One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Eating patterns for health andenvironmental sustainability
A
Reference
Guide forDietitians

1One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Contents

1
Introduction
One Blue Dot
About this guide

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Why should environmentally sustainable diets be important for dietitians?
Our current diets are harming the environment and our health
Dietitians as key players in combatting climate change
Greenhouse Gas emissions, global warming and the food system
UK government policy
The UK diet’s contribution to GHG emissions
Agriculture and food waste related emissions have failed to come down
Devolved government policy
Growing public interest

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12
14
15
17
19
20
21
22

3
What do we mean by a sustainable diet?
The BDA Environmentally Sustainable Diet recommendations for the UK
Current definitions of sustainable diets

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28
30

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

4
A more environmentally sustainable diet can be a healthy diet
Healthy, sustainable eating habits included in thegovernment’s Climate Change Act
Eatwell guide: an example of a more sustainable and healthy diet?
Reducing Red and Processed Meat (RPM)
The health impact
UK’s meat eating habits and how they impact on the environment
Increase consumption of plant food sources of protein
Protein quality
Moderate dairy intake
Meet fruit and vegetable intake targets
Consume fish from sustainable sources
Sustainable hydration
Eating less energy-dense foods
Waste less food and drink
What is NOT meant by an environmentally sustainable diet

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36
38
41
45
46
48
48
49
52
53
55
56
57
59

5
Summary of specific nutritional considerations
Protein
Iron
Zinc
Calcium
IodineVitamin B12
Omega 3
Selenium
Vitamin D

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64
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66
68
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69
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70

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

6
Motivators and opportunties for a more sustainable diet
Food price
Taste
Accessibility
HealthInternational considerations
Food Waste
Popular champions
Animal welfare
Language
Creating supportive environments

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73
74
74
74
74
75
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76

7
Barriers to more sustainable diets
Awareness
Convenience and difficulty
Food culture
Expense

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References

82

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for Dietitians

Introduction

Contents

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Us

Photograph of the Earth taken by the Voyager 1 space probe on February 14th 1990
at a distance of 6 billion kilometers. ©NASA
6

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

We are one blue dot
The speck on the photograph taken by Voyager 1 as it left our solar system,
is Planet Earth. It sits on the western spiral arm of an unremarkable galaxy in an
unremarkable part of space. But it is our home. It is the only one we have andultimately, the responsibility of taking care of it lies squarely with us.
In this, the early part of the 21st century, it is accepted that our eating habits arehaving an adverse impact on the environment and we are endangering the future of
the planet.
There is mounting pressure for radical change from leading environmental
specialists, organisations, and governments - as well as growing public interest andsupport.
We need to work together to combat climate change. By making dietary changes,
it’s win-win for the planet and health if we all act now.
BDA Dietitians are perfectly placed to help consumers, clients, and stakeholders
navigate the complex messages surrounding this subject. They are able to translate
national and international guidance to help the public understand what practicalchanges they can make to improve both their own health and that of our planet our one blue dot.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

About this guideThis reference guide forms the basis of a toolkit which expands on the BDA’s
Sustainable Diets Policy Statement. The policy states that the profession shouldbe leading discussions on how our food behaviours can affect both health and theenvironment. Dietitians are in a strong position to combine healthy eating messages
and sustainable diet advice.
The BDA believe that dietitians should be able to reconcile the nutritional andenvironmental science to give consistent messages about a healthy, sustainable,
and varied diet. They should be aware of the challenges that may result forvulnerable groups and individuals (e.g. those suffering ill health, pregnant women,
people on low incomes, and older adults) and be able to provide advice onsustainable eating as appropriate.
This reference guide forms the core part of the toolkit. This begins by describing
the reasons that dietitians need to understand sustainable diets, before looking
in more detail at what a more sustainable diet looks like. With reference to the
UK Eatwell Guide, the guide considers specific nutritional issues raised by a moresustainable diet that dietitians will need to consider.
The wider toolkit will be made up of the reference guide, and other documents
including practical tips, as well as plenty of links to other useful resources andinformation sources. The toolkit will, by necessity, remain “live” with updates andextra information.
We are grateful for the assistance of our Sustainable Diets Working Group fordrafting this guide and identifying many of the useful links, to Alpro for providing
an education grant, and to the many individual dietitians, allies and partners who
contributed to the drafting process.

8One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

This reference guide was created by a specially convened working group:
Dr Clare Pettinger RD
Sandra Hood RD
Lynne Garton RD
Linda Convery RD
Ursula Arens
Dr Pamela Mason RNutr
Elphee Medici RD (Nutrilicious)
Tanya Haffner RD (Nutrilicious)
Kate Arthur RD (Alpro)
Jo Lewis (BDA)Tom Embury (BDA)
Our thanks to Dr Brian Cook, Senior Researcher in Health Behaviours, Nuffield
Department of Primary Care Health Sciences for his contribution to the 'Motivators
and Opportunities' section.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Why should environmentally
sustainable diets beimportant for dietitians?

10One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

From farm to fork to waste
All stages of food production impact on the environment

Fisheries
Livestock

Processing + Packing

Growing +Harvesting

Distribution

RetailCooking + Eating

Waste +
Recycling

Landfill

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Our current diets are harming
the environment and our healthAs dietitians, we are all too aware of the poor eating habits of the nation: low
intakes of fibre, fruit and vegetables, and essential micronutrients whilst we are
overconsuming energy, saturated fats, and sugars.1 Our current dietary habits are
fuelling obesity, type 2 diabetes, heart disease, and as some cancers.2
But, our eating habits also have an impact on the environment and are jeopardising
the future security of our planet.
Taking into consideration farming, production, distribution, and delivery through towaste, our current food system has a major impact on the planet:• Food production contributes 15-30% of total greenhouse gas (GHG) emissions
in the UK and therefore contributes significantly to global warming.3• Is a leading cause of deforestation, biodiversity loss, and soil and waterpollution.4• Accounts for 70% of all human water use.4• 9.5 million tonnes of all food produced is spoiled or wasted in the UK every
year with the majority (71%) occurring in the home.5 Some of this is avoidable
and represents a waste of land, water and other inputs, and produces‘unnecessary’ GHG emissions.6• Over fishing and poor fishing practices have impacted on fishing stocks with
90% of fisheries now fully exploited7 and/or over fished, the marine vertebrate
population fallen by more than a third8 and the marine ecosystem has beendamaged.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

The environmental impact
How current food systems damage our planet

Deforestation%

Agriculture

30

Manufacture

Depletedfish stocks

of global
greenhouse gas
emissionsFishing

Delivery

Waste

StorageSoil
degradation

Damagedecosystems
Food Prep

Water use

Loss ofbiodiversity

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Dietitians as key players incombatting climate changeThis section looks at international and UK policies, as well as other stakeholder
views. As part of the development of this guide and the preceding policy statement,
the BDA undertook an online survey with members (319 dietitians), a workshop
at the March 2018 BDA Live event (70 dietitians) and a specially convened focus
group (8 dietitians). Feedback was also gathered from members during thedevelopment of the policy statement in 2017. This helped the working group to
understand dietitians’ perceptions and interest in the topic of sustainable diets.
It became clear that this is a topic that dietitians feel is of growing importance. A
range of possible barriers and challenges were also highlighted.
In particular, dietitians emphasised four key areas they believe we need to focus on
to ensure that dietitians can play an important role in the facilitation of sustainable
diets, as outlined in our 2017 Policy Statement:• Changing the environment and multi-organisation involvement: Improving
the availability of sustainable and healthier foods by developing integrated
multi-organisation sustainable polices with government, local authorities,
farmers, local producers, and NGOs such as food banks and commercial
companies.

• Improving education and knowledge for health professionals as well as
consumers: A strong focus for under and post graduate dietetic training onsustainable diets, as well as placing sustainable diets on the school curriculum
and training other healthcare professionals.

• Clear and simple language: Making sustainable diets easier to understandand taking part in conversations which move us towards gaining a consensus.

• Relevancy: Ensuring that messages were relevant for different populationgroups, especially teenagers, and accommodating different cultures. Use ofsocial media was highlighted, especially for the younger generations.
These four key areas of focus have been considered to inform the development of
this reference guide and associated toolkit aspects/elements.
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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Greenhouse Gas emissions,
global warming and the food system
Increased Greenhouse Gas (GHG) emissions have a direct impact on global warming
which, as well as increasing temperatures, cause extreme weather events (droughts
and floods) and water scarcity.6 Whilst a rise is inevitable, the UN Intergovernmental
Panel on Climate Change (IPCC) has proposed a safe limit for global warming increaseby 2050. At the IPCC meeting of October 2018, experts set the safe limit for global
warming increase to no more than 1.5°C by 2050 if we are to prevent catastrophic
consequences for extreme weather conditions: heat, droughts, floods, and subsequent
poverty.11,12 The glossary which accompanies this guide will assist you in better
understanding terms like CO2 eq and GHG emissions.

