April 2024 Issue

What Do RDs Really Think About Sustainability?
By Sharon Palmer, MSFS, RDN
Today’s Dietitian
Vol. 26 No. 4 P. 24

Findings From the 2023 Sustainability and Food Insights Survey

The impact of our food system on the planet is undeniable. Food production accounts for more than 25% of our greenhouse gas emissions, uses half of the world’s habitable land and 70% of its freshwater withdrawals, and is responsible for 78% of global eutrophication. 1 The mounting concerns over planetary health, as well as other dimensions of sustainability, including sociocultural, economic, and nutritional, bring into focus the urgency for dietitians to be involved in promoting sustainable diets in their practice settings.2

But how do dietitians feel about including sustainability in their work? Do they want to be part of the food sustainability movement? And what are their barriers to advancing sustainable food systems in their practices? These were some of the questions addressed in a new survey by Food + Planet, a nonprofit organization aimed at empowering dietitians to advance sustainable food systems, in conjunction with Today’s Dietitian and Johns Hopkins Center for a Livable Future.

This landmark survey, which is available at https://foodandplanet.org/experience, revealed first-of-its-kind findings on dietitians’ beliefs, practices, and challenges regarding incorporating sustainability into their practices, which is relevant given that RDs are one of the most trusted voices on diet and nutrition.3

The survey comes at a good time, as sustainability is on dietitians’ radars. According to Jack Graham, chief operating officer of Today’s Dietitian, “At Today’s Dietitian, we continually review and assess learner evaluations of, and feedback on, our continuing education activities. Based on our review of these evaluations and feedback, it is clear that dietitians are demonstrating an increased interest in learning about sustainable diets. This trend has been particularly true over the past three years and is borne out by both increased attendance numbers in sustainability programs and specific learner feedback on these programs. Learner feedback has indicated that interests in the field include the roles that dietitians can play in meeting the environmental, economic, social, and nutrition needs of the planet through their professional work.”

Conducted online in May 2023, the survey engaged 1,161 RDs across the United States with a focus on the following six key criteria:

1. Perceptions on how to promote sustainable food systems.

2. Practical application opportunities for incorporating sustainability into their work settings.

3. Knowledge on the best strategies to guide people toward sustainable diets.

4. Confidence in guiding clients on sustainable food choices.

5. Barriers to implementing sustainable diets in their professional practices.

6. Beliefs in the importance of integrating sustainability science into the Dietary Guidelines for Americans.

Nearly one-half of the RD respondents practice in a clinical setting (47%), followed by other types of settings (13%), education (12%), private practice (8%), foodservice (7%), and consulting (7%). On average, respondents interact with 194 clients, patients, or consumers each month, and over one-half interact with 50 to 499 per month.

RDs Want to Be Involved in Sustainability
One encouraging finding from the survey is that most dietitians (95%) believe that RDs should be involved in advocating for sustainable food systems, with 40% reporting that dietitians should be very involved in sustainable food systems. In addition, more than two out of three dietitians felt that their clients were very interested in sustainability (64% reported that their clients were moderately to very interested). A noteworthy 62% of RDs reported that they believe sustainability should be formally integrated into the Dietary Guidelines for Americans, which currently hasn’t included these considerations.

Graham says dietitian learners “have overwhelmingly indicated that the reasons for their increased interest in sustainable diets stem from their personal desire to be an agent of change, as well as the need to be competent in educating and counseling clients and patients who are also demonstrating a marked increase in interest in sustainability.”

Gaps and Barriers
The survey uncovered major gaps and barriers in sustainability knowledge and practice in the field of nutrition. Almost all RDs (98%) reported barriers to advancing sustainable diets. Top reported barriers to advancing sustainable diets in communities included lack of knowledge, tools, and resources (37%) and lack of access and affordability (30%).

Another key gap for dietitians is education on sustainable food systems. Almost one-half of RDs (48%) have informal training (online courses or webinars) or no training at all in sustainable food systems, and only 13% receive formal training (dietetic internships, advanced degree programs). It shouldn’t be a surprise then that 69% of RDs reported that they don’t feel confident or feel neutral in their ability to provide guidance on sustainable food choices with their clients and communities—only 8% reported that they feel very confident. However, RDs who receive formal training or education are 2.6 times more likely to incorporate sustainability into their practices.

Among the areas of sustainability, RDs reported that they’re least knowledgeable about agricultural practices and sociocultural issues. They listed the following as the top sustainability issues they feel least knowledgeable about: environmental impacts of food choices (28%), ethical labor, sourcing, and climate justice (23%), soil health and biodiversity (20%), and providing equitable guidance through a culturally inclusive lens (18%).

“Our profession hasn’t previously prioritized education on planetary health. As science continues to highlight the importance of a systems-based approach to health and wellness, the connection between sustainable diets and planetary health will continue to emerge as a leading solution. Our profession has the opportunity to incorporate planetary health into dietetic internship training, as well as continued education opportunities so that RDs can become trusted advocates in this space,” says Chris Vogliano, PhD, RDN, cofounder of Food + Planet.

