Building sustainability into healthy eating guidelines

Building sustainability into national healthy eating guidelines

Review of international practice and practical implications for policy.

Executive summary

Aims and objectives

This 18-month project commenced in April 2021. A mixed methods approach was utilised to identify best practice and practical approaches to building sustainability in healthy eating guidelines, along with the potential policy implication, based on the literature and the lived experience, knowledge and expertise of a broad range of actors on the island of Ireland. To achieve this, the project was carried out in five distinct but interconnected tasks:

A case study exploring the context, content and process evidenced in seven countries who have integrated sustainability within their food-based dietary guidelines ;
A review of peer-reviewed literature (n= 54) to identify consumer behaviours and attitudes towards sustainable diets;
An online survey of 2525 persons living on the island of Ireland to identify dietary patterns, attitudes, knowledge and behaviours towards more sustainable diets;
An online survey (island of Ireland), policy action review and a workshop with a multidisciplinary team of experts in Ireland (IE) to identify both common and contested ground regarding which sustainable dietary guidelines could be included along with the wider challenges and opportunities associated with promoting more sustainable diets in Ireland and Northern Ireland (NI); and
Seven consumer focus groups to investigate potential issues with sustainable dietary recommendations across the island of Ireland.

Key findings and recommendations

Case study

The case study enhances our current understanding of best practice to integrating sustainability into national healthy eating food-based dietary guidelines (Task 1), which can inform the development process of sustainable dietary guidance on the island of Ireland.

Case study results

Based on the case studies exploring the integration of sustainability into healthy eating guidelines in seven countries, several similarities were noted:
All countries based their guidelines on current eating patterns and health challenges, have complementary policies in place, and assume a whole food rather than a nutrient approach. The majority also facilitated public consultations and workshops during and after the development of the initial draft and pre-tested for understanding.
Most of the guidelines speak to food waste reduction. All recommend choosing local, seasonal or regionally produced foods, and all outline the relationship between food and the environment, albeit to varying degrees.
Several offer guidance specific to the environmental benefits of limiting overconsumption; in most instances, this is specific to highly processed foods.
Further certainty in dietary guidance, particularly pertaining to animal-based foods, will be required for future food-based dietary guidance.

Several considerations pertaining to the various stages of development were also highlighted for consideration:

The process should be guided by experts representing the multiple dimensions of sustainability, led by strong guiding principles and delivering a clear statement of intent.
Capturing citizens’ expectations and the challenges associated with past guidance pre-development will be beneficial.
Protective measures to limit potential conflicts of interest in the development process will be essential.

In relation to the guidance itself, considerations were also noted in the context of the guidelines explored and emerging literature:

Highlighting a clear link between each guideline and its relationship with the various dimensions of sustainability;
Recognition of the influence of food environments (e.g., marketing) and advice on how to navigate same;
Specific guidance on seafood in terms of species to favour over others, and portion size;
Specific guidance for vegetarian and vegan diets;
The promotion of breastfeeding as a cornerstone of sustainable diets.

To support sustainable dietary guidelines, further ‘multi-level, multi-actor and multi-sector’ complimentary actions will also be required. These include:

Incorporating joint human and environmental health remits and objectives within the working of key state bodies;
Aligning national (agricultural production) efforts with proposed consumer efforts - recognising the interdependence of production and consumption;
Complimenting, by further actions and collaborations, dietary diversity, healthy eating practices and sustainability;
Developing guidelines along with introducing or updating national food policy.

Review paper

The review of international literature identifies the factors influencing consumer behaviour towards more sustainable diets and contributes to our understanding of how support can be generated for the necessary structural and system level changes that are required to support behaviour change (Task 2).

Review paper results

A rapid review of 54 journal articles provided an overview of how sustainable diets are conceptualised by consumers, the factors influencing consumers’ attitudes and behaviours, and the strategies that can be employed to assist people in moving towards more sustainable diets.