1.5°C
Recommended
safe limit for global
warming increase

Requires 70-95% reduction incurrent GHG emissions by 205012

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Fig 2.1: The UN Intergov recommendations Climate Change13

IPCC
2018

ConsumeLESS meatand dairy

Buy MORE
locally sourced,
seasonal foods

Throw LESS
food away

The IPCC’s 2018 report emphasises that livestock is by far the biggest contributor todietary GHG emissions, and urgent changes are necessary if the target of a 1.5°C riseis to be achieved. In the report, as well as focusing on changes to farming practices
and food processes needed to mitigate the impact on global warming, it tackles theshifts needed in consumer behaviour change. With regard to diet, the IPCC’s reportlists specific actions that individuals should be urged to take, including the above.13
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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

UK government policy
The UK Government, through a 2019 amendment to the Climate Change Act
200814, is committed to an 100% reduction in GHG emissions by 2050 (compared
to 1990 levels), and to contribute to global emission reductions to limit global
temperature rise to no more than 1.5°C above pre-industrialised levels. This issupplemented by 5-yearly “carbon budgets”15 where the government sets out its
GHG emission reduction targets. Even an 80% GHG emission reduction target
equates to reducing our current emissions of 11.9 tonnes per person per annum
from all activities (including travel, food, heating, etc.) down to 2.4 tonnes CO2
equivalent per person by 2050.16
Fig 2.2: Current proportion of GHG emissions perperson in the UK showing impact of dietary intakes

GHG emissions fromUK diets (18-25%)

All other GHG emissions
incl. travel, heating,manufacture (75%)
17One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

There has been no progressin reducing emissions fromagriculture since 2008.

The UK Committee for Climate Change (CCC) report, Net Zero, included specificdietary recommendations that UK intakes of ruminant meat (beef and lamb) anddairy should be reduced by 20%.19
Current UK dietary habits (based on the National Diet and Nutrition Survey
2013/14) are estimated to contribute on average 2.1 tonnes CO2 eq per person perannum. When taking account of typical under-reporting of energy intakes, this may
be as high as 3 tonnes CO2 eq.17 These values equate to 18% and over 25% of anindividual’s total (measured by carbon footprint of products, CFP).
The UK reduced its GHG emissions by 40% between 1990 and 2018, ahead ofits carbon budget targets.18 However, the latest assessment by the Committee on
Climate Change (CCC) has emphasised that the majority of these reductions are
attributable to the switch from fossil fuel and that emissions from agriculture haveactually increased slightly in recent years. There has been no progress in reducing
emissions from agriculture since 2008.18 It is estimated that despite an excellent
start, the UK will fail to meet future carbon budget targets, with projections of a 3%
and 7% overshoot for the fourth and fifth budgets (2023-2032) respectively.20

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Figure 2.3: Foods that contribute the most to GHG emissions in the UK diet17

Proteins
Red meat
FishWhite meat, poultry
Eggs
Beans & pulses
Nuts & seeds

24.2
6.4
5.4

1.8
0.7
0.2

Dairy
14.3

Dairy products

DrinksSoft drinks inc. fruit juice
Sugars & confectionary
Alcohol
Tea
Coffee
Water

8.9
6.2
5.2
2.7
0.6
0.2

Cereals
6.8

Cereals

Oils
Butter & margarines
Vegetable Oils

5.80

Fruit & vegetables
Fruit
Vegetables
Potatoes

5.1
2.8
2.8
% GHG emissions (CO2 eq) of total dietary intake
19One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Agriculture and food waste related
emissions have failed to come down
The Committee for Climate Change in the UK voiced their concerns about our lackof progress in agricultural practices, and indeed the overall share of emissions
is increasing as other sectors do more to reduce their footprint. Amongst its
recommendations, the committee suggests urgent action to “help consumers tomake food choices which reflect government nutritional advice and which support
lower carbon footprint food products”.21 In practice, this means a reduction in meat(especially beef) and moderation in dairy intakes, with a consequent increase inplant food sources of protein such as beans, legumes, and seeds.
Additionally, the UK’s lack of resource efficiency policies, including food waste, isa key contributor to the projected overshoot of future carbon targets. Food waste
alone (mainly in the home but also in food manufacture) will contribute between
16% and 12% to the projected overshoot in the fourth and fifth carbon budget
targets respectively.20 The committee has highlighted waste as a key priority forthe government, recommending that strategies are put into place to ensure that nobiodegradable waste, including food, is sent to landfill by 2025.18

The UK’s lack of resource efficiency
policies, including food waste, isa key contributor to the projected
overshoot of future carbon targets.20

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Devolved government policy
Sustainability is not just a priority for policy in England, but for each of the devolved
governments in the UK. The Climate Change Strategy for Wales sets an evenmore ambitious target to reduce GHG emissions in Wales by 3% every year andachieve at least a 40% reduction by 2020 compared to figures from 1990.22 The
Welsh Government action plan for the food and drink industry 2014-202023 alsoemphasises a vision of “green growth where [food] businesses are the custodiansof our natural resources, businesses that are both environmentally and socially
responsible”.
In Scotland, the government’s climate change plan for 2018-203224 went one
step further, targeting a 42% reduction in emissions by 2020, and has the specificambition for agriculture in Scotland to be among the lowest carbon and mostefficient food producers in the world. The Good Food Nation policy, first publishedin 2014, set out an aspiration for Scotland to produce food which is “both tasty to
eat and nutritious, fresh and environmentally sustainable”.25
There are no specific targets in Northern Ireland for emissions reduction. However,it has asked the Committee on Climate Change to model a target of a 35%
reduction by 2030 compared to 1990 levels.159 Agriculture is a relatively highcontributor to emissions in Northern Ireland and there has been little reduction
since 2009 because of its contribution.

In Scotland, the government’s climatechange plan for 2018-203224 went
one step further, targeting a 42%
reduction in emissions by 2020.
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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Growing public interest
Aside from the obvious policy drivers, dietitians are going to increasingly encounter
individuals who are seeking information on the sustainability and environmental
impact of their diets. In the UK the public are becoming more aware of how theireating habits impact on our planet.
More than seven in ten (74%) people regularly surveyed by the Department of
Business, Energy and Industrial Strategy, are very or fairly concerned about climatechange.26 This figure has grown slowly year on year since surveying began in
2012. A ComRes survey 27 has found that taste, value for money, reducing costs,
convenience, and the healthiness of food rank most highly. However, over half ofthe respondents stated that they were likely to consider changes to their diets
if doing so would reduce their impact on climate change. Whilst a fifth reported
they consumed meat only once or twice a week, another 38% stated they would
consider changing their diet in the future. Over half stated that they already seek tochoose seasonal fruit and vegetables, whilst another third would consider doing so
in the future.
Another Ipsos poll28 has identified that although over half of respondents ate meaton a daily basis, 48% reported a consumption frequency of three times a week orless. A 2017 survey by the Food Standards Agency found a small decline in redmeat consumption from previous surveys, with 84% of respondents reporting toconsume beef, lamb or pork less than three times a week: however, this was at theexpense of a higher white meat consumption. The survey also identified that dairy
consumption occurred on a daily basis for over 74% of respondents.29

In the UK the public are becoming
more aware of how their eating
habits impact on our planet.26
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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Although the awareness andintention is there, it is clear
from the latest UK dietary
survey that this has yet totranslate into sustainabledietary behaviour change forthe majority, and significant
barriers will need to be
identified and overcome.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Fig 2.4: Intention vs current behaviour in samples of the UK population27,28

Intention

50% of us are likely toconsider dietary changes
to reduce impact on
climate changevsBehaviour

more than50%
of us eatmeat

80%
of us eatdairy

on a daily basis

Intention is there but significant barriers to
behaviour change for the majority24

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

What do we mean by asustainable diet?

25One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

What do we mean by asustainable diet?
Defining what is meant by a sustainable diet is difficult, and there is currently noconsensus. The word sustainable itself is used in a number of ways, and there
are generally accepted to be three broad ‘pillars’ of sustainability; 1) economic,
2) social and 3) environmental.30 All three are important when considering overallsustainability, but within the context of this reference guide and the BDA’s
Sustainable Diets policy, we have focused specifically on an environmentally
sustainable diet.

Fig 3.1: The three pillars of sustainability30

Sustainability

Economic

SocialEnvironmental

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Further complexity is added by the fact that environmental sustainability itself
can have a range of meanings, and that there can often be differing priorities –land and water use, GHG emissions, biodiversity, etc. Sometimes one priority cancontradict another.
Despite this complexity it is important to have a clear direction of what is meantby the term sustainable diets, at least in relation to this reference guide. In thissection we summarise the BDA recommendations and we consider definitions
from key organisations and thinkers in the field, which taken together give a good
indication of what is meant by an environmentally sustainable diet.

A clear direction27

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

The BDA Environmentally Sustainable
Diet recommendations for the UK
Red meat

Red meat
If consumed, no more than
70g/per person per day or
350g-500g per person per
week (cooked weight).

Plant proteins

Prioritise beans and lentils, soya
(beans, mince, nuts, tofu), mycoprotein(Quorn™), nuts and seeds.

Fish

From sustainable sources andfollow oily fish recommendations.

Dairy

Moderate dairy consumption.
Use calcium fortified plant-basedalternatives where needed.

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

Recommend wholegrain.
Recommend tubers such as potatoes.

>

continues

Processed
meats.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for Dietitians

Fruit and vegetables

Portion control

Contents

Air freighted,
pre-packed andprepared fruitand vegetables.

Seasonal +locally produced
vegetables/fruitor tinned/frozen.

High Fat, Sugarand Salt (HFSS)
foods

Animal proteins

Dairy produce

Hydration

Tap water and tea or
coffee over soft drinks.

Reduce foodwaste

Especiallyperishable fruitand vegetables.