“Food justice, health equity, animal welfare, and culturally inclusive diets are rarely discussed, if at all, in an in-depth manner during our dietetics studies,” says Sherene Chou, MS, RDN, cofounder of Food + Planet. “Our coursework to become dietitians has at most one course focused on cultural foods to address all the cultures around the world and almost never includes the intersection of sustainability. There’s a critical need for us to diversify dietetics and increase education to better support our communities.” Chou adds that the Commission on Dietetic Registration identifies only 14% of dietitians as part of a racial or minoritized group.

Another gap became apparent in the disparity between how US RDs view the impact of sustainable diet practices and the evidence-based global food-based dietary guidelines that incorporate sustainability. When guiding people towards sustainable diets, RDs ranked fewer ultraprocessed foods, a focus on local/seasonal foods, and reducing food waste as having the greatest impact on sustainability while ranking regenerative or organic agriculture practices and sustainable meat and seafood as having the least impact. This disconnection between RDs’ beliefs on sustainable diet practices compared with a review of 13 global food-based dietary guidelines that incorporate sustainability emphasizes the need for increased education on sustainable food systems.4

Kate Geagan, MS, RD, cofounder of Food + Planet, says, “This discrepancy presents an opportunity for us to explore the underlying factors behind this gap. Is it a lack of confidence and knowledge in certain domains, such as agricultural or livestock practices, or does it point to a greater familiarity and comfort level with topics associated with dietetics education, such as food waste and ultraprocessed foods? Or is it reflective of the influence of industry-sponsored education on our profession? This is definitely something we intend to look at more closely in our 2024 survey.”

The survey highlights the net result of these gaps and barriers: 42% of dietitians don’t incorporate sustainability into their work, and only 8% report that they intentionally include sustainability in their practice.

Joining the Movement
Despite the gaps and barriers in sustainability knowledge and practice, the survey highlights many opportunities for dietitians to get involved in sustainability. “Nutrition and sustainability are so interconnected in the food system. We can’t solve one without addressing the other,” says Becky Ramsing, MPH, RDN, senior program officer at the Center for a Livable Future at Johns Hopkins Bloomberg School of Public Health in Baltimore.

“At a time when the food and agriculture system is central to the conversations around the climate crisis, environmental degradation, and injustice, nutrition professionals have an incredible opportunity to be influential agents of change,” says Mary Purdy, MS, RDN, an integrative and functional eco-dietitian based in Seattle. “Any dietitian can see their work through the lens of sustainability, especially knowing that there are usually health benefits attached.”

How can dietitians gain knowledge on sustainable food systems? Chou recommends learning from organizations engaged in advocating for a sustainable, diverse, and just food system, such as HEAL Food Alliance, headquartered in Oakland, California, a multisector, multiracial coalition of organizations that represent the food system with a goal of building a movement towards a system that cares for land, local economies, communities, and the sovereignty of all beings.

RDs also can take the self-study course “Supporting Equitable Dietetics Education” offered by Diversify Dietetics, an organization based in Atlanta that’s committed to increasing diversity in the nutrition and dietetics profession. “Continue to seek education to learn how our roles as dietitians are an integral part of changing the food system,” Chou says. “RDs can advance their knowledge in sustainable diets and planetary health by reading and watching trusted research and content from organizations like the Food and Agriculture of the United Nations, World Resources Institute, and Food + Planet,” Vogliano adds.

Dietitians can make an impact across multiple nutrition career pathways. “Food procurement in hospitals or foodservice can focus on sourcing from regenerative and local farms using climate-friendly practices and who treat their farm workers well,” Purdy says. “Those working in retail or with food brands can make a sustainable supply chain and sustainable or fair-trade ingredients central to how they advise and guide. Those in communications can help craft language and messaging that highlight the critical importance sustainable food systems play in human and planetary health as well as the myriad of ways any eater can reduce their food print,” Purdy continues. “Academics and teachers can incorporate the benefits of sustainable diets into any and all classes and curriculum. Dietitians across all sectors can talk about ways to reduce food waste, from what’s purchased and how it’s stored, to offering creative strategies for utilizing food parts that are often discarded or are seemingly on their way out.”

Dietitians also can work sustainability messaging into their daily consultations with clients, patients, and communities. “Sustainability is a conversation that we all have to have,” says Ashley Carter, MS, RD, LDN, program director of EatWell Exchange, a nonprofit organization based in Miami aimed at empowering lower socioeconomic communities to gain access, knowledge, and the confidence they need to eat a nutritious diet within their own food culture. “It’s not a separate message, but sustainability needs to be woven into the fabric of all communication we have about food and food practices.”

Ramsing adds, “You don’t have to be in a sustainability position to center sustainability in everything you do.”

