The Future of Plant-Based Diets: Aligning Healthy Marketplace Choices with Equitable, Resilient, and Sustainable Food Systems.

The future of plant-based diets is a complex public health issue inextricably linked to planetary health. Shifting the world's population to consume nutrient-rich, plant-based diets is among the most impactful strategies to transition to sustainable food systems to feed 10 billion people by 2050. This review summarizes how international expert bodies define sustainable diets and food systems and describes types of sustainable dietary patterns. It also explores how the type and proportion of plant- versus animal-source foods and alternative proteins relate to sustainable diets to reduce diet-related morbidity and mortality. Thereafter, we synthesize evidence for current challenges and actions needed to achieve plant-based sustainable dietary patterns using a conceptual framework with principles to promote human health, ecological health, social equity, and economic prosperity. We recommend strategies for governments, businesses, and civil society to encourage marketplace choices that lead to plant-rich sustainable diets within healthy, equitable, and resilient agroecological food systems.

Policy Insights from High-Income Countries to Guide Safe, Nutritious, and Sustainable Alternative Proteins for Low- and Middle-Income Countries.

The United Nations has encouraged governments to promote sustainable healthy diets to address undernutrition, obesity, and climate change. This perspective paper examines policy insights from selected high-income countries in Asia, Europe, and North America to understand how traditional and novel alternative proteins (AP) may support sustainable healthy diets in low- and middle-income countries (LMIC) where populations experience malnutrition in all forms. AP products must be affordable, locally sustainable, and culturally acceptable to improve diet quality and health. Food-based dietary guidelines are a policy tool to guide AP product formulation, manufacturing, processing, labeling, and marketing to ensure that these products complement traditional plant- and animal-source proteins in sustainable healthy diets. This paper suggests that a new food categorization taxonomy is needed to guide AP product recommendations. Decision-makers must harmonize multisectoral policies to ensure LMIC populations have access to sustainable healthy diets to achieve a protein transition and food systems transformation by 2050.

US Adults' Perceptions, Beliefs, and Behaviors towards Plant-Rich Dietary Patterns and Practices: International Food Information Council Food and Health Survey Insights, 2012-2022.

Expert groups recommend that populations adopt dietary patterns higher in whole, plant-based foods and lower in red and processed meat as a high-impact climate action. Yet, there is limited understanding of populations' willingness to adopt plant-rich dietary patterns. This study examined United States (US) adults' perceptions, beliefs, and behaviors towards plant-rich dietary patterns and practices over a decade. Fifteen questions from the International Food Information Council's Food and Health Surveys (2012-2022) were analyzed across four sustainability domains (i.e., human health, environmental, social, and economic domains). Most respondents had favorable perceptions of environmentally sustainable food and beverages, but sustainability influenced less than half of consumers' purchase decisions. Plant-rich dietary pattern adherence increased across survey years (12.1% [2019] to 25.8% [2022], p < 0.001). One-quarter (28.1%) of Americans reported reducing their red meat intake over 12 months (2020-2022). Yet, another 15.5% reported greater red meat intake, and 18.8% reported greater plant-based meat alternative (PBMA) intake over 12 months. The percentage of respondents who reported greater red meat and PBMA consumption in the previous 12 months significantly increased across the years surveyed (2020-2022, p < 0.05). IFIC Survey findings highlight growing US consumer awareness of health, environmental, and social sustainability but low adoption of plant-rich dietary patterns and practices. Government leadership and coordinated actions by health professionals, civil society, and businesses are needed to educate and incentivize Americans to adopt plant-rich dietary behaviors, and greater industry transparency is needed to show how food and beverage products support human and planetary health.

Children and teens must develop digital literacy skills to navigate complex and evolving food ecosystems.

Ares et al 2023 discussed multisectoral strategies that practitioners could use to foster food literacy competencies (ie, relational, functional, and critical) across the lifespan. This letter encourages the authors to include digital food and nutrition literacy skills to help children and teens navigate a complex food ecosystem shaped by digital technologies. Existing digital food and nutrition literacy models and metrics could be adapted to enable young people to make healthy dietary choices within future sustainable food systems.

Comment on Lau et al. Trends in Beef Intake in the United States: Analysis of the National Health and Nutrition Examination Survey, 2001-2018. Nutrients 2023, 15, 2475.

We were interested to read the results of Lau et al., 2023 [...].

A Content Analysis of Persuasive Appeals Used in Media Campaigns to Encourage and Discourage Sugary Beverages and Water in the United States.