Avoid

ReduceModerate

Any food waste
should berecycled.

Increase

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Current definitions of sustainable diets
United Nations
The official definition of a sustainable diet from the Food and Agriculture
Organisation (FAO) of the United Nations, which we use in the BDA Policy
Statement, is:‘Sustainable Diets are those diets with low
environmental impacts which contribute to foodand nutrition security and to healthy life forpresent and future generations. Sustainable diets
are protective and respectful of biodiversity andecosystems, culturally acceptable, accessible,
economically fair and affordable;
nutritionally adequate , safe and healthy while
optimizing natural and human resources.’
FAO, 201031
This definition, perhaps understandably, tries to define sustainable diets in the
broadest possible terms, but has been critiqued for including too many stipulations.
It is interesting to note however, that within its definition, the nutritional adequacyof a diet for health is included. In 2019 the FAO has expanded on this definition,
creating more comprehensive guiding principles for sustainable healthy diets. They
still have the aim of "promoting all dimensions of individuals’ health andwellbeing; and having low environmental pressure.160

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Fischer and Garnett
Carlos Fischer and Tara Garnett from the Food Climate Research Network (FRCN)
at the University of Oxford32 provide a more practical definition of a sustainablediet, taking on board key aspects of the FAO definition but with a clear focus on
nutritional adequacy for health, or in their words: “low environmental impact diets
consistent with good health”. The definition can easily be applied to current dietary
recommendations.

'... low environmental impact diets consistent
with good health...'• Diversity – a wide variety of foods eaten.
• Balance achieved between energy intake and energy needs.
• Based around: minimally processed tubers and whole grains; legumes; fruits
and vegetables.

• Meat, if eaten, in moderate quantities – and all animal parts consumed.
• Dairy products or alternatives (e.g. fortified milk substitutes and other foods
rich in calcium and micronutrients) eaten in moderation.

• Unsalted seeds and nuts.
• Small quantities of fish and aquatic products sourced from certified fisheries.
• Very limited consumption of foods high in fat, sugar or salt and low in
micronutrients.

• Oils and fats with a beneficial Omega 3:6 ratio such as rapeseed and olive oil.
• Tap water in preference to other beverages – particularly soft drinks.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

EAT-Lancet Planetary Health Diet
A very rigorous definition of a environmentally sustainable diet was provided
in 2019 by the EAT-Lancet Commission. The Commission convened 37 leading
scientists from 16 countries in various disciplines including human health,agriculture, political sciences and environmental sustainability. The commission
reviewed global targets for healthy diets defined to reduce premature deaths fromchronic disease, and sustainable food systems. Planetary boundaries directly
linked to food production were assessed by six measures including greenhousegas emissions, cropland and water use, nitrogen and phosphorus application, andbiodiversity scores.
Overall, the commission recommends;'doubling in the consumption of healthy foods
such as fruits, vegetables, legumes and nuts,
and a greater than 50% reduction in global
consumption of less healthy foods such asadded sugars and red meat.'161
The commission calculated a reference diet to provide adult reference intakes ofenergy, macro- and micronutrients. Compared to typical UK diets, the EAT Lancet
diet contains more fruit and vegetables, more wholegrain starchy foods and more
plant protein, but less meat and dairy, starchy tubers, sugars and processed foods.
They also provide specific quantities of foods, including as little as 14g per day of
red meat, 29g of white meat but 75g or legumes and 50g of nuts. The BDA has
deliberately avoided such a prescriptive approach, as individual diets will varyconsiderably. However, EAT-Lancet does provide a clear indication of the degreeof change necessary to sufficiently reduce environmental impact from our foodsystem.

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Fig 3.2: EAT-Lancet Planetary Health Diet

Wholegrains

Starchy
vegetables
Dairy foods
AnimalsourcedproteinFruit and green
vegetables
Plant sourced
proteinUnsaturated
plant oils

Added sugars

Saturated fats

Note: Percentages for food groups other than fruit and vegetables based on proportion of calories consumed.

For further information on terms and ideas, take a look at our glossary, which forms
part of the wider toolkit.
33

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A more environmentally
sustainable diet can be ahealthy diet34One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

A more environmentally sustainablediet can be a healthy diet
The FAO, EAT-Lancet and Fishcher and Garnett definitions of sustainable dietsstate that such diets must be nutritionally adequate for the health of a populationand therefore, sustainable diets can be synonymous with healthy diets.
However, care needs to be taken as not all healthy eating patterns are guaranteed
to be sustainable and a diet that has a low environmental impact is not necessarily
nutritionally adequate.33 For example, sugar has a relatively low environmental
burden whilst perishable fruit and vegetables can have a high environmental burden
due to the high level of wastage, greenhouse energy use and air freight.
Overall, the scientific evidence consistently demonstrates some common traits
between sustainable and healthy diets. In the main, a lower reliance on livestock
products (especially beef and dairy), with a shift to more plant proteins (including
wholegrains, beans, nuts and seeds), and reduced intakes of pre-packaged or
highly processed foods, especially those high in fat, salt, and sugar.
Modelling and real consumption data studies have repeatedly demonstrated that
dietary patterns of higher nutritional quality, which are based on healthy plant foods
and lower intakes of meat and dairy products, also have lower GHG emissions andbetter overall sustainability scores. 17,34-41
Such dietary patterns, whilst meeting national micronutrient recommendations,tend to be lower in energy dense foods and saturated fat whilst providing higher
fibre and fruit and vegetable intakes. It is not surprising, therefore, that healthysustainable eating patterns have been associated with improved health outcomessuch as reduced risk of obesity and reduced rates of diabetes and heart disease,and could result in reductions in total mortality by 6–16%.38,42

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One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Healthy, sustainable eating habits
included in the government’s
Climate Change Act
As part of the government's Climate Change Act, agriculture and farming are
targeted for improved practices to lower their carbon foot print. Changing current
consumer dietary habits were a key focus in the fourth carbon budget.43
Three dietary scenarios involving various adaptions to current intakes were
evaluated for macro and micronutrient adequacy and environmental impact
by Scarborough and colleagues – see Table 4.1. Scenario 1 showed significant
reductions in all meat and moderation in dairy, and provided the most favourable
outcomes for both environmental and health benefits.44
Additionally, key micronutrients often associated with red meat and dairy
consumption were similar to actual dietary intakes across all 3 dietary scenarios.44
All dietary scenarios, including current intakes failed to meet male zinc dietary
recommendations. With regard to iron intakes, despite reductions in red meat, ironincreased in scenario one which could reflect contributions made from increased
cereal product consumption. As expected, dietary vitamin D intakes were low
across all dietary patterns.

Dietary modelling studies involving
significant reductions in all meat andmoderation in dairy, provided themost favourable outcomes for both
environmental and health benefits.
36

Table 4.1: Three dietary scenarios based on modifications to UK dietary intakes*
and the potential impact on health, nutrition and environmental outcomes.44

1
1. Reducing current

intakes of all meatby 64% and dairy
by 40%.

2. Plus adapting

intakes of allother foodgroup to meet
recommendations.

2
1. Reducing redmeat (beefand lamb)
consumption by
75% and partly
replacing withmore white meat
consumption(increasing
consumption by
45%).

3
1. Halving current

white meat
consumption.

2. No reductions

in dairy or othermeat.

3. Moderate

improvements inother food groups.

2. No other dietaryadaptations.

GHG emissions

19%

9%

3%

Land use

42%

39%

4%

Delayed or averted
deaths36,910

1,999

9,297

10.0

11.1

908

943

7.6

8.4

1.7

1.8

731

812

Current
intakes
Iron mg/d#

10.5

11.8

Calcium
mg/d

904

854

Zinc mg/dˆ

8.3

7.4

Riboflavin
mg/d

1.7

1.5

Vitamin A
mcg/d

799

727

Vitamin D
mcg/d**

2.7

2.3

2.6

2.6

Vitamin B12
mcg/d

5.8

3.9

5.2

5.7

* Meat, dairy and other food group intakes based on 2008 Family Food Survey data. Nutritional comparisons based on NDNS 2000/1 data.
# Iron: similar intakes across all dietary scenarios. None meeting female under 50 year recommendations of 14.8mg/d.
^ Zinc: all dietary scenarios providing similar levels to current intakes. No dietary scenario meets male recommended intakes of 9.5mg/d.
** Vitamin D consistent between current and all 3 dietary scenarios – all below latest recommended intakes of 10mcg/day.

37

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Eatwell Guide: an example of a moresustainable and healthy diet?
Public Health England sought to address sustainability in its broadest sense within
the revised Eatwell Guide while at the same time ensuring that all macro andmicronutrients and fibre recommendations were met.45
As a result, the Eatwell Guide came with some notable modifications to its
predecessor, the Eatwell Plate.
The Carbon Trust analysis of the Eatwell Guide shows a lower environmental
impact than the current UK diet16 attributed to a number of factors, including an
increase in potatoes, fish and bread, vegetables, and fruit, alongside reduced
amounts of meat, dairy, rice, pasta, pizza, and sweet foods. The Carbon Trustestimates that if individuals moved from current eating patterns to the Eatwell
Guide recommendations, a 31% reduction in GHG emissions, 17% saving on water
use and 34% reduction in land use could be achieved. Based on the more recent
assessment of UK dietary habits, estimating 2.1-3 tonnes CO2 eq per person perannum,17 this means an individual’s food related emissions would reduce to 1.5-2.1
tonnes CO2 eq by 2050. This is a significant reduction and does not include theimpact of improved farming and food production practices or reductions in waste
which would further lower the carbon foot print.

