A Scoping Review of Indicators for Sustainable Healthy Diets

Abstract

Introduction: Diets are currently unsustainable in many countries as evidenced by the growing burden of malnutrition, degradation of natural resources, contributions to climate change, and unaffordability of healthy diets. Agreement on what constitutes a healthy and sustainable diet has been debated. In 2019, FAO and WHO published the Sustainable Healthy Diets Guiding Principles, defining what qualifies as a sustainable healthy diet. While valuable, these principles require measurable indicators to support their operationalization. Our scoping review aims to describe how sustainable healthy diets have been assessed in the literature since 2010.Methods: A search for English-language articles published in peer-reviewed journals was conducted from January 2010 through February 2020 across three databases. Out of the 504 articles initially identified, 103 articles were included. Metadata were extracted from each article on: publication year, country of study, study aims, methods, main data sources, indicators used to assess sustainable healthy diets, reported indicator strengths or limitations, and main study findings. A qualitative content analysis identified major conceptual themes across indicators and their frequency of use.Findings: From the 103 empirical articles included in our review, 57.3% were published after 2017. Most studies were carried out in high-income countries (74%). Approximately 42% of the articles assessed the sustainability of diets using solely health and environmental indicators; <25% assessed the sustainability of diets across health, environmental, and sociocultural aspects of sustainability. We found a substantial number of unique indicators used for assessing health (n = 82), environmental (n = 117), and sociocultural (n = 43) aspects of diets. These indicators covered concepts related to health outcomes, aspects of diet quality, natural resources, climate change, cultural acceptability, and cost of diets. The preponderance of indicators currently used in research likely poses challenges for stakeholders to identify the most appropriate measures.Conclusion: Robust indicators for sustainable healthy diets are critical for understanding trends, setting targets, and monitoring progress across national and sub-national levels. Our review highlights the geographical imbalance, the narrow focus on health and environmental aspects, and the lack of common measures used in research. Measures registries could provide the decision-support needed by stakeholders to aid in the indicator selection process.

Double‐ and triple‐duty actions in childhood for addressing the global syndemic of obesity, undernutrition, and climate change: A scoping review

“…74 In addition, our review provides a summary of the most common outcome measures to assess the effectiveness of double-and tripleduty actions. In line with Harrison et al's review on indicators for evaluating sustainable healthy diets, 75 we found that the most frequently reported outcomes were changes in dietary intake, diet composition, greenhouse gas emissions, and food waste. We extend this knowledge by identifying further outcome measures that include changes in food and environmental sustainability-related attitudes and knowledge, changes in the nutritional quality and environmental sustainability of school food purchases, changes in the frequency of active travel, and changes in mortality and other health-related outcomes.…”

Measuring Adherence to Sustainable Healthy Diets: A Scoping Review of Dietary Metrics

“…The concept of territorial diets informs several metric developments, as shown in this review, but other sociocultural aspects have not yet been considered. Indicators of affordability and cultural acceptability of diets have been proposed [ 28 ]. However, evidence of inclusion of these indicators in dietary metrics and development of indicators for desirability and adverse sex-related effects are still lacking [ 28 ].…”

“…Indicators of affordability and cultural acceptability of diets have been proposed [ 28 ]. However, evidence of inclusion of these indicators in dietary metrics and development of indicators for desirability and adverse sex-related effects are still lacking [ 28 ].…”

Basics of Sustainable Diets and Tools for Assessing Dietary Sustainability: A Primer for Researchers and Policy Actors

“…The principles of sustainable healthy diets are set to provide flexible roadmaps for policy actors [ 100 ]. On the other hand, for a sustainable and healthy diet to be quantified, the dimensions selected for each index require meticulous assessment by relevant indicators [ 101 ].…”

“…According to Eme [ 102 ], and as demonstrated in the present review, the evidence basis for selecting specific and robust indicators for sustainable diet indexes is frequently weak, fragmented, and arbitrary. Furthermore, great heterogeneity is apparent among the included indicators and their weight on population health [ 100 ]. Many indexes do not adequately account for the diets’ environmental impact, whereas others fall short in the economic impact domain.…”