The frequent consumption of sugary beverages is associated with many health risks. This study examined how persuasive appeals and graphics were used in different media campaigns to encourage and discourage sugary beverages and water in the United States (U.S.) The investigators developed a codebook, protocol and systematic process to conduct a qualitative content analysis for 280 media campaigns organized into a typology with six categories. SPSS version 28.0 was used to analyze rational and emotional appeals (i.e., positive, negative, coactive) for campaign slogans, taglines and graphic images (i.e., symbols, colors, audiences) for 60 unique campaigns across the typology. Results showed that positive emotional appeals were used more to promote sugary beverages in corporate advertising and marketing (64.7%) and social responsibility campaigns (68.8%), and less to encourage water in social marketing campaigns (30%). In contrast, public awareness campaigns used negative emotional appeals (48.1%), and advocacy campaigns combined rational (30%) and emotional positive (50%) and negative appeals (30%). Public policy campaigns used rational (82.6%) and positive emotional appeals (73.9%) to motivate support or opposition for sugary beverage tax legislation. Chi-square analyses assessed the relationships between the U.S. media campaign typology categories and graphic elements that revealed three variables with significant associations between the campaign typology and race/ethnicity (χ2(103) = 32.445, p = 0.039), content (χ2(103) = 70.760, p < 0.001) and product image (χ2(103) = 11.930, p = 0.036). Future research should examine how positive persuasive appeals in text and graphics can promote water to reduce sugary beverage health risks.

Multisectoral Strategies Needed to Establish Healthy Portion Size Norms That Disincentivize Hyperpalatable, Energy-Dense Foods and Sugary Beverages in Food Environments Linked to Obesity and Diet-Related Chronic Diseases in the United States.

Over 40 y, Americans have consumed larger portions of hyperpalatable, energy-dense foods, sugary beverages, and meals prepared at home and away from home, which have contributed to obesity and diet-related chronic diseases in the United States (US). This perspective article explores synergies between the portion size and food matrix effects, and their associated biological, physiological, environmental, and cultural susceptibilities for populations. Thereafter, we describe evidence of US public- and private-sector initiatives to reduce, standardize, and incentivize portion size norms to align with recommended servings to promote a healthy weight for children, adolescents, and adults. Practitioners could use the Individual plus Policy, System, and Environment (I + PSE) Framework to implement multisectoral strategies for the US government, businesses, and civil society organizations to establish healthy portion size norms aligned with servings recommended by the Dietary Guidelines for Americans 2020-2025, and to disincentivize overconsumption of hyperpalatable products to reduce obesity and chronic disease risks.

Perspective: Examining Conflicts of Interest for Professional Service within the 2020 Dietary Guidelines Advisory Committee.

Judgments and integrity uphold professionalism. Failure to manage professional conflicts of interest (COIs) may undermine trust in an individual, practitioner, or institution. This perspective article examines standards for nutrition researchers and practitioners to manage COIs for the Dietary Guidelines for Americans (DGA) process. Thereafter, this article analyzes a study published by Mialon et al. that raised concerns about the expert advisory committee selection process and management of COIs for 20 professionals appointed by the Department of Health and Human Services (HHS) and the USDA, who served on a federal government advisory committee to review evidence for the Dietary Guidelines Advisory Committee (DGAC) 2020 scientific report. The analysis found that Mialon et al. enumerated COIs for each DGAC member with industry, removed from the original context, which prevented readers from assessing the COI risk. Moreover, the USDA ethics office concluded that "the 20 committee members were in full compliance with the federal ethics rules applicable to special government employees." I conclude that Mialon et al. could use institutional mechanisms to encourage the USDA and HHS to strengthen future COI policies and procedures, aligned with the 2022 National Academies of Sciences, Engineering and Medicine report recommendations to improve the DGA 2025 to 2030 process.

A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States.

OBJECTIVE: To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE: Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA: English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION: Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS: Data were analyzed by the lead investigator and described narratively. RESULTS: Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS: The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.

Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers' public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers' public commitments. METHODS: Prominent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann-Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05). RESULTS: Average total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1). CONCLUSIONS: Results of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.

A collective call to strengthen monitoring and evaluation efforts to support healthy and sustainable food systems: 'The Accountability Pact'.

There is widespread agreement among experts that a fundamental reorientation of global, regional, national and local food systems is needed to achieve the UN Sustainable Development Goals Agenda and address the linked challenges of undernutrition, obesity and climate change described as the Global Syndemic. Recognising the urgency of this imperative, a wide range of global stakeholders - governments, civil society, academia, agri-food industry, business leaders and donors - convened at the September 2021 UN Food Systems Summit to coordinate numerous statements, commitments and declarations for action to transform food systems. As the dust settles, how will they be pieced together, how will governments and food corporations be held to account and by whom? New data, analytical methods and global coalitions have created an opportunity and a need for those working in food systems monitoring to scale up and connect their efforts in order to inform and strengthen accountability actions for food systems. To this end, we present - and encourage stakeholders to join or support - an Accountability Pact to catalyse an evidence-informed transformation of current food systems to promote human and ecological health and wellbeing, social equity and economic prosperity.