The review reaffirmed that several factors influence people’s capacity to access more sustainable diets. In addition to numerous structural barriers, a low awareness of the environmental impact stemming from diets, scepticism of the scientific evidence, and the belief that individual habits play a minimal role in the global context of climate change, all contribute to a resistance in shifting towards more sustainable diets.
The concept of sustainable diets encompasses multiple meanings at the level of the individual, with human health representing the strongest. People find the terminology used to capture and measure the ecological impacts of diets confusing. They also have difficulty in discerning which dietary behaviours carry the heaviest environmental burden, tend to underestimate the ecological impacts stemming from dairy, fish, and ruminant meat production, and overestimate the impact of food miles, origin and the healthiness of cheese and cured meat.
The review also highlighted several strategies that can be used to facilitate access to more sustainable diets. For instance, targeting people before strong values are formed – e.g., at primary school level - with widespread promotion of the co- benefits of more sustainable food choices or targeting the perception that individual diets do not matter in the global picture.

Consumer survey

The review informed the development of a quantitative online study to provide insight into the current dietary patterns and beliefs, attitudes, knowledge and behaviours of a representative sample of adults on the island of Ireland towards sustainable healthy diets (Task 3), and further identifies opportunities and challenges for supporting and encouraging a more sustainable dietary pattern.

Consumer survey results

A survey of consumer beliefs, attitudes, knowledge and behaviours of a representative sample (n=2525) across the island of Ireland towards sustainable healthy diets indicates that:

Much work needs to be done in reconnecting human and ecological health, building awareness and knowledge of sustainable diets, and in making the more sustainable choice the easier choice.
Affordability, accessibility and nutrition and health are the most important characteristics of sustainable diets that influence food purchases, whereas organically produced food, low environmental impact and a short or local supply chain are the least important.
Almost half of all respondents were not interested in eating less animal-based food and more plant-based food. However, roughly one in five said they have started reducing their consumption of red and processed meat ‘some of the time’.
The most popular sustainable dietary behaviours that people are already engaged with are: eating more home-cooked meals and wholegrain foods, reducing food waste through prevention, and eating less discretionary foods.
There is an apparent knowledge gap in relation to environmental impact (e.g., carbon and land footprint) of foods and food products (e.g., animal-based foods versus plant-based alternatives).

Expert group panel

Incorporating the evidence from task one and two, the expert survey, policy action review process and workshop identified which sustainable dietary guidelines could be considered in the island of Ireland context, and prioritised actions with the most practical relevance to inform the development of sustainable FBDGs and supportive policies (Task 4). This facilitated the translation of actionable knowledge, from a multidisciplinary perspective, to allow the development of food-based dietary guidelines of practical relevance for optimal health and environmental sustainability in both Ireland and Northern Ireland.

Expert group panel results

This mixed methods approach brought together a diverse range of academic and professional expertise that spans the health, environmental, social, political and economic disciplines and sectors.

The report identifies a set of broad measures that can be used as a starting point to build sustainable dietary guidelines for the population in Ireland, along with practical approaches that can be used to strengthen existing policies that influence how we produce and consume food.
Based on the challenges raised by the expert panel, five goals and 26 actions are proposed to assist in moving both people and policy towards more sustainable diets. These goals include:
- Ensuring policy coherence and shared responsibility across multiple sectors,
- Promoting plant-based diets as the norm rather than the exception,
- Redefining people’s relationship with food, encouraging sustainable food literacy, and further collaboration between research and practice,
- Addressing vested interests and counteracting industry narratives, and
- Addressing inaccuracies presented within policy and media frameworks.
There is a high level of agreement amongst various experts in terms of what guidance is important and what challenges need to be overcome to move towards a more sustainable diet. However, some divergence is also evident concerning some of the most important and widely used guidance. This includes reducing reliance on animal-based foods and promoting plant-based whole foods along with seasonal, local and organic diets and sustainable seafood consumption.
Further qualitative research with a multidisciplinary group of experts would be beneficial to understand the low levels of agreements associated with these guidelines prior to the development of sustainable dietary guidelines. Such research may limit future conflicts and facilitate unified and well supported public messaging, reducing consumer confusion and encouraging more sustainable diets.

Consumer focus group

Finally, seven consumer focus groups convened across the island of Ireland (Task 5) to investigate the potential issues arising from the recommendations supported by the multi- disciplinary expert panel and assist in outlining the scope and content of dietary guidelines with sustainability considerations. Participants (n=40) were aged between 18 and 65 and mixed in gender and socio-economic backgrounds. The focus group discussion focussed on exploring familiarity with and adherence to current healthy eating, perceptions of the term ‘sustainable diets’, and four sustainable dietary recommendations:

eating more plant-based whole foods,
reducing processed meat,
reducing red meat consumption, and
limiting ultra-processed foods.