The Carbon Trust analysis of
the Eatwell Guide shows alower environmental impact
than the current UK diet.16

38

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Figure 4.2: Summary of the changes when the
Eatwell Plate was updated to the Eatwell Guide45

Potatoes,bread, pasta,
rice andother starchy
carbohydrate
foods

Fruit &
vegetables
Achieve 5 a day
sustainablyHigh fat, salt
and/or sugary
foods anddrinksAvoid

Red andprocessed
meat

ReduceModerate

Wholegrains

Dairy and
alternatives

Oils andspreads

Increase
39

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

As well as environmental benefits, the Eatwell Guide, if all recommendations are
met and energy requirements are not exceeded, would increase life expectancy bymore than five months. It would also avert 17.9 million disability-adjusted life years
over the lifetime of the current population as a result of reduced incidence of type 2
diabetes, cardiovascular disease, and colorectal cancer.46
The UK is not alone in adopting sustainable factors into national dietary guidelines.
The current dietary guidelines of countries such as Canada,47 Belgium (Flanders),48
and the Netherlands49 have also placed sustainability at the core of theirrecommendations.

Figure 4.3: Benefits of adopting Eat Well Guide recommendations16,46

31
%
34
%
17
17.9m
%

GHG emissions

Land use

Water useYears of healthy life40One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Reducing Red andProcessed Meat (RPM)
The environmental impact
Red and processed meats have the single biggest environmental impact of any
type of food, with beef and dairy cattle in particular contributing significantly tothe environmental burden.17,50-52 Livestock farming is the biggest contributor tofood related GHG emissions, deforestation, biodiversity loss, and soil pollution, as
well as land and water use.

Red and processed meats
have the single biggest
environmental impact ofany type of food.17,50-52

41

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Livestock farming:• Globally, livestock are by far the biggest contributor to food-related GHG
emissions, estimated to be responsible for 14.5% of all human-caused
emissions.54• An assessment of UK dietary intakes (NDNS 2008/2009-2011/12) found that
red meat alone (including beef, lamb, pork, goat, and venison) was responsiblefor 24.2% of dietary related GHG emissions whilst white meat contributed
5.4%.17 The authors took into account under-reporting and provided values
based on ‘plausible’ food intakes over the course of a day.

• An earlier assessment by Green and colleagues52 using NDNS 2008/2009–2010/11, found similar findings and also provided a more detailed breakdownof GHG emissions of different types of red meat. Results were presented as
per capita per year.
- Based on this analysis: Beef consumption was by far the biggest single 		food contributor to dietary GHG emissions at 16.2%, lamb contributed 		
3.8%, whilst white meat contributed another 4.1%.52• Cattle are by far the largest contributors due to being ruminants (methane gas
emitters) and the most commonly farmed animal.17,53,54 It is estimated that cattle
are responsible for around 5.0 gigatonnes CO2-eq, or 62% of the sector's
emissions.

• Livestock is the largest single agricultural water user.
• Finally, livestock farming is responsible for degrading 33% of UK soil, polluting
1/3rd of water supply and has the biggest impact on biodiversity loss.9
Figure 4.4 illustrates that, taking into consideration regional and process
variability, shifting our reliance from meat (especially red meat) to plant protein will
significantly reduce both GHG emissions and land use.

42

Figure 4.4: Mean GHG emissions, land use and water use values of different foods
providing 100g of protein55-57
These are average values based on a combination of data sets from around theworld, therefore there will be significant variability depending on country of origin
and practices used6. See table below.
GHGe as kg CO2 eq
per 100g of protein

Land use m2
per 100g of protein

Stress weighted water
use 1000s litres
per 100g of protein

Nuts

0.3

7.9

140.8

Peas

0.4

3.4

12.6

Other pulses

0.8

7.3

10.5

Peanuts

1.2

3.5

23.6

Tofu

2

2.2

3.2

Eggs

4.2

5.7

16.2

Poultry meat

5.7

7.1

8.2

Fish (farmed)

6

3.7

18.2

Pig meat

7.6

11

41.3

Cheese

11

40

81.9

Dairy cattle (milk)

17

22

60.7

Shellfish (farmed)

18

2

86.2

Sheep meat

20

185

70.9

Beef meat

50

164

17.4

“Water stress” considers several physical aspects related to water resources, including water scarcity, water quality,
environmental flows, and the accessibility of blue (stored) water for human consumption. Therefore a product with highstress weighted water use, implies it is using blue water (storage water) for irrigation due to dry conditions which isdepleting water stores that could be used for human consumption in an area whose overall water levels are alreadyscarce. Crops relying more on rainfall will utilise more ‘green’ water, thus their stress-weighted water use will be lower.

43

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Table 4.5: Fuller summary of the original data by Poore and Nemecek 2018highlighting the significant variability in values for GHGe and land and water use.55-57

Functional unit

Per 100g protein
Land Usem2

GHG Emissions
kg CO2eq

5th %ile

Mean

Median95th %ile

5th %ile

Mean

Median95th %ile

5th %ile

Mean

Median95th %ile

Environmental
measureStress-Weighted Water Use
litresBeef meat

19

50

30

135

35

164

85

456

103

17,419221

95,685

Dairy cattle(milk)

7.6

17

17

29

6.2

22

13

54

21,36560,692

61,893

108,521

Sheep meat

12

20

20

30

24

185

64

362

129

70,927

129

297,490

Pig Meat

4.3

7.6

6.5

15

4.6

11

8.3

21

32

41,32733,525

94,147

Poultry Meat

2.3

5.7

4.3

12

3.7

7.1

6.4

12

12

8,186

193

38,132Cheese

4.6

11

8.4

27

3.6

40

9.1

146

787

81,90736,442

358,171

Eggs

2.6

4.2

3.8

7.7

3.8

5.7

5.1

7.9

369

16,206

16,782

34,931Fish (farmed)

2.4

6.0

3.5

14

0.1

3.7

2.5

12

2,417

18,2293,720

58,695

Crustaceans(farmed)

5.0

18

10

78

0.4

2.0

0.6

3.5

15,57086,16032,998

666,721

Other Pulses

0.4

0.8

0.6

1.9

1.9

7.3

5.7

20

0

10,499049,582

Peas

0.2

0.4

0.4

0.8

1.0

3.4

3.0

9.2

0

12,5780

118,810

Nuts

-2.5

0.3

-0.8

6.6

2.5

7.9

5.3

16

0

140,778

79,219494,586

Peanuts

0.5

1.2

1.3

2.3

1.6

3.5

3.0

5.9

908

23,605

16,941

74,536

Tofu

0.9

2.0

1.6

4.5

1.0

2.2

2.1

3.7

8

3,196

20

19,67744

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Additionally, the overall environmental impact will also depend on many other factors
including biodiversity loss, deforestation, pollution of water, and degradation of soil.6
Meat protein’s potent environmental impact is also reflected in studies looking at
dietary patterns which consistently show a direct correlation between the quantity ofmeat in the diet and the projected environmental burden.36,37,44,58

The health impact
Attempts to reduce rates of obesity, type 2 diabetes, cardiovascular disease, andcancers by the government,45,46 WHO,59 and many health organisations include limiting
red meat (especially processed meat) and/or shifting towards a diet with more plant
protein as overarching dietary recommendations.
In 2011, SACN recommended that high red meat consumers (>90g per day) should
reduce intakes to no more than 70g per day, to reduce colorectal cancer risk withoutcompromising iron intakes.60 The Eatwell Guide has prioritised plant proteins overanimal proteins whilst assessing that micronutrients including iron and zinc are notcompromised for the general population.44 Current intakes of red meat alone in theUK, taking into consideration under-reporting within the national diet and nutrition
survey data, is estimated to be at 90.5g per day.17 The WHO59 has been emphasisingmore plant-based diets for a number of years and dietary recommendations from theWCRF61,62, and Heart UK63 focus on reducing red and processed meat intakes whilst
increasing plant proteins. The WCRF has specifically recommended that processedmeat should be avoided. Red meat, if consumed, should be limited to no more than
350-500g per week (50-70g daily).45,60,62
In the main, reductions in red and processed meats are associated with reduced riskof colorectal cancer and reduced intakes of saturated fat and salt while the inclusionof plant proteins in the diet results in an improved fat profile, lower energy density andsignificantly increased fibre content.44,64-67 These dietary modifications are associatedwith reduced incidence of obesity, cardiovascular disease, type 2 diabetes, and somecancers.38,41,42,44,46,68-71

45

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

UK’s meat eating habits and how
they impact on the environment
Figure 4.5 highlights that reduced intakes, and not avoidance, of meat can significantly
reduce our carbon foot print.58 A reduction in current UK consumption of total meat
(108g per day)1 for adults to 50-99g would reduce our carbon foot print by around
22% whilst a further reduction to below 50g per day would result in a 39% reduction.
It is expected that similar savings would be made to land and water use as well as
biodiversity loss, soil degradation and water pollution.
More recent UK consumption data (NDNS data set 2008/2009 and 2013/2014),
further emphasise that switching to more plant protein sources is key to reducing theenvironmental burden and improving the nutritional quality of the diet (see Figure 4.5).17

39%

A reduction in current UK consumption of total meat
(108g per day)1 for adults to below 50g per day would
result in a 39% reduction in our carbon footprint.44
46

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Figure 4.5: Daily mean GHG emissions (kg CO2 eq) per person
consuming a self-selected diet of 2,000kcal.58

High meat eaters >100g/day

7.19

22%
Moderate meat eaters 50-99g/day

5.63

Low meat eaters <50g/day

Fish eaters

Vegans

4.67

3.91

Vegetarians

39%% dropin carbon
footprint

3.81

2.89

47

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Increase consumption of plantfood sources of protein
A key part of a more sustainable diet is to consume more plant sources of protein
in place of animal proteins. As discussed above, it is clear that shifting dietary
patterns towards more plant proteins such as beans, pulses, nuts, and seeds
will help reduce both the environmental and some of the health burdens we are
currently facing.

