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A Plate for the Planet by Christina Badaracco, MPH, RD

Human and environmental health are linked in so many ways, and yet movements to advance these fields in policy and throughout society rarely seem to collaborate or even intersect. In general, Western medicine primarily focuses on treating disease with medications and procedures that are ever-increasing in price, while not placing nearly enough value on opportunities to improve health through diet, lifestyle and environmental protection. Meanwhile, prominent activists and food companies touting plant-based alternatives to meat, eggs and dairy are including far too many processed ingredients devoid of nutrients in their products, and leaders in sustainable animal agriculture typically fail to incorporate adequate fruits, vegetables, whole grains and other fibrous foods into their dietary recommendations. As an alternative to these approaches, a diet based on whole foods requires minimal resources for production, packaging and consumption. As a dietitian and public health professional, I am always eager to share this message with patients and the public. I am pleased to see that many leading health professionals, providers and institutions around the world are following suit.


How should we eat for planetary health?

Previous Soulful Insights have described how to follow a more sustainable diet and how our diet affects our health (to offer just two examples). To expand upon the world’s awareness and capacity to eat in ways that support these goals, our food system is in need of fundamental transformation, both nationally and internationally. Toward this aim, in 2019, The Lancet collaborated with EAT (a nongovernmental organization based in Norway) to bring together international experts to review existing evidence and agree upon targets for healthy diets and sustainable food production that could lead to the coordinated efforts necessary for this transformation. This EAT-Lancet Commission was co-chaired by Walter Willett and Johan Rockström. Recognizing that “food is the single strongest lever to optimize human health and environmental sustainability on Earth,” the group produced a report titled, “Food in The Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems,” to share their findings and conclusions. (The Anthropocene denotes the current geological epoch. Per the report, it is “demarcated as the time when human activities began to have a substantial global effect on the Earth's systems.”) 


The recommendations were designed to increase the likelihood of achieving the United Nations’ Sustainable Development Goals by 2030 so that we are able to feed the world’s expected population of 10 billion by 2050. The recommendations include goals addressing environmental sustainability, such as “responsible consumption and production,” as well as development and economic growth, such as “quality education.”


The report includes two targets:

  1. “Healthy diets,” which are designed to be flexitarian but primarily plant-based (see figure below).

  2. “Sustainable food production,” which reflects planetary boundaries for global food production that decrease the risk of catastrophic shifts in the ecosystem.

Figure Source: Marcone, A & Garvey, B. Planetary Health Plate. 2019.

The Commission recommends five strategies to achieve these targets:

  1. Seek international and national commitments to shift toward healthy diets

  2. Reorient agricultural priorities from producing high quantities of food to producing healthy food

  3. Sustainably intensify food production to increase high-quality output

  4. Develop strong and coordinated governance of land and oceans

  5. Halve (at least) food losses and waste, in line with UN Sustainable Development Goals

While the Commission concluded that these recommendations are possible and indeed necessary, it warned that current evidence suggests immediate action is needed.


Should everyone follow a planetary health diet?

These recommendations apply to the majority of the world’s population to promote health and prevent disease while also following general principles of sustainability. These strategies and targets apply to what the Commission considers a “universal healthy reference diet.” Notably, it is not necessarily the best diet for everyone at all times, given that people with certain health conditions or diseases may need to follow a different dietary pattern or mode of eating. For example, people with certain forms of gastrointestinal disease or surgical resections may need to avoid the tree nuts, legumes and whole grains that would benefit most people.  


Also, the targets may require either an increase or a decrease in the consumption of certain food groups, depending on the geographic region. For instance, people in most regions of the world fall short of meeting the recommended amount and varieties of seafood consumption, but East Asia Pacific residents eat copious amounts of seafood. Having this population reduce their intake in favor of other sources of protein (such as legumes and nuts) could yield benefits to human health and the sustainable management of fisheries and wildlife. Further, many developing countries are experiencing crippling undernutrition, which cannot be adequately addressed without increasing the consumption of animal-source foods. Thus, the Commission concludes that the recommendations for each country depend on its local context. Accounting for this variability, the Commission estimated that its recommended dietary changes could prevent about 11 million deaths per year.


How did the world respond, and what has changed?

