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Ecologically (environmentally) Sustainable Diets vs Sustainable Food Systems? A critique for educators

The BDA General and Education Trust (GET) Fund exists “to advance education and other charitable purposes related to the science of dietetics”.

Dr Clare Pettinger RD RNutr (Public Health)

University of Plymouth, British Dietetic Association

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Final year Dietetic students, University of Plymouth, May 2023

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Content

Definitions...
[Sustainable Food Systems (SFS) – briefly]
Ecologically (environmentally) Sustainable diets
One Blue Dot as exemplar (UK context)
Collaboration & leadership
Our future leaders (students)

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Definitions...

“Dietary patterns that promote all dimensions of individuals’ health and wellbeing; have low environmental impact; are accessible, affordable, safe and equitable; and are culturally acceptable.”

(FAO, 2019)

“...delivers food and nutrition security for all in such a way that the economic, social and environmental bases to generate food security and nutrition for future generations are not compromised”

(FAO & UN high level task force on Global Food and Nutrition Security)

Sustainable Diet(s)

Sustainable Food System(s)

“Eat food. Not too much. Mostly plants” (Michael Pollan)

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Sustainable Food Systems (SFS)

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One Blue Dot:

Showcasing how dietitians can influence and shape national policies on environmentally sustainable diets

Ecologically (environmentally) Sustainable Diets

(BDA 2017) https://www.bda.uk.com/resource/sustainable-diets.html

So if you have not yet heard of ONE BLUE DOT – it is The British Dietetic Associations enviro sust diets project – a reference guide or toolkit, which includes infographics, tools and links to help ppl (professionals and public) improve their understanding of enviro sust diets – a live toolkit....

I was on the steering group that co-created this toolkit

We chose to focus on environmentally sustainable diets specifically because we felt that this was the area where nutrition professionals already had key skills

After a hefty debate, we chose (as a steering group) NOT to focus on wider food systems aspects....as we felt this focus was within the scope of practice for dietitians (and our membership agreed)....but even with this narrow focus there are nuances, challenges and barriers to tackle...

The One Blue Dot toolkit came about following the first publication of the BDA policy statement on enviro sust diets ((BDA2017)

It is firmly evidence based – and informed by the UKs dietary guidelines (the eat well guide)

link to sheelbeek

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Can a UK sustainable diet be healthy?

30%

34%

4%

7%

GHG emissions

Land

use

Water

use

Years of healthy life

Potatoes, bread, pasta, rice and other starchy carbohydrate foods

Fruit & vegetables

Red & processed meat

Dairy & alternatives

Oils &

spreads

Calories

Sat fat

Sugars

Salt

Fibre

5-a-day

Vits & Mins

(Scheelbeek et al , 2020)

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Red meat

≤70g / day

350-500g / week

Processed meat

Meat protein

Prioritise beans, soya (beans, mince, nuts), tofu, mycoprotein (Quorn^TM), nuts & seeds

Plant proteins

Moderate

Use calcium fortified plant-based alternatives

Dairy

From sustainable sources

Follow recommendations:

2 servings / week (1 oil-rich)

Fish

More wholegrains

Choose tubers & potatoes

Starches

Seasonal & local or used tinned / frozen

Air-freight,

pre-packed & prepared

Fruit & veg

Tap water

Unsweetened tea over soft drinks

Hydration

Animal proteins

HFSS

Portion control

Dairy

Especially perishable

fruit & veg

Recycle all food waste

Reduce food waste

Vegan / vegetarian

Organic

Animal welfare

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Challenges & barriers

Clinical

context?

Food

culture?

Time?

£££

Nutritional issues?

*We must always recognise and prioritise health and care needs first. Many Health Professionals work with vulnerable patients and a range of communities, and not every approach to ‘sustainability’ will be appropriate or applicable.

Cost?

The GREEN elephant

Lack of confidence

Political influences

Not enough time

Someone else’s job

Imposter syndrome

Insufficient knowledge

Complexity (Paralysis)

Power dynamics

First = nutritional aspects of dietary change at scale

Also important are 1) clinical context, 2) food culture, 3) time and 4) cost

The recommendations within ONE BLUE DOT are generalized and not tailored for specific audiences

So special considerations needed –

Especially the link to CLINICAL CONTEXT – given that 70% of UK dietitians work within the NHS ...

Important acknowledgement to make - I have termed this ‘the green elephant’ – we can not ignore the obvious – and these CHALLENGES have been flagged by the dietetic members (and students) themselves

I also share some of the challenges I have encountered by dietitians and students along my journey - here for you...READ SOME OF THESE

Carlsson and Callaghan quote from recent article on the ‘social license for RD to practice in this area’ - outlines nicely the need to acknowledge the various challenges that we face...READ QUOTE... “if we dilute our role too much, we may not be seen as credible, we will be too overwhelmed with such a large area that we will be immobilized to take action” (Carlsson & Callaghan, 2022, p6)

So in the UK we have followed a journey

Next slide

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BDA, Nov 2017

(updated Jan 2021)

UK Dietitians (&BDA) continue to champion this agenda!