Participants also completed a short exit survey upon completion of the focus groups to explore the degree to which participants consider their current diets to be sustainable, and to capture the level of agreement with the 15 sustainable dietary guidelines presented to the experts. Quantitative data was analysed descriptively using SPSS and qualitative data was analysed thematically, guided by the research objectives, and supported by NVivo version 12 Pro Software.

Consumer focus group results

Knowledge and awareness of sustainable diets was low. While some people do consider additional sustainable dietary components, such as packaging and food waste, when making decisions about what foods to purchase and consume, the general consensus is that a sustainable diet is “hard work”, a lifestyle choice, more expensive, time-consuming and less accessible, particularly for families. Outside of the high concern for food waste and packaging, the environmental impacts of food production and consumption do not appear to influence dietary choices. This is complicated further by a general confusion concerning terminology, distrust of information, the positioning of certain foods as ‘bad’, perceived vested interests, conflicting narratives, and a legacy of changing dietary advice.

Eating more plant-based whole foods

There is a clear need for guidance on the term ‘plant-based’ in particular. For most consumers, particularly those not familiar with more plant-based wholefoods, perceptions that plant-based diets are another fad diet, associated with vegan and vegetarian diets, and with a commercialised industry containing many highly processed foods, appear to be prevalent. The distinction made between traditional vegetarian diets containing plant-based wholefoods such as legumes, versus new vegetarian diets which were considered by some to be highly processed, is an important one that can be used to raise more awareness of plant- based wholefoods.

Eating less red meat

It is important to note that consumption of red meat was not high in any group, with most participants suggesting they eat red meat about three times per week. However, there also appeared to be some confusion around what red meat is. There is a need for further awareness of what meats are classified as red meat, with that awareness accompanied by a clear “eat less” not “exclude” message based on actual consumption patterns. Given the dissonance evident in some of the discussions on reducing red meat, many of which were concerned with the potential economic and nutritional impacts, consumers require and desire clear and transparent reasoning as to why they are being encouraged to consume less red meat, so that those with the resources to do so can make an informed decision. In the context of sustainable diets and making the relationship between people, food and the environment clear, expanding the conversation beyond carbon footprints and nutrients, and highlighting potential economic gains, will be essential in encouraging a reduction in red meat consumption.

Eating less processed meats

Much of the food we eat today is processed in some form. However, the degree of processing is an important distinction that is not entirely, or at all, understood by most people. There is a negative connotation associated with the term ‘processed’ which may be causing further confusion amongst consumers and creating a stigma around some processed foods. Further awareness of what processed meat is, which food products are included in this category, along with clear explanations as to why these foods should be consumed and easier swaps for parents substituting processed meat in lunches, would be useful to consumers.

Moreover, and as suggested by some participants, food products commonly associated with the term ‘processed meats’, such as burgers or chicken goujons, can be made using raw and minimally processed ingredients such as fresh mincemeat or chicken breast, which may not pose the same health risk as some of their highly processed counterparts. Thus, less of a focus on end product and more of a focus on the ingredients, form and process may prove a useful distinction that avoids demonising particular foods and promotes consumer education.

Eating less or avoiding ultra-processed foods

While consumers appear very open to recommendations on limiting ultra-processed foods (UPFs), they require more knowledge of how to identify UPFs, which must be accompanied by making more minimally or unprocessed foods more accessible. Most people are not familiar with the term ‘ultra-processed’ and there are overlaps between some ‘processed meats’ and ‘ultra-processed meats’. For instance, industrially produced chicken nuggets are considered as processed meat by some, but as ultra-processed by others. While the language of ultra- processed foods is not mainstream yet, growing evidence concerning these foods in the context of the multiple dimensions of sustainable diets, and the increasing use of the terms within media and academic circles, means that equipping consumers with the knowledge of how to distinguish such foods may be beneficial to avoid further confusion. This would also help clarify some of confusion between processed foods and ultra-processed foods and bring the issue of concern back to the degree of processing, the purpose of the processing and the ingredients added, rather than the food itself.