Eating Patterns For Health And Environmental Sustainability
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsEating patterns for health andenvironmental sustainabilityAReferenceGuide forDietitians1
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsContents1IntroductionOne Blue DotAbout this guide6682Why should environmentally sustainable diets be important for dietitians?Our current diets are harming the environment and our healthDietitians as key players in combatting climate changeGreenhouse Gas emissions, global warming and the food systemUK government policyThe UK diet’s contribution to GHG emissionsAgriculture and food waste related emissions have failed to come downDevolved government policyGrowing public interest1012141517192021223What do we mean by a sustainable diet?The BDA Environmentally Sustainable Diet recommendations for the UKCurrent definitions of sustainable diets2628302
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents4A more environmentally sustainable diet can be a healthy dietHealthy, sustainable eating habits included in thegovernment’s Climate Change ActEatwell guide: an example of a more sustainable and healthy diet?Reducing Red and Processed Meat (RPM)The health impactUK’s meat eating habits and how they impact on the environmentIncrease consumption of plant food sources of proteinProtein qualityModerate dairy intakeMeet fruit and vegetable intake targetsConsume fish from sustainable sourcesSustainable hydrationEating less energy-dense foodsWaste less food and drinkWhat is NOT meant by an environmentally sustainable diet3536384145464848495253555657595Summary of specific nutritional considerationsProteinIronZincCalciumIodineVitamin B12Omega 3SeleniumVitamin D636364656668686969703
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContents6Motivators and opportunties for a more sustainable dietFood priceTasteAccessibilityHealthInternational considerationsFood WastePopular championsAnimal welfareLanguageCreating supportive environments73737373747474747575767Barriers to more sustainable dietsAwarenessConvenience and difficultyFood cultureExpense78787679798References824
1One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansIntroductionContents5
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsUsPhotograph of the Earth taken by the Voyager 1 space probe on February 14th 1990at a distance of 6 billion kilometers. NASA6
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsWe are one blue dotThe 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 anunremarkable 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 ofthe planet.There is mounting pressure for radical change from leading environmentalspecialists, 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 stakeholdersnavigate the complex messages surrounding this subject. They are able to translatenational 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.7
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsAbout this guideThis reference guide forms the basis of a toolkit which expands on the BDA’sSustainable 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 messagesand 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 describingthe reasons that dietitians need to understand sustainable diets, before lookingin more detail at what a more sustainable diet looks like. With reference to theUK 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 documentsincluding 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 providingan education grant, and to the many individual dietitians, allies and partners whocontributed to the drafting process.8
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsThis reference guide was created by a specially convened working group:Dr Clare Pettinger RDSandra Hood RDLynne Garton RDLinda Convery RDUrsula ArensDr Pamela Mason RNutrElphee 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, NuffieldDepartment of Primary Care Health Sciences for his contribution to the 'Motivatorsand Opportunities' section.9
2One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsWhy should environmentallysustainable diets beimportant for dietitians?10
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsFrom farm to fork to wasteAll stages of food production impact on the environmentFisheriesLivestockProcessing PackingGrowing HarvestingDistributionRetailCooking EatingWaste RecyclingLandfill11
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsOur current diets are harmingthe environment and our healthAs dietitians, we are all too aware of the poor eating habits of the nation: lowintakes of fibre, fruit and vegetables, and essential micronutrients whilst we areoverconsuming energy, saturated fats, and sugars.1 Our current dietary habits arefuelling obesity, type 2 diabetes, heart disease, and as some cancers.2But, our eating habits also have an impact on the environment and are jeopardisingthe 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) emissionsin 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 everyyear with the majority (71%) occurring in the home.5 Some of this is avoidableand 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 with90% of fisheries now fully exploited7 and/or over fished, the marine vertebratepopulation fallen by more than a third8 and the marine ecosystem has beendamaged.12
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsThe environmental impactHow current food systems damage our edfish stocksof globalgreenhouse tionDamagedecosystemsFood PrepWater useLoss ofbiodiversity13
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsDietitians as key players incombatting climate changeThis section looks at international and UK policies, as well as other stakeholderviews. As part of the development of this guide and the preceding policy statement,the BDA undertook an online survey with members (319 dietitians), a workshopat the March 2018 BDA Live event (70 dietitians) and a specially convened focusgroup (8 dietitians). Feedback was also gathered from members during thedevelopment of the policy statement in 2017. This helped the working group tounderstand 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. Arange of possible barriers and challenges were also highlighted.In particular, dietitians emphasised four key areas they believe we need to focus onto ensure that dietitians can play an important role in the facilitation of sustainablediets, as outlined in our 2017 Policy Statement: Changing the environment and multi-organisation involvement: Improvingthe availability of sustainable and healthier foods by developing integratedmulti-organisation sustainable polices with government, local authorities,farmers, local producers, and NGOs such as food banks and commercialcompanies. Improving education and knowledge for health professionals as well asconsumers: A strong focus for under and post graduate dietetic training onsustainable diets, as well as placing sustainable diets on the school curriculumand 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 ofthis reference guide and associated toolkit aspects/elements.14
