sustainability in a discipline specific context and the need for understanding students’ perceptions of sustainability to inform N&D curriculum design.

Dietetics Program Directors in the United States Support Teaching Vegetarian and Vegan Nutrition and Half Connect Vegetarian and Vegan Diets to Environmental Impact

Registered Dietitian Nutritionists (RDNs) are clinicians trained in the application of food, nutrition, and dietetics. Vegetarians and vegans have a lower risk of many nutrition-related chronic diseases that are epidemic while vegetarian and vegan diets are associated with reduced environmental impact. Despite this strong diet-disease and diet-environment connection, it is not known if dietetics students are taught the principles of vegetarian and vegan nutrition. The overarching goal of our study was to investigate curricular practices in accredited dietetics training programs in the United States (U.S.) including (1) the prevalence and perceived importance of vegetarian and vegan nutrition instruction and (2) if program directors connect vegetarian and vegan diets to climate change mitigation and resource conservation. Primary data were collected by way of a cross-sectional, Internet-based survey. All Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors in the U.S. (N = 574) were sent a 37-question survey and invited to participate in the study. Outcome measures included the prevalence of vegetarian and vegan nutrition instruction, quantifying if relationships exist among variables, and the frequency of connecting vegetarian and vegan diets to environmental impact. Descriptive and inferential statistics were utilized. Respondents (n = 205) indicated that over 51% of programs teach vegetarian nutrition while 49% teach vegan nutrition. There were significant differences between program type and the prevalence of vegetarian (p = 0.00005) and vegan (p = 0.00005) nutrition instruction. Over 90% of program directors believe that vegetarian and vegan nutrition should be taught. Over 50% of programs identify the connection between vegetarian and vegan diets in climate change mitigation and resource conservation. Most ACEND program directors believe vegetarian and vegan nutrition should be taught and half connect diet to environmental concern. Nevertheless, there is a discrepancy between beliefs and practice behaviors. These results suggest the need for increased collaboration and the use of novel techniques that better incorporate vegan and vegetarian nutrition throughout dietetics education.