ABSTRACT
Registered dietitian nutritionists (RDNs) are experts in a wide range of food, health and nutrition topics. RDNs also play an important role in supporting sustainable food systems. However, not all RDNs and other food system stakeholders realize RDN’s role in supporting sustainable food systems – applying a skillset that is central to the RDN profession. Using the lens of the five professional entry points identified by the Cultivating Sustainable Food and Water Systems: A Nutrition-Focused Framework for Action, we provide a snapshot of how a clinical, retail and public health dietitian support sustainability in their local food system every day.
Introduction
With a growing global population, mounting challenges surrounding climate change and limited natural resources, there is a critical need to improve the sustainability of our food systemsCitation1. The goal of a sustainable food system is to create a system that ensures food security and nutrition for all in such a way that the economic, social and environmental bases to generate food security and nutrition of future generations are not compromised.Citation2
Materials and Methods
To ignite momentum around sustainable food systems and connect stakeholders from across local food systems, National Diary Council and eleven local dairy councils organized 25 Jeffersonian-style dinners across the country in 2019. These dinners, called the Nourish Dialogue Dinners (NDD), were designed to create a shared dialogue around issues and opportunities related to advancing agriculture, nutrition, health and sustainable food systems. Stakeholders in the supply chain (farmers, processors and distributors), those impacting food environments (retailers, schools, hospitals and food banks) and those providing guidance (physicians, nurses, dietitians, fitness professionals and culinary experts) were invited to participate.
Registered dietitian nutritionists (RDNs) were among the stakeholders that participated in the NDDs. The actions and skillset needed to support sustainable food systems are central to the RDN profession. To showcase this, following the NDD we conducted stakeholder interviews with several RDNs working in different fields who attended the NDDs. We used the Cultivating Sustainable Food and Water Systems: A Nutrition-Focused Framework for ActionCitation3 and it’s five entry points: – Shape and deliver dietary guidance; Improve food and nutrition security and water security; Align food production and nutrition; Optimize supply chains and food environments; and Reduce waste to describe how a clinical, retail and public health dietitian who attended the NDDs support sustainability in their local food system every day.
Results
Amy Carter, Director of Clinical Nutrition and Lifestyle Health for Eskenazi Health oversees the hospital’s Lifestyle Medicine program, in which clinical nutrition services focus on building a framework to support both education and behavioral changes – aligning food production and nutrition & optimizing supply chains and food environments.. Recognizing that access to quality care and education alone cannot achieve healthy outcomes, particularly among the low-income, high-need community the hospital serves, Carter works with a multidisciplinary team to make affordable, nutrient-dense foods more accessible to her patients. Through the team’s efforts, a 5,000 square foot hospital rooftop garden, the Sky Farm, was born. Produce from the farm is provided free of charge to participants in outpatient classes, creating opportunities to grow and access healthy food. Building on this success, Carter and team set their sights on procuring all food used in the hospital’s meals and restaurants locally, supporting Hoosier farmers and the Indiana economy by purchasing as close to home as possible. To date almost 70% of food offerings in the hospital are grown locally.
The team also created the Fresh for You food market inside the hospital, conveniently located for staff and visitors to easily and affordably purchase items needed to prepare healthy meals at home. Patients in the hospital who are identified by screening as being food insecure are immediately provided a $30 Fresh for You market voucher – improving food and nutrition security. In the future, Carter hopes to see this program expand to other community health centers.
Taylor Sutton shapes and delivers dietary guidance and reduces waste in her role as a retail dietitian at the United Family’s Market Street. Sutton sells health to the consumer by translating complex nutritional science into practical advice about the food consumers purchase, prepare and eat. She promotes the consumption of all food groups and showcases healthy options both on the perimeter and interior of the store, all while working to reduce food waste both in the store and at home through consumer education. Sutton provides tools for her shoppers to use as they navigate the grocery store. As a part of Market Street’s marketing team, Sutton collaborates with other team members to be innovative with food, create new experiences for customers (e.g. finding unique ways for customers to pair foods) and focus on waste reduction (e.g. promoting smart shopping techniques so consumers do not make unnecessary purchases of foods they will not consume and boosting sales of surplus produce so foods do not get thrown out).
The COVID-19 pandemic significantly shifted Sutton’s work. Ninety percent of her consumer interactions were moved to the retailer’s website, www.happyandnourished.com. She writes blogs to help shoppers find nutritious foods on a budget and stay healthy, and she myth busts as consumers are barraged by misinformation about the food system, sustainability and nutrition. Sutton’s increased online presence has created new opportunities to educate consumers, increased her consumer reach and allowed her to be a leader within her company and in her community. Market Street’s in-house digital marketing also allows Sutton to easily access data on her online effectiveness and tailor her actions accordingly to maximize her impact. As an RDN, leader, and valued team member, Taylor is making her local food system more accessible, healthier and less wasteful.
Laura Holtrop-Kohl weaves sustainability into state-wide programing as a public health nutritionist at the Utah Department of Health. Holtrop-Kohl is always considering the accessibility, affordability, cultural appropriateness, nutrition, and environmental impact of the foods available in her local community. Holtrop-Kohl works with a multidisciplinary team to improve food and nutrition security, optimize supply chains and food environments and reduce waste. She educates around food and nutrition misconceptions (e.g. fresh is not always the best option) and partners with community-based organizations to deliver these messages and promote participation in nutrition assistance programs when needed.
Since the onset of the COVID-19 pandemic, Holtrop-Kohl has predominantly focused on addressing food and nutrition security in communities hit hardest by the pandemic. By collaborating with representatives from local government, nonprofit organizations, community health organizations, food banks and food pantries and local farmers, Holtrop-Kohl has been able to serve these communities nutritious, culturally appropriate foods in ways that support the dignity of the people and community, support local farmers and producers and reduce food waste. Making adaptations to provide culture-specific foods through culturally responsive distribution methods allows individuals to maintain cultural integrity while accessing nutrition supports. Holtrop-Kohl is continuously evaluating program effectiveness to replicate and scale best practices. She credits her success to learning her community’s unique needs and collaborating with partners from diverse backgrounds.
Discussion
The NDDs were an opportunity to bring stakeholders from across local food systems together and see themselves as part of an interconnected system. As the Framework for Action describes, RDNs use entry points to leverage their strengths and cross-functional skillset to realize opportunities that cultivate sustainable food systems.
Acknowledgments
The authors wish to acknowledge Carole Clemente for managing the Nourish Dialogue Dinner (NDDs) outputs and deliverables, and Amy Carter, Taylor Sutton and Laura Holtrop-Kohl for participating in the NDDs and sharing details about their work and accomplishments.
Disclosure statement
Dana Engel Gerstein and Katie Brown are employed by National Dairy Council and Hanna Kelley, Katie McKee and Ann Lokuta are employed by state/regional dairy councils, however none of them have any relevant financial/non-financial relationships with any proprietary interests.
References
- Godfray HC, Beddington JR, Crute IR, et al. Food security: the challenge of feeding 9 billion people. Science. 2010;327(5967):812–818. doi:https://doi.org/10.1126/science.1185383.
- HLPE. Nutrition and food systems. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome; 2017. http://www.fao.org/3/a-i7846e.pdf. Accessed February 19, 2021
- Spiker ML, Knoblock-Hahn A, Brown K, et al. Cultivating sustainable, resilient, and healthy food and water systems: a nutrition-focused framework for action. J Acad of Nutr Diet. 2020;120(6):1057–1067. doi:https://doi.org/10.1016/j.jand.2020.02.018.