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsGreenhouse Gas emissions,global warming and the food systemIncreased Greenhouse Gas (GHG) emissions have a direct impact on global warmingwhich, as well as increasing temperatures, cause extreme weather events (droughtsand floods) and water scarcity.6 Whilst a rise is inevitable, the UN IntergovernmentalPanel 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 globalwarming increase to no more than 1.5 C by 2050 if we are to prevent catastrophicconsequences for extreme weather conditions: heat, droughts, floods, and subsequentpoverty.11,12 The glossary which accompanies this guide will assist you in betterunderstanding terms like CO2 eq and GHG emissions.1.5 CRecommendedsafe limit for globalwarming increaseRequires 70-95% reduction incurrent GHG emissions by 20501215
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsFig 2.1: The UN Intergov recommendations Climate Change13IPCC2018ConsumeLESS meatand dairyBuy MORElocally sourced,seasonal foodsThrow LESSfood awayThe 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 practicesand 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.1316
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsUK government policyThe UK Government, through a 2019 amendment to the Climate Change Act200814, is committed to an 100% reduction in GHG emissions by 2050 (comparedto 1990 levels), and to contribute to global emission reductions to limit globaltemperature 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 itsGHG emission reduction targets. Even an 80% GHG emission reduction targetequates to reducing our current emissions of 11.9 tonnes per person per annumfrom all activities (including travel, food, heating, etc.) down to 2.4 tonnes CO2equivalent per person by 2050.16Fig 2.2: Current proportion of GHG emissions perperson in the UK showing impact of dietary intakesGHG emissions fromUK diets (18-25%)All other GHG emissionsincl. travel, heating,manufacture (75%)17
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsThere 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%.19Current UK dietary habits (based on the National Diet and Nutrition Survey2013/14) 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 maybe 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 onClimate Change (CCC) has emphasised that the majority of these reductions areattributable to the switch from fossil fuel and that emissions from agriculture haveactually increased slightly in recent years. There has been no progress in reducingemissions from agriculture since 2008.18 It is estimated that despite an excellentstart, 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.2018
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsFigure 2.3: Foods that contribute the most to GHG emissions in the UK diet17ProteinsRed meatFishWhite meat, poultryEggsBeans & pulsesNuts & seeds24.26.45.41.80.70.2Dairy14.3Dairy productsDrinksSoft drinks inc. fruit juiceSugars & .2Cereals6.8CerealsOilsButter & margarinesVegetable Oils5.80Fruit & vegetablesFruitVegetablesPotatoes5.12.82.8% GHG emissions (CO2 eq) of total dietary intake19
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsAgriculture and food waste relatedemissions have failed to come downThe Committee for Climate Change in the UK voiced their concerns about our lackof progress in agricultural practices, and indeed the overall share of emissionsis increasing as other sectors do more to reduce their footprint. Amongst itsrecommendations, the committee suggests urgent action to “help consumers tomake food choices which reflect government nutritional advice and which supportlower 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 wastealone (mainly in the home but also in food manufacture) will contribute between16% and 12% to the projected overshoot in the fourth and fifth carbon budgettargets 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 2025.18The UK’s lack of resource efficiencypolicies, including food waste, isa key contributor to the projectedovershoot of future carbon targets.2020
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsDevolved government policySustainability is not just a priority for policy in England, but for each of the devolvedgovernments 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 TheWelsh 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 sociallyresponsible”.In Scotland, the government’s climate change plan for 2018-203224 went onestep 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 toeat and nutritious, fresh and environmentally sustainable”.25There 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 reductionsince 2009 because of its contribution.In Scotland, the government’s climatechange plan for 2018-203224 wentone step further, targeting a 42%reduction in emissions by 2020.21
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for DietitiansContentsGrowing public interestAside from the obvious policy drivers, dietitians are going to increasingly encounterindividuals who are seeking information on the sustainability and environmentalimpact 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 ofBusiness, Energy and Industrial Strategy, are very or fairly concerned about climatechange.26 This figure has grown slowly year on year since surveying began in2012. 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 dietsif doing so would reduce their impact on climate change. Whilst a fifth reportedthey consumed meat only once or twice a week, another 38% stated they wouldconsider changing their diet in the future. Over half stated that they already seek tochoose seasonal fruit and ve
One Blue Dot Eating patterns for health and environmental sustainability: A Reference Guide for Dietitians 16 Contents The IPCC’s 2018 report emphasises that livestock is by far the biggest contributor to dietary GHG emissions, and urgent changes are necessary if the target of a 1.5 C rise is to be achieved. In the report, as well as focusing on changes to farming practices . One Blue Dot .
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6. Detection of Eating Disorders 63 7. Diagnosis of Eating Disorders 73 8. Interventions at the Different Levels of Care in the Management of Eating Disorders 81 9. Treatment of Eating Disorders 91 10. Assessment of Eating Disorders 179 11. Prognosis of Eating Disorders 191 12. Legal Aspects Concerning Individuals with Eating Disorders in Spain 195
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eating and may not be able to stop even if they want to. Eating habits is used as a way to cope with challenging emotions. A person with Binge Eating Disorder will often have a range of identifiable eating habits. These can include eating very quickly, eating when they are not physically hungry and continuing to eat even when they are full,
Binge Eating Disorder: Basic Criteria continued B. The binge-eating episodes are associated with 3 (or more) of the following: 1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of feeling embarrassed by how much one is .