Given that the report recommends a drastic shift in current global patterns of consumption and production, it resulted in significant opposition. Organizations such as the Missouri Farm Bureau that yield short-term benefit from current production patterns suggested that the recommendations would impede upon citizens’ sovereignty and “leave followers short of a number of essential nutrients supplied in our present diets by animal products.” (There was similar opposition to the potential addition of sustainability recommendations to the Dietary Guidelines for Americans in 2015 from many such groups). Zagmutt et al. expressed concern about the lack of transparency in the methods used to estimate preventable deaths.


Subsequent studies have yielded additional insights. Later in 2019, researchers estimated the affordability of these recommendations based on retail prices and per capita household income in various countries. They found that the diet costs little compared to average incomes in high-income countries but is not affordable for at least 1.58 billion people in low-income countries; further, it is more expensive than a diet deemed “nutritionally adequate” by a mean factor of 1.6.


Other prominent groups of health professionals and researchers have supported this report and its strategies, like the True Health Initiative, which was founded by Dr. David Katz to rid the world of preventable disease through changing policy, changing minds and improving lives. Similarly, leading researchers at the Harvard TH Chan School of Public Health, Johns Hopkins University Center for a Livable Future and other institutions continue to advance these opportunities.

The current COVID-19 pandemic has exacerbated the existing burden on our healthcare system caused by chronic disease and the environmental impacts of our food production systems. The prevalence of malnutrition, both in developing countries and within the United States, has grown while food producers are forced to destroy the abundance of food that is typically supported by our current systems of subsidies, trade policies and dietary patterns. Further, we have seen notably poorer health outcomes among those with diseases attributed largely to poor diet and the effects of our food production systems’ rigid structure on food access. Offering one very thin silver lining to our current public health crisis, many nutrition and environmental health advocates are hopeful that the new light and attention being paid to these issues may result in more integrative solutions in the future, ultimately helping to achieve the goals put forth in the EAT-Lancet report.


How can I implement this planetary health in my diet and lifestyle?

  • To support your own health and that of the planet, aim to follow the proportions shown in the plate above for most of your meals. Opt for variety in the foods from each group to ensure your body gets enough of all essential nutrients.

  • Balanced snacks can include fruits and vegetables as well as smaller servings of whole grains, healthy fats and protein foods.

  • Lead by example and help to provide these foods for your own family, encouraging behaviors that children will carry forward throughout their lives.

  • Buy food that supports producers and businesses whose practices promote planetary health; i.e., efforts that minimize food waste, source local ingredients, engage in regenerative agriculture, etc.

As always, consult with a registered dietitian and/or physician to ensure you are following a nutritionally adequate diet and to make changes based on your acute needs.


Resources

  • Hirvonen K, Bai Y, Headey D and Masters WA. “Affordability of the EAT–Lancet reference diet: a global analysis.” The Lancet Global Health. 2019; 8(1):E59-E66.

  • Hurst B. “Recent Study Recommends Government Control of What You Eat.” January 31, 2019. mofb.org/recent-study-recommends-government-control-of-what-you-eat/.

  • Willett W, Loken B, Springmann M, et al. “Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems.” The Lancet. 2019; 393(10170):447-492.

  • Zagmutt FJ, Pouzou JG and Costard S. “The EAT–Lancet Commission: a flawed approach?” The Lancet. 2019; 394(10204):1140-1141.


Christina Badaracco, MPH, RD

Christina is a registered dietitian and author who aims to improve access to healthy and sustainable food and educate Americans about the connections between food and health. She loves to experiment with healthy recipes in the kitchen and share her creations to inspire others to cook.


Christina completed her dietetic internship at Massachusetts General Hospital and earned her Master of Public Health degree from the University of California, Berkeley. Previously, she graduated with a degree in Ecology and Evolutionary Biology from Princeton University, after conducting her thesis on sustainable agriculture and energy in Kenya. She has done clinical nutrition research at the National Institutes of Health, menu planning and nutrition education at the Oakland Unified School District and communications at the Environmental Protection Agency’s Office of Water. She has also enjoyed contributing to children’s gardens, farmers’ markets and a number of organic farms.


cbadarac@gmail.com

www.linkedin.com/in/christina-badaracco/


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