Protein quality
Protein quality and quantity is not compromised when switching to more plantbased diets, whether meat and dairy are included at reduced quantities or totally
excluded. Plants contain all essential amino acids and diets entirely based ona variety of plant foods which meet daily energy requirements will also meet all
essential amino acid requirement.71-76 Thus the terms ‘complete’ and ‘incomplete’ or‘high biological value’ and ‘low biological value’ should be used with care as these
only reflect the quantity and quality of essential amino acids in one serving of asingle food and do not provide an assessment of the overall ability of a diet to meetrequirements.
The graphs and tables above demonstrate the significantly lower GHG emissions,water use, and land use needed to produce 100g plant proteins versus 100gof animal protein. Additionally, it has been demonstrated that diets based
predominantly on plants which meet national dietary needs have an overall lower
environmental impact compared to high meat diets.33,36-38,41,42,46

48

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Moderate dairy intake
Compared to ruminant meat products, dairy products produce significantly lower
GHG emissions, however, their footprint remains a major contributor to dietary
emissions and is significantly higher when compared to plant-based alternatives.
In terms of actual consumption in the UK, the most recent assessment of the
NDNS data found dairy products to be the second biggest contributor after redmeat at 14.3%.17 These findings concurred with the earlier assessment by Greenand colleagues52 estimating dairy* (milk, yogurts, cream, cheese, ice-cream,
dairy desserts) to be responsible for 11.7% of total dietary GHG emissions andsecond only to beef consumption. Green et al also identified cheese as the most
GHG emission intense dairy product. Table 4.6 below shows that despite cheese
consumption being significantly lower (15g per day) compared to milk, yogurt,
cream, and dairy desserts (>189g/d), it was responsible for almost 40% of dairy
GHG contributions.52
Table 4.6: UK dairy consumption and estimated GHG emissions contributions52
Dairy
category

Consumption
g/day

GHGe
(kg CO2 eq
per capita per
year)%
contribution
to totaldietary GHGe%
contributionof dairycategory only

Milk, yogurts,
cream, dairy
desserts

189

138

6.6%

56.5%

Cheese

15

97

4.6%

39.7%

Ice cream

5

9.3

0.4%

3.8%

All dairy

208

244.3

11.7%

NA

These factors are reflected in the government’s more sustainable Eatwell Guide
where the dairy section has been reduced by almost a half (from 15% to 8% of
total food weight).45 This means that dairy can continue to contribute to important
calcium and iodine intakes in the UK diet.
*This does include plant-based dairy alternatives, but these represent a very small proportion of the total.

49

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Environmental impact of dairy and plant-basedalternatives beyond GHG emissions
Whilst this document relies mainly on GHG emissions as an indicator of climatechange impact, the Sustainable Nutrient Rich Foods index (SNRF)86 is a newmeasure which reflects both the climate and nutritional impact of food products.
Using this system, dairy milk is rated as a food with good nutrients and medium
climate change impact.
As well as considering GHG emissions from plant based dairy alternatives, it isimportant to also take note of other environmental factors such as land and water
use which could mitigate any benefits of a lower GHG emission value. Table 4.7
highlights that soya dairy alternatives (tofu and soya drinks) are significantly
more sustainable compared to dairy (cheese and milk) across all measures: GHG
emission, land use and water use.
Data on plant-based drinks other than soya is more limited. Available data indicatesthat the overall environmental impact of plant-based drinks will be more favourable
than dairy milk.77,79,80

Table 4.7: Environmental impact of dairy milk, dairy cheese, tofu and soya drinks
per average serving – from farm to household waste. Value ranges reflect the 5th
and 95th percentiles. Taken from Poore & Nemecek 2018 supplementary data.55,57
Dairy vs soya
alternatives

Serving size

GHG
emissionskg CO2 eq

Land use
m2

StressWeighted
Water Use
(Litres)

Cheese30g

0.3-1.8

0.2-9.9

53.1-24,177

Tofu

75g

0.1-0.5

0.1-0.4

0.9-2,263

Milk

200ml

0.3-1.4

0.16-6.4

40.2-16,284

Soyaalternative to
milk

200ml

0.1-0.3

0.06-0.2

0.4-1,153

50

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

There is more information on plant-based milks in the One Blue Dot FAQ document
which accompanies the reference guide. The FAQ highlights the variability in theenvironmental impact data available and different stages of the product lifecycle
used for different foods, making comparisons sometimes difficult. Of importance,is the need to consider all environmental factors when assessing the sustainabilityof a product and not just GHG emissions, which although important, are not areflection of the total environmental cost and sometimes trade-offs need to bemade.

Dairy farm and production processes gradually
improving to help reduce the environmental burden
Acknowledging the heavy environmental burden of dairy farming, in 2007, Dairy
UK set out its roadmap for improvements in dairy production processes in the UK
to reduce its burden. 10 years on, they have been successful in improving energy
efficiency and effluent waste management (only 5% factory waste going to landfill
and a target of zero factory waste sent to landfill by 2020).81 The report highlightsthat they still have a way to go and they have set further targets to improvebiodiversity and soil quality.

Nutritional quality of plant-based drinks
Most non-organic variants are calcium fortified with a similar content andbioavailability to dairy milk.82-85 Additionally, many non-organic plant-based drinks
are also fortified with vitamins B2, B12 and D84 and some are now also fortified withiodine.85,162

51

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Meet fruit and vegetableintake targets
While the consumption of plant proteins would be more environmentally
sustainable, assessing the environmental impact of fruits and vegetables is more
complex and trade-offs between health and environmental impact may have tobe taken into consideration. The environmental impact of fruit and vegetables willvary significantly depending on how and where they are produced. Consuming fruitand vegetables out of season which are produced in greenhouses and/or require
heating, refrigeration, or airfreight and are perishable resulting in waste will mitigate
any environmental benefits.6,54
Perishable fruit and vegetables make up the majority of household waste which
is a major source of potent GHG emissions.5 The environmental impact of using
more affordable frozen or tinned fruit and vegetables is not necessarily greaterthan opting for fresh produce which will also require refrigeration, are often air
freighted and make up the largest proportion of unavoidable food waste.54,87,88
Other considerations include water use, pesticide use and the impact on soil andwater quality.

Seasonal, locally produced fresh
vegetables and fruits are a better
choice, with tinned and frozen
produce reducing waste fromperishability.552

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Examples of particularly GHG intensive fruits and vegetables from the Food
Climate Research Network89:• Air freighted produce: Typical examples include US berries and cherries,
African green beans and peas, and pre-prepared salads produced outside
Europe.

• Unseasonal Mediterranean style produce: Grown either in heated greenhousesin the UK or under protection (sometimes heated) overseas. Examples include
tomatoes, courgettes, aubergines, peppers, and salads.

• Pre-prepared, trimmed or chopped produce: Examples include salad bags andbowls, fruit salads, and cut pineapple.

• Fragile or highly perishable foods: These foods are prone to spoilage, which
represents a waste of the energy embedded in their production, transport, andstorage.

Currently few of the age groups monitored by the NDNS are managing to eat therecommended at least five portions of fruit and vegetables per day, with just 8%
of children aged 11-18 and 31% of adults aged 19-64 achieving this.1 Increasingawareness and nudging consumers towards more sustainably sourced fruitand vegetables and how to reduce waste will help bring down emissions whilst
achieving the recommended 5-a-day. Based on current emission, land use, andwater use data, a diet based predominantly on plants which includes fruit andvegetables to recommendations, will still lower GHG emissions significantly.41,42

Consuming fruit and vegetables
out of season will have a higher
impact on GHG emissions.6,54

53

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Consume fish fromsustainable sources
Consuming sustainably sourced fish is paramount for the environment: 90% offisheries are now fully exploited or overfished, the marine vertebrate population
has fallen by more than a third in the last 50 years and there is extensive
degradation of the marine ecosystem.6
Sustainable fish sources are those that can continue indefinitely and do not have an
impact on the wider ocean ecosystem. A ‘certified fishery’ has received certificationfrom the Marine Stewardship Council (MSC). The MSC standards are based on
three principles: sustainable fish stocks, minimizing environmental impacts, andeffective management.90

9090% of fisheries are fully
exploited or overfished7%

54

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Additionally for farmed fish, the Aquaculture Stewardship Council (ASC) logo
represents sustainably farmed fish.91 The Marine Conservation Society (MCS)
maintains a “Good Fish Guide” which can be used to identify which fish andshellfish species are most at risk and which are most sustainable.92
It is important to eat a variety of fish species both for health and sustainability. The
recommendation remains that the public should consume two portions of fish, oneof which should be oily, per week. Reliance on marine foods should be for longchain omega 3s and iodine only as other sources of lean and plant proteins areplentiful in typical UK diets.