How have media campaigns been used to promote and discourage healthy and unhealthy beverages in the United States? A systematic scoping review to inform future research to reduce sugary beverage health risks.

Sugary beverage consumption is associated with many health risks. This study used a proof-of-concept media campaign typology to examine U.S. beverage campaigns that promoted healthy beverages and encouraged or discouraged sugary beverages. We used a three-step systematic scoping review to identify, organize, analyze, and synthesize evidence. Step 1 used Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines to search four electronic databases and gray literature through 2021. Step 2 categorized relevant media campaigns using a media campaign typology. Step 3 examined campaign evaluation outcomes. We identified 280 campaigns organized into six campaign typology categories. The media landscape was dominated by corporate marketing campaigns for branded sugary beverages (65.8%; n = 184) followed by public awareness (9.6%; n = 27), public policy (8.2%; n = 23), social marketing (7.1%; n = 20), corporate social responsibility (5.7%; n = 16), and countermarketing (3.6%; n = 10) campaigns. Evaluations for 20 unique campaigns implemented over 30 years (1992-2021) across 14 states showed reduced sugary beverage or juice and increased water or low-fat milk sales and intake. Positive short-term cognitive and mid-term retail and behavioral changes were reported. There was limited evidence for long-term policy, social norm, and population health outcomes. Future research is needed to use media campaigns in strategic communications to reduce sugary beverage health risks for Americans.

A systematic scoping review of the literacy literature to develop a digital food and nutrition literacy model for low-income adults to make healthy choices in the online food retail ecosystem to reduce obesity risk.

Adults with lower incomes are disproportionately affected by poverty, food insecurity, obesity, and diet-related non-communicable diseases (NCDs). In 2020-2021 amid the coronavirus disease 2019 (COVID-19) pandemic, the United States Department of Agriculture (USDA) expanded the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot program to enable eligible participants to purchase groceries online in 47 states. This expansion underscores the need for SNAP adults to have digital literacy skills to make healthy dietary choices online. Currently, a digital literacy model does not exist to help guide USDA nutrition assistance policies and programs, such as SNAP. We conducted a systematic scoping review of the academic and gray literature to identify food, nutrition, health, media, financial, and digital literacy models. The search yielded 40 literacy models and frameworks that we analyzed to develop a Multi-dimensional Digital Food and Nutrition Literacy (MDFNL) model with five literacy levels (i.e., functional, interactive, communicative, critical, and translational) and a cross-cutting digital literacy component. Utilization of the MDFNL model within nutrition assistance policies and programs may improve cognitive, behavioral, food security, and health outcomes and support equity, well-being, digital inclusion, and healthy communities to reduce obesity and NCD risks.

Star Trek Offers Insights That Illuminate Actor Engagement in Global Nutrition Governance Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

This commentary describes insights from Star Trek's fictional television series to understand how state and non-state actors address conflicts of interest (COIs) through global nutrition governance. I examine the findings of Ralston and colleagues for 44 state and non-state actors who responded to the World Health Organization's (WHO's) consultation for a COI risk-assessment tool, developed for member states to engage effectively with non-state actors to address malnutrition in all forms. Star Trek reveals that actor engagement is inevitable in a shared universe. The Prime Directive is a non-interference principle reflecting a moral commitment to reduce harm, respect autonomy and protect rights. Engagement principles are relevant to all actors who influence nutrition policies and programs, and must be held accountable when their actions undermine healthy and sustainable food systems. Certain actors use COI to justify non-engagement with commercial actors yet competing interests, biases, corruption and regulatory capture are distinct challenges to manage. Finally, Star Trek's characters serve as allegories to understand actors' motives and actions to promote healthy and sustainable food systems. Unlike non-state actors, states are legally required to achieve their commitments and targets in the United Nations' (UN) Decade of Action on Nutrition (2016-2025) and Sustainable Development Goals (SDGs) 2030 Agenda.

A mixed-methods study of American Millennials' views about celebrity endorsement of foods and beverages.

More than one-third of American Millennial adults have obesity, and a significant amount of their household budget is spent on purchasing energy-dense and nutrient-poor food and beverage products. Consumers' brand awareness and purchasing behaviors are influenced by celebrity credibility measured by trustworthiness, expertise and attractiveness; and celebrity 'fit' between products, brands and consumer' self-image. This empirical mixed-methods study combined Q methodology with questionnaires to explore the shared and distinct viewpoints of demographically diverse Millennial adults about celebrity endorsement of food and beverage products or marketing campaigns in the United States (USA). Millennials (n = 40; aged 26-39 years) sorted photo images (n = 48) of US celebrities associated with branded food and beverage product endorsements on a 9-point normal distribution scale from 'most trusted' (+4) to 'most distrusted' (-4). Participants also completed a 4-item post Q-sort questionnaire to interpret their thoughts during the card sorting process, and a 3-item questionnaire to examine their views about celebrity credibility, 'fit' and multiple brand and product endorsements. Three distinct viewpoints were identified that included: (i) healthy lifestyle champions who trusted celebrities associated with healthy products or campaigns; (ii) female role-model admirers who trusted female celebrities associated with positive social impacts and (ii) African-American celebrity fans who trusted African-American celebrities who endorsed any brand or products. Qualitative analysis of the questionnaire identified the potential negative influence of celebrity endorsement for unhealthy products on Millennials' dietary behaviors. Businesses and organizations should carefully select credible celebrities trusted by Millennials to encourage food and beverage products associated with a healthy diet.

