A sustainable diet is a healthier diet?

1. A sustainable diet is a healthier diet? Roy Ballam, BNF Thank you to Prof Judy Buttriss

2. Diet and nutrition Why is sustainability an important consideration? What does sustainability mean? What does a nutritious diet look like and how does this compare with what we eat currently in the UK? What would the impact on health be if such a diet were to be consumed? Are the two characteristics – sustainability and healthiness - compatible? What are the challenges ahead ….. ?

3. What does the future hold?

4. Need healthy, sustainable, low impact food supply that is affordable by all. Global nutrition and health challenges: double burden in 21st century >1 billion adults are overweight or obese ~1 billion people go to bed hungry Poor growth, nutrient deficiencies, infection, intergenerational effects Living longer: 2 years per decade in UK Another billion have micro-nutrient deficiencies. Poor diet quality.

5. Family food Chad:Food expenditure for one week US $1.23 Ecuador: Food expenditure for one week US $31.55 • Impact of climate change on what we can grow • Increasing prosperity • Increasing lifespan • Increasing global population Germany:Food expenditure for one week US $500

6. FSA consumer survey: key findings • People are not used to thinking globally about food. • People recognise the importance of the challenges faced but were concerned to realise how little they knew about the complex global food system. • Would like to know more about: • Links between our food production systems and climate change • The complexity of the global farm to fork process • The role of the food industry in shaping global food trends • The role of government in working with global industry. • Convenience versus connection with food: • Participants didn’t want to sacrifice convenience but also didn’t want a ‘connectionless future’ • Saw a need to strike a balance between health and quality, and price. [Same priorities emerged in a study by Which? and GO Science, 2015]

7. Multiple challenges ahead Need healthy, sustainable, low impact food supply that is affordable by all. • Global food supply has to be sustainable. • Global food supply hasto be nutritious/promote health. • Both are necessary, indeed essential for the human race is to survive. • Are they compatible? CHALLENGES Increasing global population. Increasing lifespan. Double burden of over- and undernutrition. Increasing prosperity (and changing demand for foods). Expected impact of climate change on what we can grow.

8. In the UK alone, we produce less than 60% of our own food, and import the rest from over 180 countries Climate change (& extreme weather) and rising income in developing countries will change the global picture. Complex pressures on supply chains bring challenges – traceability, volatile prices and even crime. New technology and new sources of food will change what’s available. https://www.food.gov.uk/news-updates/campaigns/ourfoodfuture#sthash.vd6p95OZ.dpuf

9. Global GHGs from food approximate 30% of total Inputs eg. fertilisers, manure, pesticides About 20% Home: cooking, fridge, washing up Land use change Farming Supermarkets, shops, markets Waste disposal Slaughtering, processing, manufacturing Restaurants, school canteens etc. 1.3 billion people involved in producing food - livelihoods Packaging About 10% Vermeulen, S. J. et al.(2012) Climate Change and Food Systems. Annual Review of Environment and Resources. 37. p.195-222. Arrows = transport

10. To support health, food needs to be nourishing! • Predicted that by 2030, the world will need to produce 50% more food than now and to secure 30% more fresh water (Population Institute 2010) • FAO predicts that by 2050, the expanded population will be consuming two-thirds more animal protein (FAO 2013) • Growing emphasis on plant-based diets (less environmental impact; though even this is influenced by where and how the foods are grown) • But need to be certain that essential nutrients will still be delivered in adequate amounts - Important role for dietary data, as well as analysis of environmental impact – to ensure sustainable diets are also nutritious. • Multi-disciplinary approach to research essential to integrate the many facets of a sustainable food supply (e.g. including water but also livelihood/economics/social aspects). • Dissemination of findings into practice.

11. What is sustainability & why is sustainability of the food supply so critical? Complex interaction of factors. Trade-offs involving the food supply and ecosystem will need to be identified, accepted and adopted. It implies the use of resources at rates that do not exceed the capacity of the earth to replace them.

12. What does a nutritious diet look like? How does this compare with what we eat currently in the UK?

13. Is the current British diet healthy?

14. Vitamins and minerals - evidence of low intakes

16. Current UK consumption vs ‘Eatwell Guide’ scenario and the ‘old recommendations’* scenarioPeter Scarborough et al. BMJ Open 2016;6:e013182 % * ie lower fibre and higher NMES

17. The challenge

18. Comparison of the impacts of the Eatwell Guide compared with current diet (Carbon Trust 2016) For an equivalent provision of energy, the Eatwell Guide has a 32% lower environmental footprint than the current national (NDNS) diet, having fallen to 71% of our ‘sustainable lifestyle impact’, i.e. within globally sustainable levels.