Figure 4.8: The state of our fisheries: Global trends in thestate of world marine stocks since 19747

%
100
90

Overfished

80
70
60
50

Fully fished

40
30
Underfished

20
10
0
1974

1979

1984

1989

1994

1999

2004

2009

2013

2015

2017

At biologically unsustainable levels
Within biologically sustainable levels

55One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Sustainable hydration
Tap water remains the most sustainable and healthiest source of hydration andshould always be recommended as such. Tea and coffee, although contributing
slightly more GHG emissions (3.5% of the UK’s dietary carbon footprint) comparedto tap water, are still good sustainable hydration sources.17,52
However, soft drinks and fruit juice are the third biggest contributors to our dietary
GHG emissions (9-10%).17,52 Soft drinks require more energy to produce and havesignificantly higher transport costs as a result of a range of ingredients. Although
the government’s 2018 tax on sugary soft drinks will bring about appreciable healthbenefits, it will do little to help reduce the environmental burden as consumers
are simply switching to unsweetened variants rather than reducing their overall
consumption.93 The impact of plastic waste from drinks packaging is also significant,and efforts should be made to encourage people to use refillable water bottles or
public water fountains to rehydrate, plus to choose easily recyclable packaging.
Tea and coffee are commonly referred to as an important and healthy source of
hydration.

Soft drinks and fruit juice are
the third biggest contributors
to dietary GHG emissions.17,52
Tap water remains ourmost sustainable sourceof hydration.17,52
56

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Eating less energy-dense foods
In the simplest terms, overall dietary intake in the UK is too high, especially ofenergy dense, micronutrient poor foods.1 The majority of the population needs tosignificantly reduce energy intake if we are to make headway with reducing obesityand obesity related diseases.94 Currently, 63% of adults and 28% of children aged
2-15 years are overweight or obese.95 To tackle this, the government is taking
aggressive action to curb the offerings of high sugar foods, portion sizes, andcalories by all out of home food suppliers.93,94 Correcting the over consumption offood and in particular animal proteins has been recognised as the most significant
change that can be made to improve the sustainability of diets.97

Figure 4.9: An example of altering energy density
and improving sustainability in a typical meal

Spaghetti Bolognese
Made with 100% beef mince and alarge portion of spaghetti

Spaghetti Bolognese
Made with 50% beef and 50%
beans and pulses, average amountof spaghetti with a side of carrots
and broccoli

57

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Waste less food and drink
Wasted food and drink, regardless of its source, is harmful to the environment
because of all of the land, water and energy used in its production as well as therelease of potent GHGs (methane) by decomposing organic matter in landfill.6,54
Household waste accounts for 70% of all food and drink waste which equates toapproximately 25% of all food purchased.5 More importantly, 60% of food waste
is avoidable. WRAP estimates that in 2018 the UK needlessly wasted 6.4 million
tonnes of food, which is responsible for 25 million tonnes of GHG emissions.5
Positively, by 2018 there has been a 7% reduction in food waste from the 2015
Courtauld baseline, or a reduction of 480,000 tonnes of food waste.163 This is good
progress but more will need to be done. The government has been advised thatpolicies to reduce food waste are paramount if the UK is to meet its future carbon
foot print targets.19,20

70
60

%

Household waste accounts for
70% of all food and drink waste
which equates to approximately
25% of all food purchased.5%
60% of food waste is avoidable.5

58

One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Figure 4.10: Courtauld Commitment 2025 Food Waste Baseline
The Courtauld Commitment 2025 baseline covers food waste from UK households, retail,manufacturing, and the hospitality industry and food service sector in 2015.98

10.2 million
tonnestotal waste

156kg
per person

Waste by sector

Retail
260,000t (£0.8bn)
Hospitality industry +food service sector
1,000,000t (£2.9bn)

Household7,100,000t (£15bn)

Manufacturing
1,850,000t (£1.4bn)

Household waste

Avoidable£470

Most of this is avoidable
fruit and vegetable(especially salad) waste.

The average household lost £470 a year
because of avoidable food waste, whilstthose with children incurred a loss of£700, with the average person in the UK
losing £200 a year.99

1.5Mt

Household waste

less food waste per year by 2025 if
Courtauld Commitment 2025 targets are met

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What is NOT meant by anenvironmentally sustainable diet
Given the broad definitions of sustainable diets, it is also important to consider
what is not meant (for the purposes of our policy and this reference guide) by anenvironmentally sustainable diet.

Vegetarian or Vegan diets
As per the Fischer and Garnett definition32 and modelling undertaken on UK dietary
habits,17,31,34,35,44,52,58 sustainable diets can be, but do not necessarily equate tovegetarian or vegan diets, although these do have a lower environmental impact
than the typical UK diet. Research has shown that linking more sustainable or“plant-based” eating to vegetarianism and veganism will significantly lower the
likelihood of the majority of the UK population changing their eating behaviour.100
Therefore, for the majority of the UK population, emphasis should be placed ona significant reduction in meat and moderating dairy consumption alongsideincreasing consumption of plant foods to improve the sustainability and nutritional
quality of a diet.
The BDA believes that dietitians are best placed and able to provide sustainablediet messages to meet all types of circumstance/eating preferences, including
vegetarian and vegan diets.

Animal Welfare
Although animal welfare is an important consideration for many people when
thinking about their food choices, it is not something that is usually within thedefinition of an environmentally sustainable diet.

60One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

However, it is beneficial that dietitians understand animal welfare issues, as they
can be key motivators for some individuals to adopting a diet lower in meat anddairy. For more information on animal welfare standards the following links may be
helpful:
UK Government Animal Welfare policy:
https://www.gov.uk/guidance/animal-welfare
RSPCA Farm Animal Welfare assurance scheme:
https://www.rspcaassured.org.uk/farm-animal-welfare/Compassion in World Farming guide for consumers:
https://assets.ciwf.org/media/7432869/compassionate_food_guide_web_
download.pdf

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Summary of specificnutritional considerations

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Summary of specificnutritional considerations
Some dietitians and consumers have concerns that an environmentally sustainablediet places individuals at risk of deficiency for some key micronutrients and protein.
The evidence-based Eatwell Guide and some international recommendations
e.g. in Sweden and Germany demonstrate that a healthy sustainable diet that is
predominantly based on plant foods can be nutritionally adequate.
For most adults who choose to consume the recommendations set out in the
Eatwell Guide of reduced amounts of meat, dairy, and eggs and increased plant
based protein sources, nutritional deficiency is unlikely. This section sets out
some of the specific nutritional considerations of eating a more environmentally
sustainable diet - and some of the population groups which dietitians should beaware of. Full details on these considerations and ideas on alternative sources of
key nutrients are available within the full toolkit resources.

Protein
There is often concern that reducing meat and dairy intake will lead to reduced
protein intake. The Reference Nutrient Intake (RNI) for protein is 0.75g per kilogram
body weight per day in adults. This equates to approximately 56g/day for men
and 45g/day for women aged 19-50 years in a person of healthy weight. However,
NDNS data101 shows that most adults eat more protein than they require (87g formen and 67g for women). The reduction in protein food intakes required to balance
the Eatwell Guide can easily be achieved by a shift away from meat, meat products
and animal proteins.
Including more plant protein sources will increase variety in the diet, provide
antioxidants and go towards achieving 5-a-day, as well as boosting fibre intake. As
covered previously, fish can be consumed for long chain omega 3 fats, iodine andother micronutrients, but not for protein.

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More detailed nutritional information on protein and plant based proteins is available
on the One Blue Dot webpages for dietitians.

Iron
Red meat is the best source of bioavailable iron and for many people, a sustainablediet would still include some meat. SACN modelling estimates that red andprocessed meat contributes 12% of men’s total iron intake and 9% of women’s. Thissame research has shown that reducing red meat amongst those in the UK who
consume large amounts (90g+) would have little impact on iron status of the adult
population.60
Men are unlikely to struggle to meet iron requirements from plant sources due torelatively lower iron requirements. However, in more vulnerable groups, such as
toddlers, girls and women of childbearing age, low iron intake is a concern as low
iron stores remains a health issue (even with current intakes of red meat). Fifty-fourpercent of girls aged 11-18 and 27% of women aged 19-64 have iron intakes below
the Lower Reference Nutrient Intake.1 However, when assessing the prevalence ofpoor iron status (below the threshold for both haemoglobin and plasma ferritin), this
only translates to 9% of girls aged 11-18 years old and 5% of women aged 19-64(NDNS Yr 7&8).101
In their report SACN highlighted the discrepancy between the high proportion ofcertain population groups having iron intakes below the recommended amounts andthe low prevalence of poor iron status in these groups. They suggested this as anaction for research as the DRV may be set too high.60
Individuals following a diet lower in meat and higher in plant protein have beenshown to have adequate iron intakes and meet national and international
recommendations.66,67,102 Despite relatively lower iron bioavailability and lower
overall iron stores, evidence of an increase in iron deficiency anemia amongst those
consuming diets mostly placed on plant foods, such as vegetarian diets, is lacking.103
Up to a point, the absorption rates of iron increase in individuals with low ironstores over time. In fact research shows that individuals can adapt to inefficient ironabsorption in order to maintain iron status.104 This may be due to an adaptation to
the inhibitory effects of phytate on non-haem iron absorption.106,107,109 A study showed64One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

that after consuming a high-phytate diet for eight weeks, non-haem iron absorption
increased by 41% compared to baseline values.108
According to the 2016 position paper of the Academy of Nutrition and Dietetics71,
the absorption process appears to adapt effectively in the case of Westernvegetarians because their haemoglobin values, and most other measures ofiron, are within the normal range although iron stores are typically lower but notabnormal.
Alternative sources of iron for vulnerable groups include fortified breakfast cereals,
nuts and seeds, or vegetables. Recent research has found the non-haem ironfound in soya, is absorbed relatively well and does not appear to be affected by theclassic inhibitors of iron absorption.111,114
Supplements are a useful option, although a number of studies have identified
low adherence to supplementation, in particular to iron supplementation.117-120 Thismay be due to side effects, lack of understanding or inconvenience . Nonetheless,policies that advocate fortification with iron or the provision of supplements (inaddition to current folic acid and vitamin D supplements) may be required andshould be supported by dietitians.
More information for the public on iron:
https://www.bda.uk.com/resource/iron-rich-foods-iron-deficiency.html
More detailed nutritional information on iron and sustainable diets is available on
the One Blue Dot webpages for dietitians.