Advice for Food Systems Governance Actors to Decide Whether and How to Engage With the Agri-Food and Beverage Industry to Address Malnutrition Within the Context of Healthy and Sustainable Food Systems Comment on "Challenges to Establish Effective Public-Private Partnerships to Address Malnutrition in All Its Forms".

The effectiveness of public-private partnerships (PPPs) to address malnutrition will depend on the issue, engagement purpose, policy context and actors' interactions. This commentary offers advice for governments, United Nations (UN) and civil society organizations to decide whether and how to engage with industry actors to improve diets for populations. First, food systems governance actors must acknowledge and reconcile competing visions, harmonize numerous corporate-engagement principles, and support a shared narrative to motivate collective actions toward healthy sustainable diets. Second, food systems governance actors have tools to guide engagement through many alliances, networks, coalitions and multi-stakeholder platforms with different levels of risk and trust. Third, food systems governance actors must prioritize accountability by setting corporate-performance threshold scores to justify private-sector engagement; evaluating engagement processes, outcomes and consequences; using incentives, financial penalties and social media advocacy to accelerate time-bound changes; and revoking UN consultative status for corporate actors who undermine healthy people and planet.

Perspective: Unpacking the Wicked Challenges for Alternative Proteins in the United States: Can Highly Processed Plant-Based and Cell-Cultured Food and Beverage Products Support Healthy and Sustainable Diets and Food Systems?

Over the past decade, a plethora of alternative protein (AP) products has entered the US food system as plant-based food and beverage products. These AP products, which include plant-based meat and dairy alternatives and cell-cultured meat and seafood products, are being developed for the marketplace to simulate the appearance, texture, taste, and flavor and nutritional profiles of animal products. The new generation of AP plant-based and cell-cultured food and beverage products are part of a market-driven narrative that has embraced technology to address future human health, environmental, ethical, and planetary health challenges. This perspective article synthesizes evidence about the benefits of adopting minimally processed plant-based diets that support sustainable food systems and human and planetary health. Thereafter, it examines 4 wicked challenges related to AP products in the US context that include 1) a confusing marketing landscape for the public; 2) diverse views and varying acceptance among consumers about the health and environmental benefits of these products; 3) inadequate education and labeling provided by federal agencies to enable consumers to understand how these may support healthy sustainable diets; and 4) slow federal policy and regulatory actions to address the range of AP products and provide industry guidance. The article concludes with suggested policies and actions for government agencies and food system actors to address these challenges. Future research and actions are needed to balance the human health, equity, animal welfare, and economic viability goals and to clarify how AP products may support safe, healthy, sustainable diets and food systems.

A mixed-methods study to test a tailored coaching program for health researchers to manage stress and achieve work-life balance.

Dissemination and implementation (D&I) researchers serve critical scientific, practical, and personal roles in translating science to public health benefit. However, they face multifaceted barriers that may erode their capacity to plan, lead, and evaluate implementation. Individualized coaching focused on human flourishing is an unexplored approach to fully actualize D&I researchers' capacity to bridge the research-practice gap. The purpose of this exploratory pilot study was to investigate a tailored coaching program to support human flourishing among D&I researchers. A pragmatic, mixed-methods approach guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework was used to evaluate an individualized, nine session coaching program called FUEL (Focus, Unplug, Exercise, Love). Reach and Implementation were assessed through descriptive statistics and rapid qualitative analysis of surveys and coaching logs. Effectiveness and Maintenance were assessed through descriptive statistics and iterative content analysis of participant surveys, as well as iterative content analysis of proxy (e.g., colleague) semi-structured interviews. Reach results indicated that demand for coaching exceeded study enrollment capacity (n = 16 participants). Implementation results showed that the coach spent 12.96 ± 2.82 hr per participant over 3 months. Effectiveness and Maintenance results indicated that FUEL was well-received and provided participants with myriad psychological and professional benefits. Preliminary evidence suggests that the FUEL coaching program is a promising and feasible approach to enhance flourishing among D&I researchers. Future research is needed to evaluate Adoption and scalability. This pilot study may inform future D&I capacity-building initiatives that address researchers' holistic situatedness within the implementation process.