“Continue to address climate change in our work and practice” (BDA Strategic plan, 2021)

Curriculum (pre-reg dietetic education) aims to:

“Produce dietitians who improve the nutritional health and wellbeing goals of individuals, groups and populations, in a holistic manner, with due consideration given to planetary health and environmental sustainability”

(BDA 2020)

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UK context – NHS net zero

Launch of ‘Delivering a ‘Net Zero’ National Health Service’ (NHS 2020)
Chief AHPs national sustainability advisory panel ‘Greener AHPs hub’ (released Oct 2021)
‘environmental sustainability’ key focus of AHP Strategy for England (AHP, 2022)
AHP pre-reg curriculum guidance (forthcoming)

https://www.england.nhs.uk/ahp/greener-ahp-hub/

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“Current and future needs for [dietetic] workforce education and development...

...to address the impact of climate change, growing inequities, the democratisation of knowledge and the disruption of health and food systems”

(Boak et al 2021)

Recommendations for stronger leadership, learning and collaboration for dietitians in practice (Carlsson & Callaghan, 2022) to champion this agenda

(Boak et al 2021)

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Collaborative Leadership for Sustainability (cLS study) Pettinger et al JHND (under review)

Exploratory qualitative study: April – June 2021

11 Interviews: AHP leaders

2 Focus Groups: AHP future leaders (students)

Dietitians & nutrition professionals, to be supported to step into their role as leaders and educators to promote enviro. sustainable diets and food systems within broader healthcare contexts

Very briefly – small exploratory study carried out and currently under review JHND – showed the importance of collaborative leadership for dietitians as AHP

Themes outlined here – the paper provides critique of leadership and what is needed for dietitians and nutrition professions to step into their role....

What REALLY struck me about this small study is how important students are as ASSETS in this space – so the importance of nurturing their agency

SO a DIFFERENT kind of LEADERSHIP is required – as an educator I have come to realise that LEADERSHIP roles for SUSTAINBILITY should be the key educational focus for students

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Leaders, rather than providing a solution, “create opportunities for people to come together and generate their own answers” (Ferdig 2007, p31)

Support for sustainability agenda needs to be ubiquitous and collaborative rather than coming from one actor or sector (Carlsson & Callaghan, 2022).

Recognising everyone’s expertise on this green topic and nurturing their agency (Cavazzoni, 2022) is a vital step for both current and future leaders.

Balance power within current leadership models and boost the confidence of students coming into their professions by offering them transferable skills within curricula (Shaw et al 2021) building ‘eco-ethical’ leadership (and followership) competencies (McKimm & McClane 2020)

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Leadership ‘training’ for RD2b

2019-2022 - DIET603 (Public Health Nutrition) – using One Blue Dot as exemplar to communicate message to target audience

2023 – DIET611 Leadership Roles for Sustainability – present ‘digital pitch’ of more sustainable area of dietetic practice

So as an educator and advocate of eco sust diets, the way that I have embedded this into dietetic curriculum has been via two key modules:

My previous module – public health nutrition – the assessment of which was...
My current module – for which students are submitting their work TODAY!!! – emerged following a programme review and update

Students are learning how to design, evaluate and communicate the impact of a more sustainable area of practice.

They will use sustainability leadership techniques and appraise how these will impact more effective sustainable management in all areas of practice.

There will be a focus on assessing impact e.g. using quality improvement frameworks and other means to monitor effectiveness.

There will also be scope to explore the use of digital marketing techniques to promote best practice.

All of the learning will offer students transferable skills in leadership and resilience, which align with the University of Plymouth’s strong focus on ‘Education for Sustainability’ and ‘net zero’ as well as aligning with AHP professional drivers to lead action in this agenda (NHS net zero; BDA strategy; AHP strategy).

Demonstrate an understanding of the theories of sustainability leadership (and management).
Design, evaluate and communicate the impact of a more sustainable area of practice, critically reviewing evidence and judging risks and barriers to implementation
Appraise the use of quality improvement frameworks and digital marketing tools as applied to sustainable professional practice.
Appraise the relevant sustainability and change leadership literature, as well as evidence to support digital professionalism, collaboration, ethical aspects, that impact on more sustainable professional practice.
Critically reflect on the role of the dietitian as a collaborative advocate for sustainability (change) leadership

Preliminary feedback next

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Modules such as "Leadership Roles for Sustainability" are absolutely essential if Healthcare sector is to experience transformation and adapt to the future landscape and face sustainability challenges successfully. It needs to be integrated both into the teaching curriculum and on-placement teaching in order to become part of future thinking and living.

(Ania, final year dietetic student Uni of Plymouth)

“A challenging but important topic that allows us the opportunity to be innovative within our profession” (Annabel, final year dietetic student Uni of Plymouth)

After learning about leadership within ‘sustainable diets’ and the effects that the food industry has on environment, I feel inspired to ensure that the advice and education I will be providing as an RD is going to support suitable dietary choices.

Really enjoying this module, thank you Clare!

(Esta, final year dietetic student, university of Plymouth)

Student feedback

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Student exemplars

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Summary

Ecological (enviro) sustainable diets vs sustainable food systems approaches:

Definitional nuances
Context is important

Collaboration & (different style of) leadership required
Training for future nutrition professionals

Greater attention to be paid to educational & developmental programmes that emphasise (transferable) Leadership skills