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Zinc
Red meat is also a significant source of zinc in the UK diet, and animal foods moregenerally are a major source of zinc. Good plant food sources of zinc include
fortified breakfast cereals, beans and lentils, sunflower seeds, pumpkin seeds andnuts. Food preparation methods such as soaking and sprouting of beans, grains,nuts and seeds can improve its absorption.
SACN modelling estimates that red and processed meat contributes 32% of men’s
total zinc intake and 27% of women’s.60 Children in particular have low zinc intake,with 27% of girls aged 11-18 and 18% of boys reporting intakes below the LRNI.101
As with iron, for vulnerable groups consuming red meat below the SACN
recommendations, supplements may need to be considered. Like iron, thebioavailability of zinc from plant sources is likely to be lower due to the presence ofphytates.
Fully understanding the impact of reduced zinc bioavailability and intake has beensomewhat hindered by the lack of sensitive clinical measures for zinc status.103
More detailed nutritional information on zinc and sustainable diets is available on
the One Blue Dot webpages for dietitians.

Calcium
A reduction in milk and dairy consumption would make an important contribution
to a reduction in our environmental footprint. The Eatwell Guide has taken this into
consideration as well as the need to meet the nation’s calcium needs by reducing
the recommended dairy contribution to the UK diet from 11 to 8% by food weight.
Some concern exists about the impact for certain population groups falling below
the LRNI: 22% of 11-18 females, 11% of 11-18 males and 11% of women over 19.115
It is therefore important that dietitians are able to make recommendations topatients to ensure they are consuming sufficient calcium, and this can include dairy
products.

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It is important to note that milk is not the only major contributor of calcium inthe diet. Milk and dairy products contribute 34% of calcium intakes in 11-18 year
olds whilst cereal product (mainly from the mandatory fortification of white flour)
contribute 39%. Similarly with adults aged 19-64 years, dairy accounts for 34% andcereal products for 31% of total calcium intakes101. While milk and milk-products
form 43% of calcium intake in the UK population, other sources, including especiallywhite bread and products made with white flour (which are fortified) also play asignificant role.102
Most non-organic plant-based drinks and yogurt alternatives are fortified withcalcium to a similar level and with comparable bioavailability to dairy. These havethe added advantage of providing vitamin D (not present in UK dairy) which willfurther enhance calcium bioavailability and contribute to bone health.
As well as considering calcium amounts in food, we also need to take into accountbioavailability. Milk and milk-products have calcium bioavailability of around 30%.
Bioavailability of calcium from plant foods, which is related to oxalate content offoods and, to a lesser degree, phytate and fibre, is an important consideration.121
Absorption from high-oxalate vegetables, such as spinach and Swiss chard, may be
as low as 5%, and so despite their high calcium content, they cannot be consideredgood sources. In contrast, absorption from low-oxalate vegetables, such as kale,turnip greens, Chinese cabbage, and pak choy, is about 50%. Soya foods such as
calcium-set tofu and calcium-fortified soya drinks have similar bioavailability to milk
and so can be considered good alternatives to dairy.83,122,124
Dietary patterns in East Asia can be a useful consideration here – studies haveshown that high intake of fruit and vegetables is associated with better bone healthin these populations, despite the high incidence of milk intolerance. In client groups
where calcium excretion is a concern, dietitians can advise on other lifestyle factors
which can influence this e.g. smoking, caffeine intake and the benefits of physicalactivity.
More information for the public about calcium:https://www.bda.uk.com/resource/calcium.html

67One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

More detailed nutritional information on zinc and sustainable diets is available on
the One Blue Dot webpages for dietitians.

IodineSimilar to calcium, NDNS data has shown that iodine intake is low amongst children
and women and is a particular concern for pregnant women. 27% 11-18 girls, 14% of
11-18 boys and 15% of 19-64 women are estimated to be below the LRNI for iodine.1
However, it is important to note that iodine intakes are a poor measure of adequate
iodine status and according to the latest NDNS, iodine status as measured by spot
check urinary analysis, was found to be adequate across all age groups.101
Iodine content in milk varies significantly, depending on seasons and farming
practices. Iodine in milk is a by-product of iodine added to animal feed or used asa disinfectant, and organic farming practices or areas of origin can lead to lower
iodine content.125
Plant-based drinks are less often fortified with iodine. Iodine supplements should
be considered for at risk groups or those with higher demands e.g. pregnant andlactating mothers. Iodine supplements are of mixed quality, and patients should berecommended supplements containing “potassium iodide” or “potassium iodate”
and they should not exceed the daily adult requirement of 150 mcg. Supplements
created from seaweed and kelp should be avoided as total iodine content can varysignificantly and it is possible to overdose.126
All marine-source foods are good sources of iodine.
More information for the public on iodine:https://www.bda.uk.com/resource/iodine.html
More detailed nutritional information on iodine and sustainable diets is available on
the One Blue Dot webpages for dietitians.

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Vitamin B12
Vitamin B12 is only available from animal sources and a few fortified plant foods- breakfast cereals, plant-based drinks, fortified yeast extract such as Marmite.
Even so, for most adults still consuming reduced amounts of meat, dairy, and eggs,
achieving the 1.5 µg/day recommended by government should not be a challenge.127
Supplements are strongly recommended for individuals following a vegan diet.
More detailed nutritional information on zinc and sustainable diets is available on
the One Blue Dot webpages for dietitians.

Omega 3As stated, SACN advice remains that people should consume two portions of fish aweek of which one should be oily128 in order to ensure sufficient long chain omega
3 intake. A portion is 140g of fresh fish or one small can of oily tinned fish. All fish
and aquatic products should be consumed in small quantities and from certified
fisheries, and people encouraged to eat a diverse range of fish, including from moresustainable populations. NDNS data101 indicates that all age groups on average
consume less than the recommended amount of oily fish.
Non-marine sources of the omega 3 fat, alpha linolenic acid, include nuts and seeds
e.g. walnuts and pumpkin seeds; vegetable oils e.g. rapeseed and linseed; soya andsoya products.129 However, research indicates these are good sources of alphalinolenic acid (ALA), but are much less effective sources of eicosapentaenoic (EPA)
and docosahexaenoic acid (DHA), which are related to health benefits.130 Algae
may be a promising sustainable source of EPA and DHA for the diet.131 However,products available produced from algae are currently very expensive.
More information for the public on Omega 3:
https://www.bda.uk.com/resource/omega-3.html

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Selenium
Although there is good selenium intake in the very young, intakes are exceptionally
low in all other age groups for both men and women with 25-76% falling below
the LNRI1. Despite fish being an exceptionally good course of selenium, cereal
products and meat are the key sources in the UK diet.1 5-6 Brazil nuts daily willmeet recommendations for older teens and adults, whilst 2-4 will meet the needs
for younger age groups.
More detailed nutritional information on zinc and sustainable diets is available on
the One Blue Dot webpages for dietitians.

Vitamin D
There is a significant drive for vitamin D food fortification in many countries,
including the UK, due to the prevalence of sub-optimal status and lack of dietary
sources.149,150
Studies comparing vitamin D status between meat eaters and vegetarian and/or vegans reflect lower intakes and status in vegans and vegetarians. However,vegans still maintain serum 25(OH)D levels above 50nmol/L in winter and summer
months.151,152
Red meat, although providing some vitamin D, has a low concentration at 0.20.8mcg per 70g serving. Additionally, unlike other countries such as the US, UK
dairy is not standardly fortified with vitamin D. Thus, reducing intakes of both meatand dairy will have little, if any, impact on vitamin D status or vitamin D related
health outcomes.
More information for the public on Vitamin D:
https://www.bda.uk.com/resource/vitamin-d.html
More detailed nutritional information on zinc and sustainable diets is available on
the One Blue Dot webpages for dietitians.

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Motivators and opportunities
for a more sustainable diet71One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents

Motivators for a more sustainable diet
Food price
Food prices have remained fairly stable in recent years and for most people foodhas fallen as a proportion of income spent since 2015.132 However, meat and related
products remain a relatively expensive commodity, especially for poorer people
which may drive reductions in consumption.