19. DALYs* averted (millions) over the lifetime of the UK populationCobiac et al 2016 doi:10.1371/journal.pone.0167859.g001 • Changing from ‘average’ UK diet to the eatwell diet (with no rise in energy intake) would: • avert 17.9 million DALYs over the lifetime of current population • Increase life expectancy by 5.4 months in men and 4 months in women • Benefits re: type 2 diabetes, in particular, also CVD and colo-rectal cancer * Disability adjusted life years

20. Systematic reviewAleksandrowicz et al 2016 • Reviewed evidence on changes in GHG emissions, land use and water use from shifts in dietary pattern • Found 14 sustainable dietary patterns, with reductions as high as 70-80% (GHG and land use) and 50% (water) • Reductions in environmental footprints generally proportional to magnitude of animal-based food restriction. • Dietary shifts also gave modest benefits in all-cause mortality risk. CONCLUDED: • Environmental and health benefits are possible by shifting current western diets to a variety of more sustainable patterns.

21. So, the story so far … • Eatwell guide modelling. • Carbon Trust analysis shows reduced environmental impact. • Disability adjusted life years averted and positive impact on life expectancy. • Systematic review - modest benefits in all cause mortality risk, as well as reduced environmental footprint. Diets can be constructed that are both healthier than current diets in terms of achieving dietary recommendations and with a lower environmental impact.

22. How achievable are modelled diets such as eatwell? • FAO (2013) predicts that by 2050, expanded global population will be consuming two-thirds more animal protein, with meat consumption rising nearly 73% and dairy growing by 58%. • Production of these requires more natural resources than staple crops, e.g. wheat and rice. Need to understand: • Public’s priorities and expectations. • Public dialogue –Which? &GOS 2015; FSA 2016. • Response to messages designed to encourage more sustainable dietary patterns. • Substitutions and impact on overall nutritional quality of diets, including bioavailability (Green et al 2103, 2015). • Impact on health (Milner et al 2015).

23. Impact of substitutions on nutrition and the environment • Critically important to understand substitutions – for example, if less animal protein is eaten, what replaces it and what is the effect of this on nutrition and on the environment? • Is it possible to reduce ‘greenhouse gas’ emissions and also achieve nutrition recommendations? • Green et al. 2015, modelling using NDNS: • If average diets conform to WHO dietary recommendations, GHG emissions would reduce by 17%. • Further reductions could be achieved but would need greater dietary change • Reductions beyond 40% through dietary change alone will be unlikely without radically changing current dietary patterns and potentially reducing the nutritional quality of diets.

24. Impact on health of diets with lower GHG emissions (Milner et al 2015) • Estimated dietary changes in the UK that would meet nutrition and climate change mitigation targets. • Also accounted for potential acceptability (consumer behaviour data). • Radical change in diet, e.g. veganism not necessary to reduce emissions and bring quantifiable benefits to health (av. life expectancy increased by 8 months). • Reduction >40% may place limits on health benefits. Modelled health impacts associated with dietary changes in the UK for different levels of greenhouse gases (GHG) reduction.

25. What is needed to achieve sustainable nutrition? • Changes in land use and agriculture – protein. • Changes in food production/diet. • Changes in behaviour: consumers through to governments. • Trade-offs identified, accepted and adopted, e.g. technologies, more plants, less animal protein. 17 United Nations Sustainable Development Goals: 8 directly or indirectly relate to agriculture and food

26. Environmental and health benefits appear possible if diets are changed. BUT Billion people in developing world now ‘middle class’ and have different dietary aspirations. To achieve the UN goals; big decisions needed: Land use Crops for the future (yield not the only metric) Use of technologies Waste avoidance Impact on dietary choices and dietary advice Where will sustainable protein come from? What does the future hold?

27. Biofortification Mealworm, cricket and grasshoppers with polenta chips! Tapping into plant biodiversity and the oceans’ bounty Fungi, e.g. mycoprotein Snacking on deep-fried grasshoppers

28. To sum up: • Health gains are likely to result from a shift from current diets to ones that conform to the eatwell guide. • The eatwell pattern has been shown to be more ‘sustainable’. • This shift will require a substantial change in dietary behaviour. • Research is needed to identify ways to motivate people to make this shift.

29. Thank you for listening. For further information, go to: www.nutrition.org.uk