Every time dietitians make recommendations to clients or patients, they should first step back and ask how that choice will impact the food system, Ramsing suggests. “Think about how it’s grown, packaged, transported, and how that product impacts our planet and our communities. Is there a better option that still addresses the nutrition requirements? When you give advice or guidance, take the opportunity to talk about sustainability.” For example, she says RDs can recommend peanut butter—a sustainable crop that pulls nitrogen back into the soil—as a better choice than cream cheese. Dietitians also can suggest options that have less packaging.

A key strategy is making dietary recommendations for foods with a lighter environmental footprint, such as pulses, which offer a high nutrient value often missing in dietary patterns, Purdy says. According to Vogliano, “Sustainability can be as simple as swapping beans for beef on the menu and can actually be cost-saving. Of course, not all solutions are more affordable, such as compostable containers. Therefore, we must find contextual solutions that support the triple bottom line of people, planet, and profit.”

Lilian M. Correa, MA, MPH, RDN, DipACLM, founding director of education and training for nutrition and lifestyle medicine at NYC Health + Hospitals/Bellevue, finds ways to weave sustainability messages into her education. “During the consultation, I always encourage people to use Britta filters or tap water instead of buying plastic water bottles. We make goals for how much water they drink each day, so I encourage purchasing a water bottle with the ounces on it and refilling it,” Correa says.

Reducing food waste is another way RDs can make an impact on sustainability. Chef and dietitian Breana Lai Killeen, MPH, RD, who lives on a farm in Shelbourne, Vermont, and practices regenerative agriculture, focuses on food waste. “Research shows that as much as 30% of our food is wasted, and composting isn’t the only way for us to reduce that food waste. We must work towards using more of what we produce in a sustainable way, such as through cooking with what we have instead of buying more, freezing, canning, and preserving.” Correa encourages food combinations to lessen food waste, such as using one grain three ways. For example, cooking 3 cups of quinoa can yield a breakfast cereal with soymilk, berries, and nuts; a salad with edamame and veggies for lunch; and a dinner side dish during the week. She also advises her clients on how to use leftovers wisely to reduce food waste.

“Learning the meals and foods a client likes to eat can help guide us to the conversation of how food is used or discarded,” Carter says. “We can start conversations about recipe creation and ways to include more parts of food. An example is making a strawberry salsa and including the strawberry greens that most people discard.” Carter adds that there also may be trauma-induced nutrition practices that may result in people overeating or overpurchasing due to a scarcity mindset with food. RDs can help clients assess their hunger and fullness cues and relearn that they don’t have to eat large portions due to previous fears of not having enough food.

Dietitians also can contribute to sustainability by promoting local, seasonal foods. “As dietitians, I think we need to focus on what foods people have access to as much as what we tell them they should eat,” Killeen says. “Yes, we all need to eat more vegetables, but instead of picking ones that aren’t in season and having them grown and shipped from across the world, let’s show people what local really means and how to incorporate that into our diets in a healthy way.” Killeen suggests that the impact of the foods dietitians recommend should first stem from the question, “What is grown near you?” so we not only support the farms and people growing food around us but also reduce carbon emissions from the transport of food grown all over the world.

Honoring cultural food traditions is an oft neglected aspect of sustainable diets. “I focus on sustainability by looking into culinary heritage and how it impacts nutritional choices. Many cultures have practices that highlight sustainability,” says Carter, who lists examples like canning pickled vegetables, such as chow-chow in African American cultures, pikliz in Haitian cuisine, and kimchi in Korean dishes, as well as root-to-stem eating (greens and peels of vegetables) in Indian cultures. “It’s important to realize that even though these practices have been a part of these cultures for centuries, the people within this culture may not notice that the technique they’re using is contributing to sustainability,” Carter says. “Some cultures may even look down on some sustainability techniques, as it could have been associated with being of a lower class or status.”

In addition to being aware of sustainable cultural food traditions, Ramsing suggests RDs not ignore the power of getting involved with local, state, and federal policies. “They may seem far removed from your work, but they influence our food environment and how our communities interact with food and make food choices. Local and institutional policies, in particular, are much easier to get involved with and have far-reaching influences.” n

— Sharon Palmer, MSFS, RDN, is a plant-based nutrition and sustainability expert, nutrition editor at Today’s Dietitian, and cofounder of Food + Planet.

1. Ritchie H, Rosado P, Roser M. Environmental impacts of food production. Our World in Data website. https://ourworldindata.org/environmental-impacts-of-food. Published 2022.

2. Four dimensions of sustainable food systems. Food + Planet website. https://foodandplanet.org

3. 2023 sustainability and food insights survey. Food + Planet website. https://foodandplanet.org. Published November 8, 2023.

4. Vogliano C, Geagan K, Chou S, Palmer S. Empowering nutrition professionals to advance sustainable food systems. Food + Planet website. https://foodandplanet.org. Published 2021.