Taste
One of the biggest drivers for foods choices is taste and/or taste perception.
Therefore, to encourage the behaviour change needed to adopt a sustainableeating pattern, recommendations must ensure that taste will not be compromisedand convince individuals that this is the case.

Accessibility
We can choose from a wider variety of food and drink products, and personalise
our diets more easily than at any time in human history. Despite some areas ofconcern (e.g. food deserts in cities, rural villages), new product development,
access to world foods, and online retail make it easier to access the foods we wantin the UK. Plus, apps/digital technology mean we can identify products which meet
our preferences.
The more accessible sustainable food choices are made, the more likely it is for
consumers to eat more sustainably. Therefore, an integrated multi-organisational
approach is fundamental, bringing together government, NGO’s, food providers,local authorities, and consumers.

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HealthAs has been discussed throughout this reference guide, reducing red meat intake inparticular and increasing plant food intake is beneficial to health. Some people may
be motivated to improve their diet in this way and as a consequence improve theenvironmental sustainability of their diet.

International considerations
The impact of our food choices and over consumption on the rest of the global
human population may well be a driver for some. Nearly 690 million people in thedeveloping world are undernourished and about two billion do not have regularaccess to safe, nutritious and sufficient food.133 There is an increasing demand
for food from a growing human population, and a challenged food system that isalready stressed by the degradation of global ecosystems.134 The FSA’s ‘Our Food
Future’ Report highlighted a range of concerns from members of the public about
the safety and sustainability of the food system at a global level.135

Food Waste
Linked to food prices, some people will desire to waste less food, potentially forenvironmental but also for financial reasons. The total cost of wasted food in UK
homes is estimated to be worth £13 billion per year.136

Popular champions
UK food writers like Jack Monroe and Jay Rayner, celebrity chefs like HughFearnley-Whittingstall and environmentalists like Sir David Attenborough have
popularised discussions on eating well for the planet with their followers. Although
growing awareness has not translated into behaviour change for most, this could
still be used as a driver alongside other strategies.

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Animal welfare
Many people choose to reduce their meat or dairy intake for ethical reasons
related to animal welfare, and in doing so, reduce their environmental impact. Thisis a complex area as animal welfare considerations are not necessarily entirelycompatible with sustainable diets - often the most environmentally sustainable
forms of meat or dairy production have the worst animal welfare implications.
This concern for animal welfare extends to those animals harmed indirectly by the
production of meat, fish or dairy, such as deforestation for cattle ranching and soya
based animal feed, or environmentally unsustainable fishing practices.

Language
Many perceive eating "plant-based" food as restricted to vegetarians or vegans.
A 2018 conference looked at ‘How Language Can Advance Sustainable Diets’100
and found that the descriptions of these can play a critical role in this negative
perception. It was shown that putting these dishes in a vegetarian section of amenu can reduce consumer ordering by 56%. Similarly, calling a dish “healthy” a typical term used for "plant-based" food - can suppress perceptions of taste
and how filling a food will be. New research, however, is finding that changing thelanguage of food on menus and in dining environments can help overcome theseperceptions and significantly impact consumer behaviour.
Recent experiments suggest that giving vegetables indulgent names anddescriptions can increase sales.153 Researchers changed the names of vegetables
to sound more indulgent (e.g., “slow roasted caramelised zucchini bites”) and thisled to a 25% increase in the number of diners choosing them compared to basic
labelling (“zucchini”).

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Creating supportive environments
Individual lifestyle counselling involving motivational and educational sessions withtrained health professionals can be effective in promoting more sustainable diets,
but are unlikely to be a scalable option. Research has shown that the environments
within which food choices are made (physical, economic, digital, social, cultural, andmore) exert a very significant impact on decisions people make. The environments
we navigate every day contain a huge number of cues that we interact with, mostly
below the level of awareness. Research points to a number of strategies thatcan be harnessed to reshape food environments into ones that support healthysustainable diets. However, much of the research has been done in experimental or
virtual settings and more work needs to be done in real consumer environments tounderstand what works.

Increasing availability
Increasing the relative availability of healthier, more sustainable food choices (e.g.
increasing the proportion of vegetarian sandwiches from 25% to 50%) may leadto more consumers choosing veggie options. A recent review of interventions invending machines (in schools, universities, hospitals, and worksites) found that fiveof the seven studies that increased the availability of healthier foods saw increased
sales of these foods with no loss of overall sales.154 Making more choices available
means that there’s greater variety for different tastes but it also has the effectof helping to normalize these options. This is especially important for meat-freechoices that often suffer the stigma of being seen as only for those who identify asvegan or vegetarian.

Decreasing portion size
Decreasing the portion size of meat in a restaurant meal has been shown todecrease meat consumption, but just as important, the research also found that
there was no negative impact on customers’ perceptions of their restaurant
experience.155
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Research has shown that placing
vegetarian meals at the end of amenu and in a separate section
decreases the selection of thosemeals even by vegetarians.157
Positioning
A recent systematic review of evidence on “nudges” to reduce meat consumption
found that positioning vegetarian choices to give them priority over meat items
could be a promising way to reduce the demand for meat in some settings.156 In
these experiments, meat options were repositioned to appear after, rather than
before, vegetarian options in online meal booking systems or on restaurant foodmenus. Other research has shown that placing vegetarian meals at the end of amenu and in a separate section decreases the selection of those meals even byvegetarians.157

Promoting shifting social norms
Marketers often draw attention to what others are doing as a way to influence
consumers’ choices. Most famously, for years many McDonald’s restaurants
displayed “over 99 billion served” on their signs. Some studies have looked at
the effect of promoting sustainability norms on food purchases. As part of asurvey, researchers at Stanford told people standing in line at a café that “overthe last 5 years, 30% of Americans have started to make an effort to limit theirmeat consumption”. Customers were more likely to order a meat-free lunch (34%)
compared to a control condition (17%).15876

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Barriers to moresustainable diets

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Barriers to more sustainable diets
Awareness
Despite the growth in people interested in sustainable diets and reducing meat
consumption, as mentioned above, many people still show general ambivalence tothe environmental impact of their food.137
Research by Chatham House indicates that many people are not aware of theenvironmental impact of meat/livestock production, especially compared withother protein sources. Despite being the joint fourth biggest contributor to climatechange, fewer than 30% of those surveyed across 12 countries believed meatand dairy production to be a major contributor to climate change, considerably
below those who highlighted heating buildings and waste disposal, despite them
contributing significantly less to emissions.138

Convenience and difficulty
The importance of convenience to people’s food choices is not unique tosustainable diets, it also impacts on people’s willingness or ability to consume
higher quality, healthier diets.139
Cooking and preparing fresh food, and reducing intakes of highly processed foods,
in order to eat more sustainability challenges convenience. In Our Food Future,
the Food Standards Agency found young people in particular were concerned thatmoving away from highly convenient foods would be difficult.135 YouGov have foundthat nearly one in eight people in the UK avoided cooking food from scratch.140
Taste is important and skills to recognise food are falling, along with preparation
skills, so recommendations should be feasible.
Additionally, any changes to day to day behaviour is a significant barrier to mostconsumers, therefore encouraging someone reliant on convenience foods to cook
more of their meals will be a significant barrier to overcome.

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Food culture
UK food culture includes a significant consumption of meat, fish and dairy. The BBC’s
Good Food Nation Survey 2016 found that many people still regard meat as a core
part of every meal - (49%) stating that ‘a meal isn’t a meal without meat’141. Studies
have shown that there is an unwillingness to accept the role of meat in contributing
to climate change and a resistance to changing their own meat consumption.142
As has already been highlighted, men eat considerably more meat than women,
above the currently recommended upper limit from SACN. Meat has historically
had an association with power, wealth and success, and more modern stereotypicalassociations of meat with strength and virility have been exploited by advertisers.
Modern studies have found participants rate omnivorous men as more masculine
than vegetarian men.143 Messages should be around meat reduction and advice
should consider challenging groups.

ExpensePrice remains one of the strongest influencing factors that governs choice. There is aperception that healthier eating, especially the higher consumption of fresh fruit andvegetables, is more expensive.
It has been shown that positive pricing policies on healthy foods can influence
dietary choices.144,145 Due to inequalities in society, however, there are limits for somecommunities as to how much control they actually have over their food choices.
Adults from lower income groups, for example, are known to be more likely to cite
cost as an important influence on their eating habits. Recent research has shown, thelower the income, the higher the proportion of income is spent on food.148
Dietitians should have the skills to show how a more sustainable diet can becost effective in relation to a ‘traditional’ diet, especially by replacing meat withplant protein alternatives such as beans and pulses. This may also need to beaccompanied with training to help provide the cooking skills necessary to preparesuch a diet. A recent costing based on the Eatwell Guide suggested making changes
to the diet to improve sustainability would not lead to significant change in the priceof the diet.43
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Modelling based on the Eatwell Guide
To achieve the health gains in the Eatwell Guide, the UK population would need toincrease consumption of fruits and vegetables, carbohydrate-based foods, fish,
and legumes, while reducing consumption of red, processed, and white meats, dairy
products, and foods high in fat and sugar. Scarborough et al found that the impact
on total food and drink costs for the individual would on average be insignificant,actually reducing slightly from 2016 - £6.02 to £5.99.46
However, the paper notes the possible impact on the agricultural system on theoverall economy.

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References

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Produced by the BDA with project partners
in the science & nutrition team at Alpro.
Published November 2018
Updated August 2020
For review November 2021

INDD/v8/August 2020